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December 2015 Client Newsletter

Insurance Company Debit & Virtual Credit Cards
Payments from health plans to providers are considered "commercial payments," and Card system operating rules do not require you to accept virtual card payments for commercial transactions. We suggest that clients refuse this type of payment due to the high cost of those transactions! Be sure to notify CMB of such a payment so we can track.  You can request either an EFT arrangement or paper checks.  Both of which have the same price - FREE!  
Medicare Approves End-of-Life Counseling
While CMS approved coverage and payment for End-of-Life Counseling (called "Advanced Care Planning" - ACP), they are leaving implementation up to each MAC. NJ Participating Allowed Amounts for 99497 and 99498 are $91.24 and $79.10, respectively, in the office.  Slightly lower if performed at a place of service outside the office:  $83.98 and $78.70, respectively.
  • 99497 covers a discussion of advance directives with the patient, a family member, or surrogate for up to 30 minutes.
  • 99498 is an add-on code for each additional 30 minutes of discussion.
According to what we have read so far, "End of Life Counseling" can also be paid in addition to office and hospital visits, and in addition to the Medicare annual wellness visit. 
The 2016 Medicare Part B Deductible for 2016 is $166. 
Podiatrists - Routine Foot Care 
Routine Foot Care is only covered by UHCC if the patient has diabetes.  Be sure to include that diagnosis if the patient has UHCC for insurance -1', 2'or 3'. 
Ambulance Services Reduction
The Centers for Medicare and Medicaid Services (CMS) has announced in  MLN Matters® Number: MM9412  that the Ambulance Inflation Factor (AIF) for calendar year 2016 is negative 0.4%.  This means that ambulance services will see a slight reduction in Medicare reimbursement rates next year. 
CMS also published a Final Rule containing three important items for the ambulance industry.  Those items are:
  1. Ambulance Bonuses: CMS is updating the Medicare regulations to reflect that ambulance bonus payments have been extended through December 31, 2017. 
  2. Geographic Designations: The changes that CMS made last year to geographic designations - when some ZIP codes changed from urban to rural, and a lot more ZIP codes changed from rural to urban - are sticking around in 2016 and thereafter under this rule.
  3. Ambulance Staffing Regulations:  Finally, CMS is updating the Medicare regulations related to ambulance staffing requirements.  The regulations will now provide that all vehicles must meet and be staffed in accordance with all state and local rules.  
ICD-10 Preparation Pays Off
Overall, the switch to ICD-10 seems to have gone smoothly.  No significant issues. However, there are some minor issues with ambulance claims due to the new, more stringent Medicare LCD requirements, including the "Dual code."  
2015 Client Newsletter Archive