Jun 12, 2020 | Uncategorized
Changes in E&M coding are important to go over including information regarding prescription drugs. This week’s coding conundrum goes over the parts of the table of risk and medical decision making. Read below to find out more!nnAs 2021 approaches and we think about the changes to evaluation & management (E&M) coding it’s more important than ever to really spend some time to break down what medical decision making (MDM) means and how to assign the correct level.nnMDM consists of 3 individual parts, but often it’s only the table of risk that is considered in choosing a level. Like for instance that if you write a prescription that is an automatic level 4. Wrong!nnIn the example of an established patient with well-controlled hypertension and allergies, they are at the clinic for a routine follow-up and prescription refill. They are feeling well with no other complaints. You review their most recent lab work which is within normal limits, write a prescription for the refill and the patient agrees to follow-up again in 6 months. This would be coded to a level 3, 99213, E&M visit.nnTo break it down, MDM part A would equal two, two stable established problems. MDM part B would equal one, review of lab work. And MDM part C would be of moderate risk for two stable chronic problems and prescription drug management.nnBased on our guidelines in CPT; “To qualify for a given type of decision making, two of three elements in Table 1 must be met or exceeded”. Below is a copy of the table referenced.nn
Table taken from an article by AAFP
Jun 2, 2020 | Uncategorized
The Welter Healthcare Partners team is closely monitoring the payer updates for telehealth as they continue to unfold. Please do not hesitate to contact us if you have any coding or billing issues. Below is updated information regarding COVID-19 Telehealth and billing updates. Click here to download the PDF. n
Payer Updates & Resources: COVID-19 (Coronavirus)
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| Aetna |
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Updated May 20, 2020n
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- Until June 4, 2020, Aetna will waive member cost-sharing for any in-network covered telemedicine visit – regardless of diagnosis – for their Commercial plans.
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- Through September 30, 2020, Aetna is extending all member’s cost-sharing waivers for covered in-network telemedicine visits for outpatient behavioral and mental health counseling services for their commercial plans.
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- Through September 30, 2020, Aetna will offer zero co-pay primary care and behavioral health telemedicine visits with network providers to all Individual and Group Medicare Advantage members
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- For Medicare Advantage plans, effective May 13, 2020, through September 30, 2020, Aetna is waiving member out-of-pocket costs for all in-network primary care visits, whether done in-office and via telehealth, for any reason.
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- Aetna will continue to cover limited minor acute care evaluation and care management services, as well as some behavioral health services rendered via telephone, until August 4, 2020. The member cost-share waivers for medical care for Commercial plans will end on June 4, 2020.n
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- Self-insured programs may opt-out of cost-sharing waivers
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| Anthem |
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Update May 29, 2020n
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- Through at least June 15, 2020, Anthem’s affiliated health plans will waive member cost-share for telehealth visits, including visits for behavioral health, for insured health plans in Colorado.
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- Cost-sharing will be waived for members using Anthem’s authorized telemedicine service, LiveHealth Online, as well as care received from other providers.
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- Through at least June 17, 2020, Anthem’s affiliated health plans will cover telephonic-only visits with in-network providers.n
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- Self-insured programs may opt-out of cost-sharing waivers
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| Cigna |
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Updated May 22, 2020n
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- Through July 31, 2020, Cigna will waive customer cost-sharing related to COVID-19 screening, testing, and treatment.
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- Through July 31, 2020, Cigna will waive customer cost-sharing for telehealth screenings for COVID-19.
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- Through July 31, 2020, Cigna will cover usual face-to-face E/M visits via telehealth, but standard cost-share will apply.n
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- This is applicable for Cigna Commercial, not Cigna MA
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| Humana |
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Updated May 15, 2020n
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- Humana will extend cost-sharing waivers through the end of the year for individual and group Medicare Advantage members. This waiver applies to audio and video telehealth visits with all participating/in-network providers, including primary care, behavioral health, and other specialist providers.
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- As of May 15, 2020, Humana will resume pre-payment medical record claims review and post-payment medical record claims review. This will be a return to the normal Humana policy.
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- As of May 22, 2020, Humana will reinstate authorizations and referrals for required services for Medicare Advantage, Medicaid, and Commercial lines of business. This will be a return to the normal Humana policy.n
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- Humana will continue to suspend all medical authorizations and referrals for COVID related diagnosis
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| Medicare |
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- Medicare (Novitas) will keep COVID-19 related telehealth changes in place for the “duration of the PHE” for services rendered on or after March 1st, 2020.
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- Information from CMS is updated regularly, and timelines will reflect the most recent updates.
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| Medicaid |
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- Health First Colorado (Medicaid) will keep COVID-19 related telehealth changes in place for the duration of the PHE.
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- Services can be provided between a member and a distant site provider when a member is in their home or other location of their choice. Additionally, the distant provider may participate in the telemedicine interaction from any appropriate location.
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- Information from CMS is updated regularly, and timelines will reflect the most recent updates.
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| RMHP |
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Updated April 7, 2020n
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- Through June 18, 2020, RMHP will waive cost-sharing for in-network, non-COVID-19 telehealth visits.
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- Through June 18, 2020, RMHP will reimburse appropriate claims for telehealth services delivered by telephone if delivery is provided through live, interactive audio, and visual transmission.
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| UHC |
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Updated May 22, 2020n
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- Through June 18, 2020, UnitedHealthcare will reimburse appropriate claims for telehealth for dates of service starting March 18, 2020.
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- Through June 18, 2020, UnitedHealthcare is waiving the CMS originating site for Medicare Advantage, Medicaid, and Individual and Group Market health plan members.
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- Through at least September 30, 2020, UnitedHealthcare will cover the full cost share for Medicare Advantage members for applicable services.
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Payer Telemedicine Resources:
nAetna – COVID-19: Provider ResourcesnnAnthem – Information from Anthem for Care Providers about COVID-19nnCigna – Cigna’s Response to COVID-19nnHumana – Provider Resources for COVID-19nnMedicare (Novitas) – Coronavirus COVID-19 InformationnnHealth First Colorado – Telemedicine Provider InformationnnRocky Mountain Health Plans – Telehealth FAQs for ProvidersnnUnitedHealthcare – COVID-19 Information & Resourcesn
Additional Resources:
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nPart B Newsn
nCCHPCA Updatesn
Jun 2, 2020 | Uncategorized
Summer is here and many people are spending more time outside, swimming and taking vacations. It is very important to wear your sunscreen to protect yourself from the sun. Read below for more information from the American Academy of Dermatology about the importance of sunscreen!nnWith the “Official start of summer” (a.k.a Memorial Day) officially past and the reopening of many beloved outdoor activities after the shutdown from COVID-19, it’s more important than ever to remember your sunscreen.nnEspecially after so many of us just spent months indoors. The American Academy of Dermatology (AAD) has a great two-minute video as well as 5 tips for proper sun protection.nnSo get outside, enjoy your favorite activities, and do not forget to apply that sunscreen, it’s finally summer!nnClick here to read more on Sunscreen from the AAD.
May 29, 2020 | Uncategorized
The number of people using telehealth has grown tremendously since the COVID-19 outbreak. Many patients are equally satisfied with virtual encounters rather than their in-person visits to the doctor. Read the article below for more on the survey given to patients regarding telemedicine and what they preferred about their virtual visit.nnThe advent of COVID-19 has fueled the rise of telemedicine, accelerating growth beyond what was even imaginable only three months ago. Along with this phenomenon, a related mystery has been seemingly solved: can patients be as satisfied with virtual interactions as they are with in-person encounters?nnAccording to a new, large-scale Press Ganey survey, that answer is yes. The South Bend, Indiana-based company, known for its patient satisfaction surveys, took a deep look into comparing the two forms of provider-patient interactions and found that “virtual visits can achieve similar ratings for patient experience as in-person visits, with some specific differences in methods of care delivery,” according to a news release.nn“The rapid adoption of telehealth has enabled caregivers to meet the needs of patients with the levels of attentiveness, expertise, and empathy provided during an in-office visit,” said Patrick T. Ryan, chairman, and CEO of Press Ganey. “If caregivers actively adapt their processes and behaviors to the telemedicine environment, they can effectively build the unbreakable bonds of trust that are so critical to patient-centered care.”nnThe survey was conducted over a six-week period concluding at the end of April and includes more than 30,000 responses. During that time respondents reported nearly 70% of their encounters involved a full or mixed virtual medicine component. Mixed visits could have included a combination of video and in-person visits, telephone, email, or text.nn”Based on the data, patients are overwhelmingly positive about their virtual interactions with their care providers, even when technical issues posed challenges,” according to The Rapid Transition to Telemedicine: Insights and Early Trends, issued by Press Ganey. A chart in the report demonstrates tight alignment between patient’s satisfaction scores for virtual or in-person visits when asked about their likelihood of recommending care provider, the provider’s concerns for their questions or worries, efforts to include them in decisions, explanations of problems and conditions, treatment discussions, and “whether the staff worked together to care for you.”nnThe survey also indicates, however, opportunities to improve processes related to telemedicine. For example, ease of scheduling appointments and ease of contacting the provider scored much lower for virtual care versus in-office visits. As a result, patients are less likely to recommend virtual visits to others compared to office encounters.nn”This is not unexpected given the quick, large-scale transition to telemedicine and the learning curve for the provider and the patient,” the report states. “These data highlight opportunities for enhancing the physician-patient connection by addressing technical barriers that impede consistent and reliable communication.”nnThe report suggests several recommendations to help providers enhance the patient experience when conducting virtual visits:n
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- Be genuine and conscious of the warmth conveyed during the opening and closing of each session. Confirm that the patient can hear and see you clearly and avoid interruptions.
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- Set an agenda at the outset. Identify and confirm the patient’s priorities and communicate how they will be addressed.
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- Consistently convey empathy through language. Deliberately check in about patients’ worries or concerns throughout the visit and especially at the end of the session.
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- Bring structure to officially closing out the session. Summarize the post-visit plan, reinforcing patient, and provider actions. Review questions and answers. Offer instructions for follow-up concerns.
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nOriginal article published on healthleadersmedia.com
May 29, 2020 | Uncategorized
This week’s code spotlight highlights the social determinants of health codes that deal with many factors including prescribed medications or a patient’s BMI. Read below for more information on some of the benefits of including social determinants of health in reporting.nnAs the health care industry sees an increase of risk adjustment coding, the importance of correct and accurate ICD-10 coding is continuing to be an area of discussion among the various organizations. Although these codes do not carry an HCC level, from a correct coding standpoint, it is always important to code to the greatest specificity supported by the documentation. Social determinants of health (SDoH) category codes of Z55-Z65 are part of Chapter 21 [Factors Influencing Health Status and Contact with Health Services] which all deal with a wide range of factors from prescribed medications to a patients BMI. As coders, it’s important to not forget to report these codes if they are supported by the documentation. As clinicians, it is important to make sure that these factors are documented when present.nnIn a November 2019 article posted on the American Medical Associations website (aha.org) some of the benefits of including SDoH in their reporting include:n
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- Track the social needs that impact their patients, allowing for personalized care that addresses patients medical and social needs
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- Aggregate data across patients to determine how to focus on a social determinants strategy
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- Identify population health trends and guide community partnerships
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nFor hospitals, this is not a new concept. They have social workers on staff who typically are charged with documentation of these factors. This is why independent practices and outpatient services can begin doing a better job to capture these data points, and making sure our clinical staff are including these important factors in their documentation.nnClick here to read more on the social determinants of health.
May 19, 2020 | Uncategorized
The House approved the Heroes Act in a 208-199 vote. The Heroes Act is a critical $3 trillion-dollar rescue for front line workers, cities, states, and small businesses. Read the article below to learn more about the Heroes Act.nnThe U.S. House late Friday approved a massive, $3 trillion coronavirus spending package that would, among other things, provide a second round of $1,200 stimulus checks, $200 billion in hazard pay for essential workers – including those at Electric Boat shipyards– and extend the federal $600-per-week unemployment benefits for six more months. The Heroes Act, was approved on a 208-199 vote, with the unanimous support of Connecticut’s House members, all Democrats.nnOriginal article published on healthleadersmedia.com
