Jul 21, 2017 | Uncategorized
Due to the recent interest to repeal and replace Obamacare, healthcare-provider groups have called on Congress to cut a bipartisan deal on healthcare reforms!nn”The best approach would be for Congress members to reach across the aisle and address some of the specific problem areas of the Affordable Care Act,” Elizabeth “Betsy” Ryan, JD, president and CEO of the New Jersey Hospital Association, told HealthLeaders.nn”To me, letting Obamacare fail would be a dereliction of government’s responsibility to the people. This is not just a political fight to be won—these are real people, real families, whose healthcare is at stake.”nnPartisan congressional approaches to repealing, replacing, or repairing the PPACA are likely destined for the scrapheap, Nicholas Schilligo, MS, vice president of public policy at the Chicago-based American Osteopathic Association (AOA), told HealthLeaders. “Any meaningful solution is going to require bipartisan discussion, including hearings that thoroughly examine and vet a lot of the issues that are going to be put forward.”nnThis past weekend’s collapse of the Senate’s Obamacare repeal-and-replace bill, the Better Care and Reconciliation Act (BCRA), prompted Majority Leader Mitch McConnell to call on his Senate colleagues to pass repeal-only legislation. The Kentucky Republican’s repeal-only plan includes a two-year grace period to give Congress time to craft a replacement for the Patient Protection and Affordable Care Act (PPACA).n
“A repeal of the ACA without an adequate replacement would be devastating. Hospitals and other healthcare providers conceded billions of dollars in federal funding under the ACA, because they knew those reductions would be balanced by more insured patients. If we lose both—federal funding and healthcare coverage—it would be unsustainable for our healthcare system, and that would impact all of us.”
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nThis article was originally posted on HealthLeadersMedia.com
Jul 14, 2017 | Uncategorized
Welter Healthcare Partners is excited to present our monthly Code Spotlight! Each month, Welter Healthcare Partners will spotlight a unique CPT or ICD-10 code to profile and discuss practice applications of the code, as well as pertinent guideline reminders.nnICD-10 Code I16 – Hypertensive Crisis
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- I16.0 — Hypertensive Urgency, which should be reported when a patient has a systolic blood pressure equal to or greater than 180 or a diastolic pressure greater than 110 in the absence of associated organ damage or dysfunction, he or she is said to be in hypertensive urgency. Immediate blood pressure reduction is often not necessary and acute complications are unlikely, but the patient will need his or her medication adjusted and blood pressure monitored more closely to ensure it continues to stay at a suitable level.
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- I16.1— Hypertensive emergency, which should be reported when a patient is experiencing a hypertensive emergency when blood pressure levels exceed 180 systolic over 120 diastolic and organ damage is present. The organ systems typically affected include cardiac, renal, and neurologic, manifested as coronary ischemia, disturbed cerebral function, renal failure, cerebrovascular events, and pulmonary edema. These cases require intensive care hospital admission for immediate but controlled blood pressure reduction via IV medications. Complete work-up and evaluation should be completed to determine the underlying cause or trigger of the hypertensive emergency.
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- I16.9 — Hypertensive crisis NOS, which should be reported when there is a life-threatening rapid increase in a patient’s blood pressure. The presence or absence of associated organ damage further classifies the type of hypertensive crisis as urgent or emergent.
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Jul 14, 2017 | Uncategorized
Check out this article about how the lack of preparedness could hurt physicians financially, even with the new flexibility shown by CMS.
nnAs a group, doctors are ill-prepared to meet the requirements of a law that will change the way they are paid, shows a survey of a thousand physicians by the American Medical Association and Big Four auditing firm KPMG.nnThat lack of preparedness could hit them in the pocketbook, even amid new flexibility shown by CMS in last week’s proposed changes that would delay mandatory reporting data for another year and reduced reporting burdens for small physician practices.nnPhysicians must choose one of two reimbursement tracks under the Medicare Access and CHIP Reauthorization Act (MACRA). One, known as the Merit-based Incentive Payment System, is where most physicians will start, but some will participate in approved Advanced Payment Models (APMs) that will reward physicians with as much as 5% annual payment bonuses in return for taking more upside and downside risk based on value measures.nnIn either scenario, physicians rate themselves as less prepared than they should be, with half calling MACRA requirements “very” burdensome, according to the survey.nnMore than 56% of those surveyed still planned to participate in the MIPS program in 2017, while 18% are expected to quality for higher and more stable payment as an APM participant.n
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nThis article was originally posted on HealthLeadersMedia.com
Jul 7, 2017 | Uncategorized
nnAs part of the new coding format for our newsletter, Welter Healthcare Partners is excited to offer you a new surgery coding series in which we want to help you! The 2nd week of every month we will highlight a complicated surgical case. This week we are highlighting a general surgery case. We want to hear from you! If you have a complicated surgery case and need help with coding, please upload the operative note by clicking on the link below. Remember to remove ALL patient protected health information and organization identifiers. Welter Healthcare Partners will not use any medical records submitted in which PHI is not removed and protected. Click Here To Submit Redacted Surgery Case StudynnProcedure: Left heart catheterization with selective coronary angiography and ventriculogram.nnIndications: 73-year-old woman with a history of hypertension who presents with acute chest pain and who was found to have an abnormal stress test.nnFindings: n
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- Hemodynamics: Left ventricular pressure as well as aortic root pressure were normal with mildly elevated left ventricular end-diagnostic filling pressure. No specific gradient was seen across the aortic valve suggesting aortic stenosis.
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- Ventriculogram: In the right anterior oblique view ventriculogram was performed and demonstrated normal ventricular systolic function of 60% with no segmental wall motion abnormalities. No significant mitral regurgitation was appreciated.
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- Coronary anatomy: The left main gave rise to the left anterior descending artery and left circumflex branch. The left main was free of any significant disease.
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- The left anterior descending artery was a good size vessel that wrapped around the apex and gave off several septal perforators, as well as three diagonal branches. Diagonal 2 was a larger vessel and the LAD as well as the diagonal branches had a small contour and no high grade obtrusive lesions were appreciated.
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- The left circumflex is a large nondominant vessel which terminates within the AV groove and gives off a left posterolateral branch. The left circumflex gave off two obtuse marginal branch the larger vessel. The contour of this vessel and its branches were smooth and no high grade obstructive lesions were appreciated.
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- The right coronary artery was a large and dominant vessel which gave off an acute marginal branch and terminated as a right posterolateral and right posterolateral branch. The contour of this vessel was smooth and no high grade obstructive lesions were appreciated.
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Correct CPT and ICD-10 Codes:
n93458 -26 Modifier = Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when performednnR94.39 – Abnormal result of other cardiovascular function studynnR07.9 – Chest pain, unspecifiednnI10 – Essential (primary) hypertensionn
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Jul 7, 2017 | Uncategorized
nnCheck out this article about a half-dozen changes to the adjudication of Medicare claims-denial appeals that are designed to ease a backlog of cases.nnThe new rules for Medicare claim-denial appeals feature several changes crafted to ease administrative burdens and speed reductions in a backlog nearing 1 million cases. The new rules went into effect March 20. “This final rule streamlines administrative appeal processes, increases consistency in decision making across appeal levels, and improves efficiency for both appellants and adjudicators,” a Department of Health and Human Services fact sheet on the new rules says.nnThursday afternoon, three officials at the Office of Medicare Hearings and Appeals (OMHA) led a presentation to walk healthcare providers through more than a dozen significant changes in the new rules. OMHA reports directly to Health & Human Services Secretary Tom Price, MD.nnDisputed Medicare claims of more than $160 can be appealed to Administrative Law Judges (ALJs) and attorney adjudicators for reviews that can include a hearing. The last stop before federal court is the Medicare Appeals Council.nnThursday’s Medicare Learning Network (MLN) presentation featured a half-dozen changes to the claims-denials appeals process at the ALJ-level that are designed to either quicken or streamline adjudication:n
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- Attorney adjudicators are a new position at the ALJ level created this year to help clear the appeal backlog. “Attorney adjudicators are not authorized to conduct a hearing, which also means they cannot issue a decision in any case where a hearing is necessary,” said Jason Green, JD, chief adviser at OMHA. “However, attorney adjudicators can issue decisions when a hearing is not required, including cases where the records support a fully favorable decision.”
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- OMHA-100 form: This new form “is user-friendly and helps walk you through all the information required for a valid request for ALJ hearings,” OMHA’s Amanda Axeen, JD, said during the presentation. OMHA-100 can be used to request new hearings or review of appeal dismissals. The new form is not mandatory as long as previously required documents and information are filed.
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- Statistical Sampling Initiative: This new option for appeal adjudication “draws a random sample from a universe of claims and extrapolates—or projects—from the sample to the entire universe of claims,” OMHA’s Anne Lloyd said during the presentation. For example, she said a statistician could pick a sample of 30 claims out of a total of 1,000 for review in a ALJ hearing.
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nThis article was originally posted on HealthLeadersMedia.com
