Feb 25, 2021 | Uncategorized
Making the most out of the time we have at work to stay healthy can be a real struggle. Health and workplace environments can alter the way we feel so finding this balance is essential to feeling your best. Continue reading to learn more about workplace health and how to stay active.nnHeart health is essential and should be part of your daily routine both at home and at work. As part of Heart Health Month, this little reminder from the American Heart Association can be printed or saved as your reminder to not let your workload distract you from a healthy life.nnFollow these five exercises as a way to break up your day.nn
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- Start with your commute; try walking or cycling to work. Even if this isn’t possible park further from the entrance or in our current COVID PHE, start with a working walk around the yard or neighborhood. Even a 5-minute walk to the mailbox can be beneficial.
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- Stretch it out; Start at your neck and move throughout your body, taking a few moments to concentrate on each area. YouTube can be a great resource to follow simple full-body stretching routines that can be done in 15 minutes or less.
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- Transform screen time; Use a standing desk or even under desk bike pedals to allow productivity to continue while moving. Even the use of stability ball chairs can help to strengthen and tone core muscles.
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- Walk and talk; the use of headsets and cellphones can allow those lengthy phone meetings to be a great opportunity for movement. You can even do this without braving the cold winter weather by using the stairs or hallways in your buildings.
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- Deskercise; Use your desk, chair, and walls to practice modified exercises. Those heavy codebooks can even be used as weights.
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Click here to learn more about health in the workplace!
nOriginal article published on heart.orgnn nn
Feb 19, 2021 | Uncategorized
MGMA CFO analyzes the financial impact of COVID-19 on physician practices and outlines some long-term strategies that healthcare organizations should implement as a precaution in case another pandemic occurs. These strategies may help avoid the negative financial impact we saw with COVID-19. Continue reading below to learn more!nnThe path forward to a more financially sustainable operation and prosperous future remains tenuous for most medical groups but there are opportunities for leaders who are willing to make the necessary changes.nnWhile hospitals and health systems suffered historic financial challenges related to the COVID-19 pandemic in 2020, medical groups and physician practices were not spared either. These smaller provider organizations endured similar constraints due to declining revenues and rising expenses, a trend that hasn’t ceased thus far in 2021.nnThe path forward to a more financially sustainable operation and prosperous future remains tenuous for most medical groups but there are opportunities for leaders who are willing to make the necessary changes. Akash Madiah, CFO of MGMA, outlines the long-term strategies that medical group executives should follow to be more resilient and less vulnerable if another pandemic or industry-changing calamity occurs.nnThis transcript has been edited for clarity and brevity.nnHealthLeaders: What is your advice for financial executives at provider organizations as they continue to deal with the difficult dynamics caused by COVID-19? Are you optimistic or pessimistic about their prospects? Why or why not?nnMadiah: First, I’d advise that everyone take advantage of the federal financial assistance programs, namely the [CARES Act] Provider Relief Fund, which has now been reopened, and the Paycheck Protection Program. Our government affairs team based in [Washington, D.C.] has done remarkable work advocating for [physician] practices and organizations to receive relief through the pandemic. MGMA members have been involved and active in the advocacy efforts. In one of our grassroots campaigns, we mobilized 2,000 medical practices to send over 7,000 letters to Congress in less than 48 hours and it helped secure sufficient funding for medical practices.nnIn the relief packages, there’s over $175 billion allocated for healthcare providers, so there is available money out there. These programs were put in place to help medical practices and businesses stay afloat and overcome the downside impact of the pandemic. With respect to these programs, they’re loans but there’s an administrative aspect to these. I think with calendar year 2021, there’s going to be a lot of backend work for the medical group community to make sure that the loans and grants are forgiven. That’s the burden for the healthcare community at large, but overall, I’m pretty optimistic about where things are going.nnThe spring and summer of 2020 were the worst of times and the darkest period. We’ve had an uptick since as people feel more comfortable going back to doctor’s offices. [With] people who skipped out on their annual checkups, those dollars aren’t ever coming back, but that’s where those relief programs were meant to help. There is a backlog of elective procedures; I think the trend is going up, and I feel that’s going to continue through the rest of the year, especially with the vaccine rollout.nnHL: What role should the federal or state governments play in assisting these care providers that are facing a dual-threat to their bottom line? Additionally, is there any action that the payer community should take to help their struggling counterparts on the provider side?nnMadiah: As I mentioned, the money is out there, so it’s up to providers to access that. I think the government has responded and everybody should be accessing the dollars based on their eligibility. But now going forward, I think the biggest thing government can do is ease the administrative burden to make sure that reconciliation and forgiveness of loans is easy for the medical groups.nnNeedless to say, medical groups are going to be busy enough this year, and focusing on patient care should be paramount and not bogged down by the administrative burden. I’ll also add that our CEO Dr. Halee Fischer-Wright sent a letter to the Biden administration [earlier this month] asking that medical group practices are included in the vaccine distribution strategy given their role as community providers across the country.nnThe payers are a little trickier, they are under no obligation to help, but I would say any cooperation and long-term view can help since we’re all in this together. [Payers] have a role in supporting the mechanisms that keep both patients and medical practices healthy in 2021, specifically making sure things that helped providers through the pandemic, like reimbursements for expanded telehealth services, continue. Then, like the government, any reduction to the administrative burden, such as relaxed prior authorization, can only help going forward.nnHL: Are you fearful about the continued effort by private equity firms to acquire medical groups or physician practices? What impact do you think that behavior will have on the healthcare industry at large?nnMadiah: When private equity enters an industry, there’s a general sense that they will cut costs, slash-and-burn, and then sell it for a profit. I think that’s probably the most pessimistic view of them. I’m not fearful of them; they’re a player in all industries across America and they can cut costs in a good way and try to create synergies to make sure revenues are increasing. When it comes to healthcare, there’s a fear [that private equity] is going to hurt the patient and decrease access to healthcare. The profit tone that comes along with private equity often takes away from the altruistic tone that we convey with our members at MGMA. That’s the push and pull with private equity.nnThe big question is how will [private equity] generate the returns they’re used to seeing while also improving the patient experience, which again means more access and better outcomes. If they’re willing to invest in technology and processes that can help the industry, there can be an upside. But that comes at a time horizon that’s a little bit longer than they’re typically used to because while healthcare is continually changing, the speed of that change is not always conducive to what private equity is traditionally invested in. With our members there’s general skepticism with what approach [private equity] is going to take; are they going to be investing for the long-haul or are they taking the short-term view and motivated by profits?nnHL: What are the critical long-term strategies that medical group executives should follow to be more resilient and avoid being vulnerable if another pandemic or industry-changing calamity occurs?nnMadiah: The biggest thing is always to be vigilant. On the expense side, make sure there’s no extra waste in your practice and [don’t] worry about cutting things when the money is tight. The other part of that is being on the offensive, to the extent you have the resources to do so. Invest in your organization to make it more efficient or profitable now rather than being reactive in an urgent situation in the future.nnOne example from the pandemic is telehealth. That was a huge lifeline to a lot of practices to make sure revenue was still streaming in, but many practices had not implemented telehealth prior to COVID-19 and they were being more reactive. We’re trying to invest more in data now to make sure we’re looking ahead and being prepared for the future.nn[Referencing] the MGMA year-in-review report, a lot of practices are changing the way they measure their key metrics of success and looking at things on a more frequent basis rather than a monthly basis.nnThis doesn’t just go for healthcare, but reassess space needs. Understand how successful you are as a remote organization and what you should be investing in going forward. That applies to a number of industries across America, but the bottom line is to be proactive, try to foresee what challenges you need to get ahead of, and make sure to invest in those areas to the extent that you can.nnEditor’s note: This conversation is a transcript from an episode of the HealthLeaders Finance Podcast. Audio of the interview can be found here.nnOriginal and complete article published on healthleadersmedia.com
Feb 19, 2021 | Uncategorized
nnCardiovascular coding continues to change and there have been some significant changes so far in 2021. With new shunting codes and add-on codes, it’s important to stay up-to-date with the latest changes. Continue reading below to learn more about the cardiovascular coding changes for 2021.nnWe have all been so focused on the changes in the Evaluation and Management section of the CPT manual that we wanted to spotlight a different code set that also received significant guideline changes in 2021, cardiac shunt procedures.nnIn addition to completely re-written guidelines, we also have three new shunting procedure codes, 33741, 33745, and add-on code 33746. Careful review and notation of all the changes is recommended, you can find the changes starting on page 262 of your CPT manual.
Feb 11, 2021 | Uncategorized
The 2021 E/M updates and elements of MDM are continually being clarified. The article below will address questions and answers over the new E/M Office visit guidelines. Read below to see more about the new updates and information. nnBy Ginger Avery, CPC, CPMA, CRC nFebruary 2, 2021nnQuestions and answers continue to be clarified as we are now a month into utilizing the new E/M Office Visit guidelines that took effect on January 1, 2021. Understanding how to navigate labs and other test results as they pertain to the time and medical decision-making (MDM) elements of the revamped E/M office visit rules can be hard to ascertain. The following details should help improve understanding of the new data review rules. nnData Element:nn
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- When tests are ordered during one visit and reviewed the same test during the next visit, can that count as a data point for both visits?n No. When a clinician orders a test during an E/M visit, the order and review of the test result will count toward the MDM of the first encounter.
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- If we receive a test result two days after the visit, can we count a data point toward that E/M visit for review of the test?n Yes, there’s pre-service work and post-service work associated with the encounter and receiving a test result a couple of days later and responding to it are part of the post-service work of the encounter.
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- Can the independent visualization of a test be counted in the medical decision making if the physician is also billing for the test?nPer AMA, the actual performance and/or interpretation of diagnostic tests/studies during a patient encounter are not included in determining the level of E/M service when reported separately. Clinician performance of diagnostic tests/studies for which specific CPT codes are available may be reported separately, in addition to the appropriate E/M code. The clinician’s interpretation of the results of diagnostic tests/studies (i.e., professional component) with preparation of a separate distinctly identifiable signed written report may also be reported separately, using the appropriate CPT code and, if required, with modifier 26 appended. If a test/study is independently interpreted in order to manage the patient as part of the E/M service but is not separately reported; it is part of medical decision making.
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- If one doctor orders a test that is performed in the practice, but a second doctor bills for the test, can the first doctor count the test order toward MDM for his visit?nPractices should not count a test toward MDM if the ordering practitioner’s practice also performed and billed for the test. Medicare and private payers could view that type of coding as abusive or fraudulent.
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nDocumentation Questions:nn
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- Since history and physical exam are no longer required to level the visit, should these elements still be documented?nYes, history and exam are still part of an evaluation. The documented content should be focused only on the clinically relevant details and cognitive thoughts of the clinician. Document the nature of the presenting illness(es) (subject details with pertinent ROS). Document a medically necessary exam. Documentation is about the quality of the story, not the quantity of details. Avoid importing pages of past medical history, ROS or medication lists that are note relevant or helpful. Clinicians are encouraged to write clear stories that they would like to read.
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- Do I still have to document ROS and PFSH?nYes, when clinically relevant. For example: Patient presents with chest pain. Has been having intermittent chest pain at rest for two weeks. No notable triggers. Positive for headaches and dizziness, no SOB. Patient has a family history of CAD. Remember, documentation is all about the medically necessary story.
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- When coding based on total time does the assessment and plan still need to be documented?nYes. Quality documentation should always be captured. Clear stories that include clinical impressions and plans support the medical necessity and describe the complexity for the services provided, regardless of how you choose to report the visit.
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nOther Common Questions:nn
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- Are commercial plans required to adopt the revisions to E/M codes?nYes. The CPT code set, together with the U.S. Department of Health and Human Services’ Healthcare Common Procedure Coding System, has been adopted as the nation’s standard medical data code set. HIPAA requires that health plans use the most recent version of the medical data code set, they should have implemented these revisions Jan. 1, 2021.n
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- Do the 2021 E/M code and guideline changes apply to all categories of E/M services?nNo. The E/M code and guideline changes are specific for office and other outpatient visits and apply only to codes 99201–99205 and 99211–99215. Inpatient services still need to follow the key component guidelines (1995 or 1997).n
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- When considering High-Risk MDM, there is an example listed: “drug therapy requiring intensive monitoring for toxicity”. What constitutes supporting this definition? When considering this complexity, both the drug and the monitoring must qualify. The new guidelines provide this definition when considering this High-Risk example:n“Drug therapy requiring intensive monitoring (today) for toxicity: A drug that requires intensive monitoring is a therapeutic agent that has the potential to cause serious morbidity or death. The monitoring is performed for assessment of these adverse effects and not primarily for assessment of therapeutic efficacy. Monitoring by history or examination does not qualify. The monitoring affects the level of medical decision making in an encounter in which it is considered in the management of the patient. Both the drug and the monitoring must qualify on the date of the encounter.n
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- Where can the CPT E/M code and guidelines be found?nThe CPT E/M code and guideline changes for 2021 can not only be found on the American Medical Associations’ (AMA) site at this link. They can also be found in their entirety within the 2021 CPT Code books themselves. These guidelines include details about reporting based on the total encounter time, the new level of medical decision-making table and the 22 new definitions that help clarify what the MDM terms mean.
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nAs a reminder, documentation is about painting a clear picture of each encounter. The power of storytelling is evident with these new updates. Quality documentation provides details to support and defend the medical necessity and appropriate complexity of each unique encounter, as well as improves overall patient care and clinical outcomes. Due to President Biden recently issuing several health care executive orders, we can expect policy adjustments that will lead federal auditors and investigators to focus on subjects like: fraud and abuse (especially in the telehealth arena), auditing of provider relief funds received during the PHE, HIPPA compliance, meaningful use, workplace safety and Evaluation and Management (EM) services. With increased emphasis on these interrelated topics, clinicians are encouraged to focus documentation efforts on the cognitive clinically relevant details, regardless of the clinical setting. Document what you do, code what you document. Consider an educational audit review for your clinicians to see if they are taking proper credit for all the work they do by telling great stories in their encounter notes.nnKeep an eye out for more guidance from Medicare and private payers. Currently, Medicare is still working on an update to its documentation guidelines for E/M services. Welter Healthcare Partners provides robust coding and documentation training for these updates, as well as other topics. Please contact cwhitworth@rtwelter.com to book your training now.nnReferences:nAMA CPT® E/M Code and Guideline Changes for 2021nAma-assn.orgnNovitas E/M Documentation RequirementsnNoridian E/M Documentation RequirementsnDecision Health PartBNews
Feb 11, 2021 | Uncategorized
The report below describes a patient undergoing excision of the left dorsalis pedis artery aneurysm. The entire procedure has been documented in detail, describing the step by step process used by doctors to carry out the surgery. Keep reading for more on how this procedure was performed and to learn about the use of the unlisted procedure code for this cardiovascular procedure.nnDo 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. n
– Click Here to Submit Redacted Surgery Case Study –
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nn37799: EXCISION DORSALIS PEDIS ARTERY ANEURYSM [COMPARE TO CODE 35152 FOR UNLISTED PROCEDURE] I72.4nn
nDATE OF OPERATION: 01/XX/2021nOPERATING SURGEON: S. G., M.D.nPREOPERATIVE DIAGNOSIS: Left dorsalis pedis artery aneurysm.nPOSTOPERATIVE DIAGNOSIS: Left dorsalis pedis artery aneurysm.nPROCEDURE PERFORMED: Excision of left DP artery aneurysm.nANESTHESIA: Monitored anesthesia care with local anesthetic.nASSISTANTS: None.nINDICATION: The patient is a 40-year-old male with a history of acute onset of left foot pain. Ultrasound demonstrated a pseudoaneurysm versus aneurysm of the dorsalis pedis artery. The patient did not have any blue toes but based on the symptoms of pain and the location, it was recommended he undergo excision. Risks, benefits, and alternatives were discussed with the patient. He consented to procedure.nnDESCRIPTION OF PROCEDURE: On the operative day, the patient was met in the preop holding area. All site verification consent forms were completed and placed in the chart. The patient was then taken to the OR, placed on table in supine position. After induction of general anesthetic, the patient was prepped and draped in usual sterile fashion. Final time-out was then performed by all in attendance to be correct patient, correct procedure, correct site, and the antibiotics had been administered. Using ultrasound, the anterior tibial and dorsalis pedis artery were mapped. Of note, right at the ankle, the dorsalis pedis branched into a medial and lateral branch. The lateral branch was the one that proceeded on to the aneurysmal region. This area again was marked on the skin. At this point, a sterile pulse ox was placed on the great toe and hooked up to the machine for continuous monitoring. An incision remained over the marked area after the area was anesthetized with lidocaine and Marcaine mix. This was carried down through soft tissue using electrocautery. The retinaculum was identified and divided and neurovascular bundle exposed. The dorsalis pedis just distal to the medial branch was vessel looped and a test clamp was performed. This resulted into no deficit of the waveform or pulse oximetry reading in the great toe. Additionally, he had excellent color and signal distal to this test ligation. At this point, I traced distally along the artery until the aneurysmal portion was identified. It was noted that there was no Doppler signal or flow within this vessel in this position. At this point, I then carried the incision down to more normal appearing vessel and then placed 2 clips. This was then removed and opened on the back table revealing some atheroma. At this point, the incision was irrigated. Hemostasis was assured. It was closed in multiple layers with Vicryl and a Monocryl suture. Sterile dressing was applied in addition to Steri-Strips. The patient tolerated the procedure well. No complications.nnESTIMATED BLOOD LOSS: 5 cc. TOTAL FLUIDS: 600 mL.nTOTAL LOCAL: 9 mL.nSPECIMEN: Left dorsalis pedis artery to pathology.
Feb 4, 2021 | Uncategorized
What will the “Next Haven Healthcare” look like? Let’s ask the professionals! After the failed joint venture announced the disbanding of the employer healthcare, you may have questions about the future of employer healthcare and what it might look like. Speaking to five healthcare executives, continue reading below to see what they said about the future of employer-provided healthcare. nnHealthcare executives share their thoughts on how the next big disruptor will be perceived by the industry and the steps that organizations will need to take to succeed. It was only three years ago that Amazon, Berkshire Hathaway, and JPMorgan Chase joined together to form Haven Healthcare in an effort to improve employee healthcare options. When Haven was initially announced, it was surrounded by media fanfare and many thought the joint venture would disrupt the healthcare payers market. However, the business giants announced last month that Haven would disband by the end of February. Speculation around why the joint venture failed include lack of traction towards goals, unfocused execution of organizational strategy, a high turnover rate in the C-suite, and the fact that disruption healthcare is not an easy feat. Haven is not the first company to attempt to disrupt the healthcare industry and it certainly won’t be the last. Given the likelihood that another company will attempt to be the ‘next Haven,’ HealthLeaders spoke with five healthcare executives about how the next big disruptor will be perceived by the industry and what steps such an organization should take to succeed in this tough endeavor.nn‘ABSOLUTE AND MANIACAL TRANSPARENCY’nnAshok Subramanian, CEO of Centivo, an employee health plan, says he believes the next Haven, or an organization that self-styles itself as the next Haven, will be “viewed skeptically.” “Given that Haven tried to come out with great fanfare, and then was not able to be successful, naturally breeds skepticism,” he says. Subramanian adds that there is growing skepticism among the provider community of employers following a top-down approach to healthcare reform and “declaring that they are going to be successful.”nn”What we are seeing is enthusiasm for more bottom-up approaches, employers working with organizations to take matters into their own hands,” he says. “That, like a lot of community-driven efforts, will probably be viewed more positively than any organization that would at least label itself as the next Haven.” Subramaniam suggests organizations should focus on transparency and the “true spirit of the partnership.”nn”Nothing in this industry can successfully move the needle without a commitment to absolute and maniacal transparency around financial flows, around data, around understanding that ultimately employers who are self-funded are responsible for their own health plans. And that was one of the greatest failures of the first Haven,” he says. According to Subramaniam, organizations should collaborate “community by community” with providers that have committed to move the industry towards value-based care and willing to “collaboratively partner with agents of change.” He says these organizations are accepted over “large organizations who feel like they can fix these things on their own.”nnHAVEN’S DEMISE BREEDS CAUTIONnnMichael Abrams, managing partner and co-founder of Numerof & Associates, a healthcare management consulting company, says he also believes the next big industry disruptor will be viewed with uncertainty. “In many ways, I think the demise of Haven made it that much more difficult for any organization to claim that same mantle,” Abrams says. “They brought so much firepower to their announced mission of more or less fixing healthcare, that now that they’ve closed their shop, the industry may very well take it as an admission that the problem is just not solvable, because it couldn’t be solved by those superstars.”nnHe also says that while obstacles remain, there is no lack of disruptors currently working in the market. “There is a long list of disruptors that are working to come up with innovations that will make the money, and in most cases, lower the cost of care,” he says. Among those disruptors, Abrams explained, are Amazon, (which was one-third of the partnership behind Haven), and the U.S. government. To disrupt and change healthcare, he says organizations need to look towards those who are making waves in the industry. “To change the rules of the game will take a level of political will,” Abrams said. “That is the closest approximation to a big idea and will actually change healthcare.”nnNEED A UNIFORM STRATEGYnnWhen it comes to healthcare disruptors, Craig Maloney, CEO of Maestro Health, a third-party administrator for employee benefits, says he believes the focus should be on the members served. “I’m a big believer in starting with the consumer,” Maloney says. “So many of the end users, whether it’s my 80-year-old mother, the Gen Xers, or even people in healthcare [have] so much confusion. Anybody coming into this space needs to be able to impact that digesting healthcare on a daily basis.”nnHe adds: “You also have to serve the employer groups, since they’re the drivers of so much of the healthcare delivery out there today. Anytime you talk about transformation; it comes with risk. You need to be able to digest that risk, and tolerate that risk, to facilitate change.” Maloney says for the next big disruptor to succeed, they should have a uniform strategy, a focus on not only technology but also on “the human side of things” and “the wherewithal to commit” for a long period of time. “Haven proved out that three years is not a long commitment in terms of disrupting such an established, complex, and even odd industry,” Maloney says. “When [I] talk to other organizations who are looking to impact and change healthcare, [they’re looking at a 10-, 15-, or 20-year commitment.]” When organizations are first starting out, Maloney suggests they start small instead of starting big.nnFOCUS ON THE CUSTOMER EXPERIENCEnnMark Nathan, CEO of Zipari, a technology company specialized in health insurance, says the next big disruptor should work in conjunction with payers and providers to succeed in their mission of disrupting the healthcare space. “Payers and providers have to be part of the equation,” Nathan says. “Payers and providers have made huge investments in their systems. There’s a lot of regulation and emphasis on keeping everything running efficiently, but not a lot of emphasis on innovation. And so, to build that next generation of disruption for healthcare, they have to be at the table solving the problem.”nnHe also says there should be a focus largely on customer experience to succeed, including consistent communication and messaging. “The patient at the center of everything,” Nathan says. “We have to get that alignment between the payers, the providers, and a patient. No matter where the member engages with the payer, they should get a consistent message that’s going to … improve their health. If payers get that message up to their members, then the payer brands will start to improve, their Net Promoter Score will start to improve because they’ll be trusted. That’s something that’s missing in this industry that is critically important.”nn‘VERY PESSIMISTIC’ ABOUT THE NEXT HAVENnnSteven Goldstein, MD, founder of Houston Healthcare Initiative, a website which offers resources to people and organizations who want to change the current healthcare industry, is not optimistic for disruptors who want to change the current healthcare system through technology and innovation.nn”If we go back to first principles, the primary purpose of healthcare is to keep patients well,” Goldstein says. “The secondary purpose is to care for people when they get sick. But our current system is backwards, it primarily cares for the sick, and only secondarily tries to keep the patients well. The current system of managed care frowns on innovation. In my opinion, delivery of medical care lags the technology by about 25 years. They’re not innovative, they don’t want to change the system, and that’s the problem.”nnGoldstein notes that it is difficult for disrupters to succeed in the current system. “I’m very pessimistic that we’re going to get much innovation, like the Haven ideas, accepted by the healthcare industry in the current way it’s set up,” he says.nn nnOriginal article published on healthleadersmedia.com
