2021 E/M Changes – Start Planning Today!
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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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. 
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 plansnn
Trump 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 
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 
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