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MagnoliaminutesJANUARY 2015A P U B L I C AT I O N O F M G M A O F M I S S I S S I P P IA Word From OurHappy New Year everyone!I hope that 2015 has been kicked off to a greatstart for you all. We at MGMA of Mississippi arelooking forward to helping you get through theyear as many new regulations and requirementsare put on us.PresidentJudy Stevens, CPCChief Operations OfficerPerforMax, Inc.3900 Lakeland DriveSuite 300Jackson, MS 39232Phone: (601) 420-0141jstevens@performax.bizThis year we are offering FREE monthlywebinars to our MGMA of MS members! OurFebruary webinar, Security and the SmartphoneRevolution, will be held on February 10, 12-1pm.You may click here to register now. Be on thelookout for event notifications that will give youthe topic and date of the webinar each month.Our much anticipated Insurance Forum willbe held on Friday, February 13 at the BelhavenCenter in Jackson. This event allows our membersand their staff to meet the representativeswho process your insurance and discuss yourissues with them face to face! We will start themorning off with a word from Mike Chaney,Mississippi Insurance Commissioner and BobWilliams, Director of Life and Health Actuarial.The objective of the forum is to create a dialogand establish relationships between offices andpayers and to facilitate timely reimbursement.We encourage at least one person from youroffice to attend, particularly managers andbilling personnel responsible for submitting andprocessing insurance claims.MGMA of MS will be offering an ICD-10 BootCamp presented by the AAPC May 21-22 atVirginia College in Jackson. This valuabletwo-day training will prepare you for theICD-10 implementation, October 1, 2015.Seating is extremely limited so we urge you toPresidenttake advantage of our Early Bird registrationwhich expires March 1. In the event of animplementation delay, we will postpone theboot camp and will refund our registrants.Registration details can be found here.We are so excited to be back at the PerdidoBeach Resort in Orange Beach, AL for ourSummer Conference this year! Our PresidentElect, Justin Rhodes, is working hard onpreparing an amazing agenda for us. Some hottopics on the agenda include New Technologies,Lean Healthcare: Improving Flow in ClinicOperations, Best Practices for ImprovingCollections and Patient Satisfaction. Stay tunedfor detailed agenda and registration on ourwebsite February 9. Conference dates are July8-10, hotel reservations may be made by visitingwww.perdidobeachresort.com and enteringgroup code: 10606.Also, our Outreach Chairwomen are busyplanning and scheduling local outreach meetingsthroughout the year, and we will return to theClyde Muse Center for our Annual Fall MeetingNovember 13.2015 will be a jam-packed year, and I am lookingforward to seeing you at all of our upcomingevents. I am honored to serve as your MGMAof Mississippi President and as always, if there isanything I can do to help you or your practicesucceed, please reach out to me. Thank you,here’s to a great year!Judy StevensPresident, MGMA of MSjstevens@performax.biz601-420-0141

2015 CPT changes includean important Modifier ChangeBy Nancy M. Enos, FACMPE, CPC-I, CPMA, CEMCand Mike Enos, CPC, CPMA, CEMC2015 has brought many coding changes that must beimplemented to remain compliant and optimize yourbilling. Don’t overlook modifier changes. ModifiersXE, XS, SP and XU are effective January 1, 2015. Thesemodifiers were developed to provide greater reportingspecificity in situations where modifier -59 was previouslyreported, and should be utilized in lieu of modifier 59whenever possible. Although NCCI will eventually requirethe use of these modifiers rather than modifier 59 withcertain edits, providers are encouraged to begin using thenew -X{EPSU} modifiers for claims with dates of serviceafter January 1st, 2015. Expect higher denials and requestsfor supporting documentation when claims are submittedwith Modifier 59.Coders tend to err on the side of caution when reviewingthe NCCI edits or they don't understand when modifiersshould be appended to the CPT code to indicate a separateand distinct procedure that would otherwise be consideredbundledg. In this instance, the coder's knowledge of theprocedure(s) and understanding the rationale behind theNCCI edits will assist in determining whether a modifieris applicable.Modifier 59 is known as the “unbundling modifier” and isone of the most widely reported, and incorrectly reportedmodifiers (distinct procedural service). The -59 modifiershould only be applied under certain circumstances. Theoveruse and misuse of the -59 modifier has been a red flag toMedicare and the Office of Inspector General (OIG.) This iswhat prompted Medicare to establish the new X modifiers.Some providers incorrectly consider it to be the “modifierto use to bypass (NCCI).” This modifier is associated withconsiderable abuse and high levels of manual audit activity;leading to reviews, appeals and even civil fraud and abusecases. The -59 modifier often overrides the edit in the exactcircumstance for which CMS created it in the first place.CMS believes that more precise coding options coupledwith increased education and selective editing is needed toreduce the errors associated with this overpaymentPer the CMS Transmittal 1422, " each modifier is based2 JANUARY 2015on a specific aspect of the unbundled procedure — whenthe procedures took place, the anatomical locations wherethey were performed, who performed the services or whatmade the second service unusual:1. XE (Separate encounter, a service that is distinct becauseit occurred during a separate encounter).2. XS (Separate structure, a service that is distinct becauseit was performed on a separate organ/structure).3. XP (Separate practitioner, a service that is distinctbecause it was performed by a different practitioner).4. XU (Unusual non-overlapping service, the use of aservice that is distinct because it does not overlap usualcomponents of the main service)."CMS transmittal 1422 explains that there may be instanceswhen modifier 59 is still reported, but it should not bereported when a more specific modifier is available. The-X{EPSU} modifiers are more selective versions of the -59modifier so it would be incorrect to include both modifierson the same line. Also note that MACs are not prohibitedfrom requiring the use of selective modifiers in lieu of thegeneral -59 modifier, when necessitated by local programintegrity and compliance needs. So just because CMS is notrequiring use of the -X{EPSU} modifiers immediately, thatdoes not preclude the MACs from making it a requirementon their ownThere are risks associated with overuse of Modifier 59.The -59 modifier is the most widely used HCPCS modifier. Modifier -59 can be broadly applied. Some providersincorrectly consider it to be the “modifier to use to bypass(NCCI).” This modifier is associated with considerableabuse and high levels of manual audit activity; leading toreviews, appeals and even civil fraud and abuse cases.The -59 modifier often overrides the edit in the exactcircumstance for which CMS created it in the first place.CMS believes that more precise coding options coupledwith increased education and selective editing is needed toreduce the errors associated with this overpayment.As always, please refer to current CMS transmittals,LCD/NCD directives as well as carrier specific reportingguidelines prior to implementation of any modifierMagnolia Minutes

reporting changes. For more in-depth informationregarding these four new modifiers, please refer to CMSTransmittal 1422 ransmittals/Downloads/R1422OTN.pdfSteps to take: Review your claims history for use of modifier 59, especially in cases where there have been denials or requests for review. Download the Modifier 59 Article written by CMSFor over 30 years, Mississippi physicianshave looked to Medical Assurance Companyof Mississippi for their professional liabilityneeds. Today, MACM is an integral part of thehealth care community providing a legacy ofservice to our insured physicians.o There are 10 examples of correct and incorrect useof Modifier 59 in this 10 page article that discussesthe reason for the change, the specific appropriate and inappropriate uses of Modifier 59 and thedefinition of the X modifiers.oA dedicated staff and physician involvementat every level guarantees that the interestof our policyholders remain the top priority.Share the clinical examples that affect your pracThis, combined with many years of loyaltytice as a teaching tool, and begin to report the newand support from our insureds, is what allowsus to be the1 carrierof choicein Mississippi.5/5/118:38AM Page 1XE, XS, XP and XU modifiers when appropriate. 11MM4611 MGMAMS ad:Layout1.800.325.4172www.macm.netHENRY SCHEIN AND THE MGMA of MS — AN UNBEATABLE TEAM.Henry Schein is your single sourcemedical supply partnerfor all your practice needsWhether you’re ordering diagnostic testing supplies, labequipment, vaccines, pharmaceuticals, lasers, ultrasound,implementing a computerized practice-management system,or completely renovating your office, rely on us to help youtake the best care of your patients – and your practice.Take advantage of the following array of cost-effectiveproducts and services: Widest selection of office and lab equipmentCustom Medical Buying Program for SuppliesElectronic Health Records (EHR) SolutionsDemographic analysis for your practiceProRepair equipment repair servicePRIVILEGES Loyalty Rewards ProgramHenry Schein Rx Samples ServiceAlso ask us about: Henry Schein credit card – up to 2% cash backDiscount on credit card processingFinancial Services and LeasingPerpetual Inventory Management SystemLaboratory PlanningFor more information contact Johnny LocklarPhone: 251-753-2222E-mail: johnny.locklar@henryschein.comMagnolia MinutesJANUARY 2015 3