E/M Coding Calculator from Welter Healthcare Partners
The E/M Coding Calculator is a resource designed to assist providers with appropriate code selection for evaluation and management services. This tool is a simplified version of the Novitas auditor’s instructions, and can be used as a guide to understand the evaluation and management coding and documentation guidelines.nnPage One includes a snapshot of the levels of service used in the outpatient care setting and their documentation requirements. Page One also includes time thresholds for each level of E/M service, and the specific documentation requirements for time-based billing.nnPage Two includes the formula for calculating history, exam, and medical-decision-making along with a table outlining the differences between body areas and organ systems, which is particularly important when calculating physical exam.nn nn nn
n n
CLICK HERE TO VIEW PRINTABLE VERSION OF E/M CODING CALCULATOR
Ask your patients if they have an HSA (Health Savings Account)! They will appreciate your inquiry. Keep track of those patients and run HSA specials! Have HSA specials on cash pay services at slow volume times.nnA health savings account (HSA) is a tax-advantaged medical savings account available to taxpayers in the United States who are enrolled in a high-deductible health plan (HDHP). The funds contributed to an account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account (FSA), funds roll over and accumulate year to year if not spent. HSAs are owned by the individual, which differentiates them from company-owned Health Reimbursement Arrangements (HRA) that are an alternate tax-deductible source of funds paired with either HDHPs or standard health plans. HSA funds may currently be used to pay for qualified medical expenses at any time without federal tax liability or penalty.nnStay tuned for more Todd’s Tips!nn
About R. Todd Welter • MS, CPCnFounder and President of Welter Healthcare Partners
R00.2 — PalpitationsnR00.0 — Rapid heart beatnI48.0 — Paroxysmal atrial fibrillationnI48.4 — Atypical atrial flutternnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to 
Healthcare professionals that work with coded data on a daily basis were well represented in the US House of Representatives’ Energy and Commerce Subcommittee on Health hearing, titled “
Panelist William Jefferson Terry, MD, representing the American Urological Association, as well as his own practice, voiced concerns about lost physician productivity if ICD-10 is adopted too quickly.nn“Physicians are overwhelmed with the tsunami of regulations that have significantly increased the volume of work for physicians and their staff, many of which have questionable value to improving the quality of care provided to patients,” Terry stated during the hearing. “Many physician practices, especially the rural one- or two-physician practices do not have the time, money, or expertise to follow and comply with the mounting regulatory challenges, which is why many are considering early retirement or opting out of the Medicare program.”nnProponents of implementing ICD-10-CM/PCS on the October 1, 2015 deadline likely left the hearing with optimism, based on the testimony of the panelists and comments from key committee members.nnAt the outset of the hearing, Rep. Joe Pitts (R-PA), the subcommittee’s chairman, voiced his support for moving forward with ICD-10 implementation in October 2015. This was particularly notable since the delay language was added to 
Rep. Kathy Castor (D-FL) also spoke out in support of an October 2015 implementation, and Rep. Tony Cardenas (D-CA) noted the California Hospital Association’s advocacy efforts to keep implementation on track for this year.nnOf the seven industry experts who testified today, only one—Terry, from the Mobile Urology Group—outright opposed implementation in 2015. ICD-10 advocate panelists at the hearing included Edwin M. Burke, MD, from the Beyer Medical Group; Richard Averill, from 3M Health Information Systems; Kristi A. Matus, from insurer Athena Health; Carmella Bocchino, from America’s Health Insurance Plans (AHIP); and John Hughes, MD, a health data researcher and professor of medicine at Yale University.nn
Hospitals will have to speed up changes in how well they treat Medicare patients or face lower payments under plans announced Monday by the Department of Health and Human Services.nnHHS hopes to tie 30% of traditional Medicare payments to quality or value through what are known as “alternative payment models” by the end of 2016, up from 20%. These models include accountable care organizations, which are groups of doctors, hospitals and other health care providers responsible for the health of a group of patients.nnThe plans include “bundled payments,” which are groups of payments for treatments for the same issue, such as an injury. By the end of 2018, HHS hopes to link 50% of payments to these arrangements.nn”Today’s announcement is about improving the quality of care we receive when we are sick, while at the same time spending our health care dollars more wisely,” HHS Secretary Sylvia Burwell said in a news release. “We believe these goals can drive transformative change, help us manage and track progress and create accountability for measurable improvement.”nnHealth care, including for Medicare patients, has traditionally used the “fee for service” model that pays providers for each individual treatment rather than for the overall treatment of a patient or group of patients. That is, they are paid for making people better; not just for trying.nnFor consumers, the end result of HHS’ push should be better health care, but it may not seem that way to some.nn
“Burdens are being placed on doctors who have to explain that more care isn’t always the best care,” says physician Lisa Bielamowicz, chief medical officer and executive director at the Advisory Board, which provides health care research and consulting. Americans have believed for years “that another test and another prescription is always better, but clinical evidence shows that isn’t always the case.”nnHHS’ Center for Medicare and Medicaid Services set a goal of tying 85% of all traditional Medicare payments to quality or value by 2016 and 90% by 2018 through programs such as its “value-based purchasing” and readmission reduction programs. These programs reward or penalize hospitals depending on their quality, which is sometimes defined as whether patients need to be readmitted within 30 days of being discharged.nnThis is the first time HHS has set goals for alternative payment models for Medicare.n