3 rd Party References

1. 3rd Party References Providing… NOA, Medicare, Medicaid, and other resources to help you understand 3rd party requirements and file 3rd party claims

2. Disclaimers This information was prepared by the 3rd Party Consultant to the Nebraska Optometric Association, Ed Schneider OD. To the best of his knowledge, it was current and accurate at the time it was prepared. It is not guaranteed to be error or omission free. It was prepared as general information to assist doctors and staff, and is not intended to grant rights or impose obligations.

3. Disclaimer • The ultimate responsibility for the correct submission of claims and compliance with provider contracts lies with the provider of services. • The Nebraska Optometric Association, and its presenters, agents, consultants and staff makeno representation, warranty, or guarantee that this presentation and/or its contents are error-free or omission-free, and will bear no responsibility or liability for the results or consequences of the information contained herein.

4. Coding References • CPT (Current Procedure Terminology) • Service Codes • 92000 Ophthalmology • 99000 Evaluation & Mgmt • Surgical Procedure Codes • 65205 Removal of FB • 67820 Epilation of Lashes

5. Coding References • Available from • AOA http://www.aoa.org/x12590.xml • Combines multiple references • Delivery later than some • AMA • https://catalog.ama-assn.org/Catalog/;jsessionid=Q3YRMMKGBTFOLLA0MRPVX5Q?_requestid=1669537 • Amazon.com http://www.amazon.com/ • UPDATE YEARLY – effective January 1st

6. Coding References • ICD-9-CM • International Classification of Diseases • Refractive Diagnosis Codes • Disease Diagnosis Codes • Injury Diagnosis Codes

7. Coding References • Available from • AOA http://www.aoa.org/x12590.xml • Combines multiple references • Delivery later than some • AMA • https://catalog.ama-assn.org/Catalog/;jsessionid=Q3YRMMKGBTFOLLA0MRPVX5Q?_requestid=1669537 • Amazon.com http://www.amazon.com/ • UPDATE YEARLY – effective October 1st of previous year (the 2013 issue is effective October 1st, 2012.)

8. Coding References • 1997 Documentation Guidelines for Evaluation & Management Services • Explains how to code and document the 99000 codes • Includes information on single organ systems (such as eyes) http://www.cms.hhs.gov/MLNProducts/downloads/referenceII.pdf

9. CMS: Medicare Learning Network • You can download it from:http://www.cms.hhs.gov/MLNProducts/downloads/physicianguide.pdf http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MLN_Suite_of_Products_and_Resources_for_Instructors.pdf

10. Medicare Education • NEW: How to Use the National Correct Coding Initiative (NCCI) Tools at • https://www.cms.gov/MLNProducts/downloads/How-To-Use-NCCI-Tools.pdf • ---explains--- • National Correct Coding Initiative • NCCI Program to reduce incorrect coding based on • Mutually exclusive codes (92083 & 92081) • Anatomic considerations (cataract extraction & enucleation). • Medically Unlikely Edits (MUEs) • Program to reduce errors due to clerical entries and incorrect coding based on frequency of procedures onsame day.

11. NE MedicareB References • Our Medicare B Administrative Carrier is • Wisconsin Physician Services [WPS] • http://www.wpsmedicare.com/j5macpartb/index.shtml

12. NE Medicare B References • MedicareB • Local Coverage Determinations (LCDs) • http://www.wpsmedicare.com/j5macpartb/policy/active/local/ • Standardizes what Medicare considers “Reasonable and Necessary” • Lists very specific coding requirements for those services & procedures that have a history or potential of abuse

14. NE Medicare B References • WPS Medicare CommuniquéQuarterly Newsletter • Changes in CMS policy • Updates in coding requirements • Updates on documentation needed • FAQs • Changes in contact information • Changing in billing requirements All Provider are legally responsible for reading and abiding by this document. https://corp-ws.wpsic.com/apps/commercial/unauth/medicareListservUserWelcomeLoadAction.do

15. NE MedicareDME References Medicare Durable Medical Equipment is for Cataract post-op glasses and CLs • Our DME Carrier is Noridian Administrative Services, LLC https://www.noridianmedicare.com/dme/index.html

16. NE Medicare DME References • DME Supplier Manual • What Documentation is required • Written order • Proof of Delivery • ABN • Supplier Standards • Claims Submission • V-codes • Pricing https://www.noridianmedicare.com/dme/news/manual/index.html%3f

17. NE Medicare DME References DME Quarterly Newsletter Happenings - All Provider are legally responsible for reading and abiding by this document. • DME Carrier newsletter • Changes in CMS policy • Updates in coding requirements • Updates on documentation needed • FAQs • Changes in contact information • Changes in Billing Requirements Listserv URLhttps://naslists.noridian.com/list/subscribe.html?mContainer=2&mOwner=G30392x2n39372t36

18. NE Medicare DME References https://www.noridianmedicare.com/dme/coverage/lcd.html

19. NE Medicare DME References Noridian LCD on Refractive Lenses LCD Source: https://www.noridianmedicare.com/dme/coverage/docs/lcds/current_lcds/refractive_lenses.htm

20. NE Medicare DME References Noridian Policy on Refractive Lenses Policy Article Source: https://www.noridianmedicare.com/dme/coverage/docs/lcds/current_articles/refractive_lenses.htm

21. NE Medicaid References • Medicaid Provider Manual • Includes Visual Care Services • Covered and Non-Covered Services • Examination • Lenses • Frames • Contact Lenses • Billing Requirements

22. NE Medicaid References • Medicaid Provider Manual – Vision Care http://dhhs.ne.gov/medicaid/Pages/med_phvis.aspx • Visual Care Serviceshttp://www.sos.state.ne.us/rules-and-regs/regsearch/Rules/Health_and_Human_Services_System/Title-471/Chapter-24.pdf • Payment Rules http://www.sos.ne.gov/rules-and-regs/regsearch/Rules/Health_and_Human_Services_System/Title-471/Chapter-03.pdf • Fee Schedule http://dhhs.ne.gov/medicaid/Documents/471-000-524.pdf • Billing Instructions http://dhhs.ne.gov/medicaid/Documents/471-000-65.pdf • Bulletins (bottom of page)http://dhhs.ne.gov/medicaid/Pages/med_phvis.aspx

23. NOA References • NOA 3rd Party Newsletters • Changes in Carrier Policy • LMRP Updates & Reminders • Unique Coding in Nebraska • Changes on the Horizon • HIPAA Updates • Q & A Page

24. NOA References

25. NOA References

26. NOA References Monthly Newsletter Mass Email:

27. NOA References • NOA 3rd Party Web Page • http://nebraska.aoa.org/prebuilt/NOA/index.htm • Index page with over 1000 links • Past Newsletter Articles by title • CMS, Medicare, Medicaid, BCBS, AOA, & other web sites • Archived newsletters by date published • HIPAA page, including HIPAA manual • New Licensee page • Previous 3rd Party Presentations

31. NOA References

33. NOA 3rd Party Consultation • Contact Methods • EmailSchneiderEd@msn.com • Fax 402 464-1214 (contact Ed first) • Cover page: Contains PHI-for Dr. Schneider’s eyes only • 24 hour turn-around time