Coding & Reimbursement:  Services

Since its inception in April 2001, the Coding and Reimbursement Montana Medical Association (CARMMA) division has responded to more than 1,000 inquiries related to coding issues, claim denials, medical policy development and coverage concerns, claims processing problems, compliance questions, chart auditing recommendations, and a variety of informational searches.

Janet Whitmoyer, R.N., is the Coding and Reimbursement Specialist for MMA members and their staffs. Janet’s primary purpose is to assist member physicians with reimbursement and coding issues as well as to help them implement processes to ensure compliance with third party payer requirements. Several services are currently available to achieve this purpose:

• One-On-One Assistance: We are happy to discuss reimbursement or coding problems with you, research them and recommend a course of action to resolve the problems.
  Telephone toll free (instate) 1-877-443-4000
  Fax 406-443-4042
  Email janet@mmaoffice.org

• Advocacy: We collaborate with private, state and federal insurers in Montana through proactive face-to-face discussions on a regular basis to troubleshoot problems and promote change for issues that are widespread among physicians in Montana.

• Coding and Reimbursement Seminars: Physician and staff Seminars are conducted to inform you of changes in payer rules and regulations as well as to provide coding competency training designed to improve the efficiency and efficacy of your office management procedures.
  
        2009 Coding Webinars Info (PDF)
  
        2010 Coding Webinars Info (PDF)
  
        Comprehensive Coding Education Program (PDF)
  

• Audit Finding Analysis: If you are being audited by a third party payer, we are available to review your case, provide suggestions related to working through the audit process and serve as your advocate in resolving the problem with the payer.

• Medicare Carrier Advisory Committee (CAC) Representation: In the absence of a national policy from CMS, each Medicare contractor is responsible for developing Local Coverage Decisions (LCDs) that address coverage and billing specifications for particular provider services. Physicians are encouraged to participate in the development of these policies, including input regarding covered diagnoses and other specifications of coverage. The Montana Medicare CAC meets three times each year to discuss policy issues. The MMA CARMMA staff review each draft LCD, research coverage criteria for the same service/procedure on a national basis, compile the information and disseminate it to MMA physicians who are affected by the policy asking for their input, compile all physician input into a response to the Montana Medicare carrier and attend CAC meetings to advocate.

• Publication of special Newsletter entitled the “CARMMA Report” to all members regarding coding and reimbursement issues.
  

• Special Releases are developed to address comprehensive issues such as changes in the law, e.g., HIPAA, which have a direct impact on your practice.

• Information dissemination via The Coding and Reimbursement Page on the MMA Website: Includes the CARMMA reports, specific third party payer information and coding and reimbursement issues, tips and resources.

• Coding and Reimbursement Tools:

  The Base: This database provides CPT code relative value units (RVUs) as well as Medicare, Medicaid and BCBSMT fee allowances and payment indicators. It offers a wide variety of uses from verifying reimbursement rates to identifying RVUs. Some clinic administrators have made a few simple modifications to the Base and use it for additional purposes such as costing out procedures and reviewing charges.

  The National Correct Coding Initiative (NCCI) Manual: The MMA has become a licensed reseller of Medicare’s NCCI manual. We offer this up-to-date guide on current Medicare bundling edits to our members at a rate lower than is available from the National Technical Information Service.
  
  2009 Order Form - Coding and Reimbursement Tools (PDF)