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Celebrating Over 75 Years Of Service

The American Academy of Otolaryngic Allergy (AAOA) represents over 2,700 Board-certified otolaryngologists and health care providers. Otolaryngology, frequently referred to as Ear, Nose, and Throat (ENT), uniquely combines medical and surgical expertise to care for patients with a variety of conditions affecting the ears, nose, and throat, as well as commonly related conditions. AAOA members devote part of their practice to the diagnosis and treatment of allergic disease. The AAOA actively supports its membership through education, research, and advocacy in the care of allergic patients.

"Dedicated to enhancing knowledge and skill in the care of the allergic patient."

ADVOCACY UPDATES

Breaking News on USP Chapter 797

An updated draft of USP Chapter 797 was released today. Updated Chapter 797 Posted for Public Comment: Separate Requirements…

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Congress Makes Changes to MACRA

The second year of the Quality Payment Program (QPP) authorized by the Medicare Access and…

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CMS Extends the MIPS 2017 Data Submission Deadline from March 31 to April 3 at 8 PM EDT

If you’re an eligible clinician participating in the Quality Payment Program, you now have until Tuesday, April 3,…

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Changes in MACRA

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Before the close of 2017, all physicians must take action to avoid the 4 percent cut that will be assessed in 2019 for not participating in the new Quality Payment Program (QPP) authorized by the Medicare Access and CHIP Reauthorization Act (MACRA).  Read More

CMS Announces Changes in MACRA Implementation Timeline. The Centers for Medicare and Medicaid Services (CMS) announced major changes to the implementation of the Medicare Access and CHIP Re-authorization (MACRA).
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Upcoming Dates

06/01/2018: Research Grant Cycle

12/01/2018: Research Grant Cycle
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06/15/18: Membership Application Deadline to be eligible for AAOA Member rate for the 2018 Basic Course

07/31/18: Membership Application Deadline to be voted in at the 2018 Annual Meeting and to be eligible for AAOA Member Rate (FREE) for the 2018 Annual Meeting
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04/01/2019: 2019 Fellow Exam Application Deadline
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EDUCATION

Why attend the 2018 AAOA Annual Meeting in Philadelphia from September 14-16? Learn some of the reasons to attend from the AAOA Leadership and staff. Register

Different Advanced Course

What is it in today’s otolaryngology practice that is resonating as a hot topic? Where are the novel treatment strategies? What is today’s typical otolaryngology practice or more specifically the typical AAOA member’s practice?  These are the questions we try to address when building out our Advanced Course in Allergy & Immunology. Read More

Codes/Guidelines

CMS Announces Changes in MACRA Implementation Timeline. The Centers for Medicare and Medicaid Services (CMS) announced major changes to the implementation of the Medicare Access and CHIP Re-authorization (MACRA).
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IFAR

Editor in Chief Search
The ARS-AAOA IFAR LLC is pleased to announce its search for Editor in Chief, term beginning April 2020. Read More

IFAR Impact Factor: 2.135

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Changes in Managing Practices

Mission

Working together with AAOA staff, volunteer leadership and members will enable us to have a positive impact on our members’ practices.

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Live and Online CME

2018 AAOA Annual Meeting
September 14-16 | Philadelphia, PA
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2018 Advanced Course in Allergy & Immunology
December 6-8 | Atlanta, GA
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AAOA Clinical Insights
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PATIENT CORNER

Avoidance

The first most basic treatment step, once an allergen has been identified, is to eliminate or avoid contact with it, if possible. Unfortunately, avoiding some allergens (such as dust, molds, and animals) is often difficult and thus allergen avoidance alone may not be effective.

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News and Updates

Social and Networking Events at the 2018 AAOA Annual Meeting

This year’s Annual Meeting assures to be not only educational, interactive, and practice-centered, but also…

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2018 AAOA Annual Meeting – Important Dates

August 14 - Hotel Discounted Rate Deadline Room Rate Room rate is $219 (plus 15.5% tax) single/double…

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Burnout: A Real Problem, Not Just a Trendy Talk Show Topic

When you really look at hot topics in medicine, physician burnout seems to really skyrocket…

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Practice Resources

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Documentation Requirements for Medicare 2015

Several Medicare contractors have initiated prepayment audits of billings for immunotherapy billings and documentation has been requested to support the medial necessity of the claims. Under Medicare law, only items or services determined to be medically necessary are considered covered.  Since there is not sufficient information on the claims form itself to support medical necessity, Medicare contractors have the authority to periodically request documentation from a physician to support the claims submitted.

These reviews might be conducted because of specific concern with the utilization of services for a specific provider or might be conducted because it is a high volume code in which case all physicians billing that code might be targeted.

Based on feedback we have received from some AAOA members who have experienced these reviews, we wanted to alert you to two specific problem areas that have been found. The first relates the documentation in the medical record supporting medical necessity of the services provided and the second relates to deficiencies in the legibility of clinical notes and other supporting documentation.

Medical Necessity:  Medical necessity requires that services be reasonable, necessary and/or appropriate based on evidence-based clinical standards of care. According to CMS “to meet medical necessity the service/procedure should be medically necessary and must be performed in the correct setting….To prove medical necessity, accurate and detailed information must be provided to: 1) support the diagnosis; 2) justify the treatment/procedures; 3) document the course of care; 4) identify treatment/diagnostic test results; and 5) continuity of care among healthcare providers.”

The documentation in your medical record should be sufficient to address these points particularly for patients who are on long term immunotherapy.  Some allergists have experienced denials because their progress notes did not support the medical necessity for the treatment provided.  Please keep in mind that the individuals conducted the reviews for the contractor may not be individuals with deep knowledge of allergy immunotherapy.

Thus, documentation which might seem adequate to a busy practicing allergist is not supportive of medical necessity in the eyes of a reviewer.  We urge you to review your medical documentation and assure yourself that, if audited, the medical record and progress notes supports the medical necessity for the treatments provided.

Legibility: This might seem basic but another area you must consider if you wish to prevent claim denials in the case of an audit is legibility. Obviously this can be a particular problem with physicians who are still using paper records as opposed to EHR. Notes in the medical record which are too cryptic to be understood or are virtually illegible will not be considered adequate documentation. In addition, CMS requires that “medical records should be complete and legible and medical records should include legible identity of the provider and date of service.”

CMS has indicated that while a missing signature from documentation can be validated by looking to a signature log or attestation statement to determine the identity of the author, if a signature is missing from an order, a reviewer may treat the order as though it was never written. Personnel who compound allergen extracts as CSPs, must be aware of greater potential risk of microbial and foreign material contamination when allergen extracts are compounded in compliance with the foregoing criteria instead of the more rigorous standards in the USP chapter for CSP microbial contamination risk levels. Although contaminated allergen extracts as CSPs can pose health risks to patients when they are injected intradermally or subcutaneously, these risks are substantially greater if the extract is inadvertently injected intravenously.”

References

1. Lay PC, Bass R, Lin SY. Allergen vial mixing and immunotherapy:  risks of infection and vial contamination.  Otolaryngol Head Neck Surg. 2007 Aug;137(2):243-5

2. Lin SY, Lay PC, Hughes LF, Bass R. The safety of multi-dose vials in allergy immunotherapy.  Otolaryngol Head Neck Surg. 2008 Aug;139(2):195-7

3. Lay PC, Bass R, Hughes LF, Lin SY. Risks of allergy vial contamination: Comparison of mixing in-office versus under ventilation hood. Otolaryngol Head Neck Surg. 2008 Sep;139(3):364-6.

4. Gilbert KC, Sundareshan V, Bass RM, Lin SY.  Antibacterial Properties of Additives Used in Injection Immunotherapy. Int Forum Allergy Rhinol.  2011 Dec 7. doi: 10.1002/alr.20105. [Epub ahead of print].

President Mims Message

April 2017

Working together with AAOA staff, volunteer leadership and members will enable us to have a positive impact on our members’ practices. Read More

News

New Articles from IFAR

Medical therapy for Chronic Rhino-sinusitis

The indications for surgical management of chronic rhinosinusitis (CRS) in patients with cystic fibrosis (CF) are poorly defined..
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Safety of long-term Intranasal Budesonide

The aim of this study was to determine the impact of long-term topical budesonide treatment via the mucosal atomization device (MAD) on the hypothalamic-pituitary-adrenal axis (HPAA) and intraocular pressure (IOP).. Read More

New Blog Posts

Posts from AAOA Leaders

Allergies, not just for summer anymore. Read More

How to treat allergies at home.
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