CMS Confirms the Direction E/M Changes
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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- G2086 (Office‐based treatment for opioid use disorder, including the development of the treatment plan, care coordination, individual therapy, and group therapy and counseling; at least 70 minutes in the first calendar month)
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- G2087 (Office‐based treatment for opioid use disorder, including care coordination, individual therapy, and group therapy and counseling; at least 60 minutes in a subsequent calendar month).
- G2088 (Office‐based treatment for opioid use disorder, including care coordination, individual therapy, and group therapy and counseling; each additional 30 minutes beyond the first 120 minutes).
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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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- CMS’ finalized its proposal to adjust the authority of physician assistants (PA): Allowing them to practice without specific assignment to an M.D., requiring only “documentation in the medical record of the PA’s approach to working with physicians”. o Requires that in states where the PA’s scope of practice is not specified, the PA’s “working relationship” with the practice’s physicians must be documented “at the practice level.”
- CMS cautiously approved its proposal to allow certified registered nurse anesthetists (CRNAs) to do pre‐anesthesia assessments on patients, as well as post‐anesthesia assessments without the supervision of an M.D. CMS, clarifies that “a physician must examine the patient to evaluate the risk of the procedure to be performed,” while either “a physician or anesthetist must examine the patient to evaluate the risk of anesthesia.”
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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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- Reduce the number of levels to 4 for office/outpatient E/M visits for new patients (99202‐99205);
- Retain all 5 levels of coding for established patients (99211‐99215);
- Revision of time‐based reporting and medical decision‐making process for all office‐based E/M codes; performance of history and exam only as medically appropriate (complexity will be more clearly defined);
- E/M visit level selected based on either medical decision making or time.
- CMS also finalized the relative value units (RVU) for the group of oft‐used E/M services, which will determine 2021 pay rates. The RVU changes, for example, would boost payments for code 99214 – the most‐reported E/M code – from $109 to $136 per claim, a 25% increase. Rates for 99213 would jump nearly 30%.
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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 
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).nn
Recently, Walgreens has teamed up with UnitedHealthcare to open in-store Medicare centers. Through this partnership, people will have easy access to comprehensive services for their specific needs and pharmacy services. Read the article below to find out more.nnMore seniors are opting into MA plans, which have become a lucrative business for insurers. Nearly one-third of all Medicare beneficiaries, or 22 million people, are enrolled in MA plans.nnThe deal gives UnitedHealthcare access to reach more members as Walgreens operates more than 9,000 drugstores with a presence in all 50 states. For Walgreens, the deal has the ability to drive additional foot traffic to stores as UnitedHealthcare commands the largest share of MA members, about 26% of the entire MA market, according to the Kaiser Family Foundation.nn”Through strategic partnerships like this, Walgreens store locations can offer comprehensive services tailored to the specific needs of the communities we serve that are conveniently accessible alongside our pharmacy services,” Rick Gates, senior vice president of pharmacy and healthcare at Walgreens, said in a statement released Monday.nnCVS Health, which owns its own insurance plan with Aetna, has made a similar move as it plans to open more than 1,500 HealthHUB stores across the country by the end of 2021. The HealthHUB stores earmark about 20% of CVS retail space to health services, with a special focus on preventive care and wellness.nnIn its bid for Aetna, CVS claimed the deal would serve as the “front door” to healthcare as a majority of Americans live just a few miles from a CVS store and tend to interact with pharmacists more than their doctor.nnOther nontraditional players, including Walmart, have jumped in the space as well. The company launched its first health superstore in Dallas, Georgia, this fall.nnThe recent developments underscore the rise of consumerism in healthcare in which more care is moving from outside the grip of hospitals to more convenient, lower-cost settings.nnComplete and original 
It is a word that brings dread to most people, AUDIT. The stress of an audit is real and can be felt just by walking into the room. So what can be done to help prevent all the drama? The short answer, like most things, is to be prepared. Get a plan in place and be ready when the time comes. Working with your external compliance auditors and having open lines of communication can play a big role in making sure you and your practice get the most out of it. Make sure they know what your concerns are going into their review. Have a clear and defined code set in, the addition of production reports helps to support the codes you wish to audit. In the end, they are there to help and provide an outside perspective.nnIn the November issue of the AAPC’s Healthcare Business Monthly, there is an excellent article with a six-step plan to audit success.n
Be sure to get your new Medicare card before the new year! Also, update your patients’ records before the office is hit with many new patients and appointments when the new year comes. Read below for more information from MLN Connects.nnDo not wait. Update your patients’ records and use Medicare Beneficiary identifiers (MBIs) now, before you are busy with other patient insurance changes in January.nnWe encourage people with Medicare to carry their cards with them since we removed the Social Security Number-based number; if your patients do not bring their Medicare cards with them:n