CMS Releases Shoulder Arthroscopy Billing Data
In the January 23rd edition of the MLN Connects, CMS announced the release of a Comparative Billing Report (CBR) on Shoulder Arthroscopies for Medicare part B claims. This information can be vital for Orthopedic practices during the audit process. Data will be compared based on other providers in your state as well as nationwide. However, this information is not available publicly so you must login to make sure your contact information is up to date. You can also visit the CBR website for more information. Never visited the CBR website? We strongly recommend you do, as this site contains great information about all specialties.nnnThe Comparative Billing Report (CBR) contains data-driven tables with an explanation of findings that compare your billing and payment patterns to those of your peers in your state and across the nation.nnCBRs are not publicly available. Look for an email from cbrpepper.noreply@religroupinc.com to access your report. Update your contact email address in the Provider Enrollment, Chain, and Ownership System to ensure accurate delivery. Visit the CBR website for more information.nnOriginal article published on cms.gov
Recently, there has been a new healthcare scorecard that is evaluating the cost-saving policies in Colorado. Read the article below to see where Colorado ranks and what the state is doing to make healthcare more affordable to those living here!nnColorado is doing well to make out-of-pocket healthcare costs affordable and transparent but does not have policies in place to reduce the unnecessary provision of care, a new analysis of state healthcare policies found.nnAltarum, a research and analytics consultancy, released data on Tuesday ranking the policies and healthcare outcomes of states on four metrics, including in the areas of reducing prices and extending coverage to all residents.nn“In 2018, Colorado was in the middle third of states in terms of covering the uninsured, ranking 25 out of 50 states, plus D.C.,” the scorecard states, adding that Medicaid coverage for childless adults extends to 138% of the federal poverty line.nnThe scorecard also gave Colorado high marks for reducing Cesarean-section births for low-risk mothers and for having “strong price transparency rules”.nnOn the other hand, Altarum recommended that Colorado create an oversight entity for healthcare spending and use claims data to address the provision of unnecessary care.nnThe report only evaluated policies in place before Dec. 31, 2019. Colorado plans to develop a state-regulated “public option” for health insurance scheduled to begin in 2022.nnThe most common healthcare burdens were the price of drugs and the cost of medical bills, and Colorado is one of the priciest states in healthcare spending per person. The Polis administration has stated that it would like to curb surprise medical bills from out-of-network providers, on which the report found 13 states had adopted full protections.nn“We intend to stop this practice of out-of-network surprise billing so that consumers aren’t asked to pay outrageous bills,” the administration wrote in its “Roadmap to Saving People Money on Healthcare.”nnOne policy that Altarum recommended for all states was to expand health insurance for undocumented immigrants, 45% of whom lack coverage. “Barriers to coverage cause significant hardship for these families and harm public health,” the report advised.nnOriginal 
The New Year always brings opportunities to grow and learn. While many find it difficult to be healthy in the workplace there are simple steps to take to achieve a healthier lifestyle. Below are six great tips on building healthy habits at work. Read the article below to find out 6 ways you can build healthy habits at work and how these simple changes can be beneficial for you!nnnWe all know that we need to make healthier decisions on a daily basis, yet many of us fail to initiate substantial changes until health complications, stress, or other factors force us to take action.nnConvenience is one of the more common excuses. You’ll hear people say something like, “I work 50 hours a week and simply don’t have time to eat healthy, exercise, and care for my mental health.” Upon first hearing this, it’s easy to nod your head in agreement – but is this really a viable excuse? Does the fact that you work full-time excuse you from healthy living?nnIf we’re honest with ourselves, busyness is just a scapegoat for laziness. Millions of people hone healthy habits while at work and you can, too.nnHealthy workplace habits don’t form overnight. They command purposeful commitment and repetition. But if you’re going to prioritize health while working full-time, you’ll need to commit to habits like these:nn1. Packing Your Own LunchnnOne of the worst habits office workers have is poor nutrition. With limited time for lunch breaks and a desire to get out of the office, most people opt for fast food. And while fast-food meals are fine every couple of weeks, multiple greasy burgers each week will wreak havoc on your health.nnAs impractical as the suggestion may seem, try packing your own lunch and keeping it in the break room refrigerator. By meal prepping on Sundays, you give yourself access to healthy meals throughout the week (without having to do a bunch of cooking each day).nn2. Eating Healthy Office SnacksnnLunch isn’t the only thing that holds your diet back. If your office is like most, the only snacks you have available are highly processed vending machine selections. This has to change!nnTry explaining to your boss that healthy office snacks can boost productivity and output. If nothing else, they should replace the options in the vending machine. Better yet, try convincing management to put complimentary healthy snacks in the break room!nn3. Standing Up FrequentlynnSitting in front of your desk for seven or eight hours a day is awful for your posture, circulation, and overall health. While you probably don’t have many options for getting away from your desk, you can always switch up how you work.nnTry standing at your desk for at least 30-60 minutes per day. And instead of using a traditional office chair, look into a kneeling chair to improve posture and take some of the pressure off your neck and lower back.nn4. Getting 30 Minutes of Daily ExercisennIt’s highly recommended that you get at least 30 minutes of physical activity each day. If you’re unable to carve out time for a fitness routine before or after work, perhaps your lunch break will suffice.nnWhether it’s simple bodyweight exercises in your office or a full workout at a nearby gym, here are 10 lunchtime workouts that can be done in just half an hour. No excuses!nn5. Avoiding Negative SituationsnnToo much negativity will put a strain on your emotions and adversely impact your mental health. Thankfully, it’s often possible to avoid negative situations and surround yourself with positivity.nnOffice gossip and drama between coworkers should be things you avoid at all costs. If someone tries to pull you in, politely explain that you choose not to get caught up in office riffraff. Shielding yourself from this friction will keep you focused on work and productivity.nn6. Unplugging for Periods of TimennBeing constantly connected to the internet is exhausting. Though your job may require you to be dialed in for most of the day, look for brief periods where you can unplug and disconnect. Whether it’s a mid-morning break, your lunch break, or the commute to and from the office, cherish these opportunities to connect with your soul.nnPrioritizing Health in the WorkplacennNobody is going to prioritize your health for you. If it’s important to you, you have to be the one to proactively pursue smart behaviors that enhance your physical and mental capacities. If it helps, try rallying a few coworkers together and holding each other accountable. As they say, there’s power in numbers.nnOriginal 
Medicare, the Affordable Care Act, and other issues are all hot topics being discussed in 2020. Below is more information regarding some of the big topics that are in talks right now or are in the process of change. Read the article below for more information on some of these medical issues.nnnIt’s 2020 and another year of health-related topics awaits us. What health issues will take priority? What buzzwords will we all be talking about? How might technology change healthcare?nnWe asked some experts to peek into their crystal balls and make a few predictions.nnThey tell us that how you get access to healthcare and how you pay for it will both be hot topics this presidential election year.nnIn fact, one expert says healthcare could help decide political winners and losers.nn“Whoever comes up with a plan that will work, is affordable, and something people can understand, that will push them ahead,” said Kurt Mosley, vice president of strategic alliances for Merritt Hawkins, a physician search, consulting, and research firm.nnMedicarenMedicare is front and center as we kick-off 2020.nnThat’s in part because “Medicare for All” is the single-payer option health plan being touted by two of the top Democratic presidential candidates.nnJeff Becker, the senior analyst for healthcare strategy at Forrester Research says there are also a number of bills in Congress looking to expand access to Medicare as a public option.nn“When you look at the polling numbers, our call is that Medicare for All will die in the court of public opinion and become Medicare Advantage for more,” Becker told Healthline.nnAffordable Care ActnThe Affordable Care Act (ACA), often referred to as Obamacare, will be in the courts again this year.nnIn December, a federal appeals court ruled that the health insurance law’s individual mandate provision was unconstitutional.nnHowever, the justices sent back to a federal district court in Texas the issue of whether other parts of the law could continue to exist without the mandate that requires everyone to have health insurance.nnLook for some sort of Obamacare case to wind up in the U.S. Supreme Court this year.nn“Our call is whether or not it goes to the Supreme Court, the ACA will survive because the individual mandate is severable,” Becker told Healthline.nnPrice TransparencynExperts say you’ll hear a lot of debate about price transparency, a move designed to increase competition and lower costs.nnPresident Trump signed an executive order in November that requires hospitals and insurers to publish their confidential, negotiated rates for treatments.nn“The reason this would be important is you’d be able to figure out what your out-of-pocket expenses would be” said, Becker.nnBut a coalition of hospital groups has filed a lawsuit to block the rule. They argue that the public disclosure of negotiated charges would create confusion about consumers’ out-of-pocket costs.nnThe order is scheduled to go into effect on January 1, 2021.nnLower Prescription Drug Pricesn“The thing about pharmaceuticals is, if you can’t afford them, they don’t work,” Mosley said.nnHe predicts the move to lower the costs of prescription drugs will again be on the front burner of the healthcare debate in 2020.nn“The problem is Medicare and Medicaid can’t negotiate prices with these drug companies,” Mosley told Healthline.nnThe House of Representatives has approved a bill that would do just that. The legislation also caps out-of-pocket expenses for people enrolled in Medicare Part D.nnHowever, the prognosis for this bill becoming law isn’t good.nnPolitical observers say the legislation won’t go anywhere in the Senate, and the White House has indicated the president would veto it.nnRepublicans in the Senate have crafted their own prescription drug price plan. The president has indicated he would sign this bill, but it would need to be approved by the Democrat-controlled House.nnAccess to Health Servicesn“One of the cross-cutting issues we see as a priority in 2020 is the social determinants in health disparities in our patients,” said Amy Mullins, MD, FAAFP, medical director for quality improvement for the American Academy of Family Physicians.nn“Patients need more than just access to a physician,” she told Healthline. “They need access to good food, safe places to live, to exercise, transportation, community resources, access to medication.”nn“If you don’t address those, it’s really difficult to treat your patients effectively,” she added.nnMullins says her group has an internal division called the Center for Diversity and Health Equity whose mission is to look at healthcare through that lens.nnVaccine HesitancynMullins also says the issue of vaccine myths is one you’ll continue to hear about in 2020.nn“We want to do more to counter the misinformation that’s out there around vaccines that may be holding some people back from getting what they need,” said Mullins.nnA recent study concluded that a lot of the false information is being spread on social media by a handful of anti-vaccine ad buyers.nn“We’re promoting vaccine education to physicians, their healthcare teams, patients, and communities,” Mullins said.nnA 2020 National Vaccine Plan is currently being developed by the Department of Health and Human Services’ Office of Infectious Disease and HIV/AIDS Policy.nnVapingn“Another of the big priorities for health providers in 2020 is vaping and e-cigarettes, ” Mullins said.nn“We really applaud and support the work the Centers for Disease Control and Prevention and the Food and Drug Administration is doing to try and get a handle on this crisis,” she said. “But these products target adolescents and we think marketing needs more regulation.”nnA study released last month from the National Institute on Drug Abuse reported that more teens are vaping marijuana.nnThat’s despite a lung illness linked to vaping that’s killed more than 50 people trusted Source nationwide.nnVirtual care visitsnOn the digital front, Becker predicts there will be aggressive growth in virtual care visits.nnThat’s where you interact with your doctor via text, video, or phone call.nnBecker’s group crunched the numbers after looking at outpatient visit data as well as talking to virtual vendors and tracking healthcare investments.nn“The result was 36 million net new virtual care visits in 2020,” he said.nnHe points to how employers and insurers are already embracing the concept. Amazon recently launched a pilot program called “Amazon Care,” a virtual clinic for its employees in Seattle.nnWalmart recently expanded its telehealth services to workers in Colorado, Minnesota, and Wisconsin with $4 online or video care visits.nnHumana has teamed up with “Doctor on Demand” to offer a virtual primary care plan at significantly lower monthly premiums.nn“Everybody is moving toward a model where we’re not using high-cost care centers like emergency rooms,” Becker said.nn“And consumers are demanding more cost-effective services, too,” he added. “In 2018, consumers took out $88 billion in personal loans just to pay for out-of-pocket medical costs.”nnOriginal 
Vaping and E-cigarette use by young adults has grown over the past few years. While many are ignoring the effects of using these products, the CDC and CMS have released addendums regarding these products after the World Health Organization confirmed the side effects of vapes and e-cigarettes. Read below for more on these important updates and what new codes will be used in conjunction with vaping-related disorders.nnWe have all seen the stories in the news lately about the effects vaping and e-cigarettes are having on young adults. The implications cannot be ignored and considering how quickly the World Health Organization (WHO) has responded it only confirms our suspicions.nnIn December, the CDC and CMS published the full addenda regarding the use of the new emergency U code for e-cigarette and vaping associated lung injuries (EVALI). This new code, U07.0 [Vaping-related disorder] is to be used in conjunction with other established ICD-10 codes for the reporting of medical encounters for EVALI.nnRefer to the links for the full releases by the CDC including CMS links to further information.n
Anthem and Cigna have released updates regarding the reimbursement updates and changes. These changes will go into effect in March 2020. For more information on the updates and the changes that may affect you, read below!nnAnthem sent out a Notice of Material Change (NOMC), dated December 1st, 2019. This is notice of Anthem changing the reimbursement for Advanced Practitioners (NPs and PAs), effective March 1st, 2020. Moving forward, Anthem will no longer reimburse based on the “incident to” rules and Advanced Practitioners will be reimbursed at 85% of the contracted rate. This comes as a 15% decrease in reimbursement for Advanced Practitioners. This also means that any Advanced Practitioners that have not been added to Anthem’s system will need to submit new provider applications.nnAll provider files must be finalized by 03/01/20 for providers to be reimbursed. If submitting 10+ providers, Anthem has offered a roster format to expedite the process. If submitting less than 10 providers, each file will need to be submitted via Availity for processing. Anthem has assured Welter Healthcare Partners that provider files will move quickly when submitting via a roster and there should be no concern for the effective date. If there are fewer than 10 providers to be submitted, then individual new provider applications need to be submitted through Availity as soon as possible. Advanced Practitioners do not require full credentialing unless an NP would like to be listed as a PCP, so these files should be processed more quickly; however, we are within the 90-day timeframe.nnTo summarize, Anthem is essentially making three distinct and important changes that will affect your practice:n