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Re: [CCO-L] SNF - Initial visits by NP or PA

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  • Ericadschwalm
    Also, CR 7405 from Aug 2011 - The general policy of billing the most appropriate visit code, following the elimination of payments for consultation codes,
    Message 1 of 10 , Feb 14, 2013
    • 0 Attachment
      Also, CR 7405 from Aug 2011 -

      The general policy of billing the most appropriate visit code, following the elimination of payments for consultation codes, shall also apply to billing initial visits provided in skilled nursing facilities (SNFs) and nursing facilities (NFs) by physicians and nonphysician practitioners (NPPs) who are not providing the federally mandated initial visit. If a physician or NPP is furnishing that practitioner’s first E/M service for a Medicare beneficiary in a SNF or NF during the patient’s facility stay, even if that service is provided prior to the federally mandated visit, the practitioner may bill the most appropriate E/M code that reflects the services the practitioner furnished, whether that code be an initial nursing facility care code (CPT codes 99304-99306) or a subsequent nursing facility care code (CPT codes 99307-99310) when documentation and medical necessity do not meet the requirements for billing an initial nursing facility care code.








      -----Original Message-----
      From: Ericadschwalm <EricaDSchwalm@...>
      To: CCO-L <CCO-L@yahoogroups.com>
      Sent: Thu, Feb 14, 2013 3:49 pm
      Subject: Re: [CCO-L] SNF - Initial visits by NP or PA




      Please explain why the guidelines below state otherwise? Thanks so much!

      -----Original Message-----
      From: Kergides, Jo Ann kergidjf@...>
      To: CCO-L CCO-L@yahoogroups.com>
      Sent: Thu, Feb 14, 2013 3:23 pm
      Subject: RE: [CCO-L] SNF - Initial visits by NP or PA

      NPs cannot bill initial visits in a facility.

      Jo Ann F Kergides, CPC-H
      Coding Specialist
      UMDNJ-SOM NJ Institute for Successful Aging
      42 E Laurel Rd, UDP #1800
      Stratford, NJ 08084
      Phone: 856-566-6833
      Fax: 856-566-7089

      This messeage is intended for the use of the person or entity to which it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this information is STRICTLY PROHIBITED. If you have received this message in error, please notify the sender immediately and arrange for the return or destruction of these documents.

      From: CCO-L@yahoogroups.com [mailto:CCO-L@yahoogroups.com] On Behalf Of Ericadschwalm
      Sent: Thursday, February 14, 2013 3:12 PM
      To: coding@...; cco-l@yahoogroups.com; ericacodes@yahoogroups.com
      Subject: [CCO-L] SNF - Initial visits by NP or PA

      Hello,

      I understand that in previous years an NPP could not bill for the initial SNF visit (e.g. 99306).

      However the current guidelines I'm reading state differently (see below).

      Somehow had missed that change in 2010, saw it recently and started billing the initials (previously we would change a 99306 tp 99310 when done by a midlevel).

      But now Medicare NHIC is denying our claims (e.g. 99306) when billed under an NP's name. "Service is not covered by this type of provider".

      I'm totally confused! Am I understanding these guidelines wrong or is Medicare wrong!?!? Anyone else have this issue?

      "The Centers for Medicare & Medicaid Services (CMS) would like to remind skilled nursing facilities (SNFs) and nursing facilities (NFs) of the evaluation and management (E/M) services coding policy that has been in effect since January 1, 2010. If a physician or non-physician practitioner is furnishing that practitioner‟s first E/M service for a Medicare beneficiary in a SNF or NF during the patient‟s facility stay, even if that service is provided prior to the federally mandated visit, the practitioner may bill the most appropriate E/M code that reflects the services the practitioner furnished, whether that code be an initial nursing facility care code (CPT codes 99304 – 99306) or a subsequent nursing facility care code (CPT codes 99307 – 99310) if documentation and medical necessity do not meet the requirements for billing an initial nursing facility care code. "

      and

      "A NPP may perform medically necessary E/M visits prior to and after the initial visit if all the requirements for collaboration, general physician supervision, licensure and billing are met. Payment is made for E/M visits to patients in a SNF who are receiving services for medically complex care upon discharge from an acute care facility when the visits are reasonable and medically necessary and documented in the medical record. Physicians and NPPs shall report initial nursing facility care codes for their first visit with the patient. "

      http://www.medicarenhic.com/providers/pubs/REF-EDO-0020%20PA%20NP%20CNS%20CNM%20Billing%20Guide.pdf

      [Non-text portions of this message have been removed]

      [Non-text portions of this message have been removed]

      [Non-text portions of this message have been removed]







      [Non-text portions of this message have been removed]
    • mrl
      TO: Jo Ann F Kergides, CPC-H Please explain your answer. A statement does not an answer make. Where is your documentation to backup your statement?
      Message 2 of 10 , Feb 14, 2013
      • 0 Attachment
        TO: Jo Ann F Kergides, CPC-H

        Please explain your answer. A statement does not an answer make. Where
        is your documentation to backup your statement? Coding Clinic ? CMS memo?






        On 14 February 2013 12:57, Ericadschwalm <EricaDSchwalm@...> wrote:

        > **
        >
        >
        >
        > Also, CR 7405 from Aug 2011 -
        >
        > The general policy of billing the most appropriate visit code, following
        > the elimination of payments for consultation codes, shall also apply to
        > billing initial visits provided in skilled nursing facilities (SNFs) and
        > nursing facilities (NFs) by physicians and nonphysician practitioners
        > (NPPs) who are not providing the federally mandated initial visit. If a
        > physician or NPP is furnishing that practitioner's first E/M service for a
        > Medicare beneficiary in a SNF or NF during the patient's facility stay,
        > even if that service is provided prior to the federally mandated visit, the
        > practitioner may bill the most appropriate E/M code that reflects the
        > services the practitioner furnished, whether that code be an initial
        > nursing facility care code (CPT codes 99304-99306) or a subsequent nursing
        > facility care code (CPT codes 99307-99310) when documentation and medical
        > necessity do not meet the requirements for billing an initial nursing
        > facility care code.
        >
        > -----Original Message-----
        > From: Ericadschwalm EricaDSchwalm@...>
        > To: CCO-L CCO-L@yahoogroups.com>
        > Sent: Thu, Feb 14, 2013 3:49 pm
        > Subject: Re: [CCO-L] SNF - Initial visits by NP or PA
        >
        > Please explain why the guidelines below state otherwise? Thanks so much!
        >
        > -----Original Message-----
        > From: Kergides, Jo Ann kergidjf@...>
        > To: CCO-L CCO-L@yahoogroups.com>
        > Sent: Thu, Feb 14, 2013 3:23 pm
        > Subject: RE: [CCO-L] SNF - Initial visits by NP or PA
        >
        > NPs cannot bill initial visits in a facility.
        >
        > Jo Ann F Kergides, CPC-H
        > Coding Specialist
        > UMDNJ-SOM NJ Institute for Successful Aging
        > 42 E Laurel Rd, UDP #1800
        > Stratford, NJ 08084
        > Phone: 856-566-6833
        > Fax: 856-566-7089
        >
        > This messeage is intended for the use of the person or entity to which it
        > is addressed and may contain information that is privileged and
        > confidential, the disclosure of which is governed by applicable law. If the
        > reader of this message is not the intended recipient, or the employee or
        > agent responsible to deliver it to the intended recipient, you are hereby
        > notified that any dissemination, distribution or copying of this
        > information is STRICTLY PROHIBITED. If you have received this message in
        > error, please notify the sender immediately and arrange for the return or
        > destruction of these documents.
        >
        > From: CCO-L@yahoogroups.com [mailto:CCO-L@yahoogroups.com] On Behalf Of
        > Ericadschwalm
        > Sent: Thursday, February 14, 2013 3:12 PM
        > To: coding@...; cco-l@yahoogroups.com;
        > ericacodes@yahoogroups.com
        > Subject: [CCO-L] SNF - Initial visits by NP or PA
        >
        > Hello,
        >
        > I understand that in previous years an NPP could not bill for the initial
        > SNF visit (e.g. 99306).
        >
        > However the current guidelines I'm reading state differently (see below).
        >
        > Somehow had missed that change in 2010, saw it recently and started
        > billing the initials (previously we would change a 99306 tp 99310 when done
        > by a midlevel).
        >
        > But now Medicare NHIC is denying our claims (e.g. 99306) when billed under
        > an NP's name. "Service is not covered by this type of provider".
        >
        > I'm totally confused! Am I understanding these guidelines wrong or is
        > Medicare wrong!?!? Anyone else have this issue?
        >
        > "The Centers for Medicare & Medicaid Services (CMS) would like to remind
        > skilled nursing facilities (SNFs) and nursing facilities (NFs) of the
        > evaluation and management (E/M) services coding policy that has been in
        > effect since January 1, 2010. If a physician or non-physician practitioner
        > is furnishing that practitioner"s first E/M service for a Medicare
        > beneficiary in a SNF or NF during the patient"s facility stay, even if that
        > service is provided prior to the federally mandated visit, the practitioner
        > may bill the most appropriate E/M code that reflects the services the
        > practitioner furnished, whether that code be an initial nursing facility
        > care code (CPT codes 99304 - 99306) or a subsequent nursing facility care
        > code (CPT codes 99307 - 99310) if documentation and medical necessity do
        > not meet the requirements for billing an initial nursing facility care
        > code. "
        >
        > and
        >
        > "A NPP may perform medically necessary E/M visits prior to and after the
        > initial visit if all the requirements for collaboration, general physician
        > supervision, licensure and billing are met. Payment is made for E/M visits
        > to patients in a SNF who are receiving services for medically complex care
        > upon discharge from an acute care facility when the visits are reasonable
        > and medically necessary and documented in the medical record. Physicians
        > and NPPs shall report initial nursing facility care codes for their first
        > visit with the patient. "
        >
        >
        > http://www.medicarenhic.com/providers/pubs/REF-EDO-0020%20PA%20NP%20CNS%20CNM%20Billing%20Guide.pdf
        >
        > [Non-text portions of this message have been removed]
        >
        > [Non-text portions of this message have been removed]
        >
        > [Non-text portions of this message have been removed]
        >
        > [Non-text portions of this message have been removed]
        >
        >
        >


        [Non-text portions of this message have been removed]
      • Dawn Silva
        See Section 30.6.13 - Nursing Facility Services in the claims processing manual. It has everything you need for NP SNF.
        Message 3 of 10 , Feb 14, 2013
        • 0 Attachment
          See Section 30.6.13 - Nursing Facility Services in the claims processing
          manual. It has everything you need for NP SNF.



          http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/c
          lm104c12.pdf
          <http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/
          clm104c12.pdf>



          Thank you, Dawn



          From: CCO-L@yahoogroups.com [mailto:CCO-L@yahoogroups.com] On Behalf Of
          mrl
          Sent: Thursday, February 14, 2013 4:00 PM
          To: CCO-L@yahoogroups.com
          Subject: Re: [CCO-L] SNF - Initial visits by NP or PA





          TO: Jo Ann F Kergides, CPC-H

          Please explain your answer. A statement does not an answer make. Where
          is your documentation to backup your statement? Coding Clinic ? CMS
          memo?

          On 14 February 2013 12:57, Ericadschwalm EricaDSchwalm@...
          <mailto:EricaDSchwalm%40aol.com> > wrote:

          > **
          >
          >
          >
          > Also, CR 7405 from Aug 2011 -
          >
          > The general policy of billing the most appropriate visit code,
          following
          > the elimination of payments for consultation codes, shall also apply
          to
          > billing initial visits provided in skilled nursing facilities (SNFs)
          and
          > nursing facilities (NFs) by physicians and nonphysician practitioners
          > (NPPs) who are not providing the federally mandated initial visit. If
          a
          > physician or NPP is furnishing that practitioner's first E/M service
          for a
          > Medicare beneficiary in a SNF or NF during the patient's facility
          stay,
          > even if that service is provided prior to the federally mandated
          visit, the
          > practitioner may bill the most appropriate E/M code that reflects the
          > services the practitioner furnished, whether that code be an initial
          > nursing facility care code (CPT codes 99304-99306) or a subsequent
          nursing
          > facility care code (CPT codes 99307-99310) when documentation and
          medical
          > necessity do not meet the requirements for billing an initial nursing
          > facility care code.
          >
          > -----Original Message-----
          > From: Ericadschwalm EricaDSchwalm@...
          <mailto:EricaDSchwalm%40aol.com> >
          > To: CCO-L CCO-L@yahoogroups.com <mailto:CCO-L%40yahoogroups.com> >
          > Sent: Thu, Feb 14, 2013 3:49 pm
          > Subject: Re: [CCO-L] SNF - Initial visits by NP or PA
          >
          > Please explain why the guidelines below state otherwise? Thanks so
          much!
          >
          > -----Original Message-----
          > From: Kergides, Jo Ann kergidjf@...
          <mailto:kergidjf%40umdnj.edu> >
          > To: CCO-L CCO-L@yahoogroups.com <mailto:CCO-L%40yahoogroups.com> >
          > Sent: Thu, Feb 14, 2013 3:23 pm
          > Subject: RE: [CCO-L] SNF - Initial visits by NP or PA
          >
          > NPs cannot bill initial visits in a facility.
          >
          > Jo Ann F Kergides, CPC-H
          > Coding Specialist
          > UMDNJ-SOM NJ Institute for Successful Aging
          > 42 E Laurel Rd, UDP #1800
          > Stratford, NJ 08084
          > Phone: 856-566-6833
          > Fax: 856-566-7089
          >
          > This messeage is intended for the use of the person or entity to which
          it
          > is addressed and may contain information that is privileged and
          > confidential, the disclosure of which is governed by applicable law.
          If the
          > reader of this message is not the intended recipient, or the employee
          or
          > agent responsible to deliver it to the intended recipient, you are
          hereby
          > notified that any dissemination, distribution or copying of this
          > information is STRICTLY PROHIBITED. If you have received this message
          in
          > error, please notify the sender immediately and arrange for the return
          or
          > destruction of these documents.
          >
          > From: CCO-L@yahoogroups.com <mailto:CCO-L%40yahoogroups.com>
          [mailto:CCO-L@yahoogroups.com <mailto:CCO-L%40yahoogroups.com> ] On
          Behalf Of
          > Ericadschwalm
          > Sent: Thursday, February 14, 2013 3:12 PM
          > To: coding@... <mailto:coding%40lyris.aafp.org> ;
          cco-l@yahoogroups.com <mailto:cco-l%40yahoogroups.com> ;
          > ericacodes@yahoogroups.com <mailto:ericacodes%40yahoogroups.com>
          > Subject: [CCO-L] SNF - Initial visits by NP or PA
          >
          > Hello,
          >
          > I understand that in previous years an NPP could not bill for the
          initial
          > SNF visit (e.g. 99306).
          >
          > However the current guidelines I'm reading state differently (see
          below).
          >
          > Somehow had missed that change in 2010, saw it recently and started
          > billing the initials (previously we would change a 99306 tp 99310 when
          done
          > by a midlevel).
          >
          > But now Medicare NHIC is denying our claims (e.g. 99306) when billed
          under
          > an NP's name. "Service is not covered by this type of provider".
          >
          > I'm totally confused! Am I understanding these guidelines wrong or is
          > Medicare wrong!?!? Anyone else have this issue?
          >
          > "The Centers for Medicare & Medicaid Services (CMS) would like to
          remind
          > skilled nursing facilities (SNFs) and nursing facilities (NFs) of the
          > evaluation and management (E/M) services coding policy that has been
          in
          > effect since January 1, 2010. If a physician or non-physician
          practitioner
          > is furnishing that practitioner"s first E/M service for a Medicare
          > beneficiary in a SNF or NF during the patient"s facility stay, even if
          that
          > service is provided prior to the federally mandated visit, the
          practitioner
          > may bill the most appropriate E/M code that reflects the services the
          > practitioner furnished, whether that code be an initial nursing
          facility
          > care code (CPT codes 99304 - 99306) or a subsequent nursing facility
          care
          > code (CPT codes 99307 - 99310) if documentation and medical necessity
          do
          > not meet the requirements for billing an initial nursing facility care
          > code. "
          >
          > and
          >
          > "A NPP may perform medically necessary E/M visits prior to and after
          the
          > initial visit if all the requirements for collaboration, general
          physician
          > supervision, licensure and billing are met. Payment is made for E/M
          visits
          > to patients in a SNF who are receiving services for medically complex
          care
          > upon discharge from an acute care facility when the visits are
          reasonable
          > and medically necessary and documented in the medical record.
          Physicians
          > and NPPs shall report initial nursing facility care codes for their
          first
          > visit with the patient. "
          >
          >
          >
          http://www.medicarenhic.com/providers/pubs/REF-EDO-0020%20PA%20NP%20CNS%
          20CNM%20Billing%20Guide.pdf
          >
          > [Non-text portions of this message have been removed]
          >
          > [Non-text portions of this message have been removed]
          >
          > [Non-text portions of this message have been removed]
          >
          > [Non-text portions of this message have been removed]
          >
          >
          >

          [Non-text portions of this message have been removed]





          [Non-text portions of this message have been removed]
        • Kergides, Jo Ann
          Our local carrier Novitas Solutions had an inservice on Nursing Facility E&M Services and the handout clearly states that NPs can only report subq visits
          Message 4 of 10 , Feb 15, 2013
          • 0 Attachment
            Our local carrier Novitas Solutions had an inservice on "Nursing Facility E&M Services" and the handout clearly states that NPs can only report subq visits codes. I'm not sure where you're located. Maybe you should invite your local carrier for a similar presentation.

            Jo Ann F Kergides, CPC-H
            Coding Specialist
            UMDNJ-SOM NJ Institute for Successful Aging
            42 E Laurel Rd, UDP #1800
            Stratford, NJ 08084
            Phone: 856-566-6833
            Fax: 856-566-7089

            This messeage is intended for the use of the person or entity to which it is addressed and may contain information that is privileged and confidential, the disclosure of which is governed by applicable law. If the reader of this message is not the intended recipient, or the employee or agent responsible to deliver it to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this information is STRICTLY PROHIBITED. If you have received this message in error, please notify the sender immediately and arrange for the return or destruction of these documents.

            From: CCO-L@yahoogroups.com [mailto:CCO-L@yahoogroups.com] On Behalf Of mrl
            Sent: Thursday, February 14, 2013 7:00 PM
            To: CCO-L@yahoogroups.com
            Subject: Re: [CCO-L] SNF - Initial visits by NP or PA



            TO: Jo Ann F Kergides, CPC-H

            Please explain your answer. A statement does not an answer make. Where
            is your documentation to backup your statement? Coding Clinic ? CMS memo?

            On 14 February 2013 12:57, Ericadschwalm EricaDSchwalm@...<mailto:EricaDSchwalm%40aol.com>> wrote:

            > **
            >
            >
            >
            > Also, CR 7405 from Aug 2011 -
            >
            > The general policy of billing the most appropriate visit code, following
            > the elimination of payments for consultation codes, shall also apply to
            > billing initial visits provided in skilled nursing facilities (SNFs) and
            > nursing facilities (NFs) by physicians and nonphysician practitioners
            > (NPPs) who are not providing the federally mandated initial visit. If a
            > physician or NPP is furnishing that practitioner's first E/M service for a
            > Medicare beneficiary in a SNF or NF during the patient's facility stay,
            > even if that service is provided prior to the federally mandated visit, the
            > practitioner may bill the most appropriate E/M code that reflects the
            > services the practitioner furnished, whether that code be an initial
            > nursing facility care code (CPT codes 99304-99306) or a subsequent nursing
            > facility care code (CPT codes 99307-99310) when documentation and medical
            > necessity do not meet the requirements for billing an initial nursing
            > facility care code.
            >
            > -----Original Message-----
            > From: Ericadschwalm EricaDSchwalm@...<mailto:EricaDSchwalm%40aol.com>>
            > To: CCO-L CCO-L@yahoogroups.com<mailto:CCO-L%40yahoogroups.com>>
            > Sent: Thu, Feb 14, 2013 3:49 pm
            > Subject: Re: [CCO-L] SNF - Initial visits by NP or PA
            >
            > Please explain why the guidelines below state otherwise? Thanks so much!
            >
            > -----Original Message-----
            > From: Kergides, Jo Ann kergidjf@...<mailto:kergidjf%40umdnj.edu>>
            > To: CCO-L CCO-L@yahoogroups.com<mailto:CCO-L%40yahoogroups.com>>
            > Sent: Thu, Feb 14, 2013 3:23 pm
            > Subject: RE: [CCO-L] SNF - Initial visits by NP or PA
            >
            > NPs cannot bill initial visits in a facility.
            >
            > Jo Ann F Kergides, CPC-H
            > Coding Specialist
            > UMDNJ-SOM NJ Institute for Successful Aging
            > 42 E Laurel Rd, UDP #1800
            > Stratford, NJ 08084
            > Phone: 856-566-6833
            > Fax: 856-566-7089
            >
            > This messeage is intended for the use of the person or entity to which it
            > is addressed and may contain information that is privileged and
            > confidential, the disclosure of which is governed by applicable law. If the
            > reader of this message is not the intended recipient, or the employee or
            > agent responsible to deliver it to the intended recipient, you are hereby
            > notified that any dissemination, distribution or copying of this
            > information is STRICTLY PROHIBITED. If you have received this message in
            > error, please notify the sender immediately and arrange for the return or
            > destruction of these documents.
            >
            > From: CCO-L@yahoogroups.com<mailto:CCO-L%40yahoogroups.com> [mailto:CCO-L@yahoogroups.com<mailto:CCO-L%40yahoogroups.com>] On Behalf Of
            > Ericadschwalm
            > Sent: Thursday, February 14, 2013 3:12 PM
            > To: coding@...<mailto:coding%40lyris.aafp.org>; cco-l@yahoogroups.com<mailto:cco-l%40yahoogroups.com>;
            > ericacodes@yahoogroups.com<mailto:ericacodes%40yahoogroups.com>
            > Subject: [CCO-L] SNF - Initial visits by NP or PA
            >
            > Hello,
            >
            > I understand that in previous years an NPP could not bill for the initial
            > SNF visit (e.g. 99306).
            >
            > However the current guidelines I'm reading state differently (see below).
            >
            > Somehow had missed that change in 2010, saw it recently and started
            > billing the initials (previously we would change a 99306 tp 99310 when done
            > by a midlevel).
            >
            > But now Medicare NHIC is denying our claims (e.g. 99306) when billed under
            > an NP's name. "Service is not covered by this type of provider".
            >
            > I'm totally confused! Am I understanding these guidelines wrong or is
            > Medicare wrong!?!? Anyone else have this issue?
            >
            > "The Centers for Medicare & Medicaid Services (CMS) would like to remind
            > skilled nursing facilities (SNFs) and nursing facilities (NFs) of the
            > evaluation and management (E/M) services coding policy that has been in
            > effect since January 1, 2010. If a physician or non-physician practitioner
            > is furnishing that practitioner"s first E/M service for a Medicare
            > beneficiary in a SNF or NF during the patient"s facility stay, even if that
            > service is provided prior to the federally mandated visit, the practitioner
            > may bill the most appropriate E/M code that reflects the services the
            > practitioner furnished, whether that code be an initial nursing facility
            > care code (CPT codes 99304 - 99306) or a subsequent nursing facility care
            > code (CPT codes 99307 - 99310) if documentation and medical necessity do
            > not meet the requirements for billing an initial nursing facility care
            > code. "
            >
            > and
            >
            > "A NPP may perform medically necessary E/M visits prior to and after the
            > initial visit if all the requirements for collaboration, general physician
            > supervision, licensure and billing are met. Payment is made for E/M visits
            > to patients in a SNF who are receiving services for medically complex care
            > upon discharge from an acute care facility when the visits are reasonable
            > and medically necessary and documented in the medical record. Physicians
            > and NPPs shall report initial nursing facility care codes for their first
            > visit with the patient. "
            >
            >
            > http://www.medicarenhic.com/providers/pubs/REF-EDO-0020%20PA%20NP%20CNS%20CNM%20Billing%20Guide.pdf
            >
            > [Non-text portions of this message have been removed]
            >
            > [Non-text portions of this message have been removed]
            >
            > [Non-text portions of this message have been removed]
            >
            > [Non-text portions of this message have been removed]
            >
            >
            >

            [Non-text portions of this message have been removed]



            [Non-text portions of this message have been removed]
          • Ericadschwalm
            Okay that still doesn t make sense; It clearly says that NPP can bill the initial code. The federally mandated visits in a SNF and NF must be performed by the
            Message 5 of 10 , Feb 15, 2013
            • 0 Attachment
              Okay that still doesn't make sense; It clearly says that NPP can bill the initial code.

              The federally mandated visits in a SNF and NF must be performed by the physician except as otherwise permitted (42 CFR 483.40 (c) (4) and (f)). The principal physician of record must append the modifier "-AI", (Principal Physician of Record), to the initial nursing facility care code. This modifier will identify the physician who oversees the patient’s care from other physicians who may be furnishing specialty care. All other physicians or qualified NPPs who perform an initial evaluation in the NF or SNF may bill the initial nursing facility care code.









              -----Original Message-----
              From: Dawn Silva <dawn.silva@...>
              To: CCO-L <CCO-L@yahoogroups.com>
              Sent: Thu, Feb 14, 2013 7:08 pm
              Subject: RE: [CCO-L] SNF - Initial visits by NP or PA




              See Section 30.6.13 - Nursing Facility Services in the claims processing
              manual. It has everything you need for NP SNF.

              http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/c
              lm104c12.pdf
              http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/
              clm104c12.pdf>

              Thank you, Dawn

              From: CCO-L@yahoogroups.com [mailto:CCO-L@yahoogroups.com] On Behalf Of
              mrl
              Sent: Thursday, February 14, 2013 4:00 PM
              To: CCO-L@yahoogroups.com
              Subject: Re: [CCO-L] SNF - Initial visits by NP or PA

              TO: Jo Ann F Kergides, CPC-H

              Please explain your answer. A statement does not an answer make. Where
              is your documentation to backup your statement? Coding Clinic ? CMS
              memo?

              On 14 February 2013 12:57, Ericadschwalm EricaDSchwalm@...
              > wrote:

              > **
              >
              >
              >
              > Also, CR 7405 from Aug 2011 -
              >
              > The general policy of billing the most appropriate visit code,
              following
              > the elimination of payments for consultation codes, shall also apply
              to
              > billing initial visits provided in skilled nursing facilities (SNFs)
              and
              > nursing facilities (NFs) by physicians and nonphysician practitioners
              > (NPPs) who are not providing the federally mandated initial visit. If
              a
              > physician or NPP is furnishing that practitioner's first E/M service
              for a
              > Medicare beneficiary in a SNF or NF during the patient's facility
              stay,
              > even if that service is provided prior to the federally mandated
              visit, the
              > practitioner may bill the most appropriate E/M code that reflects the
              > services the practitioner furnished, whether that code be an initial
              > nursing facility care code (CPT codes 99304-99306) or a subsequent
              nursing
              > facility care code (CPT codes 99307-99310) when documentation and
              medical
              > necessity do not meet the requirements for billing an initial nursing
              > facility care code.
              >
              > -----Original Message-----
              > From: Ericadschwalm EricaDSchwalm@...
              >
              > To: CCO-L CCO-L@yahoogroups.com >
              > Sent: Thu, Feb 14, 2013 3:49 pm
              > Subject: Re: [CCO-L] SNF - Initial visits by NP or PA
              >
              > Please explain why the guidelines below state otherwise? Thanks so
              much!
              >
              > -----Original Message-----
              > From: Kergides, Jo Ann kergidjf@...
              >
              > To: CCO-L CCO-L@yahoogroups.com >
              > Sent: Thu, Feb 14, 2013 3:23 pm
              > Subject: RE: [CCO-L] SNF - Initial visits by NP or PA
              >
              > NPs cannot bill initial visits in a facility.
              >
              > Jo Ann F Kergides, CPC-H
              > Coding Specialist
              > UMDNJ-SOM NJ Institute for Successful Aging
              > 42 E Laurel Rd, UDP #1800
              > Stratford, NJ 08084
              > Phone: 856-566-6833
              > Fax: 856-566-7089
              >
              > This messeage is intended for the use of the person or entity to which
              it
              > is addressed and may contain information that is privileged and
              > confidential, the disclosure of which is governed by applicable law.
              If the
              > reader of this message is not the intended recipient, or the employee
              or
              > agent responsible to deliver it to the intended recipient, you are
              hereby
              > notified that any dissemination, distribution or copying of this
              > information is STRICTLY PROHIBITED. If you have received this message
              in
              > error, please notify the sender immediately and arrange for the return
              or
              > destruction of these documents.
              >
              > From: CCO-L@yahoogroups.com
              [mailto:CCO-L@yahoogroups.com ] On
              Behalf Of
              > Ericadschwalm
              > Sent: Thursday, February 14, 2013 3:12 PM
              > To: coding@... ;
              cco-l@yahoogroups.com ;
              > ericacodes@yahoogroups.com
              > Subject: [CCO-L] SNF - Initial visits by NP or PA
              >
              > Hello,
              >
              > I understand that in previous years an NPP could not bill for the
              initial
              > SNF visit (e.g. 99306).
              >
              > However the current guidelines I'm reading state differently (see
              below).
              >
              > Somehow had missed that change in 2010, saw it recently and started
              > billing the initials (previously we would change a 99306 tp 99310 when
              done
              > by a midlevel).
              >
              > But now Medicare NHIC is denying our claims (e.g. 99306) when billed
              under
              > an NP's name. "Service is not covered by this type of provider".
              >
              > I'm totally confused! Am I understanding these guidelines wrong or is
              > Medicare wrong!?!? Anyone else have this issue?
              >
              > "The Centers for Medicare & Medicaid Services (CMS) would like to
              remind
              > skilled nursing facilities (SNFs) and nursing facilities (NFs) of the
              > evaluation and management (E/M) services coding policy that has been
              in
              > effect since January 1, 2010. If a physician or non-physician
              practitioner
              > is furnishing that practitioner"s first E/M service for a Medicare
              > beneficiary in a SNF or NF during the patient"s facility stay, even if
              that
              > service is provided prior to the federally mandated visit, the
              practitioner
              > may bill the most appropriate E/M code that reflects the services the
              > practitioner furnished, whether that code be an initial nursing
              facility
              > care code (CPT codes 99304 - 99306) or a subsequent nursing facility
              care
              > code (CPT codes 99307 - 99310) if documentation and medical necessity
              do
              > not meet the requirements for billing an initial nursing facility care
              > code. "
              >
              > and
              >
              > "A NPP may perform medically necessary E/M visits prior to and after
              the
              > initial visit if all the requirements for collaboration, general
              physician
              > supervision, licensure and billing are met. Payment is made for E/M
              visits
              > to patients in a SNF who are receiving services for medically complex
              care
              > upon discharge from an acute care facility when the visits are
              reasonable
              > and medically necessary and documented in the medical record.
              Physicians
              > and NPPs shall report initial nursing facility care codes for their
              first
              > visit with the patient. "
              >
              >
              >
              http://www.medicarenhic.com/providers/pubs/REF-EDO-0020%20PA%20NP%20CNS%
              20CNM%20Billing%20Guide.pdf
              >
              > [Non-text portions of this message have been removed]
              >
              > [Non-text portions of this message have been removed]
              >
              > [Non-text portions of this message have been removed]
              >
              > [Non-text portions of this message have been removed]
              >
              >
              >

              [Non-text portions of this message have been removed]

              [Non-text portions of this message have been removed]







              [Non-text portions of this message have been removed]
            • Quinten Buechner
              At one time, Congress had passed the law for SNFs restricting initial visits to MD/DO only. I heard that they were thinking of changing the law but had not
              Message 6 of 10 , Feb 23, 2013
              • 0 Attachment
                At one time, Congress had passed the law for SNFs restricting initial visits to MD/DO only. I heard that they were thinking of changing the law but had not seen the change in Medicare policy. You may want to look at transmittals for IOM 104 and 102 or you might ask NHIC the source of their info.



                Quinten A. Buechner, M.S., M.Div.,
                ACS-FP/GI/PEDS(BAMC), CPC(AAPC), CCP(PHIA), CMSC(PAHCS)

                President and CEO

                ProActive Consultants, LLC

                1659 3rd Ave, Cumberland, WI 54829

                E-mail: QuinB@...

                Phone: 715.822.8284

                Cell: 715.307.4448

                Fax: 715.822.8299



                From: CCO-L@yahoogroups.com [mailto:CCO-L@yahoogroups.com] On Behalf Of Ericadschwalm
                Sent: Thursday, February 14, 2013 2:12 PM
                To: coding@...; cco-l@yahoogroups.com; ericacodes@yahoogroups.com
                Subject: [CCO-L] SNF - Initial visits by NP or PA






                Hello,

                I understand that in previous years an NPP could not bill for the initial SNF visit (e.g. 99306).

                However the current guidelines I'm reading state differently (see below).

                Somehow had missed that change in 2010, saw it recently and started billing the initials (previously we would change a 99306 tp 99310 when done by a midlevel).

                But now Medicare NHIC is denying our claims (e.g. 99306) when billed under an NP's name. "Service is not covered by this type of provider".

                I'm totally confused! Am I understanding these guidelines wrong or is Medicare wrong!?!? Anyone else have this issue?

                "The Centers for Medicare & Medicaid Services (CMS) would like to remind skilled nursing facilities (SNFs) and nursing facilities (NFs) of the evaluation and management (E/M) services coding policy that has been in effect since January 1, 2010. If a physician or non-physician practitioner is furnishing that practitioner‟s first E/M service for a Medicare beneficiary in a SNF or NF during the patient‟s facility stay, even if that service is provided prior to the federally mandated visit, the practitioner may bill the most appropriate E/M code that reflects the services the practitioner furnished, whether that code be an initial nursing facility care code (CPT codes 99304 – 99306) or a subsequent nursing facility care code (CPT codes 99307 – 99310) if documentation and medical necessity do not meet the requirements for billing an initial nursing facility care code. "

                and

                "A NPP may perform medically necessary E/M visits prior to and after the initial visit if all the requirements for collaboration, general physician supervision, licensure and billing are met. Payment is made for E/M visits to patients in a SNF who are receiving services for medically complex care upon discharge from an acute care facility when the visits are reasonable and medically necessary and documented in the medical record. Physicians and NPPs shall report initial nursing facility care codes for their first visit with the patient. "

                http://www.medicarenhic.com/providers/pubs/REF-EDO-0020%20PA%20NP%20CNS%20CNM%20Billing%20Guide.pdf

                [Non-text portions of this message have been removed]



                _____

                No virus found in this message.
                Checked by AVG - www.avg.com
                Version: 2013.0.2899 / Virus Database: 2639/6101 - Release Date: 02/13/13
                Internal Virus Database is out of date.



                [Non-text portions of this message have been removed]
              • Quinten Buechner
                But see http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm10 4c12.pdf Quinten A. Buechner, M.S., M.Div., ACS-FP/GI/PEDS(BAMC),
                Message 7 of 10 , Feb 23, 2013
                • 0 Attachment
                  But see
                  http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm10
                  4c12.pdf



                  Quinten A. Buechner, M.S., M.Div.,
                  ACS-FP/GI/PEDS(BAMC), CPC(AAPC), CCP(PHIA), CMSC(PAHCS)

                  President and CEO

                  ProActive Consultants, LLC

                  1659 3rd Ave, Cumberland, WI 54829

                  E-mail: QuinB@...

                  Phone: 715.822.8284

                  Cell: 715.307.4448

                  Fax: 715.822.8299



                  From: CCO-L@yahoogroups.com [mailto:CCO-L@yahoogroups.com] On Behalf Of
                  Kergides, Jo Ann
                  Sent: Friday, February 15, 2013 7:10 AM
                  To: CCO-L@yahoogroups.com
                  Subject: RE: [CCO-L] SNF - Initial visits by NP or PA





                  Our local carrier Novitas Solutions had an inservice on "Nursing Facility
                  E&M Services" and the handout clearly states that NPs can only report subq
                  visits codes. I'm not sure where you're located. Maybe you should invite
                  your local carrier for a similar presentation.

                  Jo Ann F Kergides, CPC-H
                  Coding Specialist
                  UMDNJ-SOM NJ Institute for Successful Aging
                  42 E Laurel Rd, UDP #1800
                  Stratford, NJ 08084
                  Phone: 856-566-6833
                  Fax: 856-566-7089

                  This messeage is intended for the use of the person or entity to which it is
                  addressed and may contain information that is privileged and confidential,
                  the disclosure of which is governed by applicable law. If the reader of this
                  message is not the intended recipient, or the employee or agent responsible
                  to deliver it to the intended recipient, you are hereby notified that any
                  dissemination, distribution or copying of this information is STRICTLY
                  PROHIBITED. If you have received this message in error, please notify the
                  sender immediately and arrange for the return or destruction of these
                  documents.

                  From: CCO-L@yahoogroups.com <mailto:CCO-L%40yahoogroups.com>
                  [mailto:CCO-L@yahoogroups.com <mailto:CCO-L%40yahoogroups.com> ] On Behalf
                  Of mrl
                  Sent: Thursday, February 14, 2013 7:00 PM
                  To: CCO-L@yahoogroups.com <mailto:CCO-L%40yahoogroups.com>
                  Subject: Re: [CCO-L] SNF - Initial visits by NP or PA

                  TO: Jo Ann F Kergides, CPC-H

                  Please explain your answer. A statement does not an answer make. Where
                  is your documentation to backup your statement? Coding Clinic ? CMS memo?

                  On 14 February 2013 12:57, Ericadschwalm EricaDSchwalm@...
                  <mailto:EricaDSchwalm%40aol.com> > wrote:

                  > **
                  >
                  >
                  >
                  > Also, CR 7405 from Aug 2011 -
                  >
                  > The general policy of billing the most appropriate visit code, following
                  > the elimination of payments for consultation codes, shall also apply to
                  > billing initial visits provided in skilled nursing facilities (SNFs) and
                  > nursing facilities (NFs) by physicians and nonphysician practitioners
                  > (NPPs) who are not providing the federally mandated initial visit. If a
                  > physician or NPP is furnishing that practitioner's first E/M service for a
                  > Medicare beneficiary in a SNF or NF during the patient's facility stay,
                  > even if that service is provided prior to the federally mandated visit,
                  the
                  > practitioner may bill the most appropriate E/M code that reflects the
                  > services the practitioner furnished, whether that code be an initial
                  > nursing facility care code (CPT codes 99304-99306) or a subsequent nursing
                  > facility care code (CPT codes 99307-99310) when documentation and medical
                  > necessity do not meet the requirements for billing an initial nursing
                  > facility care code.
                  >
                  > -----Original Message-----
                  > From: Ericadschwalm EricaDSchwalm@... <mailto:EricaDSchwalm%40aol.com>
                  >
                  > To: CCO-L CCO-L@yahoogroups.com <mailto:CCO-L%40yahoogroups.com> >
                  > Sent: Thu, Feb 14, 2013 3:49 pm
                  > Subject: Re: [CCO-L] SNF - Initial visits by NP or PA
                  >
                  > Please explain why the guidelines below state otherwise? Thanks so much!
                  >
                  > -----Original Message-----
                  > From: Kergides, Jo Ann kergidjf@... <mailto:kergidjf%40umdnj.edu> >
                  > To: CCO-L CCO-L@yahoogroups.com <mailto:CCO-L%40yahoogroups.com> >
                  > Sent: Thu, Feb 14, 2013 3:23 pm
                  > Subject: RE: [CCO-L] SNF - Initial visits by NP or PA
                  >
                  > NPs cannot bill initial visits in a facility.
                  >
                  > Jo Ann F Kergides, CPC-H
                  > Coding Specialist
                  > UMDNJ-SOM NJ Institute for Successful Aging
                  > 42 E Laurel Rd, UDP #1800
                  > Stratford, NJ 08084
                  > Phone: 856-566-6833
                  > Fax: 856-566-7089
                  >
                  > This messeage is intended for the use of the person or entity to which it
                  > is addressed and may contain information that is privileged and
                  > confidential, the disclosure of which is governed by applicable law. If
                  the
                  > reader of this message is not the intended recipient, or the employee or
                  > agent responsible to deliver it to the intended recipient, you are hereby
                  > notified that any dissemination, distribution or copying of this
                  > information is STRICTLY PROHIBITED. If you have received this message in
                  > error, please notify the sender immediately and arrange for the return or
                  > destruction of these documents.
                  >
                  > From: CCO-L@yahoogroups.com <mailto:CCO-L%40yahoogroups.com>
                  [mailto:CCO-L@yahoogroups.com <mailto:CCO-L%40yahoogroups.com> ] On Behalf
                  Of
                  > Ericadschwalm
                  > Sent: Thursday, February 14, 2013 3:12 PM
                  > To: coding@... <mailto:coding%40lyris.aafp.org> ;
                  cco-l@yahoogroups.com <mailto:cco-l%40yahoogroups.com> ;
                  > ericacodes@yahoogroups.com <mailto:ericacodes%40yahoogroups.com>
                  > Subject: [CCO-L] SNF - Initial visits by NP or PA
                  >
                  > Hello,
                  >
                  > I understand that in previous years an NPP could not bill for the initial
                  > SNF visit (e.g. 99306).
                  >
                  > However the current guidelines I'm reading state differently (see below).
                  >
                  > Somehow had missed that change in 2010, saw it recently and started
                  > billing the initials (previously we would change a 99306 tp 99310 when
                  done
                  > by a midlevel).
                  >
                  > But now Medicare NHIC is denying our claims (e.g. 99306) when billed under
                  > an NP's name. "Service is not covered by this type of provider".
                  >
                  > I'm totally confused! Am I understanding these guidelines wrong or is
                  > Medicare wrong!?!? Anyone else have this issue?
                  >
                  > "The Centers for Medicare & Medicaid Services (CMS) would like to remind
                  > skilled nursing facilities (SNFs) and nursing facilities (NFs) of the
                  > evaluation and management (E/M) services coding policy that has been in
                  > effect since January 1, 2010. If a physician or non-physician practitioner
                  > is furnishing that practitioner"s first E/M service for a Medicare
                  > beneficiary in a SNF or NF during the patient"s facility stay, even if
                  that
                  > service is provided prior to the federally mandated visit, the
                  practitioner
                  > may bill the most appropriate E/M code that reflects the services the
                  > practitioner furnished, whether that code be an initial nursing facility
                  > care code (CPT codes 99304 - 99306) or a subsequent nursing facility care
                  > code (CPT codes 99307 - 99310) if documentation and medical necessity do
                  > not meet the requirements for billing an initial nursing facility care
                  > code. "
                  >
                  > and
                  >
                  > "A NPP may perform medically necessary E/M visits prior to and after the
                  > initial visit if all the requirements for collaboration, general physician
                  > supervision, licensure and billing are met. Payment is made for E/M visits
                  > to patients in a SNF who are receiving services for medically complex care
                  > upon discharge from an acute care facility when the visits are reasonable
                  > and medically necessary and documented in the medical record. Physicians
                  > and NPPs shall report initial nursing facility care codes for their first
                  > visit with the patient. "
                  >
                  >
                  >
                  http://www.medicarenhic.com/providers/pubs/REF-EDO-0020%20PA%20NP%20CNS%20CN
                  M%20Billing%20Guide.pdf
                  >
                  > [Non-text portions of this message have been removed]
                  >
                  > [Non-text portions of this message have been removed]
                  >
                  > [Non-text portions of this message have been removed]
                  >
                  > [Non-text portions of this message have been removed]
                  >
                  >
                  >

                  [Non-text portions of this message have been removed]

                  [Non-text portions of this message have been removed]



                  _____

                  No virus found in this message.
                  Checked by AVG - www.avg.com
                  Version: 2013.0.2899 / Virus Database: 2639/6101 - Release Date: 02/13/13
                  Internal Virus Database is out of date.



                  [Non-text portions of this message have been removed]
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