Aug 18, 2016 | Uncategorized
Problems…everyone has them. Every practice has them. A good manager knows problems and setbacks are out there and does h/her best to get in front of issues before they become major and even worse, destructive. It starts with honest assessments. An honest look at ones own shortcomings first and then the issues which do or could affect the practice and those within it. issues within a practice or department no matter how small and seemingly in consequential become destructive and even career ending when they are allowed to!nn
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About R. Todd Welter • MS, CPCnFounder and President of Welter Healthcare Partners
nMr. Welter has over 25 years of healthcare industry experience assisting physicians and other providers, hospitals and other facilities with the business side of medicine. Through strategic planning and analysis, Mr. Welter’s main focus is to strategically increase revenues and profitability in this radically changing health care environment.
Mr. Welter has a Masters Degree in Organizational Leadership from Regis University in Denver where he has had an appointment as affiliate faculty in the School for Professional Studies for over ten years. In addition, Mr. Welter holds a faculty appointment at the University of Denver’s University College. In the Health Care Leadership program he teaches Macro Economics in Health Care and Innovative Strategies and Change in Health Care to graduate students.
Aug 18, 2016 | Uncategorized
W16.111A – Fall into natural body of water striking water surface causing drowning and submersion, initial encounternnV92.06XA – Drowning and submersion due to fall off (nonpowered) inflatable craft, initial encounternnY93.16 – Activity, rowing, canoeing, kayaking, rafting and tubing
Aug 18, 2016 | Uncategorized
Medicare pays for clinical diagnostic laboratory tests (CDLTs) under the CLFS. The CLFS provides payment for approximately 1,300 CDLTs, and Medicare pays approximately $7 billion per year for these tests. As of July 6th, 2016, some of the medicare & medicaid rules and policies are changing. Read Below for some facts and information about the upcoming changes:n
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- The 2017 Medicare physician fee schedule conversion factor will drop slightly, from 35.8043 to 35.7551.
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- Family Medicine looks to be the big winner this year with a 3% increase
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- Interventional Radiology will take a huge 7% hit.
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- Pathology and Vascular surgery will also decrease by an average of 2%
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- Telehealth will see an expansion of coverage there will be new codes for these services
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- Zero-day global services are under increased study. These are the codes which are commonly billed with an E&M code along with the modifier -25
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nProposed Hospital Outpatient Payment Changes for 2017nnOn July 6, 2016, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2017 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy changes, quality provisions, and payment rates proposed rule (CMS-1656-P). CMS is proposing a number of outpatient prospective payment policies that will improve the quality of care Medicare patients receive.nnA key proposal in this year’s rule is to implement Section 603 of the Bipartisan Budget Act of 2015, which will affect how Medicare pays for certain items and services furnished by certain off-campus outpatient departments of a provider (hereinafter referenced as off-campus “provider-based departments” (PBDs)). In addition, CMS has listened to concerns raised by health care providers on the patient experience survey questions about pain management and is proposing to remove the Pain Management dimension of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for purposes of the Hospital Value Based Purchasing Program. In addition to the payment provisions and quality reporting program changes for the OPPS/ASC proposed rule, CMS has created other propositions.n
Click Here to Read More
nThis article was originally posted on CMS.gov.
Jul 27, 2016 | Uncategorized
The Justice Department is suing to block two proposed mergers between major health insurance companies, saying the deals violate antitrust laws and would lead to higher health care costs for Americans.nnU.S. Attorney General Loretta Lynch explained the decision at a press conference:n
“If allowed to proceed, these mergers would fundamentally reshape the health insurance industry. They would leave much of the multitrillion-dollar health insurance industry in the hands of three mammoth insurance companies, drastically constricting competition in a number of key markets that tens of millions of Americans rely on to receive health care.nn”Among other consequences, the number of health insurance options available to nationwide employers would shrink from four to three. Two of the largest and fastest-growing providers of Medicare Advantage plans, which millions of seniors rely on for crucial medical coverage, would combine into just one. And competition would be substantially reduced for hundreds of thousands of families and individuals who buy insurance on the public exchanges established under the Affordable Care Act.”
nThe lawsuits filed Thursday morning challenged a $37 billion merger between Humana and Aetna, which the Justice Department alleges “would lead to higher health-insurance prices, reduced benefits, less innovation, and worse service for over a million Americans,” and a $54 billion acquisition of Cigna by Anthem, which the court filing states would be the largest merger in the history of the health insurance industry.n
CLICK HERE TO READ MORE
nThis article originally posted on NPR.org.
Jul 27, 2016 | Uncategorized
T67.0XXD — Heatstroke and sunstroke, subsequent encounternnY93.02 — Activity, runningnnY92.414 — local residential or Business Street as the place of occurrence of the external cause
Jul 26, 2016 | Uncategorized
On July 7, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017. This year, CMS is proposing a number of new physician fee schedule policies that will improve Medicare payment for those services provided by primary care physicians for patients with multiple chronic conditions, mental and behavioral health issues, and cognitive impairment or mobility-related disabilities.nnCMS is proposing to expand the Diabetes Prevention Program model starting January 1, 2018. This is the second CMS Innovation Center – and first preventive services – model that has been certified for expansion. Expansion of this model will enhance access to these important services for Medicare beneficiaries who are at risk for developing diabetes.nnIn addition CMS is also:n
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- Proposing modifications to the Medicare Shared Savings Program to update the quality measures set and align with the proposals for the Quality Payment Program, changes to take beneficiary preferences for ACO assignment into consideration, and changes that would improve beneficiary protections when ACOs are approved to use the skilled nursing facility (SNF) 3-day waiver rule;
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- Requiring health care providers and suppliers to be screened and enrolled in Medicare in order to contract with Medicare Advantage health plans to provide Medicare-covered items and services to beneficiaries enrolled in Medicare Advantage;
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- Increasing transparency of Medicare Advantage pricing data and medical loss ratio (MLR) data from Medicare health and drug plans, and;
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- Continuing to implement Appropriate Use Criteria for advanced diagnostic imaging services, including proposals for priority clinical areas and clinical decision support mechanism (CDSM) requirements, among other proposals as detailed in this fact sheet.
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nThe CY 2017 PFS proposed rule is one of several proposed rules that reflect a broader Administration-wide strategy to create a health care system that results in better care, smarter spending, and healthier people.n
CLICK HERE TO READ MORE
nThis article originally posted on CMS.gov.
