Coding & Reimbursement

The New Year Brings New Changes

By Suzanne L. Corcoran, COE

Medicare and reimbursement change fast and often. Let's address some of the changes you can expect in 2012.

Q. What is going on with provider enrollment?

A. The PPACA law requires all providers and suppliers to update their enrollment information if they enrolled as a Medicare provider prior to March 25, 2011. Some time before March 2015, you will receive a notice from your local Medicare contractor (for physicians) or the National Supplier Clearinghouse (for DMEPOS suppliers, including optical dispensaries). You must respond within 60 days; CMS recommends that your response be submitted via the PECOS system online. If you aren't properly set up with PECOS, you should do that soon.

There is no charge for physicians to re-enroll. For suppliers, there is a fee of $523 in 2012. Remember that you must promptly report any changes in ownership, managing employee, address, telephone, or other salient enrollment information within 30 days of the change.

Q. Are there CPT code changes in 2012?

A. Yes, there are several affecting ophthalmology; both deletions and additions. Deleted codes are:

• 92120 – Tonography with interpretation and report
• 92130 – Tonography with water provocation
• 92070 – Fitting of contact lens for treatment of disease, including supply of lens

Code 92070 has been replaced by two new codes, which are mutually exclusive:

• 92071 – Fitting of contact lens for treatment of ocular surface disease
• 92072 – Fitting of contact lens for management of keratoconus, initial fitting

CPT instructs that the contact lens itself be reported separately as 99070 or an appropriate supply code (ie, HC PCS). As yet, Medicare has not issued instructions about these changes; look for them in the new year.

Q. Will we see changes to PQRS?

A. There are small changes affecting ophthalmology in the Physician Quality Reporting System. The bonus decreases to 0.5% of total Medicare allowed dollars, down from 1% in 2011. The nine ophthalmic measures in 2011 will continue in 2012.

It appears that CMS wants to encourage reporting via registry rather than by adding codes to your claims. There are two new ophthalmic measures, but they are only available if you report via a registry. They are: (1) improvement in patient's visual function within 90 days following cataract surgery, and; (2) patient satisfaction within 90 days following cataract surgery.

There is a new Cataract Measure Group in 2012, also only for registry reporting. The group includes: (1) 20/40 or better visual acuity within 90 days following cataract surgery (#191); (2) complications within 30 days following cataract surgery requiring additional surgical procedures (#192), plus the two new measures noted above for a total of four measures in the group.

There will no longer be a six-month reporting option for claims-based reporting, but there will be six-month reporting available via registry (July – December).

Q. What should we look at in 2012 for E-Prescribing?

A. There are minimal changes to E-Prescribing in 2012. The bonus amount remains at 1%. The threshold is again 25 successful reportings during the 2012 calendar year.

There is a penalty in 2012 for not meeting the participation requirements in 2011 or qualifying for an exemption. The penalty in 2012 is 1% on Medicare Part B allowed charges. To avoid a 2013 and 2014 penalty, you must successfully report at least 10 times in the first six months of 2012, just as you were required to do in 2011.

Remember that you are not eligible for both the EHR bonus and E-Prescribing bonus. If you have moved to electronic health records and plan to attest to “meaningful use” to earn that bonus in 2012, you still must report, via claims, at least 10 times in the first half of 2012 to avoid penalties in 2013 and 2014.

Q. What should we know for our patients in 2012?

A. The Medicare Part B premium increases to $99.90 for most beneficiaries. The good news for your patients is that the annual deductible will be decreased to $140.00. OM

Suzanne L. Corcoran is vice president of Corcoran Consulting Group. She can be reached at (800) 399-6565 or www.corcoranccg.com.