Subject Reason for Review UPMC Health Plan …

1 PHYSICIAN PARTNERU pdate A PUBLICATION OF upmc Health PLANMAY 2009 Provider Services: 4 MAY 2009 One Chatham Center 112 Washington Place Pittsburgh, PA 15219 ROUTE TO:q Physiciansq Clinical Staffq Office Managerq Office Staffq Billing Staffq _____q _____q _____IN THIS UPDATEC ongratulations to Genesis MedicalAssociates/Bentz & Grob Family Practice ..2 RVU Updates ..3 Technology AssessmentCommittee ..4 Coding Updates ..4As a participating provider, you have the ability to submit changes to your physician profile or your practice profile online instead of submitting them on paper. Simply go to our website, , click on For Providers, and then select Provider Information Change Form.

2 Instructions for completing the form are available on the following changes may be made through the online request form: Adding a credentialed upmc physician to your practice. Removing a physician from your practice. Adding new office locations and removing closed locations. Updating office hours and phone and fax numbers. Changing your billing address or tax identification number. Updating hospital privileges. Requesting the addition or removal of upmc Health plan product lines from your existing you are unable to complete the online submission form, individual change request forms are available on the website in PDFs.

3 These forms may be printed, completed, and faxed to the Network Management Department at 412-454-5664 for processing. The Technology Assessment Committee meets regularly to Review medical technology. The following chart details recent committee decisions. Please refer to the designated policy for complete indications and Reason for Review upmc Health plan SummaryTechnology Assessment CommitteeSeptoplasty-RhinoplastyPAP for Sleep ApneaPolicy ReviewPolicy Review June 1, 2009 No longer requires prior authorization. Must be medically necessary. Laser-assisted septoplasty is considered investigative and not medically necessary.

4 July 1, 2009 Codes E0471 and E0472 will be a capped rental at ten (10) months. Codes E0471 and E0472 may not be billed with a diagnosis of Obstructive Sleep Provider Information Change FormCopyright 2009 upmc Health plan , Inc. All rights reserved. 2008 Jupiterimages CorporationMAY PHYS PRTNR UPDATE C20090512-08 (RT)P 5/29/09 MPDIn the coming weeks, upmc Health plan will be updating its code-editing software to reflect current industry-standard coding guidelines. These coding standards were created to prevent confusion caused by common billing errors and will not affect reimbursement as long as your practice follows Correct Coding Initiative (CCI) and Certified Procedural Technology (CPT) coding conventions.

5 Please visit for a comprehensive list of NCCI code edits and the CPT manual for coding rules and guidelines. Examples of inappropriate medical coding include, but are not limited to: Unbundling Inappropriate modifier usage UpcodingThank you for your attention to this matter and your continued cooperation and participation with upmc Health plan . If you have any questions, please contact Provider Services at 1-866-918-1595 or your Network Management representative. CODING UPDATESS tockbyte/Getty ImagesMedioimages/Photodisc/Getty ImagesPHYSICIAN 2 MAY 3 MAY 2009 Effective July 1, 2009, upmc Health plan will update pricing rules for Relative Value Units (RVU) Multiple Surgery Reduction.

6 These physician multiple-procedure pricing rules will change to mirror the Centers for Medicare & Medicaid Services physician fee schedules. The following codes are reimbursed according to upmc Health plan pricing rules and are exempt from potential reduction until July. Effective July 1, 2009, reimbursement for these codes may be reduced, but only in a multiple surgery physicians and staff of Genesis Medical Associates/Bentz & Grob Family Practice were recognized recently for their achievements for the 4th Quarter 2008 Quality Incentive Rewards Program. They were awarded a celebratory staff luncheon, flowers, and a certificate recognizing their Medical Associates/Bentz & Grob Family Practice s dedicated and compassionate group of physicians and staff utilize a team-based care approach to continually provide their patients/our members, with comprehensive, accessible, and coordinated Health care.

7 Pauline Taylor-Raiff, Practice Director, utilizes the Partners Program tools to actively outreach and engage their upmc Health plan members in becoming active participants in their own care. upmc Health plan values the exceptional standard of care the physician leaders and their staff set and achieve! upmc Health plan s 4th Quarter CY 2008 Partners Quality Incentive Rewards Program is shared with University General Medicine Associates- upmc (Dr Ellis). Please look for their story in next month s Physician Partner UpdatesCongratulations to Genesis Medical Associates/ Bentz & Grob Family PracticeAffected Codes78802 78803 78806 78807 92975 92992 93541 93542 93543 9361993620 93640 93641 93642 93650 9365193652 93660 96405 96406 99170 G0104 G0168 G0268 G0392 G0393 Please visit for a comprehensive code you have any questions or concerns, please contact Provider Services at 1-866-918-1595 or your Network Management representative.

8 George Doyle & Ciaran Griffin/Stockbyte/Getty ImagesEffectiveJuly 1, 2009 PHYSICIAN PARTNERPHYSICIAN PARTNERU pdateUpdat