Socioeconomics
AACE Members with Socioeconomic issues may utilize this webpage to access information that may be helpful for the management of your endocrine practice. In addition to this webpage, AACE helps to develop policies and strategies, as well as, serves as a membership resource, related to the effective positioning of the clinical endocrinologists, within the managed care or integrated health care delivery system.
The content of the Socioeconomic webpage is provided under the direction of the AACE Socioeconomic Committee. The Committee is also responsible for reporting and effectively responding to member hassle factor reports or grievance issues. They further receive reports from members of abuses by managed care, insurance payor, or other third party health care delivery system parties, and develop appropriate responses to resolve and address the problem(s). The Socioeconomic Committee regularly collects, disseminates, and publishes information related to reimbursement and policies for endocrinology services, including the Socioeconomic section in The First Messenger.
For more information, on Socioeconomic related issues, please see below or feel free to contact Anita Sumpter, Director of Socioeconomic & Member Advocacy at asumpter@aace.com or Jennifer Carlin Young, Assistant Director of Socioeconomics & Member Advocacy at jyoung@aace.com.
New resources help prepare your practice to implement the 5010 standard transactions
Beginning Jan. 1, 2012, physicians will be required to use an updated version of the Health Insurance Portability and Accountability Act (HIPAA) electronic standard transactions, commonly known as "5010." To help you prepare for this compliance deadline, the AMA is developing a series of six fact sheets on what physician practices need to know in order to successfully implement the 5010 electronic standard transactions.
Visit the AMA's Web site at www.ama-assn.org/go/5010 and select "AMA educational resources" to access the first three fact sheets of this series:
- "HIPAA 101: How It Started and What's Next" provides background information on HIPAA and the electronic standard transactions
- "5010 Timeline: Getting the Work Done in Time for the Deadline" is an overview of the tasks and estimated time frames for implementing the 5010 electronic standard transactions
- "HIPAA Terminology" explains the terminology related to the HIPAA electronic standard transactions and code set standards
You can also download the new "5010 Project Plan Template" on this Web page. This resource helps guide and track your activities related to implementation of the 5010 electronic standard transactions. Additional 5010 resources will be added in the coming months.
Private Contracting/Opting out of Medicare
With the recent changes to Medicare reimbursement and reporting requirements, many physicians are asking whether they should continue as Medicare participating physicians or whether they should stop accepting Medicare altogether. While the answer to the above will depend on each physician’s practice, physicians should make an informed decision as to whether they enroll as a participating or non-participating physician or whether they should “opt out” altogether and contract privately with their Medicare-eligible patients. For more information, please visit: http://www.cms.hhs.gov/Transmittals/downloads/R92BP.pdf
Upcoming AACE Documentation Self-Audit Workshop: Tools Necessary to Prevent an Audit to be held in Las Vegas, NV
As recommended by the OIG, Provider Record Reviews are necessary to determine if providers are correctly coding and billing for services provided to patients.
The AACE Self-Audit Workshop will help educate you and your staff on how to review provider notes to determine if the provider is coding and documenting correctly, incorrectly, over-coding, under-coding, but the note has insufficient documentation to support the code, and any missed billables. Our speakers have audited over 100,000 records and increased practice revenues between 5%-31%. We have helped practices to understand the significant risks associated with over-coding. We have eliminated or lowered paybacks to insurance companies, as well as successfully overturned many government audits. It is recommended that the following protocols be put in place regardless of practice size.
- Review 10-20 records per provider
- Determine a provider's "individual" level of understanding on how to appropriately code and document
- E&M services for optimal legitimate revenue return, per established CMS and AMA guidelines
- Identify any coding patterns which pose a risk to audit
- Identify any coding patterns or individuals that trigger claim rejections/or pose a financial loss on the center
This workshop will help you prepare for the Medicare Recovery Audit Contractor (RAC) program in addition to the many third party payor medical record reviews, which have been expanded nationwide.
An audit can be time-consuming and costly if your office is not prepared. The best preparation is to put the tools in place to prevent an audit in the first place. Prepare yourself and your staff with the AACE Documentation Self-Audit Workshop: Tools to Prevent an Audit. The course will be held September 26, 2009, in Las Vegas, NV. Registration is now available. Space is limited, and slots will be filled on a first-come-first-served basis.
For more information and to register, please visit http://www.aace.com/advocacy/socio/audit.php. For hotel reservations at the Las Vegas Hilton, please call 1-800-635-7711 or 702-732-5111. If you have any questions, please contact the Socioeconomics & Member Advocacy Department at 904-353-7878.
Participant Testimonials
"Thoroughly enjoyed the speakers. Answered all our questions. Very approachable."
"Enjoyed presentation-speaker. Made class enjoyable and very informative."
"Authentic and real! Clearly transmitted. Would like to hear it again!"
Continuous Glucose Monitors (CGM)
The American Association of Clinical Endocrinologists (AACE) and the Juvenile Diabetes Research Foundation (JDRF) are working together to advocate for more patient access and better clinician reimbursement for continuous glucose monitors (CGM). Since health plans are most likely to make coverage changes after hearing directly from medical professionals in their network, AACE members can help this effort by going to http://takeaction.jdrf.org/PatientCGMCoverage to identify which health care networks they are in. With this information, JDRF can provide AACE members with timely information on ways to help make CGM technology available for everyone.
If you have any questions please contact AACE at 904-353-7878 ext 142 or JDRF via email at cgmcoverage@jdrf.org.
Clinical Trails for New Onset and Other T1DM Patients
Human clinical trials are the final phase of research done before a new drug or treatment is approved for the market. Many tests are conducted before the clinical trial stage to determine whether new treatments are both safe and effective for people. Participating in a clinical trial is one way you can play an important role in the fight to treat and cure type 1 diabetes. With this in mind, the AACE Task Force Re Joint Collaboration with JDRF recommends the following Web page for member review regarding clinical trials.