Dec 21, 2020 | Uncategorized
From our Welter Healthcare Partners family to yours, we hope you all have a merry holiday season and a safe, healthy, and happy New Year! We are grateful for the support and appreciation for the work that we do and are excited to continue in 2021!nnIn observance of the holidays, Welter Healthcare Partners will be closing at noon on December 24th and will be closed all day on December 25th and January 1st to spend time with our loved ones. Once again, happy holidays to you all and we hope you all have a great and prosperous New Year!nn
Dec 18, 2020 | Uncategorized
CMS updated payment information for Covid-19 treatments. This new update includes the reimbursement of monoclonal antibody treatments authorized by the FDA. Continue reading below to learn more.nnMonoclonal antibody products are paid under the Medicare Part B COVID-19 vaccine benefit and therefore are not eligible for a New COVID-19 Treatments Add-on Payment. CMS released new and updated FAQs on Medicare Part B billing and reimbursement for COVID-19 treatments and vaccines. The information updated December 9 is included in Section BB, Drugs and Vaccines under Part B of CMS’ COVID-19 billing FAQs.nnFor the duration of the public health emergency, CMS will pay for monoclonal antibody treatments authorized or approved by the FDA. For payment purposes, CMS is treating these products as vaccines covered under Medicare Part B. If the product is acquired for free, CMS will only pay for the administration. If the provider or supplier purchases the product, CMS will pay for the product and the administration separately. Monoclonal antibody products are paid under the Medicare Part B COVID-19 vaccine benefit and therefore are not eligible for a New COVID-19 Treatments Add-on Payment.nnPayment for administration of an infusion of bamlanivimab or an infusion of casirivimab and imdevimad is approximately $310. The payment rate is based on one hour of infusion and post-infusion monitoring in the hospital outpatient setting. CMS may change the payment rate based on additional information from providers and suppliers. When organizations begin purchasing monoclonal antibody products, CMS plans to set the payment rate in the same way it will set the payment rate for COVID-19 vaccines. The payment rate will be reasonable cost or 95% of the average wholesale price. A chart on p. 123 of the FAQ document shows payments rates by setting.nnCurrently, there is no separate payment for preparation of monoclonal antibodies, even if prepared for another provider or supplier. Monoclonal antibody products administered at a nonexcepted off-campus, provider-based department (PBD) will be paid at the full Outpatient Prospective Payment System (OPPS) rate. They will not be subject to the reduced rate (40% of the OPPS) that applies to other services provided at these facilities.nnDocumentation must support the medical necessity of the treatment as well as demonstrate that the terms of the applicable FDA emergency use authorization are met. The documentation must include the name of the practitioner who ordered the infusion.nnOther new and updated FAQs in Section BB include payment for monoclonal antibody treatment provided:n
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- By skilled nursing facilities, mass immunizers, and home health agencies
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- On the same day as evaluation and management services
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- To beneficiaries dually eligible for Medicare and Medicaid
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nOriginal article published on healthleadersmedia.com
Dec 18, 2020 | Uncategorized
The report below describes a patient undergoing a right inguinal hernia operation. The entire procedure has been documented in detail, describing the step by step process used by doctors to carry out the surgery. Keep reading for more on how this procedure was performed.nnDo you have a complicated surgery case that needs help with coding? Welter Healthcare Partners would love to help! 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. nn– Click Here to Submit Redacted Surgery Case Study –nnPATIENT NAME: D., M.nnMR#: XXXXXnnSURGEON: T. G., M.D.nnDATE: 09/XX/2020nnPREOPERATIVE DIAGNOSES: Right inguinal hernia (direct), obesity.nnPOSTOPERATIVE DIAGNOSES: Right inguinal hernia (direct), obesity.nnOPERATIONS: Right inguinal hernia repair with mesh, excision of round ligamentnnSURGICAL ASSISTANT: J. D., SA-C.nnANESTHESIA: General endotracheal.nnESTIMATED BLOOD LOSS: Minimal.nnSPECIMEN REMOVED: Round ligament.n
INDICATION FOR SURGERY:
nThis is a 65-year-old female with a history of obesity, who has pain and bulge in the right groin consistent with inguinal hernia. The need for surgery and all the possible risks and complications were discussed at length with the patient with the help of the daughter, who helped with the translation. the patient understood, all the questions were answered, and she wanted to proceed with surgery.n
DESCRIPTION OF PROCEDURE:
nThe patient was brought in the operating room and placed on the table in supine position. After the general anesthesia was administered, the right groin and abdomen were prepped and draped in the usual sterile fashion.nnA slightly oblique incision was done in the right groin and deepened through the subcutaneous tissue. In the lower part of the inguinal area, the bulge of the inguinal hernia was identified. 11ie skin flaps were dissected. Good exposure of the fascia of external oblique muscle was obtained. 111e fascia was opened, and the inguinal canal was entered. 11ie patient had a quite very large bulging of the posterior wall of the inguinal cru1al consistent with a direct hernia. The round ligament was carefully divided between ligatures ru1d excised. A purse-string was placed in the fascia of the transversalis around the neck of the hernia and the bulging direct hernia was invaginated and the purse-string was tied. This repair was done with a O silk. At this point, the posterior wall of the inguinal canal was reinforced with a 2 x 4 Marlex mesh. The mesh was secured in place with 2 rows of continuous running 0 Prolene, suturing 1 margin of the mesh to the inguinal canal and the other margin of the mesh to the conjoint tendon and lateral margin of the rectus abdominis muscle fascia. 11ie fascia of the external oblique muscle was closed on top of the mesh with continuous running 0 Vicryl. The wound was irrigated with antibiotic solution. Perfect hemostasis was noted. Local anesthesia was injected. The wound was closed with continuous running 2-0 Vicryl in 2 layers for the subcutaneous tissue and continuous running 4-0 Monocryl subcuticular closure for the skin. Steri-Strips and sterile dressing were applied. The patient tolerated the procedure well and left the operating room in stable condition.
Dec 8, 2020 | Uncategorized
Medicare released a physician fee schedule on December 1st that is set to take effect on January 1st, 2020. The release of the Final Rule delivers a 10.2% drop in the Conversion Factor. Most other E/M revisions remain on track with the AMA. Continue reading below to learn more.nnby: Ginger Avery, CPC, CPMA, CRC 12/2/2020nAccording to the 2021 Medicare physician fee schedule released on December 1st , starting Jan. 1, 2021, clinicians are facing a 10.2% drop in the Medicare conversion factor, finalized at $32.41. This CF decrease will result in an up-and-down projection in 2021 for medical specialties. CMS states the cut is needed as a counterweight to the increased fees for E/M officenvisit codes (99202-99215), which account for 20% of fee schedule spending.n
Source: Final 2021 Medicare physician fee schedule, released Dec. 1
nThe final rule confirms that CMS has adopted relative value units (RVU) approved by the AMA. The new valuations boost total RVUs for nearly all of the office visit codes and elevate RVUs for established office codes 99212-99215 by an average of 28%.nnDue to the CF reduction, office visit codes will see a diminished payment increase in 2021. For example, reimbursement for new patient E/M codes 99202-99204 will be reduced. Established office visit codes will see an increase in the range of 11% to 15%. Coding patterns are expected to shift to higher levels of service based on the new guidelines.n
Source: Final 2021 Medicare physician fee schedule
nAccording to data contained in the final fee schedule, specialties that will see a positive outcome with the new CF includes: endocrinology (+16%), rheumatology (+15%), hematology/oncology (+14%) and family practice (+13%). Specialties that are on pace for pay cuts include radiology (-10%), chiropractor (-10%), nurse anesthetist (-10%) and physical and occupational therapy (-9%).nnIn 2021, either medical decision-making (MDM) or time will drive code selection for E/M office visit codes. Medically appropriate history and/or exam will be the new accepted practice. CMS states. “We continue to believe these policies will further our ongoing effort to reduce administrative burden, improve payment accuracy, and update the O/O E/M visit code set to better reflect the current practice of medicine.”nnCMS Replaces Prolonged Service Code 99417 with HCPCS Code G2212nCMS made the decision to issue a new HCPCS code, G2212, instead of 99417, for prolonged services when reporting based on time. As expected, CMS did not agree with the AMA’s final descriptor for 99417, and is requiring the visit to exceed the maximum time for 99205 and 99215 to be met before capturing G2212 , unlike AMA’s guidance to meet the minimum time before capturing prolonged service time.nnThe descriptor for Medicare’s new prolonged services code G2212: “Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact (List separately in addition to CPT codes 99205, 99215 for office or other outpatient evaluation and management services) (Do not report G2212 on the same date of service as 99354, 99355, 99358, 99359, 99415, 99416). (Do not report G2212 for any time unit less than 15 minutes).”nnCheck with your commercial/private payers that may prefer the G code. Reach out to your software vendors to assure your systems are ready to capture these new codes. If your organization has not received training on the upcoming changes for E/M office visits services, now is the time, contact WHP for details.nnVisit Complexity Add-on HCPCS Code G2211 Enters the Coding ArenanAlthough it is not yet clear as to appropriate application, CMS will roll out add on code +G2211 (Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition. CMS stated in the final rule that the new add-on code will be appropriate for 90% of E/M office visit encounters and is appropriate for both new and established patients.nnTelehealth Rule Changes During/After COVIDnCMS finalized 114 Category 2 codes for telehealth – i.e., codes cleared for use outside of the restrictive distant-and-originating-site requirements and eligible for other flexibilities under the public health emergency (PHE). The agency also added a new “Category 3” of codes that “will remain on the list through the calendar year in which the PHE ends.” The bad news is these codes will eventually go back to the old telehealth rules if Congress does not change the law.nnCMS states it will conduct “a commissioned study, analysis of Medicare claims data or another assessment mechanism, to further study the impacts of this limited permanent expansion of the virtual presence policy to inform potential future rulemaking, and in an effort to prevent possible fraud, waste and abuse.”nnTelephone Visits New G codenCMS finalized its decision to cease separate payment for CPT telephone E/M codes 99441-99443 once the PHE ends. For the remainder of 2021, CMS created an interim code, G2252, for a “brief communication technology-based service (e.g., virtual check-in)” for established patients only. The code is priced at the same amount as CPT telephone visit code 99442 and covers 11-20-minute “medical discussion,”.nnCMS states that the G2252 service applies when a patient reports an exacerbation of an ongoing problem and wants to know whether a face-to-face office visit is warranted. CMS does not consider a telephone visit to be a substitute for an E/M service but instead “an assessment to determine the need for one.”nnCode G2252 will therefore be considered a communications technology-based service (CTBS) similar to a virtual check-in, not a telehealth service. Like the CPT phone codes, it will not be separately reported if the call occurs within seven days after a previous in-person visit or within 24 hours “or soonest available appointment.”nnRemote Patient MonitoringnCMS also finalized PHE flexibilities in remote patient monitoring codes: For example, while “only physicians and NPPs [non-physician providers] who are eligible to furnish E/M services may bill RPM services,” auxiliary personnel, including contract employees, may provide RPM services incident to under codes 99453 and 99454. Once the PHE ends, many of the current flexibilities will, too: For example, established patient-physician relationship will once again be required to initiate RPM services.nnThe waiver for direct supervision of NPPs by a physician using real-time, interactive audio and video technology is cleared through “the latter of the end of the calendar year in which the PHE ends or December 31, 2021.”nnCMS added some new virtual services that NPPs will be eligible to provide G2250 (Remote assessment of recorded video and/or images submitted by an established patient) and G2251 (Brief communication technology-based service, e.g. virtual check-in, by a qualified health care professional) for providers that cannot bill E/M services.nnTransitional Care ManagementnAs part of its ongoing quest to boost utilization of transitional care services (99495-99496), CMS is unbundling 14 end-stage renal disease (ESRD) codes and chronic care management (CCM) code G2058 – which will be replaced with 99439 next year – from the service.nnThis is a breaking news story. Please check CMS for additional updatesnnSee DecisionHealth’s Blog for more details.
Dec 8, 2020 | Uncategorized
On December 1st there was an announcement made regarding Medicare Telehealth services. The Trump Administration finalized the permanent expansion of Medicare Telehealth services and improved payment for the time doctors spend with patients. Continue reading below to learn more. nnOn December 1st, the Centers for Medicare & Medicaid Services (CMS) released the annual Physician Fee Schedule (PFS) final rule, prioritizing CMS’ investment in primary care and chronic disease management by increasing payments to physicians and other practitioners for the additional time they spend with patients, especially those with chronic conditions. The rule allows non-physician practitioners to provide the care they were trained and licensed to give, cutting red tape so healthcare professionals can practice at the top of their license and spend more time with patients instead of on unnecessary paperwork. This final rule takes steps to further implement President Trump’s Executive Order on Protecting and Improving Medicare for Our Nation’s Seniors including prioritizing the expansion of proven alternatives like telehealth.nn“During the COVID-19 pandemic, actions by the Trump Administration have unleashed an explosion in telehealth innovation, and we’re now moving to make many of these changes permanent,” said HHS Secretary Alex Azar. “Medicare beneficiaries will now be able to receive dozens of new services via telehealth, and we’ll keep exploring ways to deliver Americans access to healthcare in the setting that they and their doctor decide makes sense for them.”nn“Telehealth has long been a priority for the Trump Administration, which is why we started paying for short virtual visits in rural areas long before the pandemic struck,” said CMS Administrator Seema Verma. “But the pandemic accentuated just how transformative it could be, and several months in, it’s clear that the healthcare system has adapted seamlessly to a historic telehealth expansion that inaugurates a new era in healthcare delivery.”nnFinalizing Telehealth Expansion and Improving Rural HealthnnBefore the COVID-19 public health emergency (PHE), only 15,000 fee-for-service beneficiaries each week received a Medicare telemedicine service. Since the beginning of the PHE, CMS has added 144 telehealth services such as emergency department visits, initial inpatient and nursing facility visits, and discharge day management services, that are covered by Medicare through the end of the PHE. These services were added to allow for safe access to important health care services during the PHE. As a result, preliminary data show that between mid-March and mid-October 2020, over 24.5 million out of 63 million beneficiaries and enrollees have received a Medicare telemedicine service during the PHE.nnThis final rule delivers on the President’s recent Executive Order on Improving Rural Health and Telehealth Access by adding more than 60 services to the Medicare telehealth list that will continue to be covered beyond the end of the PHE, and we will continue to gather more data and evaluate whether more services should be added in the future. These additions allow beneficiaries in rural areas who are in a medical facility (like a nursing home) to continue to have access to telehealth services such as certain types of emergency department visits, therapy services, and critical care services. Medicare does not have the statutory authority to pay for telehealth to beneficiaries outside of rural areas or, with certain exceptions, allow beneficiaries to receive telehealth in their home. However, this is an important step, and as a result, Medicare beneficiaries in rural areas will have more convenient access to healthcare.nnAdditionally, CMS is announcing a commissioned study of its telehealth flexibilities provided during the COVID-19 PHE. The study will explore new opportunities for services where telehealth and virtual care supervision, and remote monitoring can be used to more efficiently bring care to patients and to enhance program integrity, whether they are being treated in the hospital or at home.nnPayment for Office/Outpatient Evaluation and Management (E/M) and Comparable VisitsnnLast year, CMS finalized a historic increase in payment rates for office/outpatient face-to-face evaluation and management (E/M) visits that goes into effect in 2021. The Medicare population is increasing, with over 10,000 beneficiaries joining the program every day. Along with this growth in enrollment is increasing complexity of beneficiary healthcare needs, with more than two-thirds of Medicare beneficiaries having two or more chronic conditions. Increasing the payment rate of E/M office visits recognizes this demand and ensures clinicians are paid appropriately for the time they spend on coordinating care for patients, especially those with chronic conditions. These payment increases, informed by recommendations from the American Medical Association (AMA), support clinicians who provide crucial care for patients with dementia or manage transitions between the hospital, nursing facilities, and home.nnUnder today’s final rule, CMS continues to prioritize this investment in primary care and chronic disease management by similarly increasing the value of many services that are similar to E/M office visits such as maternity care bundles, emergency department visits, end-stage renal disease capitated payment bundles, and physical and occupational therapy evaluation services. These adjustments ensure CMS is appropriately recognizing the kind of care where clinicians need to spend more face-to-face time with patients.nn“This finalized policy marks the most significant updates to E/M codes in 30 years, reducing burden on doctors imposed by the coding system and rewarding time spent evaluating and managing their patients’ care,” Administrator Verma added. “In the past, the system has rewarded interventions and procedures over time spent with patients – time taken preventing disease and managing chronic illnesses.”nnIn addition to the increase in payment for E/M office visits, simplified coding and documentation changes for Medicare billing for these visits will go into effect beginning January 1, 2021. The changes modernize documentation and coding guidelines developed in the 1990s, and come after extensive stakeholder collaboration with the AMA and others. These changes will significantly reduce the burden of documentation for all clinicians, giving them greater discretion to choose the visit level based on either guidelines for medical decision-making (the process by which a clinician formulates a course of treatment based on a patient’s information, i.e., through performing a physical exam, reviewing history, conducting tests, etc.) or time dedicated with patients. These changes are expected to save clinicians 2.3 million hours per year in administrative burden so that clinicians can spend more time with their patients.nnProfessional Scope of Practice and SupervisionnnAs part of the Patients Over Paperwork Initiative, the Trump Administration is cutting red tape so that healthcare professionals can practice at the top of their license and spend more time with patients instead of on unnecessary paperwork. The PFS final rule makes permanent several workforce flexibilities provided during the COVID-19 PHE that allow non-physician practitioners to provide the care they were trained and licensed to give, without imposing additional restrictions by the Medicare program.nnSpecifically, CMS is finalizing the following changes:nnCertain non-physician practitioners such as nurse practitioners and physician assistants can supervise the performance of diagnostic tests within their scope of practice and state law, as they maintain required statutory relationships with supervising or collaborating physicians.nPhysical and occupational therapists will be able to delegate “maintenance therapy” – the ongoing care after a therapy program is established – to a therapy assistant.nPhysical and occupational therapists, speech-language pathologists, and other clinicians who directly bill Medicare can review and verify, rather than re-document, information already entered by other members of the clinical team into a patient’s medical record. As a result, practitioners have the flexibility to delegate certain types of care, reduce duplicative documentation, and supervise certain services they could not before, increasing access to care for Medicare beneficiaries.nFor a fact sheet on the CY 2021 Physician Fee Schedule Final rule, please visit click here.nnFor a fact sheet Medicare Diabetes Prevention Program, please click here.nn2021 Physician Fee Schedule and Quality Payment Program final rule, please click here.nnOriginal article published on cms.gov
Dec 2, 2020 | Uncategorized
Medicare payment for COVID-19 vaccines is underway and CMS is currently working to make sure the vaccine is available to all Medicare beneficiaries. Continue reading below to learn more.nnQ: How much will Medicare pay for FDA-approved or emergency use authorized COVID-19 vaccines?nnA: CMS will pay $28.39 to administer a single dose vaccine.nnFor vaccines requiring two or more doses, the agency will pay $16.94 for the first dose and $28.39 for the last dose, according to the CMS toolkit.nnCMS said it hopes to enroll new Medicare providers, including pharmacies and other “mass immunizers” to help bring the vaccine to all Medicare beneficiaries.nnFor more information, see “Note from the instructor: Good news regarding COVID-19 vaccines and treatments,” by Valerie A. Rinkle, MPA, CHRI.nnRevenue Cycle Advisor combines all of HCPro’s Medicare regulatory and reimbursement resources into one handy and easy-to-access portal. News is not just repeated from other sources. It is analyzed by our Medicare experts so professionals can comprehend any new rule and regulatory updates thoroughly.nnComplete and original article published on healthleadersmedia.com
