Dec 4, 2017 | Uncategorized
There is a lot of confusion surrounding reporting for transitional care management (TCM) services. CPT offers the following options to report TCM services:n
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- 99495 – Transitional Care Management services with the following required elements: communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge; medical decision making of at least moderate complexity during the service period; face-to-face visit, within 14 calendar days of discharge
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- 99496 – Communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge; medical decision making of high complexity during the service period; face-to-face visit, within 7 calendar days of discharge
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nWhen billing for TCM services, the rendering provider must assume all responsibility for the patient’s care post-discharge leaving no gap in care. The rendering provider must deliver care during the patient’s transition back home following discharge. The patient must return to his/her residence following discharge. Authorized community settings include: home, domiciliary, rest home, assisted living facility. TCM cannot be reported if a patient is discharged from one inpatient facility to another inpatient facility, such as a skilled nursing facility. Each patient must meet the complexity requirements for each CPT code (i.e. moderate for 99495 and high for 99496).nnCMS allows TCM services to be reported in the following discharge settings:n
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- Inpatient acute care hospital
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- Inpatient psychiatric hospital
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- Long-term care hospital
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- Skilled nursing facility
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- Inpatient rehabilitation facility
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- Hospital outpatient observation or partial hospitalization
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- Partial hospitalization at a community mental health center
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Nov 28, 2017 | Uncategorized
On Nov. 2, CMS received the 2018 final payment rule, providing a 1.2 percent increase in ASC reimbursement next year. The final rule also addressed several issues pertaining to orthopedic procedures in ASCs, including total joint replacements and spine procedures.nnHere are five ways the final rule will affect orthopedic ASCs, according to guidance from ASCA:n
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- Total knee replacements: CMS removed total knee replacement from the inpatient only list, but did not add it to the ASC payable list. The agency will continue discussion on other joint replacement codes before removing them from the inpatient only list as well. While some in the industry are excited by this move, which could bring total knee replacements a step closer to the ASC payable list, others feel it could have a negative impact on an ASC’s ability to negotiate fair contracts with private payers if CMS sets the rate too low.
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- Total and partial hip replacements: In the proposed final rule, CMS solicited comments for adding total and partial hip replacements to the ASC payable list, but decided not to add them in the final rule, stating, “Our understanding is that these procedures typically require more than 24 hours of active medical care following the procedure.”
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- Spine surgery: CMS added two spine procedures to the ASC payable list, including total disc arthroplasty with discectomy (22856) and second-level cervical disc arthroplasty with discectomy (22858).
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- Quality reporting: A new quality measure was approved that will affect orthopedic surgery centers specifically: ASC-17 will collect data via claims for hospital visits after orthopedic procedures in the ASC. Data collected over the next few years will affect payment determination in 2022 and subsequent years.
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- Payment rates: Overall, ASCs received a 1.2 percent reimbursement increase and hospital outpatient departments received a 1.35 percent increase.
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nTo learn more about orthopedic-driven ASC reimbursement and what to expect from CMS in the future, attend the Becker’s 16th Annual Future of Spine + The Spine, Orthopedic and Pain Management-Driven ASC Conference June 14-16, 2018 in Chicago. Click here to learn more and click here to register.nnThis article wasvoriginally posted on beckersasc.com.
Nov 22, 2017 | Uncategorized
All of us at Welter Healthcare Partners, would like to wish our clients, families and friends a Happy Thanksgiving! We are grateful for the relationships we have formed and for your continued to support of Welter Healthcare Partners. In observance of the holiday, we will be closed on Thursday, November 23rd to give our employees the opportunity to spend time with their loved ones. We will resume normal business hours on Friday, November 24th, and will be available to assist you!
Nov 15, 2017 | Uncategorized
Decision-making in its most basic form is the act of choosing between two or more courses of action. Each and every person in the world is faced with the decision-making process on a daily basis – whether it’s trivial things like deciding what is for dinner or which route to take to work or more serious life-changing decisions like what your next career move should be or which home is the best long-term investment for your family. To be effective in the decision-making process, it is imperative to avoid impulsive behavior and really think each scenario through. This can be done via pros/cons list, intuition, and/or reasoning. All methods have both advantages and disadvantages. Regardless of the method(s) chosen, avoid the following problems that can hinder effective decision-making: not having enough information to see the big picture, having too much information and going down the path of “analysis paralysis”, having too many hands in the pot, vested interests, emotional attachments, and having no emotional attachment. Being effective in the decision-making process is key to future success!
Nov 7, 2017 | Uncategorized
On November 2, CMS issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2018.nnThe overall update to payments under the PFS based on the finalized CY 2018 rates will be +0.41 percent. This update reflects the +0.50 percent update established under the Medicare Access and CHIP Reauthorization Act of 2015, reduced by 0.09 percent, due to the misvalued code target recapture amount, required under the Achieving a Better Life Experience Act of 2014. After applying these adjustments, and the budget neutrality adjustment to account for changes in Relative Value Units, all required by law, the final 2018 PFS conversion factor is $35.99, an increase to the 2017 PFS conversion factor of $35.89.nnThe Final Rule Includes:n
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- Patients over Paperwork Initiative
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- Changes in valuation for specific services
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- Payment rates for nonexcepted off-campus provider-based hospital departments
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- Medicare telehealth services
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- Malpractice relative value units
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- Care management services
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- Improvement of payment rates for office-based behavioral health services
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- Evaluation and management comment solicitation
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- Emergency department visits comment solicitation
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- Solicitation of public comments on initial data collection and reporting periods for Clinical Laboratory Fee Schedule
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- Part B drugs: Payment for biosimilar biological products
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- Part B drug payment: Infusion drugs furnished through an item of durable medical equipment
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- New care coordination services and payment for rural health clinics and federally-qualified health centers
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- Appropriate use criteria for advanced diagnostic imaging
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- Medicare Diabetes Prevention Program expanded model
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- Physician Quality Reporting System
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- Patient relationship codes
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- Medicare Shared Savings Program
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- 2018 Value Modifier
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nClick here to read original releasennThis article originally posted on cms.gov.
