Here are the five things you should know about sequestration:

1. What is sequestration?

It is the mandatory 2% payment reduction in the Medicare fee-for-service (FFS) program required by the Budget Control Act of 2011.

2. Who does it affect?

All providers of medical services that are reimbursed under the Medicare fee-for-service (FFS) program (i.e., Part A and Part B) are subject to the 2% reduction. This also includes those entities that bill for durable medical equipment (DME), prosthetics, orthotics, and supplies.

3. When does it begin?

FFS claims with dates of service or dates of discharge on or after April 1, 2013. Payments for DME, prosthetics, orthotics and supplies will be based upon whether the date of service, the start date for rental equipment or multi-day supplies, is on or after April 1, 2013.

4. How is the 2% calculated?

The reduction is taken from the calculated payment amount, after the approved amount is determined and the deductible and coinsurance are applied.

Example:

A provider bills a service with an approved amount of $100.00.
Medicare normally would pay 80 percent of the approved amount ($100.00 x 80 percent = $80.00).
The patient is responsible for the remaining 20 percent coinsurance amount of $20.00 ($100.00 - $80.00 = $20.00).
However, due to the sequestration reduction, 2 percent of the $80.00 calculated payment amount is not paid, resulting in a payment of $78.40 instead of $80.00 ($80.00 x 2 percent = $1.60).

Billing Note: The 2% reduction will be noted on the explanation of payment as Claim Adjustment Reason Code 223. (CARC 223 is defined as adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code can be created.)

5. Where do I get more information?

Documentation was issued by CMS on March 8, 2013 and can be found via this link:

http://www.cms.gov/Outreach-and-Education/Outreach/FFSProvPartProg/Downloads/2013-03-08-standalone.pdf

You can also contact your local Medicare Administrative Contractor for further information.

The current accepted medical terminology for Autism is Autism Spectrum Disorder (ASD). The use of “Spectrum” accurately describes the wide range of symptoms, levels of impairment or disabilities and their varying degree of severity. As some children can be only mildly impaired by their symptoms, others can suffer from severe disability.

In March 2012, the Centers for Disease Control and Prevention issued their ADDM autism prevalence report. The report concluded that the ASD affects 1 in every 88 children born in the United States, with a slightly higher rate for males, almost 1 in 54.

With occurrence rates that high, almost everyone knows someone impacted by ASD. Therefore, it is important we all educate ourselves about this common and complex issue.

What are the symptoms of ASD?

As mentioned before symptomology and severity can vary widely from one child to the next. Generally accepted indicators can include:

Lack of or delay in spoken language
Repetitive use of language and/or motor mannerisms (e.g., hand-flapping, twirling objects)
Little or no eye contact
Lack of interest in peer relationships
Lack of spontaneous or make-believe play
Persistent fixation on parts of objects

Parents, family members or others in close connection with the child should bring any concerns about the potential for ASD in the child to the attention of their health care provider immediately. Early intervention can reduce or prevent the more severe disabilities associated with ASD and may also improve your child's IQ, language, and everyday functional skills, also called adaptive behavior.

How is ASD diagnosed?

Whether it is the result of an evaluation specifically initiated by a parent or a routine developmental screening during well-child checkups with a health care provider, children who show some developmental problems are referred for additional evaluation.

Initial Screening

A well-child checkup should include a developmental screening test, with specific ASD screening at 18 and 24 months as recommended by the American Academy of Pediatrics. A parent’s own experiences and concerns about the child's development are a very important part in the screening process. Notes about the child's development, even family videos, photos, and baby albums help to document behavioral timelines and developmental milestones are all useful to the health care provider in the evaluation of the child. The initial screening instruments used by the doctor for toddlers or preschoolers may consist of:

Checklist of Autism in Toddlers (CHAT)
Modified Checklist for Autism in Toddlers (M-CHAT)
Screening Tool for Autism in Two-Year-Olds (STAT)
Social Communication Questionnaire (SCQ)
Communication and Symbolic Behavior Scales (CSBS).

To screen for mild ASD or Asperger syndrome in older children, the doctor may rely on different screening instruments, such as:

Autism Spectrum Screening Questionnaire (ASSQ)
Australian Scale for Asperger's Syndrome (ASAS)
Childhood Asperger Syndrome Test (CAST).

Comprehensive Diagnostic Evaluation

The next step in diagnosing ASD involves a thorough evaluation to rule out other causes or conditions that could be responsible for the symptoms. This stage utilizes a team of health care professionals that encompasses a wide range of specialties: psychology, neurology, psychiatry, speech therapy. The evaluation at a minimum should include the assessment of cognitive and language levels, and age-appropriate skills needed to complete daily activities independently. Due to complexity in nature of ASD and the possibility of other accompanying illnesses more comprehensive testing may be appropriate: hearing testing, screening for lead poisoning, brain imaging, genetic testing, and in-depth memory, problem-solving, and language testing.

Some helpful resources on ASD screening include the Center for Disease Control and Prevention's General Developmental Screening tools and ASD Specific Screening tools on their website.

How is ASD treated?

Once a child is diagnosed as having ASD, discussions begin on treatment options. As varied and individual as each child, so are the options.

Nonmedical interventions include behavioral and educational approaches as well as focuses on sensory response and communication.

Applied Behavior Analysis (ABA) is a treatment plan that includes verbal behavior and pivotal response training interventions centered around shaping and reinforcing new behaviors, such as learning to speak and play, and reducing undesirable ones.

Developmental, Individual Difference, Relationship-based (DIR)/Floortime Model aims to build healthy and meaningful relationships and abilities by following the natural emotions and interests of the child.

TEACCH (Treatment and Education of Autistic and related Communication handicapped Children) emphasizes adapting the child’s physical environment and using visual cues.

Interpersonal Synchrony targets social development and imitation skills, and focuses on teaching children how to establish and maintain engagement with others.

Medical interventions, in children ages 5 to 16 who have ASD, with medications such as antipsychotics, antidepressants, and stimulants have been known to help reduce symptoms such as irritability which can often translate into aggression, self-harming acts, or temper tantrums.

Biomedical treatments include modifications in diet such as the gluten-free/casein-free diet, addressing food sensitivities, addition of vitamins and minerals supplements, immune system regulations and others.

Here are several links expanding on the topic of ASD awareness: