The Welter Healthcare Partners Family would like to wish you a Happy Holidays! As we spend time with family and friends, we would like to say thank you to our awesome clients and those who support and appreciate the work that we do. In observance of the holiday, Welter Healthcare Partners will be closed on December 25th to spend the holidays with our loved ones. nnIt has been a wonderful year with all of you!
Seasons Greetings! The holidays are a time filled with love and laughter as we spend time with the ones closest to us. So while you’re out at family get together’s or running to the shops for the last-minute gifts here are a few codes to watch out for. Read below for some of the important codes to know!n
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nJust to name a few. So stay safe and healthy this holiday season.
The government funding deal that is set to pass this week will block President Trump from taking major actions against ObamaCare. There will also be some notable changes on the bill which include raising the minimum age to purchase tobacco to 21. There also some major wins for medical insurance companies. Read below to find out more information!nnThe government funding deal poised to pass Congress this week would block President Trump from taking major actions to “sabotage” ObamaCare and would fully repeal three taxes in the health care law, according to a senior House Democratic aide.nnThe bipartisan deal would prevent Trump from taking what Democrats called “sabotage nuclear options” against ObamaCare. Specifically, that means the law will prevent Trump from unilaterally ending a workaround called “silver-loading,” which helps insurers compensate for the loss of key ObamaCare payments and has the effect of giving greater financial assistance to many ObamaCare enrollees.nnDemocrats had been worried Trump could end the practice in a bid to cause harm to the law. In addition, the deal will prevent Trump from ending automatic re-enrollment in ObamaCare plans, whereby if enrollees do not actively choose a new health insurance plan for the new year, they are automatically reenrolled to their current plan.nnOn a separate front on ObamaCare, the spending deal repeals three major taxes that had helped fund the law’s coverage expansion. The deal will repeal a 40 percent tax on generous “Cadillac” health plans, the 2.3 percent medical device tax and the health insurance tax.nnThose are major wins for the health insurance and medical device industries, which had long lobbied to lift those taxes. The Cadillac tax, in addition to providing about $200 billion in funding over 10 years, had been intended to help lower health care spending by incentivizing employers to lower costs to avoid hitting the tax. But the idea was opposed by unions and employers who did not want their health insurance plans taxed, setting up a broad bipartisan coalition against the idea.nnThe deal notably does not include a bipartisan measure to protect patients from surprise medical bills, despite a push from backers. That measure is mired in internal fighting among lawmakers and fierce lobbying by doctors and hospitals.nnThere are also not any major provisions included that would lower drug prices.nnHouse Democratic leaders are hoping there will be another chance to enact those priorities early next year, given that the deal sets up a May 22 deadline for renewing a range of expiring health programs like community health center funding. That deadline will create another must-pass health care bill that Democrats hope can include drug pricing and surprise billing measures.nnThe deal does include one relatively small bill to lower drug prices, called the Creates Act, which cracks down on drug companies gaming the system to delay the introduction of cheaper generic competitors.nnThe measure also raises the legal age to purchase tobacco to 21.nnDrug pricing advocates had fought for years to pass the bill, which was long opposed by the pharmaceutical industry. It is a sign of at least a small shift in the drug pricing debate that the measure is now passing.nnnOriginal article published on thehill.comnn
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As we approach 2020, we are gearing up for the changes that are making headway the coming year. Below are some of the updates that have been released regarding E/M changes, the final rule, and the physician fee schedule. For more information read below. For more on the services Welter Healthcare Partners provides contact us at 303.534.0388, or click here!nnWhat’s New for 2020 nnThe CY 2020 PFS conversion factor will increase to $36.0896, up to $0.05 from CY 2019. nnThree new Telehealth Service codes added to the Medicare-covered services list: n
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nCMS will offer these services without the usual geographical limitations for telehealth. The Medicare telehealth originating site fee increased to $26.65 in 2020, from $26.15 in 2019.nnPrincipal Care Management (PCM) for Chronic Care Management (CCM) nnIf you provide chronic care management (CCM) to patients with one chronic condition next year, report code G2064 for 30 minutes of work by a doctor or other qualified health care professional: “Comprehensive care management services for a single high‐risk disease, e.g., principal care management, at least 30 minutes of physician or other qualified health care professional time per calendar month with the following elements: One complex chronic condition lasting at least three months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been the cause of a recent hospitalization, the condition requires development or revision of disease‐specific care plan, the condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities.” When clinical staff performs the work, you will report G2065.nnReduction of Administrative Burden nnModifications to the documentation policy now allows physicians, physician assistants, and advanced practice registered nurses (APRNs – nurse practitioners, clinical nurse specialists, certified nurse‐midwives and certified registered nurse anesthetists) to review and verify (sign and date), rather than re‐documenting, notes made in the medical record by other physicians, residents, medical, physician assistant, and APRN students, nurses, or other members of the medical team. CMS also defined the APRN group of providers, which includes nurse practitioners, clinical nurse specialists, certified nurse‐midwives and certified registered nurse anesthetists.nnPhysician Assistants Make Ground n
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nCMS Final Rule Aligns with E/M Coding Changes Laid Out by the CPT Editorial Panel for Office/Outpatient E/M Visits Beginning in 2021 n
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nFor more information on these updates visit pbn.decisionhealth.com, ama-assn.org, cms.gov, and aafp.orgnn nn nn
Healthcare Spending is on the rise in the United States. The national healthcare spending has increased faster in 2018 than it did in 2017. Read the article below to see what the projected statistics of healthcare spending will be over the next seven years.nnHealthcare spending in the U.S. grew by 4.6% in 2018, totaling $3.6 trillion, according to data released Thursday by the Centers for Medicare & Medicaid Services (CMS) Office of the Actuary.nnHealthcare, as a share of the overall economy, slipped to 17.7% of gross domestic product (GDP) in 2018, down slightly from 17.9% in 2017.nnThe statistics, published in Health Affairs, show that healthcare spending averaged $11,172 per person in 2018, while the total personal healthcare spending growth rate held steady at 4.1%.nnNational healthcare spending increased faster in 2018 than it did in 2017, but it equaled the rate seen in 2016. CMS attributed the recent increase to acceleration in health insurance costs, which grew by 4.3% in 2017 and 13.2% in 2018. Another contributing factor was the reinstatement of the health insurance tax after a one-year moratorium.nnFor the second consecutive year, the total number of uninsured people rose by 1 million.nn”Healthcare spending growth picked up across all major payers in 2018 as medical prices grew faster, due in part to the reinstatement of the health insurance tax on all health insurance providers,” Micah Hartman, a statistician in the CMS Office of the Actuary, said in a statement. “However, economic growth outpaced healthcare spending and the share of the economy devoted to health care fell.”nnRising medical prices accounted for an uptick in per capita healthcare spending last year. Hospital spending—which accounted for 33% of overall healthcare spending in 2018—led the way among goods and services spending growth, at 4.5%.nnGrowth in expenditures slipped slightly to 4.5%, though hospital prices rose from 1.7% in 2017 to 2.4% in 2018. Additionally, growth in total inpatient days slid from 1.7% in 2017 to 0.7% in 2018.nnPhysician and clinical services spending slowed to 4.1% in 2018, down from 4.7% in 2017, while retail prescription drug spending rose from 1.4% in 2017 to 2.5% in 2018.nnCMS released projections in February for average healthcare spending growth rates of 5.5% annually between 2018 to 2027, totaling nearly $6 trillion.nnThe study projected acceleration in hospital spending from 4.4% in 2018 to 5.1% in 2019, thanks to faster than expected growth in Medicare and Medicaid.nnThe study also attributed the growth in overall healthcare spending to more baby boomers entering Medicare and a 2.5% increase in medical goods and services through 2027.nnOn the payer side, private health insurance spending totaled $1.2 trillion, growing by 5.8% in 2018 compared to 4.9% in 2017.nnMeanwhile, both Medicare and Medicaid experienced spending growth increases of 6.4% and 3%, respectively.nnThe federal government’s healthcare spending rose by 5.6% in 2018, doubling the rate from 2017, as growth in Medicare and Medicaid expenditures increased significantly.nnThe largest portions of healthcare spending went to the federal government and households, each with 28%, private businesses at 20%, state and local governments at 17%, and “other private revenues” at 7%.nnOriginal article published on healthleadersmedia.com
This week we wanted to take a different approach to our surgery procedure coding and talk about a diagnosis in a TTE. Read below for an example of coding TTE’s.nnnExample: Coding TTE’s that has aortic valve stenosis with mitral valve insufficiency.nn[Since the provider does not specifically state that the cause of the valve disease was non-rheumatic, our guidelines tell us to assume rheumatic origin when valve disease affects multiple valves and the valvular heart disease is not described as non-rheumatic. If referring to the index within ICD-10, we would go to category I08.- which includes “multiple valve diseases specified as rheumatic or unspecified” and use I08.0.]nnAnswer: The correct code is I08.0 multiple valve disease. If you index the mitral valve insufficiency, you see the guidance there to w/aortic valve disease I08.0. If we index the aortic valve stenosis first, we are guided to I35.0 which has an Excludes 1 note (not coded here) aortic valve disorder of unspecified cause but with disease of mitral and/or tricuspid valve(s)(I08.-).nWhat makes coding valvular heart disease most confusing is that unlike the aortic, mitral & pulmonary valves, tricuspid valve disorders are presumed rheumatic on their own (without other valvular involvement).nnHere’s a link that has some good general info about rheumatic heart disease.