May 9, 2019 | Uncategorized
Now that we are all familiar with ICD-10 it’s time that we start focusing more on specificity when it comes to diagnosis. It’s not just import for patient charts, with HCC becoming the new standard and payers tracking things like readmissions it’s becoming more important than ever for Coders to capture as much in their code selection as possible.nnICD-10 includes a classification system implemented to capture data, which previously was not tracked. Classifications such as “underdosing of drugs” can prove to be vital when readmission rates are not only tracked but also could affect a practice’s reimbursements. As coders, it’s not only important that we extrapolate this information from the documentation but also code why the drug was not taken correctly or, in some cases, not at all. Classification codes T36-T50 (utilizing a fifth or sixth character of “6”), deals with specific drug underutilization while Z codes Z91.12- Z91.19 classifies the patient’s non-compliance with medical treatment and regimen. Z codes should, when known, be accompanied by the correct underdosing code to help account for intent.nnThe Journal of AHIMA wrote about this back in 2016, however this topic will continue to become more relevant as Risk Adjustment Models are adapted by more practices and payers.nnCLICK HERE to read the full article, “Potential Impact of the ICD-10 Underdosing Classification System” in the Journal of AHIMAnn
Apr 30, 2019 | Uncategorized
Colorado Governor, Jared Polis, has been in the news for his “roadmap” to reduce healthcare costs for all Coloradans. In this article, we dive into the latest developments: which bills are still on the table, how they plan on lowering health care costs, and whether there’s still enough time and money to make this a possibility. nn
Colorado Gov. Jared Polis stood outside of Denver Health Medical Center almost a month ago laying out his “roadmap” to save people money on health care.nnAs the Boulder Democrat ticked off his list of plans, both short term and long term, it quickly became apparent that most of the governor’s ideas to lower health care costs in Colorado weren’t possible unless state lawmakers passed a series of bills.nnDemocrats and Republicans have come together to create the beginnings of a public option health plan and make hospitals turn over more of their financial data. But with a week left in the 2019 session, several items on the governor’s list still haven’t passed and the big question remaining is whether there’s enough time, money and political will to get the rest of them across the finish line.n
Reinsurance
nA high-priority bill that might not make it through in the final days of session is one that has lowered people’s premiums in other states by essentially providing an insurance plan for health insurance companies to help offset the costs of their most expensive patients.nnIt’s called reinsurance, and its sponsors basically rewrote House Bill 1168 for a third time Thursday afternoon.nn“It’s always been an issue of how to pay for it,” said Sen. Bob Rankin, R-Carbondale, as he presented the latest changes to a Senate committee.nnColorado wants to get matching dollars from the federal government for its reinsurance program. The first version of the bill was unlikely to win approval from the Trump administration, and the funding mechanism on the second jeopardized other federal dollars.nnRankin and Sen. Kerry Donovan, D-Vail, were frank with their colleagues that the new way to fund the program isn’t ideal, but Donovan said it’s the best way they could find with time running out on the 2019 legislative session.nnThe new plan is to have Colorado hospitals contribute $40 million, take $26 million from a premium tax that would otherwise go into the general fund and potentially take another $15 million to $40 million from a fee that was originally meant to raise money for affordable housing.nn“We don’t want the program to die,” Rankin said. “We want to use every possible avenue to get this program moving.”nnReinsurance is waiting on a vote by the full Senate.n
Prescription drugs from Canada
nPolis and other Democratic lawmakers see our neighbors to the north as a potential cure for the high drug prices Coloradans pay every day.nnThat’s why Democrats introduced Senate Bill 005 on the first day of the 2019 session. It directs the Department of Health Care Policy and Financing to create a program to buy prescription drugs from from licensed Canadian suppliers and then distribute them to pharmacies and hospitals across the Centennial State.nnThe bill passed the Senate a month ago, but it has yet to clear the House.nnColorado would need a waiver from the federal government to legally bring those drugs across the border, and it’s unclear whether the White House would allow that. Both the Bush and Obama administrations rejected requests from other states.n
Prescription drug transparency
nAnother bill aimed at lowering the price people pay at the pharmacy is running out of time.nnHouse Bill 1296 would authorize the state Department of Insurance to collect data from every part of the prescription drug supply chain, analyze it and report annually to lawmakers on ways to reduce costs. It also would require drug companies to publish certain price increases on the DOI’s website 30 days before they go into effect.nnThe bill has yet to get a vote from either chamber.n
Out-of-network billing
nTwo different bills — one from each chamber — would limit how much money patients can be charged for out-of-network services they likely unknowingly received during an in-network hospital visit.nnThey’re called surprise or balance bills, and this is the fifth time lawmakers have tried to pass some kind of legislation to address them. House Bill 1174 appears to be on its way to becoming law; it’s awaiting a final vote in the Senate.nnOriginal article published on denverpost.com.
Apr 24, 2019 | Uncategorized
Todd Welter has some opinions when it comes to the upcoming Colorado State Bill HB19-1174 Out-Of-Network Health Care Services Provided To Covered Persons. Read it for yourself to see why he believes that the government should not be in the process of setting prices, and why health insurance companies should keep their patients’ best interest in mind by keeping prices low for the future.nnOur very own Todd Welter has been invited to the Colorado State Senate hearing on HB19-1174 Out-Of-Network Health Care Services Provided To Covered Persons.nnIn his own words, “The government should not be in the business of setting prices, there are too many unintended consequences. A free and transparent market should set prices.”
nnThis bill would require “health insurance carriers, health care providers, and health care facilities to provide patients covered by health benefit plans with information concerning the provision of services by out-of-network providers and in-network and out-of-network facilities; outlines the disclosure requirements and the claims and payment process for the provision of out-of-network services; requires the commissioner of insurance, the state board of health, and the director of the division of professions and occupations in the department of regulatory agencies to promulgate rules that specify the requirements for disclosures to customers, including the timing, the format, and the content and language in the disclosures; establishes the reimbursement amount for out-of-network providers that provider health care services to covered person at an in-network facility and for out-of-network providers or facilities that provider emergency services to covered persons; and creates a penalty for failure to comply with the payment requirements for out-of-network health care services.nnRead the rest of the bill here. (PDF)nnIf the state government sets prices for out-of-network services the health plans will be encouraged to use this as a ceiling rate. Any provider who has a higher rate (specialists in rural areas, very unique services, new procedures, etc.) will simply get their contracts terminated allowing the payers to use the state imposed ceiling rate.nnPlease contact your government representatives and make your opinion known!
Apr 24, 2019 | Uncategorized
Simon Sinek has a simple but powerful model for inspirational leadership — starting with a golden circle and the question: “Why?” His examples include Apple, Martin Luther King Jr. and the Wright brothers.nnThis talk was presented to a local audience at TEDxPuget Sound, an independent event. TED’s editors chose to feature it.n
n nnInformation and article originally published on ted.com.
Apr 18, 2019 | Uncategorized
Colorado Governor, Jared Polis, has been in the news for his ‘roadmap’ to reduce healthcare costs. We now uncover the latest developments of a state-run health insurance option. This advancement is seen as a step toward universal healthcare, but only one part of his strategy for achieving universal coverage. Read the article below to learn more about the public option health insurance bill.nnColorado’s Senate advanced another piece of Democratic Gov. Jared Polis’ healthcare agenda on Tuesday by tentatively endorsing a study on creating a state-run health insurance option.nn
nnThe bill would direct state agencies to recommend a plan that would compete with existing private insurance plans and those offered on Colorado’s healthcare exchange. Another Senate vote sends the study bill to the governor. It’s already cleared the House on a bipartisan 46-17 vote.nnBackers say it’s designed to curb some of the nation’s highest insurance premiums in mountain and other rural areas. Fourteen of Colorado’s 64 counties have just one insurer for the individual market, and monthly premiums there can be $500 higher than in metropolitan Denver.nnThe so-called “public option” bill is one of several measures advocated by Polis to reduce health care costs and increase accessibility for Colorado residents. In Washington state, Democratic Gov. Jay Inslee has called for a state-based public option health insurance plan that he has called a “step toward universal healthcare.”nnPolis’ campaign for office stressed a variety of strategies for achieving universal coverage.nnThe first-term governor already has signed a hospital price transparency bill into law.nnMajority Democrats in the Legislature are expected to send him bills to create a state reinsurance program to help private insurers lower premiums; a prescription drug price transparency bill; and a bill to get the federal government’s permission to import cheaper prescription drugs from Canada.nnThe public option legislation directs the Department of Health Care Policy and Financing and the Department of Regulatory Agencies to present a proposal in November. The plan would assess costs, funding sources, necessary federal permissions and funding, consumer eligibility and who in government would run a plan.nnSupporters say enrollment could begin in 2020 and a plan could start operating in 2021. Sponsors include Sen. Kerry Donovan and Rep. Dylan Roberts, both Democrats, and Republican Rep. Marc Catlin.nnDonovan noted Tuesday that too many residents in her own district, which includes Aspen, Vail and Glenwood Springs, have to choose between health insurance and paying mortgages or other family expenses.nnRepublican Sen. Jim Smallwood, an insurance broker, questioned the wisdom of having government step in as a competitor. He noted that high rural premiums persist and are rising under a state health insurance exchange adopted under the 2010 Affordable Care Act.nn”Introducing the concept of a public cure for what is broken in Obamacare seems hypocritical,” Smallwood said.nnOriginal article published on modernhealthcare.com.
Apr 18, 2019 | Uncategorized
I
n the Code Spotlight, Welter Healthcare Partners aims to profile and discuss practice applications of the code, as well as pertinent guideline reminders. Allograft Coding 2019 saw several changes to CPT, three codes that were added to the Surgery code set are for Allografting.nnCodes 20932, 20933 and 20934 all include templating, cutting placement and internal fixation, when performed.n
n
- Code 20932 is for osteoarticular
n
- Code 20933 is for hemicortical intercalary, partial
n
- Code 20934 is for intercalary, complete
n
nAll codes are add-on codes and should be listed in addition to the primary procedure, they can not be listed together.
