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Issue #20 — February 22, 2012

AAPC BillingInsider e-Newsletter

F R O M   T H E   F I E L D

Paid by EFT? Choose One Recipient

You may be contacted by your Medicare Administrative Contractor (MAC) soon about where you want electronic payments sent. Starting April 1, only one receiver will see electronic payment for a claim, no matter how many national provider IDs (NPIs) are on file.

The change results from the Centers for Medicare & Medicaid Service's (CMS) new Healthcare Integrated General Ledger Accounting System (HGLAS). Under the old system, Medicare would create one check per claim and each provider could have multiple recipients of each electronic payment, which would prompt an electronic remittance advice (ERA). Unfortunately, when MACs transitioned to HGLAS, old system logic didn't work and billers received remittance advice not containing all the claims processed in a given cycle, or not containing the total amount.

To fix the problem, MACs will choose only one recipient for electronic fund transfers (EFT) or checks and won't consider the sender information. You should choose a single recipient for your Medicare money.

G O O D   T I P S

Be Ready for 5010 Enforcement

Version 5010 enforcement begins April 1, having been postponed from Jan. 1 to allow providers, payers, and vendors to catch up. Here are some tips to help you be ready when the time comes.

  • Complete both internal and external testing of Version 5010 transactions. Conduct tests with vendors, clearinghouses, and payers. Take the following steps to evaluate your vendor and vendor products to ensure a timely Version 5010 upgrade:
    • Establish a tracking system and timeline for milestones.
    • Review existing and new contractual obligations with vendors.
    • Coordinate vendor capabilities with your practice needs and expectations.
    • Evaluate ease of use of vendor products.
  • Ask your vendor the following questions about the Version 5010 upgrade to help assess your readiness for this upgrade:
    • Have they upgraded their systems to meet Version 5010 standards?
    • If they have not yet upgraded, when will they do so?
    • What will it cost you for each upgrade?
    • What versions of their software will be upgraded, and will these upgrades require any additional hardware upgrades?
    • How often will updates occur and what is the delivery method?
    • How are issues logged and how will they be addressed?
    • Is there training available for new system changes and/or functionalities?

Visit the CMS ICD-10 website for additional information and resources about the Version 5010 upgrade. Check with your clearinghouse and Medicare Administrative Contractor (MAC) for answers and tips.

F E A T U R E D   S T O R Y

Avoid Payment Reduction for eRx
By Yvonne Dailey, CPC, CPC-I

Many providers' offices suffer the 1 percent reduction in Medicare fees even after having a remittance with the N365 code for successfully submitting a G8553 code for electronic prescribing (eRX). Here are some common errors made with the submission of the G8553:

  1. Your PM system will strip the zero balance lines from the claim, which will cause some providers to resubmit the G code alone.
  2. Providers submit the G code without a claim for the eligible office codes alone to avoid the duplicate submission of the office, or the eligible office codes were submitted prior to the G code simply as human error.
  3. Your office didn't submit eRx because you are participating in the meaningful use incentive and you can't be paid for both.

The errors listed above are valid, but CMS is still penalizing professionals for 2012 with the 1 percent reduction. To avoid being hit with the 1.5 percent cut in 2013, be sure your office is doing the following.

Each provider must have 10 successful eRx submissions filed by June 30, 2012 and processed by July 29, 2012 with the CPT® code and G8553 along with the eligible codes listed below. When you've submitted the claims, be sure to review your remittance advice for N365 on the remittance, as well as the N365 on the remittance form (Found at the bottom in the message area as well within the claim line items), usually received within 14 business days from submission.

To be incentive-eligible for the 2012 eRx reporting year, each provider needs to have an additional 15 successful eRx submissions by December 31, 2013 for these eligible office codes: 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90862, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0101, G0108, G0109.

Many providers participating in the Meaningful Use program are under the impression they can bypass the eRx because each will only be paid for one incentive. Many eligible providers participating in the Meaningful Use program in 2012 will still need to report eRx incentive claims to avoid the 2013 payment adjustment.

An eligible professional will only receive the incentive from the program with the highest incentive payout.

If you see "Reduction Co: CO‐237 & N545 Payment reduced based on status as an unsuccessful eprescriber per the eRx Incentive Program" in your remittance, CMS has flagged your account for the 1 percentage reduction. Your fee schedule has already been reduced the 1 percent and you are being paid the full allowed amount. If you wish to complain about the reduction fee and how the procedures were unclear or you had system errors, you may do so at the following website: www.cms.gov/erxincentive. Scroll down to the bottom of the page and click on "Submit Feedback."

FROM THE FIELD is thoughts and experiences from you the reader. If you have any tips, ideas, case studies, or just anecdotes please submit them to us for future editions.

In This Issue
Choose One Recipient
Be Ready for 5010
eRx Payment Reduction

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