Do 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.nn– Click Here to Submit Redacted Surgery Case Study –nnDATE OF SURGERY: 06/10/2019nnPREOPERATIVE DIAGNOSES: Left shoulder pain, status post hemiarthroplasty/biologic glenoid resurfacing with glenoid arthrosis and erosion. Rotator cuff deficiency. History of rheumatoid arthritis.nnPOSTOPERATIVE DIAGNOSES: Left shoulder pain, status post hemiarthroplasty/biologic glenoid resurfacing with glenoid arthrosis and erosion. Rotator cuff deficiency. History of rheumatoid arthritis.nnPROCEDURES:n
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Left shoulder open exploration with capsular contracture and extra articular scar release.
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Left revision reverse total shoulder arthroplasty.
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Vertical humeral osteotomy for removal of implant with subsequent ORIF with intramedullary stem and cerclage suture/wire.
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nESTIMATED BLOOD LOSS: 300 cc.nnFLUIDS AND URINE OUTPUT: Per Anesthesia record.nnINDICATIONS: This is a very pleasant 56-year-old female, who has had significant pain and dysfunction of her left shoulder refractory to conservative care with the aforementioned diagnoses. Options were discussed at length, and she wished to proceed with the above-mentioned operative procedures. After a lengthy discussion of the risks and benefits involved, full informed consent was obtained to proceed with the above preoperatively.nnCOMPONENTS REMOVED: Tornier Aequalis cemented humeral stem and Achilles tendon/soft tissue allograft glenoid surface.nnCOMPONENTS PLACED: Wright Medical Aequalis PerFOrM Plus reverse total shoulder system with half wedge augment baseplate 25 mm x 35-degree, 39 mm +3 mm lateralized glenosphere, 9 mm PTC proximal body, Aequalis Flex revised stem with 9 mm x 90 mm PTC distal stem, standard locking cap +0 mm reverse tray, eccentricity 3.5 mm placed at approximately 5.5 mm, and a +9 mm reversed insert for 39 mm glenosphere angle C 7.5 degrees. Total neck shaft angle 140 degrees.nnOne central locking/compression screw, one superior compression screw, and 2 additional locking screws.nnDESCRIPTION OF PROCEDURE:nnThe patient was brought to the operating room, where general endotracheal anesthesia was induced by Dr. H. after interscalene block was administered.nnThe patient was carefully placed in beach chair position with hips flexed 45 degrees, knees flexed 30 degrees. All bony prominences were padded well, and the head was held in a near neutral position by McConnell head holder. The left shoulder was prepped and draped in standard sterile fashion using a Betadine scrub and paint. The left iliac crest region was also prepped and draped in case an iliac crest bone graft would be required. After prep and drape of the left upper extremity, examination under anesthesia revealed stiffness in all planes with 100 degrees forward flexion and abduction, external rotation of 30 degrees with the arm at side, and internal rotation of 20 degrees with the arm abducted. Ioban sticky drape was applied. Antibiotics were held until appropriate cultures were obtained. Previous scar was incised for a length of approximately 15 cm extending it slightly distally. Full-thickness skin flaps were elevated and deltopectoral interval fully explored proximal to distal.nnCephalic vein was not encountered. The dense scar in the subdeltoid space was released revealing the humeral scapular interface superiorly laterally and anteriorly underneath the coracoid. There was dense scar between the coracoid and the remaining rotator cuff and anterior scar. Multiple soft tissue specimens were sent for pathology and microbiology including multiple sutures. The rotator interval was opened. The subscapularis was essentially completely deficient with only a thin layer of scar in the anterior shoulder taking place of the original subscapularis tendon. The scar was removed and capsular contracture released from the inferior glenoid. Scar was released superiorly and posterolaterally and laterally. The proximal humerus was dislocated revealing significant proximal humeral bone loss from the metaphysis. Soft tissue and bony samples were sent for pathology and microbiology. Osteotomes and rongeur were used to remove cement, and soft tissue and bone from around the prosthesis. A thin bur was used to remove bone and cement from around the lateral prosthesis to allow disimpaction of the prosthesis and removal.nnInitially, attempts were made to lightly disimpact the prosthesis to remove cement mantle, but these attempts were unfruitful. The decision was made to proceed with a vertical osteotomy of the humeral shaft to facilitate removal of the implant and removal of cement.nnOsteotomy was made at the location of maximum bone loss and distally just lateral to pectoralis and latissimus dorsi/teres major insertions and medial to the deltoid insertion. This was carried on just to the level of the deltoid insertion and carried out horizontally medially with direct retractor protection of the soft tissues. The osteotomy was opened and the Ultra-Drive used with a flat tip to remove cement from around the osteotomy and from around the prosthesis itself. The prosthesis was then disimpacted without difficulty. Proximal humerus was irrigated with pulse lavage. The Ultra-Drive was then used to remove additional cement to allow diaphyseal fitting component. The 6.5 and 9 mm discs were used to remove cement using Ultra-Drive under continuous irrigation to prevent overheating.nnThe cement plug was penetrated using the Ultra-Drive and the canal enlarged to allow the smallest revive component to be placed. The trial was placed at 25-30 degrees of retroversion and humerus retracted posteriorly. The wound was irrigated with pulse lavage. Significant amount of scar was removed circumferentially around the glenoid and scar released from the inferior glenoid along with capsular contracture. The wound was irrigated with pulse lavage.nnSmall guide pin was placed followed by reaming the inferior glenoid flat followed by reaming the superior glenoid with a 35-degree reamer for the half wedge component. This would fit well with the half wedge placed superiorly and posteriorly. The wound was irrigated with pulse lavage. 2g of Ancef had been given after obtaining adequate bone and soft tissue samples. The center hole was overdrilled followed by drilling for the central screw measuring 35 mm in length. The final component was placed into position and set screw tightened with excellent compression of the baseplate against the bone. The wound was irrigated with pulse lavage and the shoulder trialed with above-mentioned components trialing well. There was slight rotational instability of the humeral component, so decision was made to cement proximally. The wound was irrigated followed by placing the final component which was fixed with a central set screw. The proximal humerus was redislocated followed by removing the trial component. It should be noted that 2 NiceLoop sutures had been placed in modified racking hitch fashion and one 18-gauge wire placed proximally in standard fashion to close the vertical osteotomy. This opened slightly with placement of the press-fit component. The press-fit component would engage the distal aspect of the humerus distal to the osteotomy as well. The wound was irrigated with pulse lavage. One batch of DJO surgical cobalt G cement was mixed, and when reached the appropriate consistency, the humerus was irrigated, suctioned, and the cement was allowed, applied in doughy fashion to the proximal aspect of the component. It was impacted into position and excess cement removed. The wound was irrigated further. The cement was allowed to fully harden. Prosthesis was approximately 25 degrees of retroversion. A 2 cc aliquot of H-GENIN Wright Medical allograft DBM putty was then placed into the vertical osteotomy site to facilitate and expedite healing. This was after copious irrigation with pulse lavage. The pectoralis major was closed to the deltoid insertion covering the bone graft. A deep 3/16-inch Hemovac drain was placed followed by irrigating the joint further. Small bleeders were coagulated with electrocautery. The deltopectoral interval was closed using running O PDS Stratafix suture. Skin was closed using buried O and 2-0 Monocryl sutures followed by 3-0 Monocryl subcuticular and Steri-Strips. A 4 x 4 Tegaderm dressing was applied. The patient’s arm was placed in a well-padded, well-fitting UltraSling. She tolerated the procedure well.nnIt should be noted that 2 skilled surgical assistants, PA-C and SA-C, were absolutely required in order to perform procedure to the current standard of care in timely fashion. Total skin-to-skin operating time was approximately 3 hours and was prolonged due to the complex nature of this revision procedure.nnPOSTOPERATIVE PLANnnTo start early gentle passive range of motion program per protocol. Maximum forward flexion and abduction 90 degrees, external rotation of 30 degrees, internal rotation to the abdomen with active assisted motion allowed at 4 weeks postop, active motion allowed at 8 weeks postop. At 6-8 weeks postop, maximum forward flexion and abduction allowed would be 130 degrees, external rotation of 50 degrees, internal rotation to L3 with no aggressive end-range stretching. The patient will be admitted for standard postoperative medical and orthopedic care. Her culture results will be followed.nn
Colorado emergency charges vary in price across the state, which prevents patients from seeking care due to the price of their treatments. The article below gives more insight to the unusual healthcare prices that many people are looking to fix. Read below to find out more on this dive.nnDive Brief:n
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The cost of emergency department visits in Colorado vary enormously depending on facility and condition severity, according to new data from the state’s all-payer claims database analyzed by the Center for Improving Value in Health Care.
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Colorado’s EDs were paid an average of $3,115 for the most severe life-threatening cases in 2018. The largest single charge was $47,779, and the smallest was $190.
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But Denver-based CIVHC, which administers the database, only looked at reimbursement from commercial payers to the facility directly, meaning the entire cost of care for a Colorado patient — including common add-ons like lab tests, imaging services, surgical procedures or other physician fees — is likely much higher.
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nDive Insight:nnColorado’s data provides the U.S. an unusual glimpse into healthcare prices, albeit in one state and one type of provider setting.nnThough national ER use remained largely unchanged over the past decade according to the Health Care Cost Institute, ER clinicians are using high severity codes more frequently. Previous research from the CIVHC found that trend held true in Colorado as well, with a decrease in coding for all other lower-tier severity levels across commercial payers between 2009 and 2016.nnLast year, the median statewide facility payment for a low severity visit was approximately $290 and high severity level claims were paid at almost $3,000.nnAs ER costs continue to rise, some payers are taking controversial steps to try and blunt the trend. Anthem faced lawsuits and backlash from a slew of providers in Connecticut, Georgia and Missouri around its cost-cutting policies, including paying patients directly for emergency care and having them reimburse their providers, and no longer reimbursing for non-emergency services given in the ER.nnIf widely adopted, that latter policy from the Indianapolis-based payer could deny payment for as many as one in six ER visits, according to a study in JAMA.nnProvider critics, wary of insurer policies that could further endanger their bottom lines, argue such measures could prevent patients from seeking care in the first place.nnOver a dozen individual states along with Washington, D.C. have put forward proposals to try and mitigate the practice. The Trump administration backs legislation to ban surprise billing, which lawmakers are set to debate after the summer recess. Often, patients hit with surprise medical bills for care not covered by their insurer get them after receiving care in the ER.nnBig hurdles remain to appease both the payer and provider lobbies, which stand diametrically opposed on the way forward to fix the problem.nnOriginal article published on healthcaredive.com
Banner Health is planning to acquire the North Colorado Medical Center which has been in operation since 1995. This new plan would bring great healthcare opportunities to the area. Read below to find out more about the deal.nnPhoenix-based Banner Health plans to acquire North Colorado Medical Center in Greeley, which it has operated since 1995.nnUnder the proposed deal, which requires regulatory approval, Banner would pay $328.4 million to acquire the land, assets and equipment associated with the hospital from Weld County (Colo.).nnA large portion of the proceeds from the transaction will be used to pay off $209.5 million in existing hospital debt, according to a press release from Weld County.nnOriginal article posted on beckerhospitalreview.com
Pinnacol recently announced that Nurse Practitioners could pursue DOWC accreditation to receive higher reimbursement. Also, Pinnacol announced the use of interpretation services to meet contract obligations and the Division of Workers Compensation requirements for injured workers. Read the article below to find out more about these two new regulations.nnDOWC Accreditation for Nurse PractitionersnnNew Colorado Division of Workers’ Compensation regulations that went into effect Aug. 2 impact nurse practitioners.nnHouse Bill 1105 allows nurse practitioners to obtain DOWC Level I accreditation solely for the purpose of receiving the higher reimbursement associated with the designation. It does not allow them to declare maximum medical improvement for an injured worker, the key component of Level I accreditation.nnNurse practitioners may begin pursuing DOWC Level 1 accreditation now via an online course. The next in-person training session will be offered via DOWC in September in Denver, and registration is open.nnBeginning on Aug. 2, Level 1 accredited nurse practitioners with prescriptive authority will be allowed to bill for 100 percent on the DOWC Medical Fee Schedule.nnReference nnWorkers’ Compensation Rules for NPs and PAs nnUse of Interpretation ServicesnnEffective Sept. 1, Pinnacol will implement procedures to meet contract obligations and the Division of Workers’ Compensation requirements for scheduling interpretation services for Pinnacol’s injured workers. These procedures comply with 2019 DOWC Rule 18-6(Q).nnPinnacol Assurance is committed to aligning all parties to provide uninterrupted, quality service for our non-English-speaking injured workers.nnThe following are the guidelines to ensure quality care.n
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Interpretation must be authorized for patients during office visits, diagnostics, injections, therapy and psychological services.
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The treating provider will call Pinnacol for authorization for interpretation services.
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Pinnacol will determine whether the requested provider is contracted with Pinnacol. If contracted, the request will be approved. If the vendor is not contracted,
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Pinnacol claims reps will refer the requester to the list of approved, contracted providers.
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Pinnacol may change the interpretation vendor at any time during the life of the claim — with or without cause — after notifying the current vendor and the primary care provider.
Do 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.nn– Click Here to Submit Redacted Surgery Case Study –nnSubjective:nnChief Complaints:n
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Bilateral L5/Sl TF Epidural PRP. Nosed. No ABX/AC. PM.
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nMedical History:nnMedications: Taking Baclofen 10 MG Tablet TAKE ONE-HALF TO ONE TABLET BY MOUTH AT BEDTIME , Taking Celecoxib 200 MG Capsule TAKE ONE CAPSULE BY MOUTH TWICE DAILY, Taking Belbuca 150 MCG Film 1 film to the gum Buccally every 12 hrs, Notes: DNF: 07/29/19, next due 08/28/19, Taking Oxycodone-Acetaminophen 5- 325 MG Tablet 1 tablet as needed Orally every 12 hrs, Notes: DNF: 07/29/19, next due 08/28/19nnObjective:nnVitals: BP 122/78 mm Hg, HR 92 /min, Ht 71.0 in, Wt 195 lbs, Oxygen sat% 95 %, BMI 27 .19 Index.nnAssessment:n
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Lumbar spondylosis – M47 .816 (Primary)
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Lumbar radiculopathy – M54.16
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Degeneration of lumbar intervertebral disc – M51.36
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nAt this point, patient has failed conservative therapy, has undergone imaging and physical examination which demonstrate facet mediated pain.nnThey also have undergone dual diagnostic MBB with over 80% relief on DOS and the duration of effect was consistent with the local anesthetic used.nnThey have had prior RFA of the same levels (over 6mo ago) with >60% relief for 4mo and, by their report, had improvement in performance of ADLs of home, work and family.nnPlan:n
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Others
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nNotes:nnFAILURE OF CONSERVATIVE MANAGEMENT OF OVER 4 WEEKSn
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Prescription strength anti-inflammatory medications and analgesics
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Adjunctive medications such as nerve membrane stabilizers or muscle relaxants
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Physician-supervised therapeutic exercise program or physical therapy
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PAIN SEVERITY IS 3/10 OR GREATER
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UNABLE TO PERFORM AOL’S of WORK, HOME,and RECREATION,
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nProcedures:nnCPS Procedures:nnPre-op, Diagnosis: Lumbar Radiculopathy and disc degeneration.nnPost-op. Diagnosis: same.nnInformed Consent: The risks and benefits per the informed consent were discussed with the patient.nnAlthough risks are theoretically possible, they are remote. We specifically discussed infection, bleeding, nerve damage, spinal cord damage and paralysis. Patient understands risks and benefits and wishes to proceed. All questions answered..nnProcedure: Bilateral LS/S1 TRANSFORAMINAL EPIDURAL, LS/S1 FACET and LEFT APPROACH Discogram and INJECTION of PLATLET RICH PLASMA .nnSedation : None.nnDetails of Procedure: First 60mL of the patient’s blood was sterll collected from the LEFT AC and processed per Celling Biosciences PRP kit instructions. Strict aseptic technique was maintained. 500 mg ancef was given IV. The patient was placed prone on the fluoroscopy table. after sterile prep and drape with chlorhexidine, C-arm fluoroscopy was used to visualize the lumbar spine. The skin puncture sites were anesthetized with cold spray. Pt placed in the prone position on procedure table. Monitors were applied.nnThe patient’s back was prepped with chloraprep and draped with sterile towels. Using AP, lateral, and oblique fluoroscopy, the neuroformina were identified. After anesthetizing the skin with bicarbonated 1% lidocaine, a 22 G 5 inch quincke needle was advanced into each neuroforamen. Needle tip position was confirmed on lateral view and with the injection of 0.5 cc of Isoview 200. The left needle was then advanced into the disk and confirmed with omnipaque/ancef mixture. Then each needle was redirected to the LS/S1 facet. The inferior aspect of the joint was accessed. ‘ After negative aspiration, injectate of PRP iML was injected through each needle without difficulty at each location ‘ ‘The patient tolerated the procedure very well..nnComplications: None.nnSpecimens: None.nnImpressions: The patient stayed in the recovery room without motor and sensory deficits and was discharged home with an escort.nnTechnically successful block. Follow up in 30 days,
The residents of Colorado are working hard to improve our healthcare system throughout the state. A recent study ranked Colorado number 11 in the US based on several different variables, however, health care costs in Colorado were ranked 47. Read the article below recapping the results from the survey and other placement factors.nnA new study places Colorado’s health care system just outside the top 10 in the nation.nnThe study, released Monday by financial website WalletHub, ranked Colorado No. 11 on its list of best and worst states for health care.nnMinnesota, Massachusetts and Rhode Island took the top three spots, with Mississippi, North Carolina and Alaska coming in at the bottom of the list.nnThe report compared the 50 states and the District of Columbia across 43 measures of cost, accessibility and outcome, using data sets ranging from average monthly health insurance premium costs, hospital beds per capita, cancer and heart disease rates, and percentage of insured people ages 19 to 64.nnColorado ranked No. 47 in terms of health care costs for its residents, which considered factors such as average hospital expenses per inpatient day at a community hospital and average monthly health insurance premium costs.nnThe Centennial State ranked 12th in access to health care — which took into account the number of hospital beds per capita and the quality of the state’s public hospital system — and No. 3 in health care outcomes, which included life expectancy and infant, child and maternal mortality rates.nnToday, the average American spends more than $10,000 per year on personal health care, or about 17.9 percent of the U.S. GDP, according to the most recent estimates from the Centers for Medicare & Medicaid Services.nn“But higher costs don’t necessarily translate to better results. The U.S. lags behind several other wealthy nations on several measures, such as health coverage, life expectancy and disease burden,” the study states. “However, the U.S. has improved in giving more healthcare access for people in worse health, and health care cost growth has slowed somewhat.”nnOriginal article published on csbj.com.
MLNConnects, the official news of CMS, recently proposed 3 new payment rules. CMS released these proposed rules on July 29, which include payment updates for outpatient and physician services and also expanded price transparency initiatives. Read below to find out more information on these proposed rules. n
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PFS: Proposed Policy, Payment, and Quality Provisions Changes for CY 2020
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Medicare OPPS and ASC Payment System CY 2020 Proposed Rule
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ESRD and DMEPOS CY 2020 Proposed Rule
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n1. PFS: Proposed Policy, Payment, and Quality Provisions Changes for CY 2020n
On July 29, CMS issued a proposed rule that includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2020. This 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 accessibility, quality, affordability, empowerment, and innovation. It also includes proposals to streamline the Quality Payment Program with the goal of reducing clinician burden. This includes a new, simple way for clinicians to participate in our pay-for-performance program, the Merit-based Incentive Payment System (MIPS), called the MIPS Value Pathways.
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The proposed rule also includes:
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CY 2020 PFS rate setting and conversion factor
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Medicare telehealth services
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Payment for evaluation and management services
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Physician supervision requirements for physician assistants
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Review and verification of medical record documentation
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Care management services
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Comment solicitation on opportunities for bundled payments
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Medicare coverage for opioid use disorder treatment services furnished by opioid treatment programs
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Bundled payments for substance use disorders
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Therapy services
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Ambulance services
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Ground ambulance data collection system
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Open Payments Program
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Medicare Shared Savings Program
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Stark advisory opinion process
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n2. Medicare OPPS and ASC Payment System CY 2020 Proposed Rulen
On July 29, CMS proposed policies that follow directives in President Trump’s Executive Order, entitled “Improving Price and Quality Transparency in American Health Care to Put Patients First,” that lay the foundation for a patient-driven health care system by making prices for items and services provided by all hospitals in the United States more transparent for patients so that they can be more informed about what they might pay for hospital items and services.
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The proposed changes also encourage site-neutral payment between certain Medicare sites of services. Finally, the proposed rule proposes updates and policy changes under the Medicare Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System. The proposed polices in the CY 2020 OPPS/ASC Payment System proposed rule would further advance the agency’s commitment to increasing price transparency, (including proposals for requirements that would apply to each hospital operating in the United States), strengthening Medicare, rethinking rural health, unleashing innovation, reducing provider burden, and strengthening program integrity so that hospitals and ambulatory surgical centers can operate with better flexibility and patients have what they need to become active health care consumers.
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In accordance with Medicare law, CMS is proposing to update OPPS payment rates by 2.7 percent. This update is based on the projected hospital market basket increase of 3.2 percent minus a 0.5 percentage point adjustment for Multi-Factor Productivity (MFP).
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In the CY 2019 OPPS/ASC final rule with comment period, we finalized our proposal to apply the hospital market basket update to ASC payment system rates for an interim period of 5 years (CY 2019 through CY 2023). CMS is not proposing any changes to its policy to use the hospital market basket update for ASC payment rates for CY 2020-2023. Using the hospital market basket, CMS proposes to update ASC rates for CY 2020 by 2.7 percent for ASCs meeting relevant quality reporting requirements. This change is based on the projected hospital market basket increase of 3.2 percent minus a 0.5 percentage point adjustment for MFP. This change will also help to promote site neutrality between hospitals and ASCs and encourage the migration of services from the hospital setting to the lower cost ASC setting.
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The proposed rule also includes:
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Proposed definition of ‘hospital,’ ‘standard charges,’ and ‘items and services’
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Proposed requirements for making public all standard charges for all items and services
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Proposed requirements for making public consumer-friendly standard charges for a limited set of ‘shoppable services’
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Proposals for monitoring and enforcement
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Method to control for unnecessary increases in utilization of outpatient services
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Changes to the Inpatient Only list
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ASC covered procedures list
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High-cost/low-cost threshold for packaged skin substitutes
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Device pass-through applications
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Addressing wage index disparities
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Changes in the level of supervision of outpatient therapeutic services in hospitals and critical access hospitals
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Hospital Outpatient Quality Reporting Program
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Ambulatory Surgical Center Quality Reporting Program
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CY 2020 OPPS payment methodology for 340B purchased drugs
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Partial Hospitalization Program rate setting and update to per diem rates
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Revision to the organ procurement organization conditions for certification
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Potential changes to the organ procurement organization and transplant center regulations: Request for Information
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n3. ESRD and DMEPOS CY 2020 Proposed Rulen
On July 29, CMS issued a proposed rule that proposes to update payment policies and rates under the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for renal dialysis services furnished to beneficiaries on or after January 1, 2020. This rule also:
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Proposes updates to the Acute Kidney Injury (AKI) dialysis payment rate for renal dialysis services furnished by ESRD facilities to individuals with AKI
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Proposes changes to the ESRD Quality Incentive Program
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Includes requests for information on data collection resulting from the ESRD PPS technical expert panel, on possible updates and improvements to the ESRD PPS wage index, and on new rules for the competitive bidding of diabetic testing strips.
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In addition, this rule proposes a methodology for calculating fee schedule payment amounts for new Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) items and services and making adjustments to the fee schedule amounts established using supplier or commercial prices if such prices decrease within five years of establishing the initial fee schedule amounts. This rule would also:
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Make amendments to revise existing policies related to the competitive bidding program for DMEPOS
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Streamline the requirements for ordering DMEPOS items, and create one Master List of DMEPOS items that could potentially be subject to face-to-face encounter and written order prior to delivery and/or prior authorization requirements
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The proposed CY 2020 ESRD PPS base rate is $240.27, an increase of $5.00 to the current base rate of $235.27. This proposed amount reflects a reduced market basket increase as required by section 1881(b)(14)(F)(i)(I) of the Act (1.7 percent) and application of the wage index budget-neutrality adjustment factor (1.004180).
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The proposed rule also includes:
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Annual update to the wage index
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Update to the outlier policy
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Eligibility criteria for the Transitional Drug Add-on Payment Adjustment (TDAPA)
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Basis of Payment for the TDAPA for calcimimetics
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Average sales price conditional policy for the application of the TDAPA:
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New and innovative renal dialysis equipment and supplies
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Discontinuing the application of the erythropoiesis-stimulating agent monitoring policy
New changes are coming regarding evaluation and management guidelines. Some of these new changes include updates on medical decision making and code selection. We will be seeing these much needed updates in 2021. Read the article below to get updated on all the other changes that are coming.nnIn an ongoing effort to reduce clinician burden, the “counting” of qualifiers in history and exam will soon be a thing of the past. Exciting changes are on the horizon for evaluation & management guidelines, including updates to how medical decision making (MDM) is determined. Although E/M codes will no longer be selected based on how much history or exam is documented, clinicians should still expect to document when the medically necessary pieces of work was done to fully address the patients presenting problem(s).nnStarting in 2021, code selection will be determined by the number/complexity of presenting problems, data reviewed and the risk of complications. Time will also be another method for appropriate E/M selection. With the new coding guidelines, clinicians will be able to count DAY OF face-to-face time AND non-face-to-face time they personally spend on a patients care. Reviewing tests, other records, ordering medications performance of medically necessary exam can all be used for time calculation.nnOffice visit codes will have new time ranges when the implementation takes place. Fine-tuning clinically relevant documentation, telling clear stories about patient encounters and getting better at time-based capture/reporting now will help prepare for these much needed changes we will be seeing just around the corner in 2021.
Welter Healthcare Partners has successfully completed yet another important project for the State of Colorado. We were asked by the Colorado State Innovation Model (SIM) to create a curriculum to help primary care practices better understand how to integrate behavioral health services into their commercial payer contracts such that these services will be reimbursed and as a result remain sustainable.nnThere are six chapters for this curriculum, made up of both workbooks and webinars to help guide you through the program. This content was developed and produced using funding from the Colorado State Innovation Model, a federally funded, Governor’s Office initiative. Click here to learn more.nnYou may follow this link to the Welter Healthcare Partners website where you can view the videos and workbooks for this curriculum and you can also check out our YouTube channel.
As difficult as it may be, embracing change is essential to growing as an individual, being a better employee and a better person than you were yesterday. Focusing on a positive perspective when faced with difficult challenges or changes can help us adapt when we are pushed out of our comfort zones. The following article focuses on this subject and includes great examples of situations that require adaptability and exercises to help you improve your acceptance to change.nnIs This Me?nnThink about these statements, and choose A or B:n
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A) I tend to think of change as bad. B) I tend to see change as an opportunity.
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A) I dislike change. B) Some change can be worthwhile.
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A) I feel uptight when plans change at home or work. B) I find changes in plans energizing.
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A) I hate making adjustments in my routines. B) I make adjustments to routines easily.
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A) I feel threatened when a challenge arises. B) I like a challenge.
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A) I often get “locked in” to an idea or approach to solving a problem. B) I’m open to new information when solving a problem.
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nIf you find yourself agreeing with most of the A statements, you may be someone who is uncomfortable with change. If you find yourself agreeing with more of the B statements, you may be more able to adapt as changes demand.nnLooking at your own beliefs and judgments can be an important first step toward greater adaptability. If you are fixed in your thinking, you may struggle against change rather than turning it into an opportunity. Learning to sit with discomfort amidst uncertainty is something every human can benefit from.nnAn agile mindset is one that recognizes that adapting to change is the price of admission for living a meaningful life. Let’s face it, any time you try something new, you face uncertainty and there is risk involved. You never know exactly how things will turn out. For example, you may have to make a decision about whether to take a new job or stay where you are. There are no guarantees the job will be a good fit. If it is, great! You took the leap and it paid off. If the new job isn’t great–you chalk it up to learning. You are wiser, you gain new skills, new connections, and you’re able to translate that into a better decision next time. The bottom line: change is difficult, uncomfortable, and at times downright painful. Our ability to effectively handle the discomfort of change improves through experimentation and repetition.nnHere’s how rigidity, the opposite of adaptability, can show up at work: Imagine an executive who quickly shuts down an idea suggested by a team member for a more tech-based system of project management that could increase productivity. The executive may not realize this “shut-down” reflex has become an unconscious habit, triggered by any suggestion of change, which results in his automatically coming up with reasons the new idea won’t work, rather than why it might. Such a habit keeps things as they are and squelches innovation. This lack of adaptability keeps inefficient practices in place, and, maybe worse, sends a message not to question the status quo. Over time, this results in stagnation, reduced passion, and energy and weaker financial results.nnHowever, imagine if that executive had been more adaptable and asked the rest of the team how they feel about the new idea and whether it’s worth trying. If they express enthusiasm, the adaptable executive might give it a chance to see how it goes. If it works, progress is made. If it doesn’t, something useful could still be learned. There is acknowledgement that innovation and change carry emotional and financial outlays. And the emotional outlay can be lessened with an emotionally agile mindset.nnAdaptability is at the heart of innovation in any environment.nnPeople who demonstrate adaptability combine curiosity and problem solving skills to achieve their goals. Persistence leads them to try new behaviors or methods of getting things done. They are resourceful and creative, especially when budgets are tight. These key building blocks to adaptability–agility, persistence, and trying multiple strategies–are vital skills for success.nnIncreasingly, adaptability is a key differentiator of effective leadership in highly tumultuous industries, such as technology and finance. Leaders who show strong adaptability recognize that their industry is continually changing and are better able to evolve. They realize they can’t be stuck doing the same old thing over and over. They think creatively and take calculated risks.nnThere are numerous case studies of once-thriving companies whose leaders were unable to embrace change, such as Blockbuster, Sears, and Kodak. Alternatively, we all know companies that make phenomenal examples of adaptability, including Apple and Google, who created new products we didn’t even know we needed. They were attuned to shifting trends and feedback from customers.nnConsider current workplace norms: teams are no longer fixed and steady, they form and disassemble; work is increasingly meted out in short-term contracts. And leaders are attempting to prepare a workforce for jobs that don’t yet exist. It should not be surprising then that employers are putting a high priority on the skill of adaptability.nnBy staying adaptable and open-minded, you continue to reinvent yourself and experience significant growth along the way.nnKeep in mind, there are times when there’s a good reason not to change, like preserving quality standards or time-tested effective strategies. The trademark of an adaptable leader, however, is the ability to balance core values with responsiveness in the face of a changing world.nnTry this exercise for developing your adaptabilitynnThink of a change in either your personal or professional life you have recently experienced or are currently experiencing. How do you feel about the change? How are you responding to the change?nnHere are some examples of situations that require adaptability:nnWe are launching a new service line. I’m excited about the possibilities it creates, but a little nervous about whether we’ve thought of everything. I’m doing significant research to position myself as an expert.nnMy daughter just turned 12 and is suddenly becoming moody and withdrawn, spending lots of time in her room and not talking to me or her Dad. I’m scared something might be going on that she’s not telling us.nnNow, ask yourself a series of questions to help find a positive perspective on that change:n
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What opportunities does this change represent?
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What positive outcome could I find in this change?
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What is outside of my control?
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What is within my control?
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What is the next (small) action I can take to move in a positive direction?
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What is the best outcome that might result?
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nAvoiding change is impossible. Instead we can change our relationship to change. We can learn to turn toward what scares us, and in turn, we gradually adapt and grow amidst uncertainty and discomfort in life.nnOriginal article posted on keystepmedia.com
While it is said D.C. is slow to make progress on healthcare, individuals are stepping up with a plan noting that “The health of our nation is more important than any political party.” With changes and advancements in healthcare, the state of Colorado is implementing a new law that gives Colorado officials the authority necessary to pursue related federal waivers as needed. The rural areas of our state are experiencing a problem of unaffordable coverage due to insurer competition and limited/nonexistent coverage and state officials are ready to overcome these issues.nnUnited States of Care is a nonpartisan, 501(c)(3) organization dedicated to the goal of every American having access to quality and affordable healthcare.nn”The health of our nation is more important than any political party or partisan victory. United States of Care will chart a path toward a long-term healthcare solution, starting by checking allegiances at the door and putting the patient—our citizens—first.” Dr. Bill Frist, former U.S. Senate majority leader and current USofC board member, said these words at our founding just one year ago. We continue to live by them.nnWith Washington, D.C., slow to make progress on healthcare, we have looked to the laboratories of our democracy—the 50 state governments—to lead our nation and help us chart a path advancing healthcare for everyone. Recently, we have seen significant progress in state legislatures across the country. Acting as a resource, facilitator, convener and technical expert, USoC has connected with healthcare leaders, advocates and others in over 30 states and has formally engaged with partners in Connecticut, Minnesota and New Mexico to support advances in healthcare delivery—learning best practices to share with other states.nnThroughout America and across income groups, Americans say affording healthcare is their most important financial problem. The majority of Americans, across party lines, are concerned about surprise medical bills, prescription drug prices, and coverage for those with pre-existing conditions. This is why state leaders are responding to their constituents’ concerns and seeking policies to make our healthcare system work better for everyone.nnThis unifying feeling—that healthcare is out of reach and unaffordable to many even when one has insurance—eclipses political party and is moving state legislatures across the country to address it. Each state is different, however, and the way lawmakers fix issues—ranging from skyrocketing prescription drug costs to finding ways to make additional coverage choices available and protecting people from financial devastation due to surprise medical bills—is unique in every state.nnThe progress being made state-by-state is a promising march toward the ultimate goal of every single American having access to quality, affordable healthcare regardless of health status, social need or income. Our 2019 State Health Policy Progress analysis hows examples of meaningful progress in 14 states across the country.nnThese state successes are emerging from across the country and from all types of states.nnnnColorado enacted bipartisan legislation directing two state agencies to develop a plan for creating a competitive state insurance plan by Nov. 15, 2019. This new law gives Colorado officials the authority necessary to pursue the federal waivers required to implement the plan. The main goal is to take on the problem of unaffordable coverage in regions of the state, overwhelmingly rural, where insurer competition and affordable coverage is limited or nonexistent.nnColorado also entered 2019 as one of six states with a “C” grade on enforcement of mental health parity. To remedy this, Colorado passed bipartisan legislation to step up requirements for mental health and physical health services to be covered equally. The legislation also increases much needed enforcement and oversight of mental health parity laws.nnMinnesota, the only state with legislative chambers controlled by opposite parties, showed that state leaders can come together across party lines to address pressing problems. Policymakers were faced with the expiration of the state’s provider tax, which helps pay for MinnesotaCare, Medicaid and other vital services that provide care to over 1.2 million Minnesotans.nnLeaders from both parties came together to maintain this crucial funding source and extend the state’s reinsurance program for an additional two years. In Minnesota, reinsurance has reduced premiums by 20% in the individual insurance market. The state also reached a consensus on laws to improve mental health access, lower prescription drug costs, expand access to telehealth, address the opioid crisis, and strengthen elder care protections.nnComplete and original article published on modernhealthcare.com.
As difficult as it may be, embracing change is essential to growing as an individual, being a better employee and a better person than you were yesterday. Focusing on a positive perspective when faced with difficult challenges or changes can help us adapt when we are pushed out of our comfort zones. The following article focuses on this subject and includes great examples of situations that require adaptability and excercises to help you improve your acceptance to change.nnScientists tell us the adaptive ability of any system is usually gauged by its response to disruptions or challenges. In the case of the human system, a.k.a. you and me, adaptive abilities mean you are a person who is flexible in handling change, juggling multiple demands, and navigating new situations with innovative ideas and approaches.nnIs This Me? nnThink about these statements, and choose A or B:n
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A) I tend to think of change as bad. B) I tend to see change as an opportunity.
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A) I dislike change. B) Some change can be worthwhile.
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A) I feel uptight when plans change at home or work. B) I find changes in plans energizing.
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A) I hate making adjustments in my routines. B) I make adjustments to routines easily.
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A) I feel threatened when a challenge arises. B) I like a challenge.
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A) I often get “locked in” to an idea or approach to solving a problem. B) I’m open to new information when solving a problem.
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nIf you find yourself agreeing with most of the A statements, you may be someone who is uncomfortable with change. If you find yourself agreeing with more of the B statements, you may be more able to adapt as changes demand.nnLooking at your own beliefs and judgments can be an important first step toward greater adaptability. If you are fixed in your thinking, you may struggle against change rather than turning it into an opportunity. Learning to sit with discomfort amidst uncertainty is something every human can benefit from.n
An agile mindset is one that recognizes that adapting to change is the price of admission for living a meaningful life.
nLet’s face it, any time you try something new, you face uncertainty and there is risk involved. You never know exactly how things will turn out. For example, you may have to make a decision about whether to take a new job or stay where you are. There are no guarantees the job will be a good fit. If it is, great! You took the leap and it paid off. If the new job isn’t great–you chalk it up to learning. You are wiser, you gain new skills, new connections, and you’re able to translate that into a better decision next time. The bottom line: change is difficult, uncomfortable, and at times downright painful. Our ability to effectively handle the discomfort of change improves through experimentation and repetition.nnas become an unconscious habit, triggered by any suggestion of change, which results in his automatically coming up with reasons the new idea won’t work, rather than why it might. Such a habit keeps things as they are and squelches innovation. This lack of adaptability keeps inefficient practices in place, and, maybe worse, sends a message not to question the status quo. Over time, this results in stagnation, reduced passion, and energy and weaker financial results.nnHowever, imagine if that executive had been more adaptable and asked the rest of the team how they feel about the new idea and whether it’s worth trying. If they express enthusiasm, the adaptable executive might give it a chance to see how it goes. If it works, progress is made. If it doesn’t, something useful could still be learned. There is acknowledgement that innovation and change carry emotional and financial outlays. And the emotional outlay can be lessened with an emotionally agile mindset.nnAdaptability is at the heart of innovation in any environment.nnPeople who demonstrate adaptability combine curiosity and problem solving skills to achieve their goals. Persistence leads them to try new behaviors or methods of getting things done. They are resourceful and creative, especially when budgets are tight. These key building blocks to adaptability–agility, persistence, and trying multiple strategies–are vital skills for success.nnIncreasingly, adaptability is a key differentiator of effective leadership in highly tumultuous industries, such as technology and finance. Leaders who show strong adaptability recognize that their industry is continually changing and are better able to evolve. They realize they can’t be stuck doing the same old thing over and over. They think creatively and take calculated risks.nnThere are numerous case studies of once-thriving companies whose leaders were unable to embrace change, such as Blockbuster, Sears, and Kodak. Alternatively, we all know companies that make phenomenal examples of adaptability, including Apple and Google, who created new products we didn’t even know we needed. They were attuned to shifting trends and feedback from customers.nnConsider current workplace norms: teams are no longer fixed and steady, they form and disassemble; work is increasingly meted out in short-term contracts. And leaders are attempting to prepare a workforce for jobs that don’t yet exist. It should not be surprising then that employers are putting a high priority on the skill of adaptability.nnAdditional information and helpful tips can be found on original article published on keystepmedia.com.n
Health insurance premiums have been an ongoing topic of discussion for Colorado government leaders, medical professionals, insurance companies and patients. With continuous changes throughout the industry, the latest development includes the drop of health exchange premiums. Read the article below for more information recently released and the expectations to come.nnWestern Slope families could save nearly $9,000 a yearnnFor the first time since Colorado started its health insurance exchange, the prices people pay for coverage are expected to drop — by a statewide average of 18.2% — next year if the federal government approves a new state program called reinsurance.nnFor families on the Western Slope, who pay some of the highest insurance premiums in the country, the savings is expected to be nearly $9,000 a year. The Colorado Division of Insurance projects the average savings for Pueblo County at $6,696 annually and $3,369 for metro area residents.nn“I mean, that’s just transformational in terms of saving families money,” Gov. Jared Polis said at a press conference Tuesday.nnReinsurance is basically a pool of $260 million in state and federal money that Colorado plans to use in 2020 to help cover some of the most expensive medical bills among the 250,000 people in the state’s individual market. The idea is that this alleviates some of the burden on insurance providers, which in turn lower their premiums.nnMinnesota’s reinsurance program, for example, dropped its individual premiums by 11.3% and Alaska’s declined by 26%.nnColorado’s reinsurance program is still waiting on final approval from the federal government, but Colorado Insurance Commissioner Mike Conway said he’s all but certain that will happen this fall. Seven states already have federal waivers.nnThe final rates for 2020 health insurance premiums will be released in late September or October.nn“We’ve been working on this for years … ,” said Sen. Bob Rankin, R-Carbondale. “But my caution on this is this doesn’t do anything to really lower the cost of health care.”nnThe news that insurance premiums on the exchange could see a double-digit drop received praise from both the Colorado Hospital Association and Colorado Consumer Health Initiative.nn“We are pleased that the Insurance Commissioner is projecting a decrease in premiums on the individual market for 2020, as it reflects the many efforts by hospitals and providers to take ownership of their portion of the total cost of care,” said Steven Summer, president and chief executive officer of the hospital association, in a prepared statement.nnThe Consumer Health Initiative “expressed cautious optimism” at the expected drop in premiums while warning thatif the Affordable Care Act — also known as Obamacare — is struck down in its latest legal challenge, it could “destabilize everything” by removing health insurance coverage for many Coloradans.nn“We hope the federal Department of Health and Human Services will quickly approve Colorado’s reinsurance program, which is basically insurance for insurance companies that ultimately helps reduce insurance premiums for consumers,” said Adam Fox, director of strategic engagement, in a statement. “Without reinsurance, consumers will face average increases of 0.5 percent and continue to face very high premiums.”nnOriginal article published on denverpost.com.
Changes to timely filing requirements for commercial and Medicare Advantage plans for all claims submitted to plan on or after October 1, 2019
nAnthem Blue Cross and Blue Shield and HMO Colorado (hereinafter collectively referred to as Anthem) continues to look for ways to improve our processes and align with industry standards. Timely receipt of medical claims for your patients, our members, helps our chronic condition care management programs work most effectively, and also plays a crucial role in our ability to share information to help you coordinate patient care. In an effort to simplify processes, improve efficiencies, and better support coordination of care, we are changing all professional agreements to adopt a common time frame for you to submit claims.nnEffective for all claims submitted to plan on or after October 1, 2019, your Anthem Provider Agreement(s) will be amended to require the submission of all professional claims for commercial and Medicare Advantage plans within ninety (90) days of the date of service. This means all claims submitted on or after October 1, 2019, will be subject to a ninety (90) day timely filing requirement, and Anthem will refuse payment if submitted more than ninety (90) days after the date of service.*nnFor instance, for a claim with a date of service of July 5, 2019, the claim would be untimely if submitted more than 90 days after that date of service (i.e. the claim would deny if submitted on or after October 4, 2019.)nnNOTE: ALL CLAIMS WITH DATES OF SERVICE PRIOR TO OCTOBER 1, 2019 THAT WILL BE MORE THAN 90 DAYS FROM THE DATE OF SERVICE ON OCTOBER 1 SHOULD BE SUBMITTED PRIOR TO OCTOBER 1, 2019 TO AVOID A TIMELY FILING DENIAL. nn*If Plan is the secondary payor, the ninety (90) day period will not begin until Provider receives notification of primary payor’s responsibility.n
Payment methodology change / reimbursement adjustment – Consult codes and Laboratory Services done in the Provider’s Office
nAnthem Blue Cross and Blue Shield and our subsidiary company, HMO Colorado (Anthem) would like to make you aware of changes to our payment methodology / reimbursement adjustment that will be effective for dates of service on or after October 1, 2019.nnConsult CodesnAnthem continues to reimburse for consult codes (99241 – 99245). Effective October 1, 2019, Anthem will adjust the reimbursement for consult codes to match the same contractual allowed amount as your contract defines for Evaluation and Management (E/M) codes.nnLaboratory Services done in the Provider’s OfficenAnthem is contracted with Laboratory Corporation of America® (“LabCorp”). All lab work, including Pap tests and routine outpatient pathology, must be sent to LabCorp, with the exception of the procedures that can be performed in the Provider’s office. (Please reference the Laboratory Services section of our Provider Manual for the full list of procedures that can be performed in the Provider’s office. The Provider Manual is available online; see navigation instructions below.)nnAnthem continues to reimburse for laboratory services done in the Provider’s office, and no changes are being made to the services allowed in office. Effective October 1, 2019, Anthem will adjust the reimbursement for lab services performed in the Provider’s office from 100% of the Medicare year Anthem has implemented to 60% of the Medicare year Anthem has implemented.nnPathology codes are excluded from this adjustment.nnAnthem’s Provider Manual is available online. Go to anthem.com. Select Providers, and Providers Overview. Select Find Resources for Your State, and pick Colorado. From the Provider Home page, under the Communications and Updates heading, select the Provider Manual link, and then select the link titled Provider and Facility Manual: February 1, 2019.nnInformation from Anthem Blue Cross Blue Shield and HMO Colorado.
Do 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.nn– Click Here to Submit Redacted Surgery Case Study –nnDATE OF PROCEDURE: 04/17/20XXnnPREOPERATIVE DIAGNOSIS: Left degenerative peritalar subluxation and deformity with contracted peroneal tendons and attenuated and tom tibialis posterior tendon, gastrocnemius contracture. nnPOSTOPERATIVE DIAGNOSIS: Same.nnPROCEDURE: Left Strayer gastrocnemius resection, subtalar and talonavicular joint arthrodesis, peroneal tendon lengthening, tibialis posterior tendon repair, cotton cuneiform osteotomy.nnSURGEON: K., MD.nnASSISTANT FOR THE CASE: M. nnANESTHESIA: General.nnBLOOD LOSS: Minimal.nnBRIEF HISTORY: The patient had chronic pain secondary to above. This was refractory conservative treatment. This was causing her severe difficulty and pain with her knee. Risks and benefits of the above procedure were explained to the patient at length which included pain, bleeding, infection, stiffness, swelling, nerve injury, nonunion, painful hardware, recurrence of deformity, blood clots, a possible need for further surgery, and complications. Informed consent was obtained.nnDESCRIPTION OF PROCEDURE: The patient was taken to the operating room and placed on the table in supine position. After a popliteal block was performed, general anesthesia was induced. A well-padded thigh tourniquet was applied. She was prepped and draped in the usual sterile fashion.nnEsmarch bandage and tourniquet elevated to 300 mmHg. An incision was made centered over the gastrocnemius aponeurosis posteriorly. Sharp dissection was carried out down to the distal aponeurosis. A linear incision was made. Care was taken to avoid injury to the sural nerve or the small saphenous vein. Excellent correction of the contracture was achieved with dorsiflexion well past neutral with the knee extended. Thorough irrigation was carried out using saline. Subcutaneous was closed using inverted 2-0 Vicryl stitches followed by staples for the skin.nnAttention was then turned to the subtalar joint. An incision was made over the sinus tarsi. Sharp dissection was carried out down to the subtalar joint. The peroneal tendons were identified. Z lengthening of the peroneus longus and brevis tendons were then carried out using a 15 blade. This allowed easier correction of the hindfoot valgus. The subtalar joint was entered. This was held open using a lamina spreader. Joint was prepped by removal of cartilage along with perforation of the subchondral bone, surfaced multiple times using a drill bit and chisel. In a similar manner, an incision was made over the talonavicular joint between the tibialis anterior and tibialis posterior tendon. This joint was exposed using a laminar spreader and the joint was prepped in a similar fashion Severe deformity of this joint was seen in a large bone fragment that was non-united from the navicular was present which was excised. The tibialis posterior tendon was obviously lengthened and attenuated. 3 mL of Trinity Elite graft was then thawed and prepped in the standard fashion. A Wright Medical augment was prepped in the standard fashion as well. The augment was first placed on the bone surfaces of both joints with the joint space then filled with the Trinity Elite graft. The talonavicular joint was then first reduced with con-ection of the forefoot abduction. Good co1Tection of the deformity was achievable. This was provisionally held using a K-wire. Once C-mm confirmed a reasonable reduction of the joint and reasonable clinical foot alignment was felt to be present, a single Paragon 28 4.5 mm partially threaded cannulated screw was then placed over the wire with good reduction and fixation.nnNext, attention was then turned to the subtalar joint. Subtalar joint was reduced with correction of the valgus deformity and held in a reduced position with the assistance of the surgical assistant. Through a small posterior incision, a single Paragon 28 7.0 mm partially threaded headless cannulated screw of appropriate size was then placed with good compression and fixation across the joint achieved and good screw placement confirmed bynnC-a1m.nnNext, a 2-hole compression plate was then applied to further supplement fixation on the talonavicular joint with good fixation achieved. Next, the forefoot varus was assessed. There was a significant forefoot varus still present and therefore the Cotton osteotomy was performed. A separate incision was made with sharp dissection down to the cuneiform bone dorsally. A TPS saw was then utilized to perform the Cotton osteotomy in the mid-portion of the cuneiform bone. An osteotome was then used to complete the osteotomy plantarly. Paragon bone wedge trials were then utilized to determine the appropriate size of the bone wedge to be used. A 5mm bone wedge was felt to be appropriate. This was then placed in saline for 5 minutes. The graft was then inserted with the deformity corrected with the aid of the surgical assistant. The correction of deformity was felt to have been achieved.nnNext, attention was then turned to the tibialis posterior tendon. The tendon was advanced and repaired onto the navicular bone using 2 Arthrex corkscrew anchors. Good fixation was achieved. Good stability of the ankle was present. Good correction of deformity was present. Irrigation of all wounds was carried out using saline. Subcutaneous was closed using inverted 2-0 Vicryl stitches followed by staples for the skin. Wounds were dressed using Xerofo1m, 4 x 4s, cast padding followed by a well-padded plaster splint followed by an Ace wrap.nnThe patient tolerated the procedure well. There were no complications. She was transferred to the recovery room in good condition. M was used for assistance for the case. Their service was essential for safe time for this case as were proper maintenance of alignment of all articulations while arthrodesis and fixation were performed.nn
“We hold these truths to be self-evident: that all men are created equal; that they are endowed by their Creator with certain unalienable rights; that among these are life, liberty, and the pursuit of happiness.” -Thomas Jeffersonnn Welter Healthcare Partners would like to wish you a Happy 4th of July! Our dedicated staff wants you to remember to relax and have a safe holiday.nnAccording to ADT, firework, grilling and water safety are collectively very important for the 4th of July. More than 50,000 fires are caused by fireworks every year and fun water activities have serious risks if the proper precautions aren’t taken! Please make sure to review safety procedures to keep you and your family safe.nnFrom all of us at Welter Healthcare Partners, we hope you take the opportunity to enjoy this day with loved ones and celebrate your freedom.nn
CMS is requesting providers to submit information regarding their concerns, suggestions, and comments on the proposed changes to help patients. The deadline for providers to take part in this request is August 12th. For more information, read the information below. nnnThere is so much talk in the medical community about the proposed “Patients over Paperwork” initiative that many providers have found themselves at a loss for what will happen next. Common questions surrounding this important topic include: What type of documentation changes will help reduce the amount of administrative burden our clinicians currently face? How will documentation changes affect their practice? How will this impact reimbursement? What does this mean for their patient interaction and day-to-day routine? Is there anyone I can talk to so that my concerns are heard?nnIn June of this year, CMS put out another request for information from providers to voice their concerns, suggestions, and comment on proposed changes. Do not delay however because the deadline for this round of comments closes on August 12th. Specific feedback that CMS is looking for can be found by visiting federalregister.gov, where you can also submit your comments. Your participation in this initiative does not have to stop with this RFI. CMS frequently releases opportunities for public comment to address specific areas of concerns and providers should prioritize to take advantage of these opportunities.
Wednesday nights democratic primary debate was dominated by talks of healthcare by the candidates. The discussions ranged from health policies to the skyrocketing drug prices which are among the key issues of the candidates. Each had different views on the topic of healthcare. Read the article below to find out what some of their ideas are and what they think they could do to better the healthcare system.nnDuring Wednesday night’s Democratic presidential primary debate — the first in a two-night event viewed as the de facto launch of the primary season — health policies, ranging from “Medicare for All” to efforts to curb skyrocketing drug prices, were among the key issues the 10 hopeful candidates onstage used to help differentiate themselves from the pack.nnHealth care dominated early, with Sens. Elizabeth Warren (Mass.) and Cory Booker (N.J.) using questions about the economy to take aim at pharmaceutical and insurance companies. Sen. Amy Klobuchar (Minn.) emphasized the difficulties many Americans face in paying premiums.nnBut the candidates broke ranks on the details and not all of their claims stayed strictly within the lines.nnOnly two candidates — New York City Mayor Bill de Blasio and Warren — raised their hands in favor of banishing private insurance to install a government-sponsored Medicare for All approach.nnKlobuchar, a single-payer skeptic, expressed concern about “kicking off half of America off their health insurance in four years.” (That’s correct: In 2017, a majority of Americans had private coverage, with 49% getting that insurance through work, according to the Kaiser Family Foundation.)nnFormer Texas Rep. Beto O’Rourke, who also supports maintaining a private insurance system, outlined his own universal health care plan, based on a “Medicare for America” bill in Congress.nnThe single-payer talk set off other discussions about the role of health insurance and the cost of care. We fact-checked some of the biggest claims.nnWarren: “The insurance companies last year alone sucked $23 billion in profits out of the health care system. $23 billion. And that doesn’t count the money that was paid to executives, the money that was spent lobbying Washington.”nnWe contacted Warren’s campaign, who directed us to a report from the National Association of Insurance Commissioners, a nonpartisan group of industry regulators. It supports her assessment.nnThe report says that in 2018, health insurers posted $23.4 billion in net earnings, or profits, compared with $16.1 billion a year prior.nnThis came up in the context of Warren’s support for eliminating private insurance under a Medicare for All system. However, the financing and price tag of such a system is unclear.nnBooker: “The overhead for insurers that they charge is 15%, while Medicare’s overhead is only at 2%.”nnThis is a flawed comparison. Booker said administrative overhead eats up much more for private carriers than it does for Medicare, the government insurance program for seniors and the disabled. But Medicare piggybacks off the Social Security Administration, which covers costs of enrollment, payments and keeping track of patients.nnAlso, Medicare relies on private providers for some of its programs, and overhead charges there are higher. Medicare’s overhead is less than that of private carriers, but exact figures are elusive.nnThe insurance companies’ trade group, America’s Health Insurance Plans (AHIP), reported in 2018 that 18.1% of private health care premiums went to non-health care services. That includes taxes of 4.7% and profits of 2.3%. The Medicare trustees reported that in 2018, total expenses were $740.6 billion, with administrative expenses of $9.9 billion. That comes to 1.3%, less than Booker said.nnWarren: “I spent a big chunk of my life studying why families go broke, and one of the No. 1 reasons is the cost of health care, medical bills. And that’s not just for people who don’t have insurance. It’s for people who have insurance.”nnIs the No. 1 reason people go broke the cost of health care? We’ve rated similar statements Half True — partially accurate but lacking important context.nnOriginal article from khn.org
In this video, we found there are 5 habits of exceptionally charismatic people! We all know people who exude charisma and always leave the best impression and charm to everyone in the room, and it has been found that charisma can be learned. From her book, Vanessa Van Edwards identifies 5 habits that exceptionally charismatic people follow. Learn why charisma matters and how you can use people skills and body language to adjust your presence and more positively influence everyone around you!nn
UnitedHealth Group has purchased DaVita Medical Group after they reached a settlement with the Federal Trade Commission saying this deal was a long time coming. This was due to the concern about harm to medical competition in Nevada. The original deal in place would have resulted in a monopoly controlling more than 80% of the medical market.nnUnitedHealth Group announced Wednesday it has closed on its $4.3 billion purchase of DaVita Medical Group after the parties reached a settlement with the Federal Trade Commission that resolves the federal government’s concerns about harm to competition in Nevada.nnUnder the FTC settlement, UnitedHealth Group has agreed to sell DaVita Medical Group’s Las Vegas operations, known as HealthCare Partners of Nevada, to Salt Lake City, Utah-based Intermountain Healthcare within 40 days of the deal’s closing. Without that tweak, the FTC said the deal would reduce competition in the Las Vegas area for managed care provider organization (MCPO) services sold to Medicare Advantage insurers and Medicare Advantage plans sold to individual Medicare Advantage members.nnThe original FTC complaint against the proposed deal said it would result in a near monopoly controlling more than 80% of the market for services delivered by MCPOs to Medicare Advantage insurers.”The complaint alleges that elimination of this competition would increase healthcare costs and decrease competition on quality, services and other amenities in the affected area,” the FTC wrote.nnColorado Attorney General Phil Weiser separately announced his office had reached an agreement with UnitedHealth Group and DaVita that resolves its concerns about anticompetitive effects in the Colorado Springs area for people covered under Medicare Advantage plans.nnDaVita Medical Group owns two physician groups in Colorado Springs, and UnitedHealthcare, a sister company to Optum, is the largest Medicare Advantage operator in the region. Weiser filed a complaint independent of the FTC to challenge the Optum-DaVita deal.nnUnder that deal, UnitedHealthcare will lift its exclusive contract with Centura Health for at least 3.5 years, which will expand the network of providers available to seniors covered under Medicare Advantage, Weiser’s office said in a news release. Additionally, DaVita Medical Group’s agreement with Humana, UnitedHealth Group’s competitor in Colorado Springs, will be extended without change at least through the end of 2020.nn”As the people’s lawyer, I am committed to protecting all Coloradans from anticompetitive consolidation and practices, and will do so whether or not the federal government acts to protect Coloradans,” Weiser said in a statement.nnUnitedHealth Group will combine DaVita Medical Group with its Optum subsidiary, which provides primary and secondary care, consulting and data analytics. Optum spokeswoman Lauren Mijajlov wrote in an email that the company is pleased to have reached an agreement with Weiser’s office, and to have closed the deal. DaVita spokeswoman Courtney Culpepper said the same in an email.nnComplete and original article posted on modernhealthcare.com
Do 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.nn– Click Here to Submit Redacted Surgery Case Study –nnDATE OF SURGERY: 06/10/2019nnPREOPERATIVE DIAGNOSES: Left shoulder pain, status post hemiarthroplasty/biologic glenoid resurfacing with glenoid arthrosis and erosion. Rotator cuff deficiency. History of rheumatoid arthritis.nnPOSTOPERATIVE DIAGNOSES: Left shoulder pain, status post hemiarthroplasty/biologic glenoid resurfacing with glenoid arthrosis and erosion. Rotator cuff deficiency. History of rheumatoid arthritis.nnPROCEDURES:n
Colorado emergency charges vary in price across the state, which prevents patients from seeking care due to the price of their treatments. The article below gives more insight to the unusual healthcare prices that many people are looking to fix. Read below to find out more on this dive.nnDive Brief:n
Banner Health is planning to acquire the North Colorado Medical Center which has been in operation since 1995. This new plan would bring great healthcare opportunities to the area. Read below to find out more about the deal.nnPhoenix-based Banner Health plans to acquire North Colorado Medical Center in Greeley, which it has operated since 1995.nnUnder the proposed deal, which requires regulatory approval, Banner would pay $328.4 million to acquire the land, assets and equipment associated with the hospital from Weld County (Colo.).nnA large portion of the proceeds from the transaction will be used to pay off $209.5 million in existing hospital debt, according to a press release from Weld County.nnOriginal 
Pinnacol recently announced that Nurse Practitioners could pursue DOWC accreditation to receive higher reimbursement. Also, Pinnacol announced the use of interpretation services to meet contract obligations and the Division of Workers Compensation requirements for injured workers. Read the article below to find out more about these two new regulations.nnDOWC Accreditation for Nurse PractitionersnnNew Colorado Division of Workers’ Compensation regulations that went into effect Aug. 2 impact nurse practitioners.nnHouse Bill 1105 allows nurse practitioners to obtain DOWC Level I accreditation solely for the purpose of receiving the higher reimbursement associated with the designation. It does not allow them to declare maximum medical improvement for an injured worker, the key component of Level I accreditation.nnNurse practitioners may begin pursuing DOWC Level 1 accreditation now via an online course. The next in-person training session will be offered via DOWC in September in Denver, and registration is open.nnBeginning on Aug. 2, Level 1 accredited nurse practitioners with prescriptive authority will be allowed to bill for 100 percent on the DOWC Medical Fee Schedule.nnReference nn
Do 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.nn
The residents of Colorado are working hard to improve our healthcare system throughout the state. A recent study ranked Colorado number 11 in the US based on several different variables, however, health care costs in Colorado were ranked 47. Read the article below recapping the results from the survey and other placement factors.nnA new study places Colorado’s health care system just outside the top 10 in the nation.nnThe study, released Monday by financial website WalletHub, ranked Colorado No. 11 on its list of best and worst states for health care.nnMinnesota, Massachusetts and Rhode Island took the top three spots, with Mississippi, North Carolina and Alaska coming in at the bottom of the list.nnThe report compared the 50 states and the District of Columbia across 43 measures of cost, accessibility and outcome, using data sets ranging from average monthly health insurance premium costs, hospital beds per capita, cancer and heart disease rates, and percentage of insured people ages 19 to 64.nnColorado ranked No. 47 in terms of health care costs for its residents, which considered factors such as average hospital expenses per inpatient day at a community hospital and average monthly health insurance premium costs.nnThe Centennial State ranked 12th in access to health care — which took into account the number of hospital beds per capita and the quality of the state’s public hospital system — and No. 3 in health care outcomes, which included life expectancy and infant, child and maternal mortality rates.nnToday, the average American spends more than $10,000 per year on personal health care, or about 17.9 percent of the U.S. GDP, according to the most recent estimates from the Centers for Medicare & Medicaid Services.nn“But higher costs don’t necessarily translate to better results. The U.S. lags behind several other wealthy nations on several measures, such as health coverage, life expectancy and disease burden,” the study states. “However, the U.S. has improved in giving more healthcare access for people in worse health, and health care cost growth has slowed somewhat.”nnOriginal 
MLNConnects, the official news of CMS, recently proposed 3 new payment rules. CMS released these proposed rules on July 29, which include payment updates for outpatient and physician services and also expanded price transparency initiatives. Read below to find out more information on these proposed rules. n
2. Medicare OPPS and ASC Payment System CY 2020 Proposed Rulen
3. ESRD and DMEPOS CY 2020 Proposed Rulen
New changes are coming regarding evaluation and management guidelines. Some of these new changes include updates on medical decision making and code selection. We will be seeing these much needed updates in 2021. Read the article below to get updated on all the other changes that are coming.nnIn an ongoing effort to reduce clinician burden, the “counting” of qualifiers in history and exam will soon be a thing of the past. Exciting changes are on the horizon for evaluation & management guidelines, including updates to how medical decision making (MDM) is determined. Although E/M codes will no longer be selected based on how much history or exam is documented, clinicians should still expect to document when the medically necessary pieces of work was done to fully address the patients presenting problem(s).nnStarting in 2021, code selection will be determined by the number/complexity of presenting problems, data reviewed and the risk of complications. Time will also be another method for appropriate E/M selection. With the new coding guidelines, clinicians will be able to count DAY OF face-to-face time AND non-face-to-face time they personally spend on a patients care. Reviewing tests, other records, ordering medications performance of medically necessary exam can all be used for time calculation.nnOffice visit codes will have new time ranges when the implementation takes place. Fine-tuning clinically relevant documentation, telling clear stories about patient encounters and getting better at time-based capture/reporting now will help prepare for these much needed changes we will be seeing just around the corner in 2021.
Welter Healthcare Partners has successfully completed yet another important project for the State of Colorado. We were asked by the Colorado State Innovation Model (SIM) to create a curriculum to help primary care practices better understand how to integrate behavioral health services into their commercial payer contracts such that these services will be reimbursed and as a result remain sustainable.nnThere are six chapters for this curriculum, made up of both workbooks and webinars to help guide you through the program. This content was developed and produced using funding from the Colorado State Innovation Model, a federally funded, Governor’s Office initiative. Click 
Is This Me?nnThink about these statements, and choose A or B:n
While it is said D.C. is slow to make progress on healthcare, individuals are stepping up with a plan noting that “The health of our nation is more important than any political party.” With changes and advancements in healthcare, the state of Colorado is implementing a new law that gives Colorado officials the authority necessary to pursue related federal waivers as needed. The rural areas of our state are experiencing a problem of unaffordable coverage due to insurer competition and limited/nonexistent coverage and state officials are ready to overcome these issues.nnUnited States of Care is a nonpartisan, 501(c)(3) organization dedicated to the goal of every American having access to quality and affordable healthcare.nn”The health of our nation is more important than any political party or partisan victory. United States of Care will chart a path toward a long-term healthcare solution, starting by checking allegiances at the door and putting the patient—our citizens—first.” Dr. Bill Frist, former U.S. Senate majority leader and current USofC board member, said these words at our founding just one year ago. We continue to live by them.nnWith Washington, D.C., slow to make progress on healthcare, we have looked to the laboratories of our democracy—the 50 state governments—to lead our nation and help us chart a path advancing healthcare for everyone. Recently, we have seen significant progress in state legislatures across the country. Acting as a resource, facilitator, convener and technical expert, USoC has connected with healthcare leaders, advocates and others in over 30 states and has formally engaged with partners in Connecticut, Minnesota and New Mexico to support advances in healthcare delivery—learning best practices to share with other states.nnThroughout America and across income groups, Americans say affording healthcare is their most important financial problem. The majority of Americans, across party lines, are concerned about surprise medical bills, prescription drug prices, and coverage for those with pre-existing conditions. This is why state leaders are responding to their constituents’ concerns and seeking policies to make our healthcare system work better for everyone.nnThis unifying feeling—that healthcare is out of reach and unaffordable to many even when one has insurance—eclipses political party and is moving state legislatures across the country to address it. Each state is different, however, and the way lawmakers fix issues—ranging from skyrocketing prescription drug costs to finding ways to make additional coverage choices available and protecting people from financial devastation due to surprise medical bills—is unique in every state.nnThe progress being made state-by-state is a promising march toward the ultimate goal of every single American having access to quality, affordable healthcare regardless of health status, social need or income. Our 2019 State Health Policy Progress analysis hows examples of meaningful progress in 14 states across the country.nnThese state successes are emerging from across the country and from all types of states.nn
nnColorado enacted bipartisan legislation directing two state agencies to develop a plan for creating a competitive state insurance plan by Nov. 15, 2019. This new law gives Colorado officials the authority necessary to pursue the federal waivers required to implement the plan. The main goal is to take on the problem of unaffordable coverage in regions of the state, overwhelmingly rural, where insurer competition and affordable coverage is limited or nonexistent.nnColorado also entered 2019 as one of six states with a “C” grade on enforcement of mental health parity. To remedy this, Colorado passed bipartisan legislation to step up requirements for mental health and physical health services to be covered equally. The legislation also increases much needed enforcement and oversight of mental health parity laws.nnMinnesota, the only state with legislative chambers controlled by opposite parties, showed that state leaders can come together across party lines to address pressing problems. Policymakers were faced with the expiration of the state’s provider tax, which helps pay for MinnesotaCare, Medicaid and other vital services that provide care to over 1.2 million Minnesotans.nnLeaders from both parties came together to maintain this crucial funding source and extend the state’s reinsurance program for an additional two years. In Minnesota, reinsurance has reduced premiums by 20% in the individual insurance market. The state also reached a consensus on laws to improve mental health access, lower prescription drug costs, expand access to telehealth, address the opioid crisis, and strengthen elder care protections.nnComplete and original 
As difficult as it may be, embracing change is essential to growing as an individual, being a better employee and a better person than you were yesterday. Focusing on a positive perspective when faced with difficult challenges or changes can help us adapt when we are pushed out of our comfort zones. The following article focuses on this subject and includes great examples of situations that require adaptability and excercises to help you improve your acceptance to change.nnScientists tell us the adaptive ability of any system is usually gauged by its response to disruptions or challenges. In the case of the human system, a.k.a. you and me, adaptive abilities mean you are a person who is flexible in handling change, juggling multiple demands, and navigating new situations with innovative ideas and approaches.nnIs This Me? nnThink about these statements, and choose A or B:n
Health insurance premiums have been an ongoing topic of discussion for Colorado government leaders, medical professionals, insurance companies and patients. With continuous changes throughout the industry, the latest development includes the drop of health exchange premiums. Read the article below for more information recently released and the expectations to come.nnWestern Slope families could save nearly $9,000 a yearnnFor the first time since Colorado started its health insurance exchange, the prices people pay for coverage are expected to drop — by a statewide average of 18.2% — next year if the federal government approves a new state program called reinsurance.nnFor families on the Western Slope, who pay some of the highest insurance premiums in the country, the savings is expected to be nearly $9,000 a year. The Colorado Division of Insurance projects the average savings for Pueblo County at $6,696 annually and $3,369 for metro area residents.nn“I mean, that’s just transformational in terms of saving families money,” Gov. Jared Polis said at a press conference Tuesday.nnReinsurance is basically a pool of $260 million in state and federal money that Colorado plans to use in 2020 to help cover some of the most expensive medical bills among the 250,000 people in the state’s individual market. The idea is that this alleviates some of the burden on insurance providers, which in turn lower their premiums.nnMinnesota’s reinsurance program, for example, dropped its individual premiums by 11.3% and Alaska’s declined by 26%.nnColorado’s reinsurance program is still waiting on final approval from the federal government, but Colorado Insurance Commissioner Mike Conway said he’s all but certain that will happen this fall. Seven states already have federal waivers.nnThe final rates for 2020 health insurance premiums will be released in late September or October.nn“We’ve been working on this for years … ,” said Sen. Bob Rankin, R-Carbondale. “But my caution on this is this doesn’t do anything to really lower the cost of health care.”nnThe news that insurance premiums on the exchange could see a double-digit drop received praise from both the Colorado Hospital Association and Colorado Consumer Health Initiative.nn“We are pleased that the Insurance Commissioner is projecting a decrease in premiums on the individual market for 2020, as it reflects the many efforts by hospitals and providers to take ownership of their portion of the total cost of care,” said Steven Summer, president and chief executive officer of the hospital association, in a prepared statement.nnThe Consumer Health Initiative “expressed cautious optimism” at the expected drop in premiums while warning thatif the Affordable Care Act — also known as Obamacare — is struck down in its latest legal challenge, it could “destabilize everything” by removing health insurance coverage for many Coloradans.nn“We hope the federal Department of Health and Human Services will quickly approve Colorado’s reinsurance program, which is basically insurance for insurance companies that ultimately helps reduce insurance premiums for consumers,” said Adam Fox, director of strategic engagement, in a statement. “Without reinsurance, consumers will face average increases of 0.5 percent and continue to face very high premiums.”nnOriginal 
Anthem Blue Cross and Blue Shield and HMO Colorado (hereinafter collectively referred to as Anthem) continues to look for ways to improve our processes and align with industry standards. Timely receipt of medical claims for your patients, our members, helps our chronic condition care management programs work most effectively, and also plays a crucial role in our ability to share information to help you coordinate patient care. In an effort to simplify processes, improve efficiencies, and better support coordination of care, we are changing all professional agreements to adopt a common time frame for you to submit claims.nnEffective for all claims submitted to plan on or after October 1, 2019, your Anthem Provider Agreement(s) will be amended to require the submission of all professional claims for commercial and Medicare Advantage plans within ninety (90) days of the date of service. This means all claims submitted on or after October 1, 2019, will be subject to a ninety (90) day timely filing requirement, and Anthem will refuse payment if submitted more than ninety (90) days after the date of service.*nnFor instance, for a claim with a date of service of July 5, 2019, the claim would be untimely if submitted more than 90 days after that date of service (i.e. the claim would deny if submitted on or after October 4, 2019.)nnNOTE: ALL CLAIMS WITH DATES OF SERVICE PRIOR TO OCTOBER 1, 2019 THAT WILL BE MORE THAN 90 DAYS FROM THE DATE OF SERVICE ON OCTOBER 1 SHOULD BE SUBMITTED PRIOR TO OCTOBER 1, 2019 TO AVOID A TIMELY FILING DENIAL. nn*If Plan is the secondary payor, the ninety (90) day period will not begin until Provider receives notification of primary payor’s responsibility.n
Anthem continues to reimburse for consult codes (99241 – 99245). Effective October 1, 2019, Anthem will adjust the reimbursement for consult codes to match the same contractual allowed amount as your contract defines for Evaluation and Management (E/M) codes.nnLaboratory Services done in the Provider’s OfficenAnthem is contracted with Laboratory Corporation of America® (“LabCorp”). All lab work, including Pap tests and routine outpatient pathology, must be sent to LabCorp, with the exception of the procedures that can be performed in the Provider’s office. (Please reference the Laboratory Services section of our Provider Manual for the full list of procedures that can be performed in the Provider’s office. The Provider Manual is available online; see navigation instructions below.)nnAnthem continues to reimburse for laboratory services done in the Provider’s office, and no changes are being made to the services allowed in office. Effective October 1, 2019, Anthem will adjust the reimbursement for lab services performed in the Provider’s office from 100% of the Medicare year Anthem has implemented to 60% of the Medicare year Anthem has implemented.nnPathology codes are excluded from this adjustment.nnAnthem’s Provider Manual is available online. Go to anthem.com. Select Providers, and Providers Overview. Select Find Resources for Your State, and pick Colorado. From the Provider Home page, under the Communications and Updates heading, select the Provider Manual link, and then select the link titled Provider and Facility Manual: February 1, 2019.nnInformation from Anthem Blue Cross Blue Shield and HMO Colorado.
Welter Healthcare Partners would like to wish you a Happy 4th of July! Our dedicated staff wants you to remember to relax and have a safe holiday.
nnThere is so much talk in the medical community about the proposed “Patients over Paperwork” initiative that many providers have found themselves at a loss for what will happen next. Common questions surrounding this important topic include: What type of documentation changes will help reduce the amount of administrative burden our clinicians currently face? How will documentation changes affect their practice? How will this impact reimbursement? What does this mean for their patient interaction and day-to-day routine? Is there anyone I can talk to so that my concerns are heard?nnIn June of this year, CMS put out another request for information from providers to voice their concerns, suggestions, and comment on proposed changes. Do not delay however because the deadline for this round of comments closes on August 12th. Specific feedback that CMS is looking for can be found by visiting 
Health care dominated early, with Sens. Elizabeth Warren (Mass.) and Cory Booker (N.J.) using questions about the economy to take aim at pharmaceutical and insurance companies. Sen. Amy Klobuchar (Minn.) emphasized the difficulties many Americans face in paying premiums.nnBut the candidates broke ranks on the details and not all of their claims stayed strictly within the lines.nnOnly two candidates — New York City Mayor Bill de Blasio and Warren — raised their hands in favor of banishing private insurance to install a government-sponsored Medicare for All approach.nnKlobuchar, a single-payer skeptic, expressed concern about “kicking off half of America off their health insurance in four years.” (That’s correct: In 2017, a majority of Americans had private coverage, with 49% getting that insurance through work, according to the Kaiser Family Foundation.)nnFormer Texas Rep. Beto O’Rourke, who also supports maintaining a private insurance system, outlined his own universal health care plan, based on a “Medicare for America” bill in Congress.nnThe single-payer talk set off other discussions about the role of health insurance and the cost of care. We fact-checked some of the biggest claims.nnWarren: “The insurance companies last year alone sucked $23 billion in profits out of the health care system. $23 billion. And that doesn’t count the money that was paid to executives, the money that was spent lobbying Washington.”nnWe contacted Warren’s campaign, who directed us to a report from the National Association of Insurance Commissioners, a nonpartisan group of industry regulators. It supports her assessment.nnThe report says that in 2018, health insurers posted $23.4 billion in net earnings, or profits, compared with $16.1 billion a year prior.nnThis came up in the context of Warren’s support for eliminating private insurance under a Medicare for All system. However, the financing and price tag of such a system is unclear.nnBooker: “The overhead for insurers that they charge is 15%, while Medicare’s overhead is only at 2%.”nnThis is a flawed comparison. Booker said administrative overhead eats up much more for private carriers than it does for Medicare, the government insurance program for seniors and the disabled. But Medicare piggybacks off the Social Security Administration, which covers costs of enrollment, payments and keeping track of patients.nnAlso, Medicare relies on private providers for some of its programs, and overhead charges there are higher. Medicare’s overhead is less than that of private carriers, but exact figures are elusive.nnThe insurance companies’ trade group, America’s Health Insurance Plans (AHIP), reported in 2018 that 18.1% of private health care premiums went to non-health care services. That includes taxes of 4.7% and profits of 2.3%. The Medicare trustees reported that in 2018, total expenses were $740.6 billion, with administrative expenses of $9.9 billion. That comes to 1.3%, less than Booker said.nnWarren: “I spent a big chunk of my life studying why families go broke, and one of the No. 1 reasons is the cost of health care, medical bills. And that’s not just for people who don’t have insurance. It’s for people who have insurance.”nnIs the No. 1 reason people go broke the cost of health care? We’ve rated similar statements Half True — partially accurate but lacking important context.nnOriginal 
UnitedHealth Group has purchased DaVita Medical Group after they reached a settlement with the Federal Trade Commission saying this deal was a long time coming. This was due to the concern about harm to medical competition in Nevada. The original deal in place would have resulted in a monopoly controlling more than 80% of the medical market.nnUnitedHealth Group announced Wednesday it has closed on its $4.3 billion purchase of DaVita Medical Group after the parties reached a settlement with the Federal Trade Commission that resolves the federal government’s concerns about harm to competition in Nevada.nnUnder the FTC settlement, UnitedHealth Group has agreed to sell DaVita Medical Group’s Las Vegas operations, known as HealthCare Partners of Nevada, to Salt Lake City, Utah-based Intermountain Healthcare within 40 days of the deal’s closing. Without that tweak, the FTC said the deal would reduce competition in the Las Vegas area for managed care provider organization (MCPO) services sold to Medicare Advantage insurers and Medicare Advantage plans sold to individual Medicare Advantage members.nnThe original FTC complaint against the proposed deal said it would result in a near monopoly controlling more than 80% of the market for services delivered by MCPOs to Medicare Advantage insurers.”The complaint alleges that elimination of this competition would increase healthcare costs and decrease competition on quality, services and other amenities in the affected area,” the FTC wrote.nnColorado Attorney General Phil Weiser separately announced his office had reached an agreement with UnitedHealth Group and DaVita that resolves its concerns about anticompetitive effects in the Colorado Springs area for people covered under Medicare Advantage plans.nnDaVita Medical Group owns two physician groups in Colorado Springs, and UnitedHealthcare, a sister company to Optum, is the largest Medicare Advantage operator in the region. Weiser filed a complaint independent of the FTC to challenge the Optum-DaVita deal.nnUnder that deal, UnitedHealthcare will lift its exclusive contract with Centura Health for at least 3.5 years, which will expand the network of providers available to seniors covered under Medicare Advantage, Weiser’s office said in a news release. Additionally, DaVita Medical Group’s agreement with Humana, UnitedHealth Group’s competitor in Colorado Springs, will be extended without change at least through the end of 2020.nn”As the people’s lawyer, I am committed to protecting all Coloradans from anticompetitive consolidation and practices, and will do so whether or not the federal government acts to protect Coloradans,” Weiser said in a statement.nnUnitedHealth Group will combine DaVita Medical Group with its Optum subsidiary, which provides primary and secondary care, consulting and data analytics. Optum spokeswoman Lauren Mijajlov wrote in an email that the company is pleased to have reached an agreement with Weiser’s office, and to have closed the deal. DaVita spokeswoman Courtney Culpepper said the same in an email.nnComplete and original