Sep 3, 2024 | Uncategorized
President Biden plans to address the mental health and addiction crisis, both of which have worsened since the start of the pandemic. He intends to allocate funding between substance abuse and mental health services. Continue reading below to learn more.
President Biden is directing $2.5 billion in funding to address the nation’s worsening mental illness and addiction crisis, according to an official from the U.S. Department of Health and Human Services, as reported by Axios.
Why it matters:
Confronting the mounting mental health and substance abuse crisis will be imperative for the Biden administration, even as its primary focus remains on combating the broader COVID-19 pandemic. The funding announced today aims to increase access to services for individual Americans.
The funding surge comes as the president has yet to fill several key permanent positions in agencies that would lead the charge in combating the drug epidemic, including the Food and Drug Administration and the White House Office of National Drug Control Policy. His pick to lead HHS, Xavier Becerra, is expected to be confirmed by a close vote.
Between the lines:
The funds will be divided into two components by the Substance Abuse and Mental Health Services Administration.
- $1.65 billion will go toward the Substance Abuse Prevention and Treatment Block Grant, providing states and territories with money to improve existing treatment infrastructure and create or enhance prevention and treatment programs.
- $825 million will be allocated through the Community Mental Health Services Block Grant program, which states will use to specifically address mental health treatment services.
By the numbers:
A survey conducted last year and published in August 2020 by the Centers for Disease Control and Prevention showed that 41% of U.S. adults reported struggling with mental health or substance abuse related to the pandemic or its solutions, like social distancing.
Before the pandemic, over 118,000 people died by suicide and overdose in 2019. An HHS official says the administration expects that number to increase because of the COVID-19 pandemic. Preliminary data from the CDC indicates that the number of drug overdoses through July 2020 increased by 24% from the previous year.
Flashback:
On the campaign trail, then-candidate Biden often spoke about the need to address the mounting mental health and substance abuse crisis in America, an issue that hits close to home. His son, Hunter, has openly discussed his own struggles with addiction.
The National Suicide Prevention Lifeline (1-800-273-8255) provides 24/7, free, and confidential support for anyone in distress, in addition to prevention and crisis resources. It is also available for online chat.
Original article posted on axios.com
Aug 27, 2024 | Uncategorized
Defining Interactive Complexity +90785:
Interactive Complexity (+90785) is an add-on code used for office visits with a psychologist or other mental health professional that are complicated by factors such as language, behavior, emotions, mandated reporting requirements, or trauma. This code is used in addition to one of the following primary service codes: 90791-90792, 90832-90834, 90836-90838, 90853. (Add-on codes may only be reported in conjunction with other codes, never alone.)
Guidelines for Appropriate Use and Documentation:
Interactive Complexity is applicable when specific communication difficulties are present with patients who typically:
- Have other individuals legally responsible for their care, such as minors or adults with guardians.
- Request others to be involved in their care during the visit, such as adults accompanied by family members, an interpreter, or a language translator.
- Require the involvement of other third parties, such as child welfare agencies, parole or probation officers, or schools.
Interactive Complexity may be reported with psychiatric procedures when at least one of the following communication difficulties is present:
- The need to manage maladaptive communication (e.g., high anxiety, high reactivity, repeated questions, or disagreement) among participants that complicates delivery of care.
- Caregiver emotions/behavior that interfere with the implementation of the treatment plan.
- Evidence/disclosure of a sentinel event and mandated report to a third party (e.g., abuse or neglect with report to a state agency) with initiation of discussion of the event and/or report with the patient and other visit participants.
- Use of play equipment, physical devices, interpreter, or translator to overcome significant language barriers.
Documentation should clearly indicate the type of interactive methods used, such as an interpreter, play, or physical device, and that the patient could not communicate through normal verbal means.
Coverage also includes interactive examinations of patients with primary psychiatric diagnoses (excluding dementias and sleep disorders) and one of the following conditions: developmental speech or language disorders, conductive hearing loss (total), mixed conductive and sensorineural hearing loss (total), deaf mutism, aphasia, voice disturbance, aphonia, and other speech disturbances such as dysarthria or dysphasia. These conditions must be clearly and concisely recorded in the medical record. Other catatonic states may be covered if documentation is submitted with the claim.
When NOT to use Interactive Complexity:
Do not report the +90785 add-on code for Interactive Complexity in conjunction with Psychotherapy for crisis codes or with E/M services when no psychotherapy service is also reported. The +90785 code cannot be used in conjunction with:
- Psychotherapy for crisis codes (90839-90840)
- Family psychotherapy codes (90846, 90847, 90849)
- E/M (evaluation and management) service where no psychotherapy service is reported
Interactive Complexity should not be billed solely for translation or interpretation services. According to the Centers for Medicare and Medicaid Services (CMS), federal laws prohibit discrimination, which in this case would take the form of higher beneficiary payments and copayments for the same service, based on disability or ethnicity. Discernment is advised when billing for translation or interpretation services.
Aug 15, 2024 | Uncategorized
Medicare physician payment cuts are set to take effect on January 1, 2023. Continue reading to learn why many physicians are reaching out to their legislators to prevent these cuts. As members of Congress head home for their August recess, the AMA is urging physicians to contact their legislators with a two-fold message: stop the Medicare physician payment cuts scheduled for January 1, 2023, and reform the Medicare payment systems to prevent the need for such appeals every year.
“The overall goals of Medicare payment-system reform are simplicity, relevance, alignment, and predictability, both for physicians and the Centers for Medicare & Medicaid Services (CMS),” said Cynthia Brown, the AMA’s vice president of government affairs. “The problems we’re seeing arise from a system so complicated that even the Medicare agency struggles to implement it correctly.”
Leading the charge to reform Medicare pay is a key component of the AMA Recovery Plan for America’s Physicians. “You took care of the nation. It’s time for the nation to take care of you. It’s time to rebuild. And the AMA is ready.” The AMA has challenged Congress to enact systemic reforms to make Medicare work better for both physicians and patients. The AMA will continue to fight tirelessly against future cuts and all barriers to patient care.
Brown spoke during “Medicare Payment Principles—A Vision for Reform,” part of the “AMA Advocacy Insights Webinar Series.” The webinar detailed the cuts scheduled for January 1 and outlined the “Characteristics of a Rational Medicare Payment System” (PDF), developed by an AMA-led coalition of 120 state medical and national specialty societies. Physicians were encouraged to contact their legislators and were given tips and resources to guide their conversations.
History Repeats
Last year, physicians faced Medicare payment cuts totaling 9.75%, scheduled to take effect on January 1. “These cuts would’ve been untenable during normal circumstances but were beyond reckless during the public health emergency we continue to face,” said Sandra Adamson Fryhofer, MD, chair of the AMA Board of Trustees. “Additional work is necessary for permanent payment reform.” Congress passed legislation averting these cuts in December, a Christmastime ritual no one wants to maintain.
“We don’t want to be here asking for money every year at the end of the year—and members of Congress don’t like it,” Jason Marino, the AMA’s director of congressional affairs, said in the webinar. “We want a bridge to a permanent solution—so we have a normal, functioning system like the hospitals, nursing homes, and home health agencies. They don’t have to come to Congress every year.”
Physicians are now facing a “portfolio of cuts” totaling 4.5%, Marino noted. But that’s just the beginning. Coupled with 9% inflation, physicians’ Medicare payment update for 2023 is 0%. Additionally, a 5% bonus for successfully participating in an alternative payment model is expiring, and a $500 million bonus pool for Merit-based Incentive Payment System high performers is “going away,” he added. While payment rates for hospitals, nursing homes, and similar facilities are adjusted for inflation, rates for physicians are not, as shown in the AMA-developed chart below.
“That chart tells the story, and we have senators now talking about this chart—that’s how you know it’s resonating,” Marino said. “Everyone who sees that chart realizes that’s not a sustainable path.” However, there is skepticism among members of Congress that Medicare’s physician payment rates are causing patient-access problems. Physicians must tell their senators and representatives how Medicare pay uncertainties hinder giving raises to staff, buying new equipment, and investing in their practices—and how this impedes patient access.
“You want to create some empathy,” he advised. “You have to start with making a connection with your own story, what this means to you as a physician, what it means for your patients’ access, and humanize it in a way that only you can.”
Original article published on ama-assn.org
Aug 13, 2024 | Uncategorized
Anthem is changing its name to better reflect its purpose in the healthcare business. The new name, Elevance Health, represents the insurance company’s evolution into a lifetime trusted health partner for the millions of people they serve. Continue reading to learn about this change. Anthem announced today that the name change to Elevance Health aims to emphasize its commitment to “elevating whole health.”
This rebrand, which serves 118 million people through its affiliated companies, will be subject to shareholder approval but will not affect the Anthem Blue Cross Blue Shield health plans’ name. “Improving health means more than just treating what ails us. We must address whole health and the physical, behavioral, and social drivers that impact it,” said Anthem president and CEO Gail Boudreaux. “This need has driven our transformation from a health benefits organization to a lifetime, trusted health partner. Our commitment to always expect more from ourselves has led us to reimagine the way we operate and take a more holistic approach to health.
As Elevance Health, we will continue to work toward a healthcare system that better serves the needs of our consumers, care providers, communities, partners, and associates,” Boudreaux said. Anthem’s portfolio has expanded over the years to offer more than just health insurance. Between pharmacy, behavioral, clinical, and complex care assets, along with its digital capabilities, the payer offers consumers a wide range of services. With the name change, Anthem believes Elevance Health better encompasses its mission as they seek continued growth. “Elevance Health represents who we are today,” said Boudreaux. “Powered by industry-leading capabilities and a digital platform for health, Elevance Health’s companies will serve people across the entire care journey, connecting them to the care, support, and resources they need to lead healthy lives.
By simplifying every step and making health more equitable and accessible, Elevance Health will remain committed to helping everyone reach their full potential.” While insurers have faced challenges during the COVID-19 pandemic, Anthem experienced an EBITDA increase of 8.7% for 2021—outpacing several other larger payers.
Original article published on healthleadersmedia.com
Jul 30, 2024 | Uncategorized
Anthem and UnitedHealthcare are among the major insurers lagging billions of dollars in payments to hospitals and doctors. New reimbursement rules, computer problems, and mishandled claims have led to these delays. Continue reading below to learn more!
Anthem Blue Cross, the country’s second-largest health insurance company, is behind on billions of dollars in payments owed to hospitals and doctors due to onerous new reimbursement rules, computer issues, and mishandled claims, according to hospital officials in multiple states. Anthem, like other big insurers, is using the COVID-19 crisis as cover to institute “egregious” policies that harm patients and strain hospital finances, said Molly Smith, group vice president at the American Hospital Association. “There’s this sense of, ‘Everyone’s distracted. We can get this through,’” she said.
Hospitals are also facing a spike in retroactive claims denials by UnitedHealthcare, the largest health insurer, for emergency department care, the AHA reports. Disputes between insurers and hospitals are nothing new, but this situation puts more patients in the middle, worried they’ll have to pay unresolved claims. Hospitals say this is hurting their finances as they cope with COVID-19 surges, even after receiving tens of billions of dollars in federal emergency assistance.
“We recognize there have been some challenges” to prompt payments caused by claims-processing changes and “a new set of dynamics” amid the pandemic, Anthem spokesperson Colin Manning said in an email. “We apologize for any delays or inconvenience this may have caused.”
Virginia law requires insurers to pay claims within 40 days. In a Sept. 24 letter to state insurance regulators, VCU Health, which operates a large teaching hospital in Richmond associated with Virginia Commonwealth University, said Anthem owes it $385 million. More than 40% of the claims are over 90 days old, VCU said. For all Virginia hospitals, Anthem’s late, unpaid claims amount to “hundreds of millions of dollars,” the Virginia Hospital and Healthcare Association said in a June 23 letter to state regulators. Nationwide, the payment delays “are creating an untenable situation,” the American Hospital Association said in a Sept. 9 letter to Anthem CEO Gail Boudreaux. “Patients are facing greater hurdles to accessing care; clinicians are burning out on unnecessary administrative tasks, and the system is straining to finance the personnel and supplies” needed to fight COVID-19.
Complaints about Anthem extend “from sea to shining sea, from New Hampshire to California,” AHA CEO Rick Pollack told KHN. Substantial payment delays can be seen on Anthem’s books. On June 30, 2019, before the pandemic, 43% of the insurer’s medical bills for that quarter were unpaid, according to regulatory filings. Two years later, that figure had risen to 53% – a difference of $2.5 billion. Anthem profits were $4.6 billion in 2020 and $3.5 billion in the first half of 2021.
‘It’s a game they’re playing’
Alexis Thurber, who lives near Seattle, was insured by Anthem when she received an $18,192 hospital bill in May for radiation therapy that doctors said was essential to treat her breast cancer. Anthem deemed the treatments “experimental” and “not medically necessary,” according to Thurber. She spent much of the summer trying to get the insurer to pay up – making two dozen phone calls, spending hours on hold, sending multiple emails, and enduring immense stress and worry. It finally covered the claim months later. “It’s so egregious. It’s a game they’re playing,” said Thurber, 51, whose cancer was diagnosed in November. “Trying to get true help was impossible.” Privacy rules prevent Anthem from commenting on Thurber’s case, said Anthem spokesperson Colin Manning.
When insurers fail to promptly pay medical bills, patients are left in a bind. They might first get a notice saying payment is pending or denied. A hospital might bill them for treatment they thought would be covered. Hospitals and doctors often sue patients whose insurance didn’t pay. Hospitals point to various Anthem practices contributing to payment delays or denials, including new layers of document requirements, prior-authorization hurdles for routine procedures, and requirements that doctors themselves – not support staffers – speak to insurance gatekeepers. “This requires providers to literally leave the patient’s bedside to get on the phone with Anthem,” AHA said in its letter. Anthem often hinders coverage for outpatient surgery, specialty pharmacy, and other services in health systems listed as in-network, amounting to a “bait and switch” on Anthem members, AHA officials said. “Demanding that patients be treated outside of the hospital setting, against the advice of the patient’s in-network treating physician, appears to be motivated by a desire to drive up Empire’s profits,” the Greater New York Hospital Association wrote in an April letter to Empire Blue Cross, which is owned by Anthem.
Anthem officials pushed back in a recent letter to the AHA, saying the insurer’s changing rules are partly intended to control excessive prices charged by hospitals for specialty drugs and non-emergency surgery, screening, and diagnostic procedures. Severe problems with Anthem’s new claims management system surfaced months ago and “persist without meaningful improvement,” AHA said in its letter. Claims have gotten lost in Anthem’s computers, and in some cases, VCU Health has had to print medical records and mail them to get paid, VCU said in its letter. The cash slowdown imposes “an unmanageable disruption that threatens to undermine our financial footing,” VCU said.
An ‘incredibly aggravating’ response
United denied $31,557 in claims for Emily Long’s care after she was struck in June by a motorcycle in New York City. She needed surgery to repair a fractured cheekbone. United said there was a lack of documentation for “medical necessity” – an “incredibly aggravating” response on top of the distress of the accident, Long said. The Brooklyn hospital that treated Long was “paid appropriately under her plan and within the required time frame,” said United spokesperson Maria Gordon Shydlo. “The facility has the right to appeal the decision.” United’s unpaid claims stood at 54% as of June 30, about the same level as two years previously.
When Erin Conlisk initially had trouble gaining approval for a piece of medical equipment for her elderly father this summer, United employees told her the insurer’s entire prior-authorization database had gone down for weeks, said Conlisk, who lives in California. “There was a brief issue with our prior authorization process in mid-July, which was resolved quickly,” Gordon Shydlo said.
When asked by Wall Street analysts about the payment backups, Anthem executives said it partly reflects their decision to increase financial reserves amid the health crisis. “Really a ton of uncertainty associated with this environment,” John Gallina, the company’s chief financial officer, said on a conference call in July. “We’ve tried to be extremely prudent and conservative in our approach.”
‘A deep fear of talking on the record’
During the pandemic, hospitals have benefited from two extraordinary cash infusions. They and other medical providers have received more than $100 billion through the CARES Act of 2020 and the American Rescue Plan of 2021. Last year United, Anthem, and other insurers accelerated billions in hospital reimbursements. The federal payments enriched many of the biggest, wealthiest systems while poorer hospitals serving low-income patients and rural areas struggled. Those are the systems most hurt now by insurer payment delays, hospital officials said. Federal relief funds “have been a lifeline, but they don’t make people whole in terms of the losses from increased expenses and lost revenue as a result of the COVID experience,” Pollack said.
Several health systems declined to comment about claims-payment delays or didn’t respond to a reporter’s queries. Among individual hospitals, “there is a deep fear of talking on the record about your largest business partner,” AHA’s Smith said.
Alexis Thurber worried she might have to pay her $18,192 radiation bill herself, and she’s not confident her Anthem policy will do a better job next time of covering the cost of her care. “It makes me not want to go to the doctor anymore,” she said. “I’m scared to get another mammogram because you can’t rely on it.”
Original article published on usatoday.com
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