Sep 20, 2019 | Uncategorized
Welter Healthcare Partners is excited to celebrate our 25th anniversary. We couldn’t have done it without all of you! To celebrate this special occasion, please join us for a night of fun, cocktails and snacks on Wednesday, September 25th. See below invitation for more information.nnA message from Todd Welter, our CEO on the past 25 years at Welter Healthcare Partners:n
Twenty-Five years ago, we started this company to help our clients succeed and thrive in a competitive marketplace which had constantly changing government rules and regulations. Twenty-Five years later I am proud that we continue to fight this good fight. We are a lot more sophisticated now than we were way back then. We have a lot more tools, services and capabilities; some I wouldn’t have even of dreamed of twenty-five years ago. I am grateful and blessed to be surrounded by so many great and dedicated employees, colleagues, friends and especially clients who believe as we do: Health care is about people and we should do everything we can to help them to be successful.
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Our next twenty-five years will see unprecedented change. (I remember buying a fax machine, the ones which used that curly heat sensitive paper and thinking we were all that!) The world of health care is turning itself upside down (again). Compliance, cost, efficiency and effectiveness will be our challenge. We are on pace and plan to develop even more sophisticated, interactive, and real-time tools to help our clients continue this good fight to be successful, profitable, and capable of supplying the best health care.
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– R. Todd Welter, CEO
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Sep 11, 2019 | Uncategorized
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The Colorado Department of Health Care Policy & Financing now requires new and currently enrolled organization health care providers to use an NPI for service location and provider type. Read the article below to get more information on the new implementation of HB 18-1282.nn
HB 18-1282 requires newly enrolling and currently enrolled organization health care providers (not individuals) to obtain and use a unique National Provider Identifier (NPI) for each service location and provider type enrolled in the Colorado interChange.nnThe Department of Health Care Policy & Financing (the Department) is responsible for implementing Section 3 of HB 18-1282, which added 25.5-4-419 to the Colorado Revised Statutes. The Department’s proposed draft regulations are related to Section 3 of HB 18-1282 and resulting statutes. Please note that Section 2 of HB 18-1282 is not within the Department’s authority and adds language to the statutes for the Department of Public Health and Environment. The Department’s proposed draft regulations are not related to Section 2 of HB 18-1282, and can only answer questions related to our proposed draft regulations implementing Section 3 of HB 18-1282.nn
nOriginal article published on colorado.gov
Sep 11, 2019 | Uncategorized
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.nn– Click Here to Submit Redacted Surgery Case Study –nnDATE OF SURGERY: 06/10/2019nnPREOPERATIVE DIAGNOSES: Left shoulder pain, status post hemiarthroplasty/biologic glenoid resurfacing with glenoid arthrosis and erosion. Rotator cuff deficiency. History of rheumatoid arthritis.nnPOSTOPERATIVE DIAGNOSES: Left shoulder pain, status post hemiarthroplasty/biologic glenoid resurfacing with glenoid arthrosis and erosion. Rotator cuff deficiency. History of rheumatoid arthritis.nnPROCEDURES:n
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- Left shoulder open exploration with capsular contracture and extra articular scar release.
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- Left revision reverse total shoulder arthroplasty.
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- Vertical humeral osteotomy for removal of implant with subsequent ORIF with intramedullary stem and cerclage suture/wire.
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nESTIMATED BLOOD LOSS: 300 cc.nnFLUIDS AND URINE OUTPUT: Per Anesthesia record.nnINDICATIONS: This is a very pleasant 56-year-old female, who has had significant pain and dysfunction of her left shoulder refractory to conservative care with the aforementioned diagnoses. Options were discussed at length, and she wished to proceed with the above-mentioned operative procedures. After a lengthy discussion of the risks and benefits involved, full informed consent was obtained to proceed with the above preoperatively.nnCOMPONENTS REMOVED: Tornier Aequalis cemented humeral stem and Achilles tendon/soft tissue allograft glenoid surface.nnCOMPONENTS PLACED: Wright Medical Aequalis PerFOrM Plus reverse total shoulder system with half wedge augment baseplate 25 mm x 35-degree, 39 mm +3 mm lateralized glenosphere, 9 mm PTC proximal body, Aequalis Flex revised stem with 9 mm x 90 mm PTC distal stem, standard locking cap +0 mm reverse tray, eccentricity 3.5 mm placed at approximately 5.5 mm, and a +9 mm reversed insert for 39 mm glenosphere angle C 7.5 degrees. Total neck shaft angle 140 degrees.nnOne central locking/compression screw, one superior compression screw, and 2 additional locking screws.nnDESCRIPTION OF PROCEDURE:nnThe patient was brought to the operating room, where general endotracheal anesthesia was induced by Dr. H. after interscalene block was administered.nnThe patient was carefully placed in beach chair position with hips flexed 45 degrees, knees flexed 30 degrees. All bony prominences were padded well, and the head was held in a near neutral position by McConnell head holder. The left shoulder was prepped and draped in standard sterile fashion using a Betadine scrub and paint. The left iliac crest region was also prepped and draped in case an iliac crest bone graft would be required. After prep and drape of the left upper extremity, examination under anesthesia revealed stiffness in all planes with 100 degrees forward flexion and abduction, external rotation of 30 degrees with the arm at side, and internal rotation of 20 degrees with the arm abducted. Ioban sticky drape was applied. Antibiotics were held until appropriate cultures were obtained. Previous scar was incised for a length of approximately 15 cm extending it slightly distally. Full-thickness skin flaps were elevated and deltopectoral interval fully explored proximal to distal.nnCephalic vein was not encountered. The dense scar in the subdeltoid space was released revealing the humeral scapular interface superiorly laterally and anteriorly underneath the coracoid. There was dense scar between the coracoid and the remaining rotator cuff and anterior scar. Multiple soft tissue specimens were sent for pathology and microbiology including multiple sutures. The rotator interval was opened. The subscapularis was essentially completely deficient with only a thin layer of scar in the anterior shoulder taking place of the original subscapularis tendon. The scar was removed and capsular contracture released from the inferior glenoid. Scar was released superiorly and posterolaterally and laterally. The proximal humerus was dislocated revealing significant proximal humeral bone loss from the metaphysis. Soft tissue and bony samples were sent for pathology and microbiology. Osteotomes and rongeur were used to remove cement, and soft tissue and bone from around the prosthesis. A thin bur was used to remove bone and cement from around the lateral prosthesis to allow disimpaction of the prosthesis and removal.nnInitially, attempts were made to lightly disimpact the prosthesis to remove cement mantle, but these attempts were unfruitful. The decision was made to proceed with a vertical osteotomy of the humeral shaft to facilitate removal of the implant and removal of cement.nnOsteotomy was made at the location of maximum bone loss and distally just lateral to pectoralis and latissimus dorsi/teres major insertions and medial to the deltoid insertion. This was carried on just to the level of the deltoid insertion and carried out horizontally medially with direct retractor protection of the soft tissues. The osteotomy was opened and the Ultra-Drive used with a flat tip to remove cement from around the osteotomy and from around the prosthesis itself. The prosthesis was then disimpacted without difficulty. Proximal humerus was irrigated with pulse lavage. The Ultra-Drive was then used to remove additional cement to allow diaphyseal fitting component. The 6.5 and 9 mm discs were used to remove cement using Ultra-Drive under continuous irrigation to prevent overheating.nnThe cement plug was penetrated using the Ultra-Drive and the canal enlarged to allow the smallest revive component to be placed. The trial was placed at 25-30 degrees of retroversion and humerus retracted posteriorly. The wound was irrigated with pulse lavage. Significant amount of scar was removed circumferentially around the glenoid and scar released from the inferior glenoid along with capsular contracture. The wound was irrigated with pulse lavage.nnSmall guide pin was placed followed by reaming the inferior glenoid flat followed by reaming the superior glenoid with a 35-degree reamer for the half wedge component. This would fit well with the half wedge placed superiorly and posteriorly. The wound was irrigated with pulse lavage. 2g of Ancef had been given after obtaining adequate bone and soft tissue samples. The center hole was overdrilled followed by drilling for the central screw measuring 35 mm in length. The final component was placed into position and set screw tightened with excellent compression of the baseplate against the bone. The wound was irrigated with pulse lavage and the shoulder trialed with above-mentioned components trialing well. There was slight rotational instability of the humeral component, so decision was made to cement proximally. The wound was irrigated followed by placing the final component which was fixed with a central set screw. The proximal humerus was redislocated followed by removing the trial component. It should be noted that 2 NiceLoop sutures had been placed in modified racking hitch fashion and one 18-gauge wire placed proximally in standard fashion to close the vertical osteotomy. This opened slightly with placement of the press-fit component. The press-fit component would engage the distal aspect of the humerus distal to the osteotomy as well. The wound was irrigated with pulse lavage. One batch of DJO surgical cobalt G cement was mixed, and when reached the appropriate consistency, the humerus was irrigated, suctioned, and the cement was allowed, applied in doughy fashion to the proximal aspect of the component. It was impacted into position and excess cement removed. The wound was irrigated further. The cement was allowed to fully harden. Prosthesis was approximately 25 degrees of retroversion. A 2 cc aliquot of H-GENIN Wright Medical allograft DBM putty was then placed into the vertical osteotomy site to facilitate and expedite healing. This was after copious irrigation with pulse lavage. The pectoralis major was closed to the deltoid insertion covering the bone graft. A deep 3/16-inch Hemovac drain was placed followed by irrigating the joint further. Small bleeders were coagulated with electrocautery. The deltopectoral interval was closed using running O PDS Stratafix suture. Skin was closed using buried O and 2-0 Monocryl sutures followed by 3-0 Monocryl subcuticular and Steri-Strips. A 4 x 4 Tegaderm dressing was applied. The patient’s arm was placed in a well-padded, well-fitting UltraSling. She tolerated the procedure well.nnIt should be noted that 2 skilled surgical assistants, PA-C and SA-C, were absolutely required in order to perform procedure to the current standard of care in timely fashion. Total skin-to-skin operating time was approximately 3 hours and was prolonged due to the complex nature of this revision procedure.nnPOSTOPERATIVE PLANnnTo start early gentle passive range of motion program per protocol. Maximum forward flexion and abduction 90 degrees, external rotation of 30 degrees, internal rotation to the abdomen with active assisted motion allowed at 4 weeks postop, active motion allowed at 8 weeks postop. At 6-8 weeks postop, maximum forward flexion and abduction allowed would be 130 degrees, external rotation of 50 degrees, internal rotation to L3 with no aggressive end-range stretching. The patient will be admitted for standard postoperative medical and orthopedic care. Her culture results will be followed.nn
Sep 6, 2019 | Uncategorized
Colorado emergency charges vary in price across the state, which prevents patients from seeking care due to the price of their treatments. The article below gives more insight to the unusual healthcare prices that many people are looking to fix. Read below to find out more on this dive.nnDive Brief:n
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- The cost of emergency department visits in Colorado vary enormously depending on facility and condition severity, according to new data from the state’s all-payer claims database analyzed by the Center for Improving Value in Health Care.
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- Colorado’s EDs were paid an average of $3,115 for the most severe life-threatening cases in 2018. The largest single charge was $47,779, and the smallest was $190.
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- But Denver-based CIVHC, which administers the database, only looked at reimbursement from commercial payers to the facility directly, meaning the entire cost of care for a Colorado patient — including common add-ons like lab tests, imaging services, surgical procedures or other physician fees — is likely much higher.
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nDive Insight:nnColorado’s data provides the U.S. an unusual glimpse into healthcare prices, albeit in one state and one type of provider setting.nnThough national ER use remained largely unchanged over the past decade according to the Health Care Cost Institute, ER clinicians are using high severity codes more frequently. Previous research from the CIVHC found that trend held true in Colorado as well, with a decrease in coding for all other lower-tier severity levels across commercial payers between 2009 and 2016.nnLast year, the median statewide facility payment for a low severity visit was approximately $290 and high severity level claims were paid at almost $3,000.nnAs ER costs continue to rise, some payers are taking controversial steps to try and blunt the trend. Anthem faced lawsuits and backlash from a slew of providers in Connecticut, Georgia and Missouri around its cost-cutting policies, including paying patients directly for emergency care and having them reimburse their providers, and no longer reimbursing for non-emergency services given in the ER.nnIf widely adopted, that latter policy from the Indianapolis-based payer could deny payment for as many as one in six ER visits, according to a study in JAMA.nnProvider critics, wary of insurer policies that could further endanger their bottom lines, argue such measures could prevent patients from seeking care in the first place.nnOver a dozen individual states along with Washington, D.C. have put forward proposals to try and mitigate the practice. The Trump administration backs legislation to ban surprise billing, which lawmakers are set to debate after the summer recess. Often, patients hit with surprise medical bills for care not covered by their insurer get them after receiving care in the ER.nnBig hurdles remain to appease both the payer and provider lobbies, which stand diametrically opposed on the way forward to fix the problem.nnOriginal article published on healthcaredive.com
Aug 30, 2019 | Uncategorized
Banner Health is planning to acquire the North Colorado Medical Center which has been in operation since 1995. This new plan would bring great healthcare opportunities to the area. Read below to find out more about the deal.nnPhoenix-based Banner Health plans to acquire North Colorado Medical Center in Greeley, which it has operated since 1995.nnUnder the proposed deal, which requires regulatory approval, Banner would pay $328.4 million to acquire the land, assets and equipment associated with the hospital from Weld County (Colo.).nnA large portion of the proceeds from the transaction will be used to pay off $209.5 million in existing hospital debt, according to a press release from Weld County.nnOriginal article posted on beckerhospitalreview.com
Aug 21, 2019 | Uncategorized
Pinnacol recently announced that Nurse Practitioners could pursue DOWC accreditation to receive higher reimbursement. Also, Pinnacol announced the use of interpretation services to meet contract obligations and the Division of Workers Compensation requirements for injured workers. Read the article below to find out more about these two new regulations.nnDOWC Accreditation for Nurse PractitionersnnNew Colorado Division of Workers’ Compensation regulations that went into effect Aug. 2 impact nurse practitioners.nnHouse Bill 1105 allows nurse practitioners to obtain DOWC Level I accreditation solely for the purpose of receiving the higher reimbursement associated with the designation. It does not allow them to declare maximum medical improvement for an injured worker, the key component of Level I accreditation.nnNurse practitioners may begin pursuing DOWC Level 1 accreditation now via an online course. The next in-person training session will be offered via DOWC in September in Denver, and registration is open.nnBeginning on Aug. 2, Level 1 accredited nurse practitioners with prescriptive authority will be allowed to bill for 100 percent on the DOWC Medical Fee Schedule.nnReference nnWorkers’ Compensation Rules for NPs and PAs nnUse of Interpretation ServicesnnEffective Sept. 1, Pinnacol will implement procedures to meet contract obligations and the Division of Workers’ Compensation requirements for scheduling interpretation services for Pinnacol’s injured workers. These procedures comply with 2019 DOWC Rule 18-6(Q).nnPinnacol Assurance is committed to aligning all parties to provide uninterrupted, quality service for our non-English-speaking injured workers.nnThe following are the guidelines to ensure quality care.n
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- Interpretation must be authorized for patients during office visits, diagnostics, injections, therapy and psychological services.
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- The treating provider will call Pinnacol for authorization for interpretation services.
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- Pinnacol will determine whether the requested provider is contracted with Pinnacol. If contracted, the request will be approved. If the vendor is not contracted,
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- Pinnacol claims reps will refer the requester to the list of approved, contracted providers.
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- Pinnacol may change the interpretation vendor at any time during the life of the claim — with or without cause — after notifying the current vendor and the primary care provider.
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nIf issues arise in the process of assigning an interpreter or with the services provided by an interpreter, please contact the Pinnacol claims representative immediately.nnPinnacol does not intend to direct the type or duration of medical treatment that may be prescribed. Prescribing providers must exercise independent medical judgment in these matters.nnIf you have any questions or need additional information, please contact Pinnacol Assurance at provider_management@pinnacol.com or 303.361.4945.nnReferences nColorado Division of Workers’ Compensation, Rules of Procedure, Rule 18-6(Q)nUse of Interpretation ServicesnPinnacol’s Contracted Interpretation and Translations Service ProvidersnnOriginal article published by pinnacol.com
