Code Spotlight — Inter-Professional Telehealth Consultations
Welter Healthcare Partners is excited to present our new Code Spotlight! Each month, Welter Healthcare Partners will spotlight a unique CPT or ICD-10 code to profile and discuss practice applications of the code, as well as pertinent guideline reminders. Today, we focus on two new codes, 99451 & 99452 related to inter-professional Telehealth consultations.nn99451 — Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative timenThe code covers assessment and management services via telephone, Internet, or electronic health record (EHR) and includes a written report to the requesting or referring provider. Report 5 minutes or more of medical consultative time by a consulting physician, typically a specialty physician who receives a written or verbal request from a physician or other qualified healthcare provider to offer an opinion on a case.nn99452 — Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes.nReport 30 minutes of time spent on interprofessional telephone, Internet, or electronic health record (EHR) referral services by a requesting or treating provider, that is, a physician or other qualified healthcare professional who is providing a consulting physician with background information regarding a patient’s condition.nnKeep in mind that in addition to these two new codes that codes 99446-99449 have also been revised. Reporting similar services with a verbal and written report, see 99446, Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified healthcare professional; 5-10 minutes of medical consultative discussion and review and add-on codes +99447, +99448, and +99449 for additional time.nnClick the links below to learn moren
nnMedicare accountable care organizations (ACOs) are not happy that they have a little more than a month to decide on whether to take on more risk or leave the program.nnThe CMS on Wednesday gave new ACOs a Feb. 19 deadline to apply to the Pathways to Success program, which forces them to take on more risk than they did in the Medicare Shared Savings Program. But the National Association of ACOs said on Thursday that the deadline is far too short, coming only two months after the CMS published a final rule for Pathways to Success.nn”ACOs barely have time to understand the new rules, and organizing an application is very complicated and for some it is now a high-risk decision,” NAACOS President Clif Gaus said in a statement.nnThe association, which has fervently fought the changes to the risk-sharing program, wants the deadline moved to late March.nnThe CMS published the Pathways to Success rule on Dec. 19. But CMS did not provide the application deadline when it posted the rule.nnThe CMS told Modern Healthcare there will be two application cycles for ACOs in 2019, and this first deadline is for the July 1, 2019 start date. ACOs joining the second round that starts Jan. 1, 2020 will have a summer deadline.nnThe Feb. 19 deadline only applies to new ACOs that want to join the program or ACOs that have an existing agreement that has expired. An ACO that has a three-year agreement that expires in either 2019 or 2020 can finish that contract before moving to the new program.nnPathways to Success represents a radical departure from the prior Shared Services Program.nn
An ACO entering the new five-year program can only be in a one-sided risk track for two to three years depending on how much they earn, with ACOs that generate a low amount of revenue staying in the track longer. After the initial period, they must start to pay the federal government if they don’t save enough money in healthcare costs or meet quality requirements.nnUnder the previous program, an ACO could be in a one-sided risk track for the duration of the five-year contract and not have to pay the federal government anything if they don’t meet quality benchmarks or cost metrics.nnExisting ACOs also will have to participate in programs that require them to take on more risk in subsequent years.nnThe NAACOS said that ACOs won’t be able to make “several critical decisions,” before the Feb. 19 deadline, such as what physicians will participate and signing agreements.nn”Setting an application deadline two months after passing the final rule does not give ACOs that have expiring agreements the necessary time to vet the decision internally,” Jennifer Moore, chief operating officer at MaineHealth ACO in Portland, Maine, said in a statement.nnThe CMS told Modern Healthcare that it is providing ACOs with documents and sample applications.nnOnly a third of ACOs will be subject to the February deadline, according Ashley Ridlon, vice president of health policy for the consulting firm Evolent Health.nnThere are 561 ACOs that are responsible for 10.5 million Medicare patients, according to data from the CMS.nnRidlon conceded that “the timeline is indeed very tight.”nnThe short turnaround means that hospitals and providers are going to not have a lot of time to think through the pros and cons of whether to apply, said David Muhlestein, chief research officer for the firm Leavitt Partners.nn”The timeline is quite short, though doable,” Muhlestein said. “Potential participants will need to prioritize this and get their boards, leadership and physicians aligned in a hurry.”nnOriginal 
32652-RT J94.2, J98.4nnSurgeon: Surgeon(s) and Role:n* XXXXX, XXXXXXX, MD – PrimarynnCase Length: 3 Hr 2 Min 20 SecnnPre-Operative Diagnosis: right retained hemothoraxnnPost-Operative Diagnosis: SamennOperation Performed: Right Video Assisted Thoracic Surgery (VATS) and total lung decorticationnwith removal of large retained old hematomannFindings (Normal + Abnormal): Large amount of old organized thrombus in the right hemithorax with trapped and scarred portions of the lung. Hematoma removed, trapped lung was released. At the end the lung was completely expanding. Good hemostasisnnOperation Description:nThe patient was brought into the operating room and was placed in a supine position. A time out procedure was carried out identifying a correct patient and site. Then general endotracheal anesthesia with a double lumen tube was placed. The patient was placed in a left lateral decubitus position. Then, the first port was placed along the posterior axillary line. A laparoscope was placed the lung was down. Then the second 5 mm port of was placed in a 5th intercostal space in the posterior axillary line. The third incision was placed in the anterior axillary line in the 5th intercostal space. All the ports were placed under a direct visualization. The soft adhesions were carefully released with a blunt laparoscopic grasper. There were soft clots in the apex that were suctioned. There was an area of the lung that was attached to the chest wall which was gently released with blunt dissection. The chest cavity was irrigated with a warm saline. Then we inspected the right chest for bleeding and meticulous hemostasis was obtained. Then a 36French chest tube was placed through the incision on the 7th intercostal space. The chest tube was secured with a #1 silk sutures. The other incisions the muscle was closed with a silk suture. Then the 2-0 Vicryl for a deep dermal tissue and a 4-0 Monocryl for skin was used. Then, glue applied. All the sponge and instrument counts were correct. The patient was extubated and was transferred to the post operative anesthesia care unit.nnRapid Frozen Section Telephone Diagnosis: NonennSpecimens Removed: NonennWound Classifications: Clean Contaminated
Enrollment in medical plans before the start of the new year is something that is on everyone’s mind to ensure continuity of medical care. However, the article below reveals that enrollment in Medicare Advantage is slower than in previous years. nnMedicare Advantage insurers added 1.4 million members to their rosters for 2019 coverage, as they looked to grow membership in a market known for being politically safe and predictably lucrative. But Advantage membership is growing at a slower pace compared with previous years.nnAccording to the latest federal data showing enrollment as of this month, 22.4 million people are enrolled in Medicare Advantage for 2019 coverage—an alternative to the traditional Medicare program in which private insurers contract with the federal government to administer program benefits. That’s an increase of 6.8% since January 2018. Health insurers, however, managed to grow their Advantage membership base by more than 1.5 million in both 2016 and 2017.nnSome industry experts were expecting more. “The formula was there: Health plans were aggressive, they got nice rate increases, the rules around benefit design relaxed a little bit,” explained Jeff Fox, president of Gorman Health Group, which provides technology and other services to Medicare Advantage plans.nnFox expected Advantage enrollment to increase by double-digits over the past year, as health plans invested heavily in marketing and the federal government provided one of the biggest rate increases for the plans in years at 3.4%. The Trump administration also granted Advantage plans the flexibility to provide more supplemental benefits in 2019, such as transportation and in-home care.nnBut Fox said distraction from the craziness of the November midterm elections may have kept some seniors from enrolling during the annual open enrollment that lasted from Oct. 15 to Dec. 7, 2018. While the CMS data captures some of the sign-ups from open enrollment, figures out next month are likely to be higher.nnDespite the slower pace, many Advantage insurers still experienced big enrollment increases as they picked up more market share. About half of all members are covered by just three companies. UnitedHealth held onto the top spot, adding nearly 500,000 Advantage members in the past year for a total 5.7 million. UnitedHealth holds more than a quarter of the total Medicare Advantage market share.nn
nnHumana remained the No. 2 Advantage insurer with 3.9 million members, an increase of 10.4% over January 2018. But thanks to its acquisition of Aetna, CVS Health took the No. 3 spot with 2.2 million Advantage enrollees. Kaiser Foundation Health Plan and Anthem rounded out the top five insurers with the most Advantage members.nnOn a percentage basis, Anthem and Aetna grew membership the fastest. Anthem’s Medicare Advantage membership spiked 53% to 1.1 million members compared with the same time last year. The Indianapolis-based insurer has long focused on serving employers, but recently turned its sights to growing Medicare Advantage rolls through acquisitions and expansions in places where it already operates.nnAnthem bought Florida-based Medicare plans HealthSun in December 2017 and America’s 1st Choice in February 2018, together giving Anthem about 170,000 more Advantage members. Anthem CEO Gail Boudreaux told investment analysts in July that the company would focus on selling group Medicare Advantage plans and serving medically complex dual-eligible members in 2019.nnCVS Health, meanwhile, grew its Medicare membership by 26.7% in 2018 to 2.2 million through its acquisition of Aetna. The deal is still technically awaiting a federal judge’s approval. In a research note Monday, Barclays equity analyst Steve Valiquette noted that Aetna’s membership growth was driven by its expansion into about 360 new counties. Valiquette wrote that the growth experienced by some public health insurers during the annual enrollment period for 2019 coverage was driven more by market share gains than by industry growth.nnMedicare Advantage enrollment is climbing as the baby boomer generation ages rapidly into Medicare. Those seniors are used to employer-sponsored managed-care plans and are choosing Advantage over traditional Medicare more often than previous generations did. Seniors also often get more benefits, including dental care, eyeglasses and gym memberships, with an Advantage plan.nnMedicare Advantage also enjoys support from both political parties and is able to weather swings from one federal administration to the next, whereas insurers that sell plans in the individual market, for example, may have to deal with more volatility.nnMoreover, Medicare Advantage margins tend to hover between 4% to 5%, whereas Medicaid margins come in at 2% to 3% and the individual market historically has had even lower margins, S&P analyst Deep Banerjee told Modern Healthcare in August. The group employer business has higher margins, but that market isn’t growing like Medicare Advantage is.nnOriginal 
Telehealth:n2019 is here and technology is continually getting better. People are able to connect quicker and better than ever, so why not with their physicians?nnTelehealth, unlike telemedicine, incorporates a broader scope of health care services remotely as well as non-clinical services like provider training, administrative meetings and continuing education. Telemedicine is strictly remote clinical services.nnPatients continue to be more involved in their health outcomes by utilizing technology that is already part of their daily lives. With advancements in smartphone apps, activity trackers, automated reminders and blood glucose monitors allowing for better “collect and transmit” health information and monitoring of chronic conditions. There are four methods that make up telehealth, they include live video (synchronous), store and forward (SFT), remote patient monitoring (RPM), and mobile health (mHealth).nnThe American Medical Association, or AMA, has created the STEPS Forward module to help practices integrate this into their care plan. This module contains four steps to adopt telemedicine into your practice:n
With voters clamoring for more affordable healthcare, Colorado’s Democratic Gov. Jared Polis on Wednesday created the Office of Saving People Money on Health Care.nnCiting soaring health insurance premiums in the state’s rural and mountain communities, the newly elected Polis said the office will work with the Democratic-controlled legislature to authorize a reinsurance program and develop lower-cost coverage options. His lieutenant governor, a healthcare expert, will be in charge of the office.nn”We need to take action to really find and act on the root causes of skyrocketing healthcare costs,” he said in announcing the executive order.nnBut Polis may run into healthcare industry resistance with his push to have the office establish programs to reduce prescription drug prices and increase hospital price transparency. He has also said he would consider establishing a public health plan option such as a voluntary Medicaid buy-in program, and allow the importation of cheaper prescription drugs from Canada, two ideas with powerful industry opposition.nnPolis is the latest newly elected Democratic governor to lay out an ambitious agenda to make healthcare more affordable for consumers, reduce costs and expand coverage. With a divided Congress likely to be gridlocked by partisan differences, observers expect most health policy action will take place at the state level for the next two years.nnCalifornia’s Democratic Gov. Gavin Newsom has proposed to extend Affordable Care Act premium subsidies to people with incomes above the law’s current eligibility threshold, and allow state agencies to directly negotiate prices with prescription drug manufacturers.nnMinnesota Gov. Tim Walz wants to allow people to buy into Medicaid. Second-term Washington Gov. Jay Inslee also has proposed a public plan option to reduce premiums.nnPolis was elected in November on a groundswell of voter demand for state action to make healthcare more affordable, said Kyle Legleiter, senior policy director at the Colorado Health Foundation..nn
Last year, his organization conducted a survey with the Kaiser Family Foundation that found nine in 10 Coloradans said lowering healthcare costs was a key issue for the state to work on, with one in four saying it was the top issue.nnMany rural and mountain counties in Colorado have only one insurer in the individual market, and those counties often are served by one hospital and a limited number of physician specialists. So individuals and small businesses in those communities have faced some of the highest premiums in the country.nn”So it’s not surprising to see Gov. Polis address healthcare costs and affordability in the second executive order he has signed,” Legleiter said.nnLt. Gov. Dianne Primavera, a veteran healthcare legislator, patient advocate and breast cancer survivor, will lead the Office of Saving People Money on Healthcare. As part of her role, she’ll also head a permanent interdepartmental healthcare cabinet including all state agencies managing healthcare and behavioral health programs to align their efforts.nnThe Colorado Hospital Association praised Polis’ initiative. “The potential and opportunity for this office’s efforts are significant and could make a great difference for Coloradans,” the association said in a written statement.nnUnder the previous governor, Democrat John Hickenlooper, the Colorado Commission on Affordable Health Care issued a broad range of recommendations in 2017 for improving affordability and access, with a heavy focus on increasing price and quality transparency.nnBut Polis may have more ability to make changes than Hickenlooper did, since the Democrats took full control of the legislature in November.nn”Healthcare costs were top of mind for voters in many states in 2018 and into 2019, and many newly elected leaders, both Democrats and Republicans, heard that loud and clear,” Legleiter said.nn nnOriginal