Changes to timely filing requirements for commercial and Medicare Advantage plans for all claims submitted to plan on or after October 1, 2019
nAnthem Blue Cross and Blue Shield and HMO Colorado (hereinafter collectively referred to as Anthem) continues to look for ways to improve our processes and align with industry standards. Timely receipt of medical claims for your patients, our members, helps our chronic condition care management programs work most effectively, and also plays a crucial role in our ability to share information to help you coordinate patient care. In an effort to simplify processes, improve efficiencies, and better support coordination of care, we are changing all professional agreements to adopt a common time frame for you to submit claims.nnEffective for all claims submitted to plan on or after October 1, 2019, your Anthem Provider Agreement(s) will be amended to require the submission of all professional claims for commercial and Medicare Advantage plans within ninety (90) days of the date of service. This means all claims submitted on or after October 1, 2019, will be subject to a ninety (90) day timely filing requirement, and Anthem will refuse payment if submitted more than ninety (90) days after the date of service.*nnFor instance, for a claim with a date of service of July 5, 2019, the claim would be untimely if submitted more than 90 days after that date of service (i.e. the claim would deny if submitted on or after October 4, 2019.)nnNOTE: ALL CLAIMS WITH DATES OF SERVICE PRIOR TO OCTOBER 1, 2019 THAT WILL BE MORE THAN 90 DAYS FROM THE DATE OF SERVICE ON OCTOBER 1 SHOULD BE SUBMITTED PRIOR TO OCTOBER 1, 2019 TO AVOID A TIMELY FILING DENIAL. nn*If Plan is the secondary payor, the ninety (90) day period will not begin until Provider receives notification of primary payor’s responsibility.n
Payment methodology change / reimbursement adjustment – Consult codes and Laboratory Services done in the Provider’s Office
nAnthem Blue Cross and Blue Shield and our subsidiary company, HMO Colorado (Anthem) would like to make you aware of changes to our payment methodology / reimbursement adjustment that will be effective for dates of service on or after October 1, 2019.nnConsult CodesnAnthem continues to reimburse for consult codes (99241 – 99245). Effective October 1, 2019, Anthem will adjust the reimbursement for consult codes to match the same contractual allowed amount as your contract defines for Evaluation and Management (E/M) codes.nnLaboratory Services done in the Provider’s OfficenAnthem is contracted with Laboratory Corporation of America® (“LabCorp”). All lab work, including Pap tests and routine outpatient pathology, must be sent to LabCorp, with the exception of the procedures that can be performed in the Provider’s office. (Please reference the Laboratory Services section of our Provider Manual for the full list of procedures that can be performed in the Provider’s office. The Provider Manual is available online; see navigation instructions below.)nnAnthem continues to reimburse for laboratory services done in the Provider’s office, and no changes are being made to the services allowed in office. Effective October 1, 2019, Anthem will adjust the reimbursement for lab services performed in the Provider’s office from 100% of the Medicare year Anthem has implemented to 60% of the Medicare year Anthem has implemented.nnPathology codes are excluded from this adjustment.nnAnthem’s Provider Manual is available online. Go to anthem.com. Select Providers, and Providers Overview. Select Find Resources for Your State, and pick Colorado. From the Provider Home page, under the Communications and Updates heading, select the Provider Manual link, and then select the link titled Provider and Facility Manual: February 1, 2019.nnInformation from Anthem Blue Cross Blue Shield and HMO Colorado.
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 PROCEDURE: 04/17/20XXnnPREOPERATIVE DIAGNOSIS: Left degenerative peritalar subluxation and deformity with contracted peroneal tendons and attenuated and tom tibialis posterior tendon, gastrocnemius contracture. nnPOSTOPERATIVE DIAGNOSIS: Same.nnPROCEDURE: Left Strayer gastrocnemius resection, subtalar and talonavicular joint arthrodesis, peroneal tendon lengthening, tibialis posterior tendon repair, cotton cuneiform osteotomy.nnSURGEON: K., MD.nnASSISTANT FOR THE CASE: M. nnANESTHESIA: General.nnBLOOD LOSS: Minimal.nnBRIEF HISTORY: The patient had chronic pain secondary to above. This was refractory conservative treatment. This was causing her severe difficulty and pain with her knee. Risks and benefits of the above procedure were explained to the patient at length which included pain, bleeding, infection, stiffness, swelling, nerve injury, nonunion, painful hardware, recurrence of deformity, blood clots, a possible need for further surgery, and complications. Informed consent was obtained.nnDESCRIPTION OF PROCEDURE: The patient was taken to the operating room and placed on the table in supine position. After a popliteal block was performed, general anesthesia was induced. A well-padded thigh tourniquet was applied. She was prepped and draped in the usual sterile fashion.nnEsmarch bandage and tourniquet elevated to 300 mmHg. An incision was made centered over the gastrocnemius aponeurosis posteriorly. Sharp dissection was carried out down to the distal aponeurosis. A linear incision was made. Care was taken to avoid injury to the sural nerve or the small saphenous vein. Excellent correction of the contracture was achieved with dorsiflexion well past neutral with the knee extended. Thorough irrigation was carried out using saline. Subcutaneous was closed using inverted 2-0 Vicryl stitches followed by staples for the skin.nnAttention was then turned to the subtalar joint. An incision was made over the sinus tarsi. Sharp dissection was carried out down to the subtalar joint. The peroneal tendons were identified. Z lengthening of the peroneus longus and brevis tendons were then carried out using a 15 blade. This allowed easier correction of the hindfoot valgus. The subtalar joint was entered. This was held open using a lamina spreader. Joint was prepped by removal of cartilage along with perforation of the subchondral bone, surfaced multiple times using a drill bit and chisel. In a similar manner, an incision was made over the talonavicular joint between the tibialis anterior and tibialis posterior tendon. This joint was exposed using a laminar spreader and the joint was prepped in a similar fashion Severe deformity of this joint was seen in a large bone fragment that was non-united from the navicular was present which was excised. The tibialis posterior tendon was obviously lengthened and attenuated. 3 mL of Trinity Elite graft was then thawed and prepped in the standard fashion. A Wright Medical augment was prepped in the standard fashion as well. The augment was first placed on the bone surfaces of both joints with the joint space then filled with the Trinity Elite graft. The talonavicular joint was then first reduced with con-ection of the forefoot abduction. Good co1Tection of the deformity was achievable. This was provisionally held using a K-wire. Once C-mm confirmed a reasonable reduction of the joint and reasonable clinical foot alignment was felt to be present, a single Paragon 28 4.5 mm partially threaded cannulated screw was then placed over the wire with good reduction and fixation.nnNext, attention was then turned to the subtalar joint. Subtalar joint was reduced with correction of the valgus deformity and held in a reduced position with the assistance of the surgical assistant. Through a small posterior incision, a single Paragon 28 7.0 mm partially threaded headless cannulated screw of appropriate size was then placed with good compression and fixation across the joint achieved and good screw placement confirmed bynnC-a1m.nnNext, a 2-hole compression plate was then applied to further supplement fixation on the talonavicular joint with good fixation achieved. Next, the forefoot varus was assessed. There was a significant forefoot varus still present and therefore the Cotton osteotomy was performed. A separate incision was made with sharp dissection down to the cuneiform bone dorsally. A TPS saw was then utilized to perform the Cotton osteotomy in the mid-portion of the cuneiform bone. An osteotome was then used to complete the osteotomy plantarly. Paragon bone wedge trials were then utilized to determine the appropriate size of the bone wedge to be used. A 5mm bone wedge was felt to be appropriate. This was then placed in saline for 5 minutes. The graft was then inserted with the deformity corrected with the aid of the surgical assistant. The correction of deformity was felt to have been achieved.nnNext, attention was then turned to the tibialis posterior tendon. The tendon was advanced and repaired onto the navicular bone using 2 Arthrex corkscrew anchors. Good fixation was achieved. Good stability of the ankle was present. Good correction of deformity was present. Irrigation of all wounds was carried out using saline. Subcutaneous was closed using inverted 2-0 Vicryl stitches followed by staples for the skin. Wounds were dressed using Xerofo1m, 4 x 4s, cast padding followed by a well-padded plaster splint followed by an Ace wrap.nnThe patient tolerated the procedure well. There were no complications. She was transferred to the recovery room in good condition. M was used for assistance for the case. Their service was essential for safe time for this case as were proper maintenance of alignment of all articulations while arthrodesis and fixation were performed.nn
“We hold these truths to be self-evident: that all men are created equal; that they are endowed by their Creator with certain unalienable rights; that among these are life, liberty, and the pursuit of happiness.” -Thomas Jeffersonnn Welter Healthcare Partners would like to wish you a Happy 4th of July! Our dedicated staff wants you to remember to relax and have a safe holiday.nnAccording to ADT, firework, grilling and water safety are collectively very important for the 4th of July. More than 50,000 fires are caused by fireworks every year and fun water activities have serious risks if the proper precautions aren’t taken! Please make sure to review safety procedures to keep you and your family safe.nnFrom all of us at Welter Healthcare Partners, we hope you take the opportunity to enjoy this day with loved ones and celebrate your freedom.nn
CMS is requesting providers to submit information regarding their concerns, suggestions, and comments on the proposed changes to help patients. The deadline for providers to take part in this request is August 12th. For more information, read the information below. nnnThere is so much talk in the medical community about the proposed “Patients over Paperwork” initiative that many providers have found themselves at a loss for what will happen next. Common questions surrounding this important topic include: What type of documentation changes will help reduce the amount of administrative burden our clinicians currently face? How will documentation changes affect their practice? How will this impact reimbursement? What does this mean for their patient interaction and day-to-day routine? Is there anyone I can talk to so that my concerns are heard?nnIn June of this year, CMS put out another request for information from providers to voice their concerns, suggestions, and comment on proposed changes. Do not delay however because the deadline for this round of comments closes on August 12th. Specific feedback that CMS is looking for can be found by visiting federalregister.gov, where you can also submit your comments. Your participation in this initiative does not have to stop with this RFI. CMS frequently releases opportunities for public comment to address specific areas of concerns and providers should prioritize to take advantage of these opportunities.
Wednesday nights democratic primary debate was dominated by talks of healthcare by the candidates. The discussions ranged from health policies to the skyrocketing drug prices which are among the key issues of the candidates. Each had different views on the topic of healthcare. Read the article below to find out what some of their ideas are and what they think they could do to better the healthcare system.nnDuring Wednesday night’s Democratic presidential primary debate — the first in a two-night event viewed as the de facto launch of the primary season — health policies, ranging from “Medicare for All” to efforts to curb skyrocketing drug prices, were among the key issues the 10 hopeful candidates onstage used to help differentiate themselves from the pack.nnHealth care dominated early, with Sens. Elizabeth Warren (Mass.) and Cory Booker (N.J.) using questions about the economy to take aim at pharmaceutical and insurance companies. Sen. Amy Klobuchar (Minn.) emphasized the difficulties many Americans face in paying premiums.nnBut the candidates broke ranks on the details and not all of their claims stayed strictly within the lines.nnOnly two candidates — New York City Mayor Bill de Blasio and Warren — raised their hands in favor of banishing private insurance to install a government-sponsored Medicare for All approach.nnKlobuchar, a single-payer skeptic, expressed concern about “kicking off half of America off their health insurance in four years.” (That’s correct: In 2017, a majority of Americans had private coverage, with 49% getting that insurance through work, according to the Kaiser Family Foundation.)nnFormer Texas Rep. Beto O’Rourke, who also supports maintaining a private insurance system, outlined his own universal health care plan, based on a “Medicare for America” bill in Congress.nnThe single-payer talk set off other discussions about the role of health insurance and the cost of care. We fact-checked some of the biggest claims.nnWarren: “The insurance companies last year alone sucked $23 billion in profits out of the health care system. $23 billion. And that doesn’t count the money that was paid to executives, the money that was spent lobbying Washington.”nnWe contacted Warren’s campaign, who directed us to a report from the National Association of Insurance Commissioners, a nonpartisan group of industry regulators. It supports her assessment.nnThe report says that in 2018, health insurers posted $23.4 billion in net earnings, or profits, compared with $16.1 billion a year prior.nnThis came up in the context of Warren’s support for eliminating private insurance under a Medicare for All system. However, the financing and price tag of such a system is unclear.nnBooker: “The overhead for insurers that they charge is 15%, while Medicare’s overhead is only at 2%.”nnThis is a flawed comparison. Booker said administrative overhead eats up much more for private carriers than it does for Medicare, the government insurance program for seniors and the disabled. But Medicare piggybacks off the Social Security Administration, which covers costs of enrollment, payments and keeping track of patients.nnAlso, Medicare relies on private providers for some of its programs, and overhead charges there are higher. Medicare’s overhead is less than that of private carriers, but exact figures are elusive.nnThe insurance companies’ trade group, America’s Health Insurance Plans (AHIP), reported in 2018 that 18.1% of private health care premiums went to non-health care services. That includes taxes of 4.7% and profits of 2.3%. The Medicare trustees reported that in 2018, total expenses were $740.6 billion, with administrative expenses of $9.9 billion. That comes to 1.3%, less than Booker said.nnWarren: “I spent a big chunk of my life studying why families go broke, and one of the No. 1 reasons is the cost of health care, medical bills. And that’s not just for people who don’t have insurance. It’s for people who have insurance.”nnIs the No. 1 reason people go broke the cost of health care? We’ve rated similar statements Half True — partially accurate but lacking important context.nnOriginal article from khn.org
In this video, we found there are 5 habits of exceptionally charismatic people! We all know people who exude charisma and always leave the best impression and charm to everyone in the room, and it has been found that charisma can be learned. From her book, Vanessa Van Edwards identifies 5 habits that exceptionally charismatic people follow. Learn why charisma matters and how you can use people skills and body language to adjust your presence and more positively influence everyone around you!nn
Anthem Blue Cross and Blue Shield and HMO Colorado (hereinafter collectively referred to as Anthem) continues to look for ways to improve our processes and align with industry standards. Timely receipt of medical claims for your patients, our members, helps our chronic condition care management programs work most effectively, and also plays a crucial role in our ability to share information to help you coordinate patient care. In an effort to simplify processes, improve efficiencies, and better support coordination of care, we are changing all professional agreements to adopt a common time frame for you to submit claims.nnEffective for all claims submitted to plan on or after October 1, 2019, your Anthem Provider Agreement(s) will be amended to require the submission of all professional claims for commercial and Medicare Advantage plans within ninety (90) days of the date of service. This means all claims submitted on or after October 1, 2019, will be subject to a ninety (90) day timely filing requirement, and Anthem will refuse payment if submitted more than ninety (90) days after the date of service.*nnFor instance, for a claim with a date of service of July 5, 2019, the claim would be untimely if submitted more than 90 days after that date of service (i.e. the claim would deny if submitted on or after October 4, 2019.)nnNOTE: ALL CLAIMS WITH DATES OF SERVICE PRIOR TO OCTOBER 1, 2019 THAT WILL BE MORE THAN 90 DAYS FROM THE DATE OF SERVICE ON OCTOBER 1 SHOULD BE SUBMITTED PRIOR TO OCTOBER 1, 2019 TO AVOID A TIMELY FILING DENIAL. nn*If Plan is the secondary payor, the ninety (90) day period will not begin until Provider receives notification of primary payor’s responsibility.n
Anthem continues to reimburse for consult codes (99241 – 99245). Effective October 1, 2019, Anthem will adjust the reimbursement for consult codes to match the same contractual allowed amount as your contract defines for Evaluation and Management (E/M) codes.nnLaboratory Services done in the Provider’s OfficenAnthem is contracted with Laboratory Corporation of America® (“LabCorp”). All lab work, including Pap tests and routine outpatient pathology, must be sent to LabCorp, with the exception of the procedures that can be performed in the Provider’s office. (Please reference the Laboratory Services section of our Provider Manual for the full list of procedures that can be performed in the Provider’s office. The Provider Manual is available online; see navigation instructions below.)nnAnthem continues to reimburse for laboratory services done in the Provider’s office, and no changes are being made to the services allowed in office. Effective October 1, 2019, Anthem will adjust the reimbursement for lab services performed in the Provider’s office from 100% of the Medicare year Anthem has implemented to 60% of the Medicare year Anthem has implemented.nnPathology codes are excluded from this adjustment.nnAnthem’s Provider Manual is available online. Go to anthem.com. Select Providers, and Providers Overview. Select Find Resources for Your State, and pick Colorado. From the Provider Home page, under the Communications and Updates heading, select the Provider Manual link, and then select the link titled Provider and Facility Manual: February 1, 2019.nnInformation from Anthem Blue Cross Blue Shield and HMO Colorado.
Welter Healthcare Partners would like to wish you a Happy 4th of July! Our dedicated staff wants you to remember to relax and have a safe holiday.
nnThere is so much talk in the medical community about the proposed “Patients over Paperwork” initiative that many providers have found themselves at a loss for what will happen next. Common questions surrounding this important topic include: What type of documentation changes will help reduce the amount of administrative burden our clinicians currently face? How will documentation changes affect their practice? How will this impact reimbursement? What does this mean for their patient interaction and day-to-day routine? Is there anyone I can talk to so that my concerns are heard?nnIn June of this year, CMS put out another request for information from providers to voice their concerns, suggestions, and comment on proposed changes. Do not delay however because the deadline for this round of comments closes on August 12th. Specific feedback that CMS is looking for can be found by visiting 
Health care dominated early, with Sens. Elizabeth Warren (Mass.) and Cory Booker (N.J.) using questions about the economy to take aim at pharmaceutical and insurance companies. Sen. Amy Klobuchar (Minn.) emphasized the difficulties many Americans face in paying premiums.nnBut the candidates broke ranks on the details and not all of their claims stayed strictly within the lines.nnOnly two candidates — New York City Mayor Bill de Blasio and Warren — raised their hands in favor of banishing private insurance to install a government-sponsored Medicare for All approach.nnKlobuchar, a single-payer skeptic, expressed concern about “kicking off half of America off their health insurance in four years.” (That’s correct: In 2017, a majority of Americans had private coverage, with 49% getting that insurance through work, according to the Kaiser Family Foundation.)nnFormer Texas Rep. Beto O’Rourke, who also supports maintaining a private insurance system, outlined his own universal health care plan, based on a “Medicare for America” bill in Congress.nnThe single-payer talk set off other discussions about the role of health insurance and the cost of care. We fact-checked some of the biggest claims.nnWarren: “The insurance companies last year alone sucked $23 billion in profits out of the health care system. $23 billion. And that doesn’t count the money that was paid to executives, the money that was spent lobbying Washington.”nnWe contacted Warren’s campaign, who directed us to a report from the National Association of Insurance Commissioners, a nonpartisan group of industry regulators. It supports her assessment.nnThe report says that in 2018, health insurers posted $23.4 billion in net earnings, or profits, compared with $16.1 billion a year prior.nnThis came up in the context of Warren’s support for eliminating private insurance under a Medicare for All system. However, the financing and price tag of such a system is unclear.nnBooker: “The overhead for insurers that they charge is 15%, while Medicare’s overhead is only at 2%.”nnThis is a flawed comparison. Booker said administrative overhead eats up much more for private carriers than it does for Medicare, the government insurance program for seniors and the disabled. But Medicare piggybacks off the Social Security Administration, which covers costs of enrollment, payments and keeping track of patients.nnAlso, Medicare relies on private providers for some of its programs, and overhead charges there are higher. Medicare’s overhead is less than that of private carriers, but exact figures are elusive.nnThe insurance companies’ trade group, America’s Health Insurance Plans (AHIP), reported in 2018 that 18.1% of private health care premiums went to non-health care services. That includes taxes of 4.7% and profits of 2.3%. The Medicare trustees reported that in 2018, total expenses were $740.6 billion, with administrative expenses of $9.9 billion. That comes to 1.3%, less than Booker said.nnWarren: “I spent a big chunk of my life studying why families go broke, and one of the No. 1 reasons is the cost of health care, medical bills. And that’s not just for people who don’t have insurance. It’s for people who have insurance.”nnIs the No. 1 reason people go broke the cost of health care? We’ve rated similar statements Half True — partially accurate but lacking important context.nnOriginal