Nov 7, 2019 | Uncategorized
State healthcare officials have until November 15 to put together a final “state option” proposal for the legislature. Many are hoping new changes will be implemented due to the rise in healthcare costs. Read the article below to find out more on what legislation may be coming and what the concerns are with this program.nnIn what is shaping up to be the major health care battle at the state Capitol this coming legislative session, Colorado hospitals, and insurance companies both have raised concerns about a proposal to dictate hospital prices for a slice of people with private health coverage.nnThe idea, unprecedented across the country in its precise details, is part of an ambitious plan to create what Colorado health officials are calling a “state option” insurance program. The program would aim to lower insurance costs for people who buy coverage on their own.nnIt would largely achieve those lower rates by limiting how much hospitals can charge people covered by state option plans, which would be sold and administered by private insurance companies. Both hospitals and insurance companies would likely be required to participate in the program, though state officials have been vague on whether they have the authority to compel participation or whether they would need to ask the legislature for that authority.nnEither way, the state-option proposal has found hospitals and insurance companies — frequent foes in the battle over health costs — sharing unusual common ground.nnThe hospitals’ opposition is fairly simple to understand. They don’t want the government telling them what their prices can be.nn“Fundamentally, we as an organization are opposed to rate-setting,” said Katherine Mulready, the chief strategy officer for the Colorado Hospital Association. She said the proposal “misses the mark” and that its architects should return to the drawing board.nnBut the Colorado Association of Health Plans, the organization that represents health insurance companies in the state, also has raised concerns about the proposal, echoing two of the hospitals’ objections, though it supports the push to bring down the underlying costs of health care.nnFirst, insurers and hospitals say the program could make health insurance provided by employers more expensive. Why? Because hospitals might make up for the money they’re not getting for patients with state-option coverage by charging people with employer-sponsored coverage more.nnThe hospital association says this “cost shift” could be $1.5 billion over five years. (State officials argue that hospitals have already — and needlessly — shifted billions in costs onto the privately insured even as they have reaped record profits.)nn
“This one-size-fits-all approach would have the effect of increasing costs for employers,” Amanda Massey, the executive director of the Colorado Association of Health Plans, wrote in an emailed statement.nnSecond, both hospitals and insurers say patients could suffer by not having access to doctors. Hospitals warn that cuts to their bottom lines could lead to cuts in staffing. Insurers say private doctors’ offices, which wouldn’t be forced to accept the coverage, might choose not to see patients with state-option insurance.nn“The result will be reduced patient access to adequate networks and quality care,” Massey said.nnThe goal behind the state option — sometimes called the public option, even though the government wouldn’t administer the plans in Colorado’s proposal — is to ensure more choices and better prices for people who don’t get health coverage through their jobs. That group currently makes up about 7% of Coloradans.nnGov. Jared Polis has frequently touted the state option and reducing hospital prices as part of his “road map” for saving Coloradans money on health care.nnThe two-state officials putting the plan together — Kim Bimestefer, the executive director of the state’s Department of Health Care Policy and Financing, and Michael Conway, Colorado’s insurance commissioner — have in recent weeks held meetings across the state seeking input on their plan. They have also received more than 200 written comments.nnThe final proposal is due to the legislature by Nov. 15.nnOriginal article published on coloradosun.com
Nov 7, 2019 | Uncategorized
Welter Healthcare Partners is providing new information regarding E/M changes in 2020. Read the updates below on what is coming next year for coding, along with changes to PCM and CCM.nnWhat’s New for 2020nnThe CY 2020 PFS conversion factor will increase to $36.0896, up to $0.05 from CY 2019. nnThree new Telehealth Service codes added to the Medicare-covered services list:n
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- G2086 (Office-based treatment for opioid use disorder, including the development of the treatment plan, care coordination, individual therapy, and group therapy and counseling; at least 70 minutes in the first calendar month);
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- G2087 (Office-based treatment for opioid use disorder, including care coordination, individual therapy, and group therapy and counseling; at least 60 minutes in a subsequent calendar month); and
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- G2088 (Office-based treatment for opioid use disorder, including care coordination, individual therapy, and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes).
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- CMS will offer these services without the usual geographical limitations for telehealth.
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- The Medicare telehealth originating site fee increased to $26.65 in 2020, from $26.15 in 2019.
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nPrincipal Care Management (PCM) for Chronic Care Management (CCM) nnIf you provide chronic care management (CCM) to patients with one chronic condition next year, report code G2064 for 30 minutes of work by a doctor or other qualified health care professional: “Comprehensive care management services for a single high-risk disease, e.g., principal care management, at least 30 minutes of physician or other qualified health care professional time per calendar month with the following elements: One complex chronic condition lasting at least three months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been the cause of a recent hospitalization, the condition requires development or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities.” When clinical staff performs the work, you will report G2065.nnReduction of Administrative BurdennnModifications to the documentation policy now allows physicians, physician assistants, and advanced practice registered nurses (APRNs – nurse practitioners, clinical nurse specialists, certified nurse-midwives and certified registered nurse anesthetists) to review and verify (sign and date), rather than re-documenting, notes made in the medical record by other physicians, residents, medical, physician assistant, and APRN students, nurses, or other members of the medical team. CMS also defined the APRN group of providers, which includes nurse practitioners, clinical nurse specialists, certified nurse-midwives and certified registered nurse anesthetists.nn
Physician Assistants Make Ground n
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- CMS’ finalized its proposal to adjust the authority of physician assistants (PA): Allowing them to practice without specific assignment to an M.D., requiring only “documentation in the medical record of the PA’s approach to working with physicians”.
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- Requires that in states where the PA’s scope of practice is not specified, the PA’s “working relationship” with the practice’s physicians must be documented “at the practice level.”
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- CMS cautiously approved its proposal to allow certified registered nurse anesthetists (CRNAs) to do pre-anesthesia assessments on patients as well as post-anesthesia assessments without the supervision of an M.D. CMS clarifies that “a physician must examine the patient to evaluate the risk of the procedure to be performed,” while either “a physician or anesthetist must examine the patient to evaluate the risk of anesthesia.”
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nCMS Final Rule Aligns with E/M coding changes laid out by the CPT Editorial Panel for office/outpatient E/M visits beginning in 2021n
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- Reduce the number of levels to 4 for office/outpatient E/M visits for new patients (99202-99205);
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- Retain all 5 levels of coding for established patients (99211-99215);
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- Revision of time-based reporting and medical decision-making process for all office-based E/M codes; performance of history and exam only as medically appropriate (complexity will be more clearly defined);
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- E/M visit level selected based on either medical decision making or time.
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- CMS also finalized the relative value units (RVU) for the group of oft-used E/M services, which will determine 2021 pay rates. The RVU changes, for example, would boost payments for code 99214 – the most-reported E/M code – from $109 to $136 per claim, a 25% increase. Rates for 99213 would jump nearly 30%.
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nThe information provided about was originally published on cms.gov, aafp.org, ama-assn.org, and pbn.decisionhealth.com
Oct 30, 2019 | Uncategorized
CMS’ Innovation Center will delay the start of a new payment model called Primary Care First by a year, according to timeline updates on the model’s information page.nnPrimary Care First, announced in April, was slated to begin in January 2020. Now, it will begin in January 2021. The voluntary model is a set of five-year payment options that tie payment to value and quality metrics in hopes of reducing healthcare costs. Options under the Primary Care First model were set to be offered in 26 regions for a 2020 start date.nnPractices that wish to apply to the model to begin participation in January 2021 could begin applying Oct. 24, 2019. Applications close Jan. 22, 2020.nnRead more about the model here.nnOriginal article published on beckershospitalreview.comnn
Oct 23, 2019 | Uncategorized
2019 ICD‐10‐CM updates went into effect on October 1st. These changes will impact encounters for dates of service October 1, 2019 through September 30, 2020. It is imperative that your organization has up‐to‐date coding resources and a keen understanding of the changes that will impact your reimbursement! The new updates can also influence your organization’s MIPS/MACRA quality reporting scores.nnThis year’s ICD‐10‐CM updates include 325 code changes (273 new codes, 15 validity changes, 7 deleted codes, and 30 code revisions).nnHere are notable highlights of the 2020 updates: n
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- Guideline Changes:
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- Coding Conventions Section 1.A.15 “with” update:
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nThe word “with” in the Alphabetic Index is sequenced immediately following the main term or subterm, not in alphabetical order. o Chapter‐Specific Coding Guidelines updates:nn➢ New section 1.C.19.b.3 Iatrogenic injuries ➢ New section 1.C.19.c.3 Physeal Fractures ➢ New paragraph 1.C.19.e.4 Adverse Effects, Poisoning, Underdosing & Toxic Effects ➢ New paragraph 1.C.19.g.5: Complication of care ➢ New language 1.C.21.c.3: Z68 BMI codes should only be assigned when there is an associated, re-portable diagnosis (such as obesity). ➢ New paragraph 1.C.21.c.10: Factors influencing health status nnNote: Code Z71.84, encounter for health counseling related to travel, is to be used for health risk and safety counseling for future travel purposes. n
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- Section IV.H. Uncertain Diagnosis has added two additional terms “compatible with & consistent with” as examples of documentation terms that cannot be coded, as they indicate uncertainty.
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n15 validity changes:n
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- H81.4 ‘vertigo of central origin’ was changed from invalid to valid
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n7 Codes Deleted:n
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- Removal of laterality for ‘vertigo of central origin’ at category H81.4‐ o Heatstroke inclusion terms and adjustment of character assignment at T67.‐
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n273 new codes:n
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- Four new codes at category I48 to increase specificity of atrial fibrillation o Ten new codes at category I80 to increase specificity/laterality of phlebitis o New codes for Pressure‐induced deep tissue damage at category L89 o Unspecified breast lumps in category N63 has new codes to identify “overlapping quadrants” o N99.85 Post endometrial ablation syndrome o Category Q66 for congenital foot conditions has 24 new codes to identify laterality o R11.15 cyclicial vomiting syndrome unrelated to migraine (persistent vomiting) o R82.81 pyuria
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- Many new additions to fractures in category S02.‐ o Many new additions to poisoning in category T50.‐ o Additions to category Y35.‐ for Legal interventions that are now categorized by 7th characters to identify episode of care o Z01.02‐ Encounter for exam of eyes & vision following failed vision screening (with or w/o abnormal findings) o New codes for tuberculosis: Latent TB screening Z11.7, Latent TB infection Z22.7 & personal history of latent TB infection Z86.15 o Encounter for health counseling related to travel Z71.84
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n*Please note this list is not all‐inclusive. For a comprehensive list of all 2020 ICD‐10‐CM changes, please visit the CMS website.
Oct 23, 2019 | Uncategorized
Reactive Hypoglycemia (ICD-10 code E16.1) or a sugar crash can do more than just make you tired. It can lead to feeling of hunger, irritability, anxiousness, headaches or even difficulty concentrating. With Halloween just around the corner, it seems there is a candy dish stocked full of treats everywhere you turn. It’s not just about the effects, it’s also about prevention. Here are a few fun reads on how to keep your blood sugar levels in check during the upcoming holidays.nnSugar Crash Effects and How to fix Them:nnThe sugar high is all fun and games until the resulting sugar crash affects the quality of your day. The term refers to the sudden drop in energy levels after consuming a large amount of carbohydrates. This can include pastas and pizza but is usually more common after eating simple carbohydrates, also known as simple sugars, such as desserts.nnA sugar crash often causes many undesired symptoms that can disrupt productivity and energy levels throughout the day.nnSanford Health, suggests balance, moderation and consistency are the most effective ways to avoid these crashes. Herrick shares her knowledge on sugar crashes, how to avoid them and what to do if you get one.nnClick here to read the full article!nn5 Tips to Avoid an Afternoon Crash:nnAre you falling asleep mid-task, having trouble concentrating on conversations, or wanting to take a mid-afternoon nap at your desk? Most of us have experienced the overwhelming sensation of exhaustion at less-than-optimal times. The good news is that you may be able to prevent fatigue and boost energy levels by paying attention to what and when you eat.nnWhat does a sugar crash feel like?nnYou may experience a crash after indulging in high amounts of carbohydrates, especially artificial sugars such as cake and ice cream. Although the human body needs sugar, it also needs the amount of sugar to remain at a consistent level.nnWhen the body has more sugar than it’s used to, it rapidly produces insulin in attempt to keep the levels consistent. This causes blood glucose to decrease, which results in a sudden drop in energy levels, also known as hypoglycemia, or a sugar crash.nnWhen the body experiences this drastic drop in energy, it can experience undesired symptoms such as:n
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- hunger
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- irritability
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- fatigue
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- discomfort
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- anxiety
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- headaches
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- difficulty concentrating
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- excess sweat
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- jitters
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- shakiness
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- dizziness
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nSugar crashes generally cause us to be incredibly distracted throughout the day, which leads to a lack of productivity and concentration. Confusion, abnormal behavior, the inability to complete routine tasks and blurred vision are also common symptoms, especially for those who have diabetes. People with diabetes may experience more severe symptoms such as loss of consciousness, seizures or coma, if the crash is harsh enough, because of their increased sensitivity to inconsistent sugar levels.nnClick here to read the full article!nnOriginal articles published on sanfordhealth.org and foodinsight.org
