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How to 'surf' for Medicare billing and coding information
Here’s a handy guide to Internet and print references.
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Thinking about surfing the Internet for Medicare billing and coding information? Looking for some “bricks and mortar”-type resources for current information in print? If you are, there are a growing number of sites on the World Wide Web for you and your staff to search and explore, and federal agencies and professional organizations are willing to mail you printed information — all at no cost to you.
If your method is Web surfing, please heed this word of advice: make sure you and your staff practice “safe surfing.” For starters, consider the Web site’s owner when retrieving information. And remember, sites maintained by the Health Care Financing Administration (HCFA) and other federal agencies tend to be far more reliable than sites sponsored by private companies or interest groups.
More ’Net wisdom
By its original intent of its creators, the Internet is a freewheeling information conduit; it is not regulated by any federal or worldwide agency. Literally, anyone can post whatever information they choose on their site.
That’s why you and your staff should be wary of sites that promise higher Medicare reimbursements and offer suggestions on new ways to use existing ICD and CPT codes and modifiers. These may be providing fraudulent information.
Here is a listing of major Web sites containing Medicare-related information, along with some of my own observations. While many of these locations are designed for Medicare beneficiaries, it is always helpful to know what agencies and carriers are telling your patients.
Sites for Medicare policy
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www.hcfa.gov: Health Care Financing Administration.
This site is designed for Medicare beneficiaries and providers. This is the site for Medicare policy, press releases, legislation and Medicare fee schedules and much more. Various paths provide valuable information at every mouse click. Site worth is checking often; I recommend bookmarking this site.
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www.medicare.gov: The Official U.S. Government site for Medicare information.
This site is designed for Medicare beneficiaries. It contains good explanations of the Medicare program and its benefits — in layman’s terms. It also contains interesting information on fraud and abuse, including new initiatives and campaigns (and the new initiative that deputizes beneficiaries to identify and report fraud and abuse).
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www.ama-assn.org/advocacy.htm: The American Medical Association (AMA).
This site is designed for physicians of all specialties. It contains great information on the Evaluation and Management (E/M) Documentation Guidelines, managed care plans, legislative issues and health policy. The latest E/M Documentation Guidelines (June 1999), as well as the previous versions (1995 and 1997), currently are available. Coding information is available to AMA members only (you’ll need your membership number to access). It’s worth creating a bookmark for this site.
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www.access.gpo.gov: The U.S. Government Printing Office.
This site provides access to the Federal Register as well as a number of other Federal publications, including the Code of Federal Regulation (CFR) and General Accounting Office (GAO). The Federal Register is the vehicle by which HCFA publishes all changes to the Physicians Medicare Fee Schedule, including the annual fee update and certain policy changes.
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www.eyenet.org: The American Academy of Ophthalmology (AAO).
This site is designed for ophthalmologists and the public. It is a comprehensive site, with ophthalmic information ranging from Medicare coding to clinical articles. Most areas of the site pertaining to Medicare coding issues, such as the Correct Coding Initiative and a coding library, only are available to AAO members (user password required). It contains guidelines on setting up compliance programs and coding requirements for ophthalmology (CPT codes 92002 to 92014) and E/M exam codes (CPT codes 99201 to 99215). It’s also worth creating a bookmark for this site.
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www.asoa.org: American Society of Cataract and Refractive Surgery and American Society of Ophthalmic Administrators.
This site is designed for ophthalmologists and ophthalmic administrators. It offers valuable pieces of coding information regarding policy changes. It has great press releases on Medicare coverage policy and reimbursement, Stark regulations, E/M codes and ambulatory surgery centers. It’s worth creating a bookmark for this site.
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www.aarp.org/indexes/health.html: American Association of Retired Persons (AARP).
This site is designed for AARP members. It offers information on Medicare coverage, benefits and fraud and abuse, and it is written in laymen’s terms. There is extensive information on HCFA’s new fraud and abuse initiative, including tips for seniors on how to identify and report suspected fraud and abuse in physician practices.
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www.dhhs.gov: U.S. Department of Health and Human Services.
This site is designed for the public. Health and Human Services is the parent organization for HCFA, the Agency for Health Care Policy and Research (AHCPR), the Food and Drug Administration (FDA) and the Office of Inspector General (OIG). It contains great links to these and other organizations.
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www.hhs.gov/progorg/oig: The OIG.
This site is designed for physicians and the public. This is Medicare’s enforcement branch. The OIG investigates significant charges of fraud and abuse. The site contains fraud alerts, lists of providers who currently are excluded from the Medicare program, information on current investigations and advisory opinions. It’s worth creating a bookmark for this site.
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Thomas.loc.gov: The U.S. Library of Congress.
This site is designed for the public. It contains current congressional legislation. The site’s search feature allows easy access to all bills pertaining to Medicare program.
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www.ssa.gov/mediinfo.htm: The Social Security Administration.
This site is designed for Social Security recipients. It describes Medicare entitlements in layman’s terms. The search feature allows visitors to access various topics on a state-by-state basis. It also has great links to other Medicare sites.
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www.senate.gov/~finance: U.S. Senate Committee on Finance.
The site is designed for the public. The committee creates and approves all changes to the Medicare program. The site contains all recently presented Medicare legislation.
Obtaining printed information
For those physicians with computer phobias, or those who just like to see things on paper, there are a number of great sources to obtain coding information. The best coding advice also is free.
Medicare carrier bulletins and newsletters also contain detailed coverage on procedures, examinations, diagnostic tests, drugs and modifier usage. Missing a newsletter or bulletin? Not to worry. The majority of carriers now have their recent newsletters archived on their Web sites.
Additional coding resources include current ICD-9 and CPT-4 books. Remember, diagnosis and procedure codes do change. In addition to new and deleted codes, existing codes often have description changes or, in the case of ICD codes, additional digits are assigned. You should purchase new ICD and CPT books each year (or every other year, at the very least). These books are available from a number of sources, including the AMA, Medicode and larger national bookstore chains.
Finally, there are newsletters devoted entirely to ophthalmology coding. For example, Eyecare Consultants’ own Medicare Advisory Capsule is a monthly newsletter devoted to national and state billing and ophthalmic coding issues. It is available on a subscription basis.
There are no excuses
Given the array of information available on the Internet and other sources, it’s hard not to stay in the loop on Medicare billing and coding matters. Stay informed, and policy compliance and clean claims acceptance will be second nature to your practice.