Another deadline is on the horizon: plan now to update your CPT® Codes by January 1, 2016. The American Medical Association (AMA) creates and distributes new CPT code sets every calendar year. The 2016 CPT® Codes will be available late November/early December 2015. The updates typically include new CPT codes, de-activated codes, and other revisions where the CPT descriptions may have changed.
Also, every client using the medical procedure software – IMO Procedure IT Terminology product – must update to the 2016 CPT codes since the IMO product will be mapped to the newest CPT code-set – 2016.
Please understand the AMA requires use of any codes in the 2016 code-set version be purchased, regardless of whether you secure them in an electronic format or even if you only wanted to manually enter the codes. The AMA has been auditing NextGen Healthcare and other vendor clients more frequently: It is important you are in compliance with the AMA’s rules.
As a result, it’s imperative to update your systems with the most recent CPT and HCPCS Codes. You must use the updated CPT codes by 1/1/16 or you put your organization at risk for:
- Overpayment/overcharging
- Underpayment/undercharging
- Claims rejections
- Fines and penalties levied by the AMA for non-compliance
We’ve got the CPT solutions required
NextGen Healthcare will continue to offer CPT, HCPCS, and RVU Codes as part of the NextGen Healthcare Coding Update File as soon as they become available for purchase. This NextGen Healthcare value-add service is less costly than if you purchased the CPT and HCPCS codes from the AMA directly and enables seamless importing of pre-formatted codes into your EHR/PM system.
Any NextGen Healthcare clients that have purchased the Annual CPT Code Subscription will automatically receive the updated 2016 codes by January 1, 2016 for $25 per user. You’ll need to verify that your user counts have not increased, in which case you may need to purchase additional licenses in addition to your renewal.
For those clients that have NOT previously purchased CPT codes in 2015, the AMA’s expectation is that you be current and for the correct number of users to ensure you are not at risk of an audit by the AMA. The updated 2016 codes may be purchased for $25 per user.
Contact your NextGen Healthcare sales rep or go to insidesales@nextgen.com to learn more about 2016 CPT codes. Enjoy the benefits of these pre-formatted codes you import effortlessly into your system.
Be in AMA compliance
With your purchase, please fully understand the AMA’s License Terms that define a “user,” found at http://www.nextgen.com/cpteula. Purchases through your sales rep must adhere to AMA requirements. Our goal is to ensure your purchase and use the correct number of licenses to lessen the chance of a future AMA audit. AMA License Terms and definition of a “user” have been in place for many years: This is not a new requirement.
- Per the AMA, CPT data files are licensed on an individual (as opposed to concurrent) user basis.
- The AMA considers an individual to be a CPT user if he or she directly accesses CPT data in a product or, in the case where CPT is embedded in a product and not directly accessible, relies on embedded CPT data to perform his or her intended function with the product or its output.
- Every Provider, regardless of their full-time, part-time, mid-level, or Resident status, is considered and defined by the AMA as a “user.”
- While most other third-party content sold by NextGen Healthcare is aligned to Provider counts and how NextGen Healthcare sells and licenses its EHR/ PM, this is not the case for the CPT codes.
- The AMA expects that not only Providers (i.e., MDs, DOs, Dentists, PAs, RNPs, PTs, etc.) must subscribe and have a license for the CPT codes, but also any front-office (i.e., making appointments using CPT codes), back-office (i.e., coders or those processing claims using CPT codes or working with reports), nurses, or other staff defined as an AMA “user” must be included in your total user counts.
Remember, even Providers such as Residents or those working limited hours must be included in the user counts for CPT utilization.