Five Heart-Healthy Exercises You Can Do at Your Desk

Feb 27, 2020 | Uncategorized

February is Heart Health Awareness Month, so we all wear red and talk about our hearts, but what are we doing every day to make sure we are keeping it healthy? How many hours each day, week, month do we each spend at our desks without so much as a break to get water? If you’re like us, we can sit at our desks for hours on end. So next time you open a different patient chart, or are waiting for a webinar to start or a webpage to load, here are a few exercises you can do right at your desk to promote heart health.nnJust because you’re at the office, that doesn’t mean you can’t incorporate some desk exercises to keep your cardiovascular health on track. Short bouts of exercise between conference calls and checking emails will help improve fitness levels and heart health while burning a few extra calories. In addition, a minimal amount of extra activity can help limit additional weight gain.n

Trump Administration Details Hospital Spending Plans in FY21 Proposed Budget

Feb 19, 2020 | Uncategorized

The Trump Administration has released their healthcare spending proposal for FY21. These plans are said to foster cost transparency, break down barriers impeding choice and competition, and reduce regulatory burdens. Read the article below to learn more about the Trump Administrations hospital spending plans for FY21.n

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• Hospitals cuts proposed in the FY21 budget include $117 billion in site-neutral payment cuts for on-campus hospital outpatient departments (HOPDs).

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• Hospitals would lose $87.9 billion over 10 years from limits on bad debt payment increases.

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• Hospitals would lose $47.2 billion from site-neutral payment policies for off-campus HOPDs.

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nIn what could be a 2021 preview if Republicans take control of Congress and retain the White House, the Trump administration included a range of sweeping healthcare policy proposals targeting hospitals in this week’s release of its proposed budget.nnThe Trump administration’s FY21 budget proposal emphasizes healthcare policies that would foster cost transparency, break down barriers impeding choice and competition, and reduce regulatory burdens.nnAlthough the current Congress may ignore the budget, the proposals could come back as last-minute funding sources for big budget packages or as part of major healthcare policy changes in the next Congress.nnThe budget projected savings of $844 billion over 10 years through implementation of a “Health Reform Vision Allowance,” which entailed:n

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• Reforming Medicare’s primary care service payments

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• Implementing a value-based purchasing program for hospital outpatient departments (HOPDs), ambulatory surgical centers and post-acute care facilities

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• Offering incentives to improve quality and health outcomes

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nProposed healthcare funding levelsnnThe Centers for Medicare & Medicaid Services (CMS) is projected to spend $1.2 trillion in FY21, or $47.6 billion more than in FY20. The budget proposes $1.6 trillion in CMS spending cuts over the next decade. Those cuts include $756 billion to Medicare over 10 years, which is projected to extend the Hospital Insurance Trust Fund by 25 years.nnThe budget also includes $920 billion in Medicaid cuts over 10 years, in part through increased eligibility enforcement and anti-fraud measures.nnThe budget would provide $5.7 billion for the 1,400 community health centers, which operate more than 12,000 care delivery locations and serve more than 28 million patients.nnHospital revenue would be significantly affectednnThe budget includes policies that would directly affect hospital revenue in widely varying ways, including:n

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• Limiting uncompensated-care bad debt payment increases to the consumer price index for all urban consumers (87.9 billion in savings over 10 years)

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• Requiring site-neutral payments between on-campus HOPDs and physician offices for services, such as clinic visits, commonly provided in nonhospital settings ($117 billion in savings)

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• Eliminating Medicare bad debt payments for disproportionate share eligible hospitals, exempting rural hospitals ($33.6 billion in savings)

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• Requiring all off-campus HOPDs to be paid under the Physician Fee Schedule ($47.2 billion in savings)

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• Allowing increased Medicaid copayments for nonemergency use of emergency departments ($1.8 billion in savings)

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nThe bad debt payment cuts would principally hit urban safety-net hospitals, said Chad Mulvany, a director of healthcare financial practices with HFMA.nnMeanwhile the site-neutral payment cuts would “blow teaching hospitals out of the water,” Mulvany said.nnAmong savings to Medicare more broadly, the budget projects that already-implemented changes to payment arrangements for Medicare accountable care organizations will save $2.9 billion over 10 years.nnPotential good news for hospitalsnnAmong the administration’s priorities is reducing the regulatory burden for providers. The Department of Health and Human Services (HHS) touted a reduction of $25.7 billion in regulatory burdens between FY17 and FY19.nnThe administration aims to add to that amount by requiring regulators to:n

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• By August 2020, issue finalized regulations on processes and procedures for issuing guidance documents

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• By the end of February 2021, establish a single, searchable database on the HHS website that contains, or links to, all of the agency’s guidance documents currently in effect

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nThe budget proposes medical liability reforms that would save HHS $27.2 billion and the federal government $40.3 billion over 10 years. Those reforms include capping awards for noneconomic damages at $250,000, indexed to inflation.nnAnother proposal would consolidate the four hospital quality payment programs in the form of a 5% payment cut that hospitals could earn back.nnThe budget would risk-adjust payments to HOPDs and ambulatory surgical centers based on the severity of patients’ diagnoses, in a budget-neutral manner.nnA value-based purchasing program for HOPDs and ambulatory surgical centers would be implemented, with 2% of payments tied in a budget-neutral manner to performance on quality and outcome measures.nnFor primary care physicians, the budget would create a risk-adjusted monthly Medicare Priority Care payment for providers who are eligible to bill for evaluation and management services and who provide ongoing primary care to Medicare beneficiaries. That payment would be funded by a 5% cut to all nonprimary care services and procedures.nnThe budget would eliminate the requirement that physicians certify all patients at critical access hospitals (CAHs) who are reasonably expected to be discharged or transferred within 96 hours of admission.nnCAHs could voluntarily convert to an emergency hospital that does not maintain inpatient beds, while receiving the same Medicare payment rates as other emergency departments, plus an additional payment to assist with capital costs.nnImpacts on bundled payments and other value-based payment policiesnnA major cut in the budget that was not targeted at hospitals but could directly affect their performance in value-based payment models was the $101 billion in 10-years savings from the establishment of a unified post-acute care payment system across all four post-acute care settings, including long-term care hospitals.nnSuch cuts could eliminate the source of nearly all of the savings obtained by hospital-led bundled payment participants, Mulvany noted.nn”If you suddenly go site-neutral on post-acute care, I don’t know why I join joint bundles, or really any bundle; there’s no savings there at that point,” Mulvany said about how hospital finance leaders might perceive such a change.nnThe budget would incentivize participation in advanced alternative payment models (APMs) by eliminating the participation thresholds needed for physicians to qualify for the 5% APMs bonus.nnIn another proposed tweak to the physician payment system, the budget would alter the Merit-based Incentive Payment System (MIPS) to assess performance at the group practice level instead of the individual-clinician level during the performance period, to reduce physician reporting burdensnnStriving to shore up rural hospitalsnnRural providers were a big focus of the administration’s budget.nnThe administration aims to build on its 2019 temporary increase in the wage index for hospitals in low-wage areas, which are primarily rural hospitals, with a proposed pilot to implement further changes to the Medicare inpatient hospital wage index.nnThe budget also would build on the expanded use of telehealth for Medicare Advantage plans with a comprehensive package to promote rural access to care and telehealth in Medicare fee-for-service.nnRural hospitals would be exempted from the proposed site-neutral payment cut to on-campus HOPDs.nnA new Medicare prospective payment system would be established for rural health clinics, with annual updates based on a market basket derived from cost report data and rebased periodically. Those changes would save an estimated $1.8 billion over 10 years.nnRural health clinics and federally qualified health centers could become distant-site providers for Medicare telehealth and be paid at a composite rate similar to that for comparable telehealth services under the Medicare Physician Fee Schedule.nn340B targeted with oversightnnThe budget would increase scrutiny of the 340B discount drug program, which is used by about 12,000 safety-net hospitals and clinics. A new $34 million oversight initiative for 340B would be established, funded in part by a new user fee based on 340B sales.nnAnti-fraud initiatives includednnThe administration said it cut the Medicare fee-for-service improper payment rate to 7.25%, the lowest since 2010, and projected that continued savings from anti-fraud program changes will provide another $31.4 billion over 10 years.nnThe budget would garner $20 million over the decade through new administrative fees for filing Medicare appeals, which the administration said is needed due to the filing of “non-meritorious appeals.”nnThe package of program-integrity legislative proposals is projected to improve payment accuracy, enhance provider and program oversight, reduce improper payments and support law enforcement.nnOriginal article published on hfma.org

Denial Rates for Modifiers 76, 77 & 91

Feb 19, 2020 | Uncategorized

In a recent release of 2018 benchmarks regarding modifiers 76, 77 and 79, the data of payment vs denials is staggering. For instance, a total of 159 codes reported with 91 and 249 codes that were reported using modifier 77 all had a 100% denial rate. Compared to the 952 codes that were denied when reported with 76 that doesn’t seem so bad. But considering your bottom line and the time it takes your team to resubmit it adds up to money lost. nnHowever when we step back and look at the big picture we see that modifier 76 although the most reported, still had the lowest overall denial rate at just 5%.n

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n nnWatching your reporting trends and utilizing billing reports will help make sure you avoid costly denials. Be aware of National Baselines for your specialty and where you fall within them.

2021 E/M Changes – Start Planning Today!

Feb 14, 2020 | Uncategorized

2021 brings us monumental changes to Evaluation and Management coding and reporting!  Notable changes will include: Deletion of CPT code 99201, new time reporting guidelines and modifications to criteria for medical decision-making.

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The new guidance also includes a revision to the work relative value units (RVU) for E/M office visits to match up with the AMA’s RVU Update Committee revised rates and increases total payments for most office codes.

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It is important to start planning your transition and training today so your practice is not at risk for delayed or lost revenue.  To support your transition and training needs, we have developed the CHIEF Implementation Plan for 2021 E/M Changes!  Click here for more details and contact us to get started!

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Ortho Note -Incomplete Diagnosis

Feb 14, 2020 | Uncategorized

As Risk Adjustment (RA) and Hierarchical Condition Category (HCC) coding continue to grow and become common practice it is important for not just coders, but also our clinicians to recognize its importance and the effect it has on reimbursement. Below is an example of a procedure and notes regarding coding and why our clinician must be queried in order for the claim to be submitted. Do 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. – Click Here to Submit Redacted Surgery Case Study –nnDATE OF SURGERY: XX/XX/19n

PREOPERATIVE DIAGNOSIS: Left foot necrosis, as well as heel ulcer. PROCEDURES:

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1. Left foot transmetatarsal amputation.

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2. Left foot heel debridement, extensive.

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nNOTE:   Documentation gives the impression that PT may have DM.  Per correct coding guidelines, in order to code for peripheral vascular disease, we need to know if this is in relation to a Dx of diabetes mellitus as it effects code selection.  Also, in order to code for heel debridement, surface area and depth must be documented (code 11043 can be reported and possibly 11046 if applicable).nnPOSTOPERATIVE DIAGNOSIS: Same.nnASSISTANT: A. SMITH, SA-C. nnANESTHESIA: Peripheral nerve block with MAC. ESTIMATED BLOOD LOSS: 25 mL.nnINTRAVENOUS FLUIDS: One L crystalloid. SPECIMENS REMOVED: Foot sent to path. COMPLICATIONS: None.nnDISPOSITION: To recovery room in good condition.nnFINDINGS: The patient was found to have left near full-thickness heel ulcers with no exposed bone. She also had necrosis of the entire forefoot.nnINDICATIONS: This is a 55-year-old female, with extensive peripheral vascular disease, who was deemed a surgical candidate for the stated procedure. Risks and benefits were discussed at length with the patient, including, but not limited to, infection, bleeding, neurologic injury, vascular injury, pain, stiffness, a possible need for further surgery. I personally marked the patient’s operative extremity prior to proceeding forth to the operating room.nnOPERATIVE REPORT: The patient was brought to the operating room on a gurney. She underwent peripheral nerve block per the anesthesia service. She was placed in the supine position and underwent MAC anesthesia. The left lower extremity was sterilely prepped and draped, using pure alcohol scrub and ChloraPrep.nnFollowing timeout confirming the correct patient, procedure, and extremity, the heel ulcer wounds were debrided. These were through the fascial layer, but not down to the bone. These were debrided back to bleeding tissue.nnWe then performed a transmetatarsal amputation by making a skin incision along viable skin. The subcutaneous tissues were stripped back to a planned osteotomy site with an oscillating saw. There was osteotomy performed along the proximal metatarsals. The specimen was sent to the path lab. We then checked for bleeding. There was bleeding at this level. This was irrigated out with 3 L normal saline mixed with bacitracin. Then with no tension, the plantar fat pad was repaired to the metatarsals. The skin was closed with 2-0 Monocryl and 2-0 nylon along with no tension. A sterile dressing was placed. The patient was then extubated and brought to the recovery room, with no further complications.nnPlease note that A. SMITH, SA-C, a skilled surgical assist, was an absolute requirement due to the complexity of this procedure. He did participate in wound exposure, retraction, and closure at the conclusion of the case.

President Trump Defends Price Transparency Rule at State of the Union

Feb 7, 2020 | Uncategorized

During the State of the Union address, President Trump discussed the price transparency rule and slammed Medicare for all. Below are some of the main points President Trump made during the speech which included drug pricing plans, association health plans, and more. Read below for more information!nnPresident Donald Trump delivered his third State of the Union address Tuesday night, elaborating on several of the administration’s major healthcare initiatives.nnUnlike his previous two State of the Union speeches, Trump mainly avoided discussing the Affordable Care Act and instead focused on new policies like the administration’s price transparency rule and efforts to lower prescription drug prices.nnTrump also did not discuss the Health Adult Opportunity initiative, which was announced by the Centers of Medicare & Medicaid Services (CMS) last week.nnHe did criticize proposals to institute a ‘Medicare for All’-style system, which has been embraced by several Democratic presidential candidates.nn”To those watching at home tonight, I want you to know we will never let socialism destroy American healthcare,” Trump said.nnBelow are the healthcare policies discussed during Trump’s speech, including reaction from industry stakeholders to his remarks.nnPotential impact of price transparency rulennTrump heralded the administration’s price transparency rule, which will go into effect in 2021, saying it will save families “massive amounts of money for substantially better care.”nnHe also added that experts believe the rule, which is being challenged in a lawsuit by provider organizations, “will be even bigger than healthcare reform.”nnOn the topic of improved price transparency, Trump said patients should never be “blindsided” by medical bills but did not address the issue of surprise medical billing, which has stalled on Capitol Hill in recent months.nnOffensive against Medicare for AllnnTrump attacked Medicare for All proposals that have been put forward by congressional leaders, warning that such policies will “take away your healthcare, take away your doctor, and abolish private insurance entirely.”nn”132 lawmakers in this room have endorsed legislation to impose a socialist takeover of our healthcare system, wiping out the health insurance plans of 180 million very happy Americans,” Trump said.nnIn addition to his critiques of Medicare for All, Trump assailed California Governor Gavin Newsom’s recent proposal to extend public healthcare coverage to undocumented immigrant seniors.nn”These proposals would raid the Medicare benefits of our seniors and that our seniors depend on while acting as a powerful lure for illegal immigration,” Trump said.nnCalls on Congress for bipartisan drug pricing plannnOn the prescription drug front, Trump highlighted the administration’s challenge to the pharmaceutical industry and pointed to the record number of generic drugs to receive approvals from the Food and Drug Administration last year.nnHe said that last year marked the first time in 51 years that prescription drug prices went down but added that Congress can do more to lower prescription drug prices.nnTrump specifically referenced conversations he has had with Senate Finance Chairman Chuck Grassley, R-Iowa, who recently told Stat News that Trump has not advocated enough for a bipartisan drug pricing bill he coauthored with Ranking Member Sen. Ron Wyden, D-Ore.nn”I am calling for bipartisan legislation that achieves the goal of dramatically lowering prescription drug prices,” Trump said. “Get a bill on my desk, and I will sign it into law immediately.”nnSome Democratic House representatives vocally rebuked Trump’s points on drug pricing, expressing support for the Elijah E. Cummings Lower Drug Costs Now Act, which passed in the chamber in December.nnPraise for association health plansnnTrump mentioned the administration’s move to introduce association health plans (AHP), saying the options are “60% less expensive, and better” than other available forms of coverage.nn”A good life for American families also requires the most affordable, innovative, and high-quality health system on Earth,” Trump said.nnTrump did not mention the ruling by a federal judge last spring that blocked key provisions of AHPs and the administration’s subsequent decision to file an appeal.nnProtect Medicare and patients with pre-existing conditionsnnDespite not mentioning the ACA, or its uncertain status due to a pending legal battle, Trump promised to protect patients with pre-existing conditions.nn”I have also made an ironclad pledge to American family: We will always protect patients with preexisting conditions,” Trump said.nnHe added that the administration will “always protect” Medicare.nnTrump also reiterated the administration’s commitment to improving kidney care and eradicating HIV by 2030.nnIndustry reaction to speechnnFollowing the address, stakeholders weighed in on the president’s remarks, expressing both support and criticism of the administration’s direction on healthcare policy.nnElizabeth Mitchell, CEO of the Pacific Business Group on Health, told HealthLeaders that business leaders are primarily concerned about policy proposals that ensure drugmakers, payers, and providers “don’t use anti-competitive practices to gain market power and raise prices.”nn“Employers are fed up with high drug costs and high healthcare costs generally,” Mitchell said in a statement to HealthLeaders. “They’re doing everything they can to be effective purchasers on behalf of their employees, but they don’t have adequate negotiating leverage with monopoly drug manufacturers. We need policymakers to stop manufacturers from egregious pricing and anti-competitive practices.”nnRep. Greg Walden, R-Ore., Ranking Member on the House Energy and Commerce Committee, said he had not seen a president “lean in further” on “lowering health care costs.”nn”President Trump is committed to driving down the cost of unaffordable prescription drugs; he is committed to helping American families. This stands in stark contrast to the command and control view of many in the Democratic Party today,” Walden said in a statement.nnContrasting Walden’s remarks, Rep. Lloyd Doggett, D-Texas, Chairman of the House Ways and Means Committee, said Trump has “failed to do anything to actually lower prices for anyone.”nn”Instead of slashing prices, Trump slashes Americans’ healthcare. He seeks to terminate Affordable Care for millions, end protections for patients with pre-existing conditions, and wreck Medicaid, while promoting ‘junk insurance’ and claiming to have a secret replacement plan,” Doggett said in a statement.nnThe Campaign for Sustainable Rx Pricing (CSRxP), which includes America’s Health Insurance Plans and the American Hospital Association as members, tweeted its approval of Trump’s call for a plan to lower prescription drug prices.nn”President @realDonaldTrump is right to call on Congress to lower #drugprices and hold #BigPharma accountable,” CSRxP tweeted. “The American people are watching to see if lawmakers can rise above politics and the influence of #BigPharma to pass bipartisan, market-based drug pricing solutions.”nnJack O’Brien is the finance editor at HealthLeaders, a Simplify Compliance brand.nnOriginal article published on healthleadersmedia.com