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April 2014 Issue

medical claim denied

CMS Reimbursements – What to Do When Insurers Shift Claims Processing Companies

When insurers shift from one claims processing company to another, reimbursement processes that were once working can fail and claims denials can start appearing in place of reimbursement checks. This was the case in California, Hawaii and Nevada in the autumn of 2013 when insurers moved from Palmetto to Noridian. The companies use different systems to process claims and may have different interpretations of Medicare policy.

One ambulatory surgery facility that reached out to SightLife for help after they found they were being reimbursed for services their surgeons provided but not for the costs of acquiring corneal tissue (HCPS V2785). We were able to help this facility receive full payment for services and they are once again able to provide care to patients with Medicare insurance.

SightLife encourages all our customers to ensure they are attaining full reimbursement on their cases. If you find you are having difficulties obtaining reimbursement for the corneal tissue processing fee, talk to us.  We have additional resources to assist you.

Please contact aaron.hayden@sightlife.org for assistance.

Our webinar explains the nuts and bolts of insurance in corneal transplantation. This is an excellent resource for private practice physicians and their staff, including business managers:

 

EBAA Shares Eye Banking Trends

Highlights from the EBAA 2013 Statistical Report:

  • From 2012 to 2013, the number of corneas procured increased 6.35% while the number of corneas transplanted went down slightly by 0.35%. This is explained by an increase in long term preserved corneas, corneas recovered but not released, and corneas released but not transplanted.
  • Types of transplants performed: DSAEK increased 1.6% to 48.7%, PK decreased 2.4% to 43.4%, DMEK increased 1.6% to 3.2%, and ALK stayed flat, comprising 2% of transplant procedures.
  • Use of donor registries for consent is increasing.
  • Use of First Person Consent (or Donor Designation) is increasing
  • Discards are decreasing as a result of more through donor medical/social history reports.

 

Changes to CMS Forms

Medicare claims forms are changing. Your facility most likely started using the new CMS-1500 format months ago, but you may want to confirm with your billing department that they’ve adapted. Version 02/12 is the most recent. Any claims submitted after April 1 on older forms will likely be denied payment.

This is one of many changes coming down the pipeline as Medicare providers are required to update their use of the International Classification of Diseases (ICD-10). Most insurance claims currently use a diagnosis code standard called ICD-9, but the new requirement will soon be ICD-10 which allows for tracking diagnoses with more precision.

In order to implement the new standard, the Center for Medicare and Medicaid Services (CMS) is requiring all providers to begin submitting claims on ICD-10 compatible forms. This affects all Medicare and Medicaid providers, and chances are your facility is prepared and has been overhauling its electronic claim submission systems accordingly.

On March 30—just before the claims form adoption deadline –CMS pushed delayed requiring ICD-10 coding by one year. It’s not yet clear if this delay means that Medicare insurance carriers will accept older versions of the CMS-1500 form, but it’s safer to assume they won’t.

You can read more about compliance with the changes at CMS on the Manage My Practice Blog: http://managemypractice.com/how-to-complete-the-new-1500-claim-form-0212-required-april-1-2014

 

ASCRS

SightLife and OSI are hosting informal education sessions during the American Society of Cataract and Refractive Surgeons (ASCRS) annual meeting in Boston. These sessions will be held on Sunday, April 27 in the Exhibit Hall at either SightLife’s booth (#130) or OSI’s booth (#1006).

Topics covered include surgical techniques for Descemet’s Membrane Endothelial Keratoplasty (DMEK) and the Endoserter corneal endothelial delivery instrument. Sessions are conducted by accomplished corneal surgeons expert in their disciplines.

To sign up or to find out more about these education sessions, visit http://sightlife.org/ascrs.

 

MySightLife

MySightLife, our innovative, new online tissue request system, allows surgeons to save time and confidently schedule corneal transplants with the following features:

Built-in accuracy checking.

MySightLife prompts the scheduler if a request is atypical of the surgeon’s standard criteria. The system confirms that designated precut parameters match the intended surgical procedure.  MySightLife even issues an alert if the user attempts to schedule a surgery for a time and place outside of when and where the surgeon typically works.

Automated confirmation.

The user will know immediately that a request has been received, scheduled, and confirmed.

Reliable record-keeping.

MySightLife allows a surgeon and their staff to review current and previous transplant records in one place.

Please contact our Surgical Services department to set up your personalized account by contacting tissue@sightlife.org or calling 1.877.682.8502.

 

SightLife Lab Opens in Irvine

On Thursday, March 27 SightLife welcomed local surgeons and members of the Orange County business community to its new lab at the Gavin Herbert Eye Institute (GHEI) in Irvine, CA. “Southern California deserves a world class eye bank solely focused on ensuring a safe, sufficient supply of high-quality corneas for transplant and providing those who wish to donate the opportunity to give the gift of sight,” said Monty Montoya, president and CEO of SightLife.

Corneal transplants transform the lives of approximately 2,300 residents of the Los Angeles metro area and Orange County each year, but a minority of the corneas used are donated locally. The majority is shipped into the area from eye banks across the country.

SightLife is currently recovering donated corneas at 13 Southern California hospitals and expects to initially recover approximately 250 donated corneas per year. It also expects to further reduce the shortage of local tissue as they partner with more facilities, with the goal of making the region self-sustaining.

SightLife’s expertise in facilitating corneal donation by involving hospital staff and supporting grieving families is expected to increase the number of Southern California donors. While other states, such Washington, have donor registration rates as high as 78 percent, only 34 percent of Californians are registered organ and tissue donors.

For more information about the lab and its services or to take a tour, please contact Christina Psalms, Director of Business Development, at 909-248-5847 or christina.psalms@sightlife.org.

laser
An iFS Advanced Femtosecond Laser donated by Abbott Medical Optics allows SightLife’s highly trained technicians to prepare tissue according to physician instructions using the latest technology, which saves time and money during surgery.

employee in lab
SightLife has a total of nine employees working out of the facility, which also will be used to store tissue for UCI research on stem cell therapies to preserve and restore sight for individuals with retinitis pigmentosa and macular degeneration.

GHEI lobby
SightLife’s new lab and office occupy approximately 1,700 square feet at the newly opened GHEI, which offers patients from both the local community and around the world access to clinically advanced eye care from internationally renowned ophthalmologists in a thoughtfully planned physical environment.

 
Rajni

0 Toni Cervantes

SightLife’s Global Program Celebrates Milestones at Annual Meeting in India

As SightLife’s global program enters its fifth year, we look back at a few notable accomplishments.

  • Number of global eye bank partners: 15. Breakdown – 12 in India, 1 in Nepal, 1 in Ethiopia, 1 in Paraguay
  • SightLife and its partners provided more than 17,000 corneas for transplant in 2013 (up from approximately 4,000 in 2010)
  • SightLife partner eye banks grew 7% annually pre-partnership as compared to 19% during partnership.
  • SightLife partner eye banks have grown their Hospital Cornea Retrieval Programs 41% annually.
  • SightLife has invested approximately $5M in the global program since 2010, focusing on scalability, sustainability and quality (include 3-circle diagram here)

3-part strategy

To learn more about our global program, click here.

 
Eye donor month

How SightLife is Building Awareness of Eye Donation

Eye Donor Month  is promoted annually as a way to increase awareness of eye donation in the U.S. While few people are ultimately able to become organ donors, most people can become an eye donor. As the need for corneal transplants rises, we are working to increase the supply of corneal tissue to benefit our partners around the world.

Our awareness efforts, along with those of other eye banks across the country, are working.  According to the EBAA 2013 Statistical Report, there was an almost 6% increase in the number of corneal grafts provided for transplant. These grafts helped to restore sight to over 48,000 people in the United States.

While we focus our awareness efforts on Eye Donor Month every March, SightLife works tirelessly all year long to promote eye donation to our partners. Corneal surgeons, recipients and donor families are all critical to helping spread the word about how transformative corneal transplantation is for those who are blind.  What many people may not know is how healing the act of donating a cornea can be for a donor family during one of the most tragic events in their lives.

SightLife’s Family Services Program is committed to our donor families, offering continued support before, during and after donation has taken place. We are humbled that during times of great grief, donor families are able to find the courage to help make the gift of sight a reality for someone struggling with blindness. This was the case for the Autry family of Montana, according to Dr. Jonathan Diamant of Kaiser Vacaville Medical Center’s Department of Ophthalmology. Dr. Diamant was present when his patient, Emelia Mijangos, met her donor family as part of SightLife’s involvement in the 2014 DonateLife Rose Parade float. “The experience was enlightening,” he says. “It opened up for me the human aspect of donation and the connection between donating and receiving tissue.” It also, he says, made him want to be an even stronger advocate for donation.

Emelia, Autrys and Dr Diamant

The Autry family, Emelia (third from left) and Dr. Diamant (third from right). Photo by Paul Joseph Brown Photography.

The Autrys have become strong advocates for donation, as has another rather unexpected family member – Emelia’s grandmother, who lives in a small village outside Mexico City and who was unaware of donation until her granddaughter found herself in need of a transplant to restore her sight. When she learned Emelia would be meeting her donor family for the first time, she called her weekly for updates and shared the exciting news with her friends, family and neighbors who were also unfamiliar with donation.

Read the story here.

Below are some videos from Eye Donor Month, first in English and then in Spanish.

The message of Eye Donation Month isn’t limited to just one month out of a year. SightLife continues to advocate for eye donation to help others see the world through new eyes.

 

SightLife and Ocular Systems Inc. Announce Partnership

SightLife and Ocular Systems Inc. have come together to achieve their shared goal of eliminating corneal blindness in the United States and around the globe. The combined organization is the largest provider of corneal tissue for transplant in the world.

“Together, SightLife and OSI will build a company that can make our goal of eliminating corneal blindness in the next 25 years a reality,” says Monty Montoya, President and CEO of SightLife. “Combining with OSI will accelerate SightLife’s global work to help eye banks in underserved parts of the world develop capacity and serve the needs of the corneal blind in their own communities.”

In 2013, OSI along with SightLife and its 15 partner eye banks provided more than 20,000 corneas for transplant, restoring sight each day to 55 people around the world. There are 10 million corneal blind people worldwide who could have their sight restored if given a corneal transplant.

OSI is the leading provider of processed corneas for endothelial keratoplasty procedures in the US and SightLife is America’s leading provider of corneal transplant tissue. In 2013, OSI placed over 2700 corneas for transplant in the United States.

“The combination of OSI and SightLife only expands our ability to serve the corneal blind,” says OSI President Jerry Barker. “With a presence on both coasts, we can more efficiently meet the needs of surgeons across the US and beyond.”  The new organization will work to improve corneal surgery for physicians and their patients by continuing to advance new technology and ophthalmic products with the potential for great impact. OSI offers the EndoSerter® and EndoSaver® corneal endothelium delivery devices used to place corneal endothelial allografts into the eye during specialized transplant procedures. SightLife helped develop the methodology to precisely cut corneal tissue using IntraLase® enabled keratoplasty (IEK) to treat a variety of corneal transplant indications.

SightLife and OSI customers will continue to receive the same high level of personalized service and adherence to high standards that they always have experienced. Information about this partnership was recently shared with all our surgeon customers. We also invite you to watch the following video:

 

Recommended Reading: Topography-Based Keratoconus Progression After Corneal Collagen Crosslinking

In this case study, physicians report the return of keratoconus progression in patients who exhibited initial stabilization after corneal collagen crosslinking. Read more »

 

Recommended Reading: Inhibition of Pathological Corneal Neovascularization by a Small Peptide Derived From Human Apolipop

Researchers demonstrated corneal neovascularization (CNV) inhibition by a novel human-derived peptide in a variety of in vitro tests that stress endothelial cell tissue of macaques. This indicates promising, non-chemical treatments for CNV in the future. Read more »

 

Recommended Reading: Know the Different Types of Health Insurance Exchanges

To get up to speed on the differences between public health insurance exchanges (like that mandated by the Affordable Care Act) and private exchanges (such as where many of your patients already find coverage), we turned to a special report from CNN. Read more »