News and Events
Important Medicare Updates
The 2010 Physician Fee Schedule
The Continuing Extension Act of 2010, enacted on April 15, 2010, extended the zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010. At this time, Congress is debating the elimination of the negative update that took effect June 1, 2010. The Centers for Medicare & Medicaid Services (CMS) is hopeful that Congressional action will be taken within the next several days to avert the negative update.
To avoid disruption in the delivery of health care services to beneficiaries and payment of claims for physicians, non-physician practitioners, and other providers paid under the MPFS, CMS had instructed its contractors on May 27th to hold claims for services paid under the MPFS for the first 10 business days of June. This hold only affects MPFS claims with dates of service of June 1, 2010, and later.
Given the possibility of congressional action in the very near future, CMS is now directing its contractors to continue holding June 1 and later claims through Thursday, June 17, lifting the hold on Friday, June 18, 2010.
This action will facilitate accurate claims processing at the outset and minimize the need for claims reprocessing if Congressional action changes the negative update. It also should minimize the health care professional and beneficiary burdens and costs associated with reprocessing claims.
PECOS-Medicare Enrollment
There has been a lot of discussion in the last couple of weeks surrounding the Provider Enrollment, Chain and Ownership System (PECOS) enrollment process date changing from January 1, 2011 to July 6, 2010. The rule states that all physicians must list the legal name and national provider identifier (NPI) of the physician who referred/ordered to them on their claims. The rule also requires any physician who refers/orders services (Durable Medical Equipment, Prosthetics, and Supplies, home health, specialist services, laboratory or imaging) to be enrolled with Medicare in the PECOS database by July 6, 2010.
The pressing question is, "Will claims be denied if the referring/ordering physician's NPI is not on the claim or registered in PECOS by July 6, 2010?" MSMS has made several inquiries with Wisconsin Physician Services (WPS), the Medicare carrier for Michigan, as well as the Centers for Medicare & Medicaid Services (CMS) to try and get clarification whether the January 1, 2011 date will be honored or if they are moving the implementation date to July 6, 2010, as stated in the Interim Final Rule published on May 5, 2010.
WPS has stated that contractors have not received notification from CMS at this time to deny claims for physicians/providers who have not complied by July 6, 2010. CMS concurred that they have not instructed contractors to deny claims effective July 6, 2010 if not in compliance. However, they did indicate that the rule states the implementation date is July 6, 2010 for requiring physicians who refers/orders services (Durable Medical Equipment, Prosthetics, and Supplies, home health, specialist services, laboratory or imaging) to be enrolled with Medicare in the PECOS database.
Blue Cross Billing Changes
BCBSM has announced the following updates in benefits for blepharoplasty and blepharoptosis procedures:
15822 Blepharoplasty - upper eyelid
15823 Blepharoplasty with excessive skin weighing down eyelid
Blepharoplasty is considered reconstructive, not cosmetic if the following criteria are met: The excessive skin redundancy causes visual impairment that results in a 30% or 12 degree loss of superior visual field that is corrected when the eyelid is taped. The medical record should include visual field testing reports in both taped and untaped positions, high quality color photographs demonstrating the head held in an erect position with eyes open and focused straight ahead. Views should reveal the full-face anterior position, as well as the right and left lateral views with straightforward gaze.
67900 Repair of brow ptosis (supraciiary, mid-forehead or coronal approach)
67901 Repair of blepharoptosis; frontalis muscle technique with suture or other materials (e.g.: banked fascia)
67902 Autologous fascial sling (includes obtaining fascia)
67903 Levator (tarso) resection or advancement, internal approach
67904 Levator (tarso) resection or advancement, external approach
67906 Superior rectus technique with fascial sling (includes obtaining fascia)
67908 Conjuntivo-tarso-Muller's muscle-levator resection (e.g.: Fasanella-Servat type)
Top Tips for Children’s Summertime Eye Health
Summer is here and that means children spend more time outdoors – taking trips to the beach, participating in outside sporting leagues and playing in the yard. While all this is great fun for the kids, research shows that children's eyes - just like their skin - can be damaged from too much exposure to the sun.
"Excess sun exposure can increase your child's risks of ocular diseases, such as, cataract, age-related macular degeneration, and eyelid cancers and can be avoided with sunglasses and a wide-brimmed hat. Avoid excess sun between the hours of 10:00 a.m. to 2:00 p.m. and don't be fooled by the clouds," says Doctor Arezo Amirikia, ophthalmologist with the Michigan Society of Eye Physicians and Surgeons."
Ophthalmologists recommend that both adults and children follow these steps to keep their eyes healthy:
1. Make sure your kids wear 100 percent UV and UV-B blocking sunglasses.
Luckily, the ability to block UV light is not dependent on the price tag— you can purchase 100 percent UV protective sunglasses quite inexpensively. When shopping, don’t focus on the color or darkness of the lenses since it doesn’t indicate their ability to block harmful ultraviolet rays. Look for sunglasses with a polycarbonate lens; Children under six may need a pair with straps to keep them in place.
2. Stay out of the sun during the peak times.
As we all know, peak damage time for skin from exposure to the sun is the middle of the day. The same is true for eyes. Keep children out of the sun when UV rays are the strongest - between 10 a.m. and 2 p.m. And if that’s not possible, wearing 100 percent UV and UV-B sunglasses becomes even more critical during those times.
3. Don’t rub when sand gets in your eyes.
If sand gets in your child's eyes, no rubbing! Rubbing even a little can irritate the thin corneal tissue that covers your eyes, making symptoms worse. To remove the sand from the eyes, encourage the child to blink — even crying will help, as the tears will remove the irritants (though it may be hard on mom and dad!) If the eye is still irritated after the sand seems to have been removed, seek medical attention from an eye MD/ophthalmologist.
4. Wear protective eyewear when playing sports.
Tens of thousands of sports and recreation related eye injuries occur each year. The good news is that 90 percent of serious eye injuries are preventable through the use of protective eyewear. While helmets are required for many organized sports like baseball, protective eyewear unfortunately is not. For all age groups, sports related eye injuries occur most frequently in baseball, basketball and racquet sports. Sports eye protection should meet the specific requirements of that sport; these requirements are usually established and certified by the sport's governing body and/or the American Society for Testing and Materials (ASTM).
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About the Michigan Society of Eye Physicians and Surgeons
The Michigan Society of Eye Physicians and Surgeons (MiSEPS) is a member-based organization of ophthalmologists, doctors of medicine or osteopathy who specialize in diseases and surgery of the eye. MiSEPS maintains 1-800-MYVISION, a hotline for members of the public who are looking for an ophthalmologist or for general eye health information. This information is also available at the MiSEPS web site: www.miseps.org.
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