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Oregonoptometry.orgMarch 2011 | In this Issue.
Annual Third Party/Practice Management Seminar - Registration is OPEN
Oregon Health Plan Pharmacy Announcement
eRx Incentive Program Reminder - Avoiding the Adjustment
Medicare Carrier Advisory Committee Update
Excerpts From The Noridian Hot Topic Q & A Session
What's the Buzz on the OOPA ON-Line Member Forum?
Annual Third Party/Practice Management Seminar - May 6 & 7, 2011
Check your mailbox, e-mail and the OOPA web site www.oregonoptometry.org for registration materials for the 2011 Third
Party Practice Management Meeting, May 6th and 7th! This year's lineup includes great topics from national y renowned
speakers Doctors Laurie Sorrenson and Chuck Brownlow and favorite practice management speaker Mary Schmidt. This year
we wil be adding a special breakout session for new coding professionals with Elizabeth Cottle, coding and bil ing expert - but
sign up early, room in the breakout class is limited!
Friday afternoon wil offer the American Heart Association Health Care Provider CPR Complete Recertification Course -
NEW 2010 Standards. You must pre-register for this course, additional registration fee applies.
Also note - new location this year: the Embassy Suites at the Portland Airport - newer, nicer and better parking! Easy
access to the Max line for those who want to venture to local shopping like Ikea and Cascade Station.
Thank You to Our Generous Sponsors
PCLI, VSP, Ciba Vision, Alcon, OSO, Optovue, Hoya, VisionSource, OHSU and AOA
Oregon Health Plan Pharmacy Announcement
Preferred Drug List (PDL) Revised March 1, 2011 Drug Products Removed
Effective March 1 2011, the Division of Medical Assistance Programs (DMAP) wil remove certain drug products from the
Preferred Drug List. Any drug being removed that a client is currently taking wil be exempt from Prior Authorization
requirements for 90 days. Of interest to optometrists is the removal of Alphagan P from the preferred list.
eRx Incentive Program Reminder - Avoiding the Adjustment
In November, CMS announced that, beginning in calendar year 2012, eligible professionals who are not successful electronicprescribers based on claims submitted between January 1, 2011 - June 30, 2011, may be subject to a payment adjustment ontheir Medicare Part B Physician Fee Schedule (PFS) covered professional services. Section 132 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorizes CMS to apply this payment adjustment whether ornot the eligible professional is planning to participate in the eRx Incentive Program. Read the complete update Medicare Carrier Advisory Committee Update:
CMS: As the process for determining the Medicare contractors for multiple areas drags on, CMS has decided that they wil
reorganize the Medicare jurisdictions yet again, decreasing the number from 15 to 10. Oregon is currently part of Jurisdiction
2 (OR/WA/ID/AK), but our jurisdiction wil now be combined with Jurisdiction 3 (ND/SD/MT/WY/AZ/UT) to create Jurisdiction F
(now al jurisdictions wil have letter designations). Noridian is the current contractor for both jurisdictions, so the medical
director is inclined to believe they wil be awarded the next 5 year contract, as avoiding the changeover costs to another
contractor would be a huge cost savings for CMS. Hopeful y a decision wil be made by the end of March, although
protests/appeals could stil delay the process.
Oregon Medicaid: Continued under funding is a problem for the Oregon Health Plan, so services wil be further decreased
(the "line" wil be moved to exclude about 40 more conditions/treatments on the prioritized list). Reimbursement levels wil
also likely decrease. This is dependent on the legislature and OHP managed care plans.
Noridian: Improved search tool for Physician Fee Schedule: Click here for the PDF
PQRI is becoming PQRS (no longer wil be considered an "incentive" program, as it wil be mandated starting in the near
future): Physicians Quality Reporting System.
Physician's original signatures are required on al orders for lab tests and on printouts of results, plus written notes regardingaction taken in chart - except with electronic records.
EXCERPTS FROM THE NORIDIAN HOT TOPIC QUESTION AND ANSWERS SESSION:
MODIFIERS: What would be the scenarios for using the modifier GU versus the modifier GX? Is one for reporting purposes
only? Would these replace the modifier GA? Answer: Modifier GU is defined as “Waiver of liability statement issued as
required by payer policy, routine notice.” Modifier GX is “the notice of liability issued, voluntary under policy.” Providers may
use modifier GX to provide notice of liability regarding services excluded from Medicare coverage by statute. It is appropriate
to use when you know the service is considered non-covered by Medicare. When the service is noncovered, the office does
not have to provide an ABN to a patient for signing, hence “voluntary.” It is, however, a good idea to inform the patient that
they are financial y responsible.
CODING: From the last October teleconference on Signature Requirements, I understood the electronic record could say
“Electronical y reviewed and approved by” (Physician and title). I am getting requests for signature attestation. Is this no
longer correct? Answer: An electronic signature should be accompanied by a statement such as “electronical y signed by” or
“verified/reviewed by” fol owed by the providers name and credentials. In addition, authentication of the signing provider must
be clearly defined in records. It may be necessary in some instances to provide a signature attestation form.
The form for the states of AK, OR, and WA is located at:
How can I get my report for PQRI? Answer: The reports are available from the Provider Contact Center (PCC) for smal
providers. The PCC can be reached at 1 800 933 0614. Group providers wil utilize Individuals Authorized to Access CMS
Computer System (IACS). For assistance with IACS contact the QualityNet Help Desk at 866-288-8912; TTY 877-715-6222 or
We only have two Ophthalmologists and two Optometrists. I cal ed and they told me the doctor has to sign up first. We have
been using PQRI measures. Answer: The IACS system has security standards that must be set up in order to get the
reports released. Smal providers are no longer required to obtain reports through the IACS system and you may contact the
PCC at 800-933-0614.
I have been told that to qualify for eRx incentive, claims must be received on paper? Is this statement correct? Answer: No,
they just have to be submitted by claim based reporting and cannot be submitted via registry or Electronic Health Records
Please define what a unique event is for E-prescribing (eRx). Please define percentage of measurement if it pertains to
submitting a prescription at the time of an office visit or if it measures al refil s prescribed by the provider. Answer: A
unique prescribing event happens when one or more prescriptions are transmitted via the eRx system during the office visit. A
refil could be counted as a unique event if handled during a different office visit. Prescriptions submitted that were not part of
an office visit do not qualify.
Our providers are general surgeons. We have an eRx system; however, they prescribe many narcotic prescriptions that
currently cannot be sent electronical y. They must be handwritten. How do we prevent being penalized for not being able to
utilize the system? Answer: If your providers ONLY prescribe narcotics and would not qualify for the 10% threshold
requirements they would not be considered an eligible EP for eRx.
Did I understand that if we didn’t do the incentive program for Electronic Health Record (EHR) there would be a penalty?
Answer: Penalties for EHR start in 2015. EPs are required to register to participate in this incentive program. For complete
information about EHR see CMS web page: http://www.cms.gov/EHRIncentivePrograms
We submitted the G8447 for PQRI measure #124 for EHR for dates of service in 2010. When can we expect payment for that
incentive? Answer: Incentive payments go out the second half of the fol owing year.
Do we need to be set up specifical y with eRx or is this simply referring to electronic prescribing? We are currently sending
scripts electronical y and reporting the G code. Answer: EP’s are not required to register for electronic prescribing. For
complete information regarding the incentive and specific requirements review CMS website at:
Do we need to register to start reporting PQRI? Answer: No, EPs are not required to register. Review the measures on the
CMS website at http://www.cms.gov/PQRI . The CMS website has great documentation and explanations on how PQRI works
and how to get started.
Who can I contact with a question about the Medicare Part B Electronic Funds Transfer (EFT) form? I’m not sure if we need to
submit a new one if nothing has changed. Answer: NAS Provider Enrol ment can be contacted at 888-608-8816. EFT
deposits your Medicare payments directly into your bank account. CMS requires that al providers that are enrol ing in
Medicare Part B, revalidating, or making any changes to their file, must use EFT. To sign up, you must fil out an
Authorization Agreement for Electronic Funds Transfer at http://www.cms.gov/cmsforms/downloads/CMS588.pdf . Complete
the form and have it signed and dated by the provider or authorized/delegated official (for groups or organizations). The
signature must be original (cannot be a copy or stamped signature)
Regarding claim filing deadlines, what do we do when another insurance takes back their payment stating the patient was noteligible and that they should have been secondary and it is now past timely filing for Medicare? Do we have any recourse? Answer: Normal filing guidelines would stil be fol owed; however, you have one year from the date of service. If NAS doeshave a claim in the system that was paid incorrectly, it can be adjusted one year from the paid date.
Can you tel us what NAS uses for E&M guidelines for their reviews? Answer: Medical professionals can use either the 1995or the 1997 guidelines. Remember E&M reviews are based on medical necessity, not the number of systems/organsreviewed. The 1995 guidelines are located at http://www.cms.gov/MLNProducts/Downloads/1995dg.pdf and the 1997guidelines are located http://www.cms.gov/MLNProducts/Downloads/MASTER1.pdf .
ICD 10 updates from Noridian:
ICD 10 updates from CMS: http://www.cms.gov/ICD10
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Neurology MCQs 1) In hereditary sensori-motor neuropathy types I+II (Charcot- Marie-Tooth) a) the axonal form (type II) is characterised by very slow motor nerve conduction b) the axonal form is associated with hypertrophic peripheral nerves commonly palpable clinically c) both forms are usually inherited as an autosomal dominant condition d) pes cavus is a frequent clinica