Aug 12, 2020 | Uncategorized
The Advance Beneficiary Notice of Noncoverage (ABN) is widely used to help out those who will be denied Medicare payments. The renewal deadline has recently been extended as a result of the COVID-19 pandemic. Here you’ll find more information regarding the details of the ABN use extension.nnDue to COVID-19 concerns, CMS is going to expand the deadline for use of the renewed ABN, Form CMS-R-131 (exp. 6/30/2023). At this time, the renewed ABN will be mandatory for use on 1/1/2021. The renewed form may be implemented prior to the mandatory deadline. The ABN form and instructions may be found at cms.gov
Aug 12, 2020 | Uncategorized
The report below describes a patient undergoing spinal surgery. 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 –nnOPERATIVE REPORTnnDATE OF OPERATION: 06/XX/2020nnOPERATING SURGEON: A.K. M.D.nnPREOPERATIVE DIAGNOSES:nC4-5 subluxation with spinal cord compression.nC4-5 anterior cervical osteomyelitis and diskitis.nnPOSTOPERATIVE DIAGNOSES:nC4-5 subluxation with spinal cord compression.nC4-5 anterior cervical osteomyelitis and diskitis.nnOPERATION PERFORMED:nC4 and C5 posterior cervical decompression with resection of epidural phlegmon.nC4-C5 posterior cervical arthrodesis with allograft and autograft.nC4-5 posterior cervical instrumentation with lateral mass screws and rods.nnFIRST ASSISTANT: B. J., P.A.nnANESTHESIA: General.nnDESCRIPTION OF OPERATION: The patient was brought into the operating room. He was intubated. Appropriate lines were placed and he was placed into Mayfield head fixation. Using strict log roll precautions, he was then turned prone onto an OR table with gel rolls going across his chest and across the iliac crest. Arms were tucked after pressure points were padded and he was positioned with his neck in a neutral position slightly extended to try to counteract to the subluxation.nnImmediate C-arm imaging was obtained to ensure good positioning. The midline neck was now shaved, prepped, and draped and surgery was begun.nnIncision was marked out over the midline what was felt to be the C4 and C5 spinous processes. Incision was made and carried down through the subcutaneous tissues remaining in the median raphe until the spinous processes were identified.nnC-arm was brought back in to positively identify the C4 and C5 levels. We now continued exposure until we had exposed from inferior C3 to superior C6 encompassing the lateral masses bilaterally of C4 and C5. We first performed the instrumentation using a drill guide and drill with C-arm to guide angle of trajectory. Standard landmarks were used to place lateral mass screws, that is the lateral mass was bisected both in a rostral-caudal and left-right fashion and the entry point 1 mm inferior and lateral was chosen. We then angled approximately 5 to 10 degrees laterally. Rostrally, the angle for the screws was determined by the C-arm. 14 mm pilot hole was drilled and then sounded with a ball probe to make sure we had not perforated, following which the 14 mm polyaxial lateral mass screws were placed. This was done into the bilateral C4 and bilateral C5 lateral masses.nnWe now decorticated. The curette was used to curette out the facet at C4-5, both the inferior articulating facet of C4 and the superior articulating facet of C5 bilaterally. We additionally used the drill to drill the lateral lamina that remained after decompression and a combination of allograft and autograft, which had been harvested with the decompression, were used to fill the facet and do an onlay lateral laminar arthrodesis.nnPrior to the arthrodesis, the decompression was done. Leksell rongeur was used to remove the spinous process of C4 and C5 as well as the lamina, which was further removed with Kerrison rongeurs. The lamina was thinned using the high- speed drill and ligamentum flavum was also removed from the C3-4, C4-5, and C5-6 interspaces.nnOf note, there was an organized vascular collection, which was unusual to see at the level of C4-5. This may have been inflammatory reaction to the infection on the opposite side. Although no clear infection was seen, this phlegmon was adhesed to the dura and had to be removed as a separate piece. It was sent half of it to pathology and half of it to microbiology for evaluation. We also took cultures in this area.nnOnce the decompression was completed, arthrodesis was done as mentioned and finally, the instrumentation was completed by placing rods into the lateral mass screws, which were then affixed with set screws and final tightening done.nnWe now thoroughly irrigated. Bleeding was controlled with Floseal, bipolar, and Bovie as well as bone wax to the bleeding bone edges. Given the patient’s renal failure and cirrhosis and low starting hematocrit, we elected to place a drain, which was tunneled out a separate incision. Finally, the wound was closed in multiple layers, first closing the cervical fascia with interrupted 0 Vicryl sutures, placing some inverted 2-0 and 3-0 Vicryl sutures and then staples were applied to the skin. Wound was cleaned, dressed with Telfa, 4x4s, and Tegaderm. The patient then turned back supine, placed back into a C-collar, extubated, and sent to the recovery room. Estimated blood loss was 20 to 25 cc. Sponge and needle counts were correct. There were no complications.nnSPECIMEN SENT: Epidural phlegmon, half to pathology, half to microbiology and cultures were also obtained.
Aug 5, 2020 | Uncategorized
CMS proposed changes to expand telehealth which would improve healthcare in rural areas. The proposal will also ensure proper reimbursement times and other important changes. Read the article below for more information on this important update.nnTrump Administration Proposes to Expand Telehealth Benefits Permanently for Medicare Beneficiaries Beyond the COVID-19 Public Health Emergency and Advances Access to Care in Rural AreasnnThe Centers for Medicare & Medicaid Services (CMS) is proposing changes to expand telehealth permanently, consistent with the Executive Order on Improving Rural and Telehealth Access that President Trump signed today. The Executive Order and proposed rule advance our efforts to improve access and convenience of care for Medicare beneficiaries, particularly those living in rural areas. Additionally, the proposed rule implements a multi-year effort to reduce clinician burden under our Patients Over Paperwork initiative and to ensure appropriate reimbursement for time spent with patients. This proposed rule also takes steps to implement President Trump’s Executive Order on Protecting and Improving Medicare for our Nation’s Seniors and continues our commitment to ensure that the Medicare program is sustainable for future generations.nnExpanding Beneficiary Access to Care through Telehealth nnOver the last three years, as part of the Fostering Innovation and Rethinking Rural Health strategic initiatives, CMS has been working to modernize Medicare by unleashing private-sector innovations and improve beneficiary access to services furnished via telecommunications technology. Starting in 2019, Medicare began paying for virtual check-ins, meaning patients across the country can briefly connect with doctors by phone or video chat to see whether they need to come in for a visit. In response to the COVID-19 pandemic, CMS moved swiftly to significantly expand payment for telehealth services and implement other flexibilities so that Medicare beneficiaries living in all areas of the country can get convenient and high-quality care from the comfort of their home while avoiding unnecessary exposure to the virus. Before the public health emergency (PHE), only 14,000 beneficiaries received a Medicare telehealth service in a week while over 10.1 million beneficiaries have received a Medicare telehealth service during the public health emergency from mid-March through early-July. For more information on Medicare’s unprecedented increases in telemedicine and its impact on the health care delivery system, visit the CMS Health Affairs blog here.nnAs directed by President Trump’s Executive Order on Improving Rural and Telehealth Access, through this rule, CMS is taking steps to extend the availability of certain telemedicine services after the PHE ends, giving Medicare beneficiaries more convenient ways to access healthcare particularly in rural areas where access to healthcare providers may otherwise be limited Improving Rural and Telehealth Access.nn“Telemedicine can never fully replace in-person care, but it can complement and enhance in-person care by furnishing one more powerful clinical tool to increase access and choices for America’s seniors,” said CMS Administrator Seema Verma. “The Trump Administration’s unprecedented expansion of telemedicine during the pandemic represents a revolution in healthcare delivery, one to which the healthcare system has adapted quickly and effectively. Never one merely to tinker around the edges when it comes to patient-centered care, President Trump will not let this opportunity slip through our fingers.”nnDuring the public health emergency, CMS added 135 services such as emergency department visits, initial inpatient and nursing facility visits, and discharge day management services, that could be paid when delivered by telehealth. CMS is proposing to permanently allow some of those services to be done by telehealth including home visits for the evaluation and management of a patient (in the case where the law allows telehealth services in the patient’s home), and certain types of visits for patients with cognitive impairments. CMS is seeking public input on other services to permanently add to the telehealth list beyond the PHE in order to give clinicians and patients time as they get ready to provide in-person care again. CMS is also proposing to temporarily extend payment for other telehealth services such as emergency department visits, for a specific time period, through the calendar year in which the PHE ends. This will also give the community time to consider whether these services should be delivered permanently through telehealth outside of the PHE.nnPrioritizing Investment in Preventive Care and Chronic Disease ManagementnnUnder our Patients Over Paperwork initiative, the Trump Administration has taken steps to eliminate burdensome billing and coding requirements for Evaluation and Management (E/M) (or office/outpatient visits) that makeup 20 percent of the spending under the Physician Fee Schedule. These billing and documentation requirements for E/M codes were established 20 years ago and have been subject to longstanding criticism from clinicians that they do not reflect current care practices and needs. After extensive stakeholder collaboration with the American Medical Association and others, simplified coding and billing requirements for E/M visits will go into effect January 1, 2021, saving clinicians 2.3 million hours per year in burden reduction. As a result of this change, clinicians will be able to make better use of their time and restore the doctor-patient relationship by spending less time on documenting visits and more time on treating their patients.nnAdditionally, last year, the Trump Administration finalized historic changes to increase payment rates for office/outpatient E/M visits beginning in 2021. The higher payment for E/M visits takes into account the changes in the practice of medicine, recognizing that additional resources are required of clinicians to take care of the Medicare patients, of which two-thirds have multiple chronic conditions. The prevalence of certain chronic conditions in the Medicare population is growing. For example, as of 2018, 68.9% of beneficiaries have 2 or more chronic conditions. In addition, between 2014 and 2018, the percent of beneficiaries with 6 or more chronic conditions has grown from 14.3% to 17.7%.nnIn this rule, CMS is proposing to similarly increase the value of many services that are comparable to or include office/outpatient E/M visits such as maternity care bundles, emergency department visits, end-stage renal disease capitated payment bundles, physical and occupational therapy evaluation services and others. The proposed adjustments, which implement recommendations from the American Medical Association, help to ensure that CMS is appropriately recognizing the kind of care where clinicians need to spend more face-to-face time with patients, like primary care and complex or chronic disease management.nnBolstering the Healthcare Workforce/Patients Over PaperworknnCMS is also taking steps to ensure that healthcare professionals can practice at the top of their professional training. During the COVID-19 public health emergency, CMS announced several temporary changes to expand workforce capacity and reduce clinician burden so that staffing levels remain high in response to the pandemic. As part of its Patients over Paperwork initiative to reduce regulatory burden for providers, CMS is proposing to make some of these temporary changes permanent following the PHE. Such proposed changes include nurse practitioners, clinical nurse specialists, physician assistants, and certified nurse-midwives (instead of only physicians) to supervise others performing diagnostic tests consistent with state law and licensure, providing that they maintain the required relationships with supervising/collaborating physicians as required by state law; clarifying that pharmacists can provide services as part of the professional services of a practitioner who bills Medicare; allowing physical and occupational therapy assistants (instead of only physical and occupational therapists) to provide maintenance therapy in outpatient settings; and allowing physical or occupational therapists, speech-language pathologists and other clinicians who directly bill Medicare to review and verify (sign and date), rather than re-document, information already entered by other members of the clinical team into a patient’s medical record.nnPublic comments on the proposed rules are due by October 5, 2020.nnFor a fact sheet on the CY 2021 Physician Fee Schedule proposed rule, click here.nnFor a fact sheet on the CY 2021 Quality Payment Program proposed rule, click here.nnFor a fact sheet Medicare Diabetes Prevention Program, click here.nnTo view the CY 2021 Physician Fee Schedule and Quality Payment Program proposed rule, click here.nnOriginal article published on CMS.govnn
Aug 5, 2020 | Uncategorized
As we move closer to 2021 and our new E/M guidelines, now is the perfect time to educate our clinicians on the importance of documenting their encounters to include medical necessity.nnIn the January 2020 issue of CMS MLN on Evaluation & Management under the General Principles of E/M Documentation, we see this guidance; Clear and concise medical record documentation is critical to providing patients with quality care and is required for you to receive accurate and timely payment for furnished services. Medical records chronologically report the care a patient received and record pertinent facts, findings, and observations about the patient’s health history. Medical record documentation helps physicians and other health care professionals evaluate and plan the patient’s immediate treatment and monitor the patient’s health care over time.nnThe key here is “record pertinent facts, findings, and observations” and the big word that we as auditors focus on most is pertinent. So often we see clinicians mark review of systems as “negative”, what is pertinent with a mark of negative? How does this tell us pertinent facts about the patient presentation of help to tell the story about how the patient is feeling?nnMoving forward, the nature of the presenting problem will become more pertinent to our coding and we will be seeing far less emphasis on things like counting ROS statements or physical exam elements. CMS will re-release their MLN next year on Evaluation and Management so be sure to make sure you are getting these updates as they become available.nnFor more information on the evaluation management guide, click here.
Jul 29, 2020 | Uncategorized
Last week, members of the House of Representatives Telehealth Caucus introduced the bipartisan Protecting Access to Post-COVID-19 Telehealth Act. Check out the article below for 7 things to consider with this new Telehealth legislation. nnThe legislation “seeks to expand the use of telehealth beyond the current national health crisis, including permanently eliminating obsolete geographic originating site restrictions,” according to the American Telemedicine Association (ATA).nnAs this legislative initiative moves forward, what do health systems, hospitals, and providers need to consider? Seema Verma, administrator of the Centers for Medicare & Medicaid Services (CMS); ATA; the Healthcare Information and Management Systems Society (HIMSS); and experts at other organizations are weighing in with insights and predictions. Here’s a look at the current zeitgeist:nn1. IS THE PROPOSED HOUSE LEGISLATION ENOUGH?nThe proposed legislation addresses most priorities outlined in a June 29 letter to Congress signed by the ATA and 340 national and regional organizations last month, urging Congress to make telehealth flexibilities created during the COVID-19 pandemic permanent, according to a statement issued by the telehealth association. These priorities include:n
n
- Removing geographic restrictions and allowing the patient’s home as an originating site
n
- Maintaining and enhancing the Department of Health and Human Services’ (HHS) authority to determine appropriate telehealth services and providers
n
- Ensuring Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) can continue to furnish telehealth
n
- Making HHS’ temporary waiver authority for future emergencies permanent
n
n”This legislation is an important step towards breaking down discriminatory geographic restrictions and modernizing our healthcare delivery system,” said ATA CEO Ann Mond Johnson.nn2. EVALUATING THE CLINICAL APPROPRIATENESS OF TELEHEALTHnIn a Health Affairs blog written by Verma and published on July 15, the CMS administrator said, “First, it is important to assess whether the mode of telehealth service delivery is clinically appropriate and safe for patients, as compared to an in-person visit.” For example, before the declared public health emergency, CMS restricted telemedicine visits to patients who already had an established relationship with a practitioner. To reduce exposure risks, those limitations were then lifted to encompass new patients. “As the health care system enters a new normal,” Verma writes, “it is important to consider whether allowing people with particularly acute needs to be seen by a clinician for the first time via telemedicine, instead of in-person, will result in the best possible outcomes.”nn3. WILL PARITY PAYMENT CONTINUE?nDuring the public health emergency, Medicare has reimbursed providers the same rate for telehealth visits as it would pay for in-person visits. One question on many minds is whether this practice will continue.nnIn her blog post, Verma said, “Further analysis could be done to determine the level of resources involved in telehealth visits outside of a public health emergency, and to inform the extent to which payment rate adjustments might need to be made.” She cited both savings and increased costs related to telehealth. “For example,” Verma wrote, “supply costs that are typically needed to enable safe in-person care (e.g., patient gowns, cleaning, or disinfectants) and built into the in-person payment rate are not needed in a telehealth visit. On the other hand, there are new processes that clinicians must create for telehealth visits, with associated costs.”nnThe surge in telehealth activity during the pandemic should provide ample data to evaluate its effectiveness, said Tom Leary, vice president of government affairs for HIMSS, during a media briefing on July 16. Through April, Medicare beneficiaries experienced 1.7 million telehealth visits. “That’s plenty enough data now for the CBO [Congressional Budget Office] to be able to really, truly understand the impact … as well as the potential cost savings or cost drivers,” he said.nn”Clearly, CMS is not going to want to increase their spend,” said Domenic Segalla, principal, healthcare advisory services, of tax advisory company, Withum, during the same HIMSS briefing. “This is something that they’re really going to dig into to see what the current rate will be going forward and the impact on both outcomes and healthcare spend,” he said.nn”We work a lot with large health systems, independent hospitals, and even physician groups,” said Segalla. “The one thing that is clear from all of the providers and health systems is they do not believe they can go back [in time].”nn4. LICENSURE ACROSS STATE LINESnTemporary waivers have enabled Medicare providers to practice across state lines during the public health emergency, said Leary, while each state had to apply for similar exceptions for Medicaid. While there is a movement to continue these endeavors moving forward, endorsed by organizations such as the American Nursing Association and the American Medical Association, the process is complicated, said Leary. “I don’t think that’s as high on the priority list as some of the other waivers,” he said.nnMedicare will look to Congress to help them solve the issue, Leary predicted, and Medicaid will continue to work with states on individual requests.nn5. THE IMPACT OF FRAUDnCMS is closely examining fraud as it relates to telehealth, said Leary. ” The last thing we want … is for bad actors to spoil what has been a very positive experience [with telehealth} during the pandemic,” he said.nnFraudulent practices, according to Verma, might include practitioners who offer shorter telehealth visits to maximize payment, or bill more visits than are possible in a day. “It is vital that beneficiaries and taxpayer dollars are protected from unscrupulous actors,” she wrote. CMS is examining data from many angles, including monitoring program integrity. “We know the path forward to expanding telehealth relies on CMS addressing the potential for fraud and abuse in telehealth, as we do with all services,” she said.nn6. INCENTIVES TO INVEST IN TELEHEALTH TECHNOLOGYnBecause telehealth requires an investment in technology, Bill Kinney, CPA, senior manager at Withum, who also spoke at the HIMSS press briefing, suggested that it might be necessary to create incentives to encourage technology expenditures.nn”In order to incentivize this … what other parts and pieces of legislation unrelated to this could be put into place?” he asked. “Is there a way to incentivize health groups, physician groups, or anyone to invest in the technology that might be necessary?” He mentioned accelerated depreciation as one approach that would enable organizations to expense things immediately, as opposed to depreciating over a specified period of time. “There are a lot of opportunities there,” he said.nnChris Cooper, managing director of the BDO Center for Healthcare Excellence and Innovation, which is part of the accounting group BDO USA, suggests that perhaps a new form of legislation could be enacted to encourage adoption of telehealth that would work similarly to the way meaningful use provide incentives for providers to adopt EMRs. During the transitional phase, incentives would be provided to close any gaps between in-person and virtual visit reimbursement.nn7. LEGISLATION TO EXPAND BROADBAND SERVICESnThe pandemic has exposed inequities in access to healthcare, said Leary. “We’ve certainly seen anecdotal issues around minority and rural communities having less access because there isn’t as much broadband exposure.” As a result, he said he anticipates Congress may address this dilemma possibly by providing additional funding for broadband services in these areas.nnOriginal article published on healthleadersmedia.com
Jul 29, 2020 | Uncategorized
We have all seen water bottles with times listed on the sides reminding you to continue drinking water throughout the day. As you spend time outside this summer and temperatures continue to increase, staying hydrated is just as important as wearing your sunscreen.nnDo you know the warning signs that you are dehydrated? Spend just a moment on an internet search and there are more articles about this topic then you will have the desire to read.nnHere are some signs to be aware of, it might just be your body telling you it needs more water. The first symptoms of dehydration include thirst, darker urine, and decreased urine production. As the condition progresses to moderate dehydration, symptoms include:n
n
- Dry mouth or bad breath
n
- Lethargy
n
- Weakness in muscles or muscle cramps
n
- Headache
n
- Dizziness
n
- Dry or flushed skin
n
- Fever and chills
n
- Food cravings, especially for sweets
n
nHere are just a few quick-read articles on the importance of hydration:nneverydayhealth.comnnmedicalnewstoday.com
