Colorado Senate Advances Public Option Health Insurance Bill
Colorado Governor, Jared Polis, has been in the news for his ‘roadmap’ to reduce healthcare costs. We now uncover the latest developments of a state-run health insurance option. This advancement is seen as a step toward universal healthcare, but only one part of his strategy for achieving universal coverage. Read the article below to learn more about the public option health insurance bill.nnColorado’s Senate advanced another piece of Democratic Gov. Jared Polis’ healthcare agenda on Tuesday by tentatively endorsing a study on creating a state-run health insurance option.nn
nnThe bill would direct state agencies to recommend a plan that would compete with existing private insurance plans and those offered on Colorado’s healthcare exchange. Another Senate vote sends the study bill to the governor. It’s already cleared the House on a bipartisan 46-17 vote.nnBackers say it’s designed to curb some of the nation’s highest insurance premiums in mountain and other rural areas. Fourteen of Colorado’s 64 counties have just one insurer for the individual market, and monthly premiums there can be $500 higher than in metropolitan Denver.nnThe so-called “public option” bill is one of several measures advocated by Polis to reduce health care costs and increase accessibility for Colorado residents. In Washington state, Democratic Gov. Jay Inslee has called for a state-based public option health insurance plan that he has called a “step toward universal healthcare.”nnPolis’ campaign for office stressed a variety of strategies for achieving universal coverage.nnThe first-term governor already has signed a hospital price transparency bill into law.nnMajority Democrats in the Legislature are expected to send him bills to create a state reinsurance program to help private insurers lower premiums; a prescription drug price transparency bill; and a bill to get the federal government’s permission to import cheaper prescription drugs from Canada.nnThe public option legislation directs the Department of Health Care Policy and Financing and the Department of Regulatory Agencies to present a proposal in November. The plan would assess costs, funding sources, necessary federal permissions and funding, consumer eligibility and who in government would run a plan.nnSupporters say enrollment could begin in 2020 and a plan could start operating in 2021. Sponsors include Sen. Kerry Donovan and Rep. Dylan Roberts, both Democrats, and Republican Rep. Marc Catlin.nnDonovan noted Tuesday that too many residents in her own district, which includes Aspen, Vail and Glenwood Springs, have to choose between health insurance and paying mortgages or other family expenses.nnRepublican Sen. Jim Smallwood, an insurance broker, questioned the wisdom of having government step in as a competitor. He noted that high rural premiums persist and are rising under a state health insurance exchange adopted under the 2010 Affordable Care Act.nn”Introducing the concept of a public cure for what is broken in Obamacare seems hypocritical,” Smallwood said.nnOriginal article published on modernhealthcare.com.
n the Code Spotlight, Welter Healthcare Partners aims to profile and discuss practice applications of the code, as well as pertinent guideline reminders. Allograft Coding 2019 saw several changes to CPT, three codes that were added to the Surgery code set are for Allografting.nnCodes 20932, 20933 and 20934 all include templating, cutting placement and internal fixation, when performed.n
nnFor example, say an internist performs an annual wellness exam and addresses a skin lesion during the same visit. If the physician doesn’t append modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the evaluation and management (E/M) service for the lesion, most payers will disregard the E/M service and only pay for the annual wellness exam, says Elhoms.nnAppending a modifier when it isn’t warranted can also be costly. For example, an internist owns their own radiology equipment. If they append modifier -26 (professional component only) to each radiology service, they actually miss out on revenue, depending on the service, says Elhoms. For example, when appending modifier -26 to the CPT code for chest x-ray, single view (71045), physicians could lose approximately $13 for every test performed.nnElhoms cites the case of an internal medicine practice with its own radiology equipment that saw an immediate 60 percent increase in reimbursement simply by removing this modifier from the radiology CPT codes it reported.nnOn the other hand, when a physician incorrectly appends a modifier and subsequently receives payment, they could be subject to a post-payment audit. “I’ve seen so many recoupments regarding inappropriate use of modifier -25 that have put private practice physicians out of business,” says Elhoms. “There’s a false sense of security when it’s paid. Recoupment requests can come out of nowhere.”nnElhoms knows of one family medicine practice that couldn’t recover from a $250,000 recoupment after a payer audited the practice’s use of modifier -25 on E/M office visit codes when providers rendered osteopathic manipulation treatment (OMT) during the same encounter.nnThe payer alleged that the documentation didn’t support a significant and separately identifiable service, and the payer felt the OMT was part of the typical work associated with the E/M code and shouldn’t have been paid separately, she says.nnIs there anything physicians can do to collect the payment they deserve while also avoiding compliance risk? Here are six tips experts recommend:nn1. Know your payer policies.nJust because one payer accepts a modifier doesn’t mean all will, says Michael Miscoe, JD, founding partner of Miscoe Health Law LLC in Central City, Pa. For example, one payer might accept modifier -25 in all instances consistent with the CPT definition of “significant, separately identifiable” while another might not permit it at all for certain services (e.g. when a physician reports an E/M code in addition to a code for a pain management injection).nnTake the time to identify the modifiers each payer does—and doesn’t—recognize. “Check each payer’s medical policies for service-specific as well as general policies regarding separate reporting,” says Miscoe.nn2. Hire a certified coder.n
“Ideally, you would have at least one person in-house who can assist with modifiers and be proactive about monitoring denials and providing education,” says Elhoms. Another option: Keep a trusted compliance consultant on stand-by as questions arise, she adds.nn3. Focus on clinical documentation.nFor example, when physicians report modifier -25, their documentation must support the history, exam, and medical decision-making for two separate services, says Elhoms.nnThink of each service as a separate encounter even though they’re rendered during the same visit, she adds. For modifier -59 (distinct procedural service), documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual.nn4. Take a closer look at your billing system.nDoes your vendor incorporate National Correct Coding Initiative (NCCI) edits and update these edits quarterly? If so, are you certain that each payer has adopted those edits in its reimbursement policies? Do templates or billing automation encourage modifiers when they aren’t warranted or omit modifiers that are required?nn5. Append each modifier to the correct code.nFor example, modifier -59 should accompany a procedure or service code but not an office visit E/M code. Always refer to the NCCI procedure-to-procedure edits or specific payer bundling rules when determining what procedure or service code should include this modifier.nnExample: When reporting an excisional biopsy and lesion destruction, append modifier -59 to the code for the lesion destruction. When removing an intrauterine device and inserting a Nexplanon during an office visit, append modifier -59 to the code for the IU removal. Modifier -25, on the other hand, is always appended to an E/M office visit code when supported by the circumstances of the encounter, says Elhoms.nn6. Know what to do if you run into payment problems.nConsider the following advice:nnBalance bill the patient. While most payer contracts don’t permit this, a physician who is not under contract with a commercial payer may have the option to do so if all other state statutory advance notice requirements are met. Physicians are not permitted to balance bill patients with Medicare, and some states are enacting statutes to limit exposure of patients to either non-covered service costs or disallowed amounts for services that are covered, says Miscoe.nFight the denial. If the payer hasn’t published a policy on modifier usage, physicians may be able to successfully appeal the denial by citing standard industry guidance (e.g., CPT definitions of various modifiers, the NCCI Policy Manual for Medicare Services, or even medical policies of other major commercial payers), says Miscoe.nNegotiate your payer contracts. Ask payers to accept modifiers in all or certain circumstances, says Elhoms.nnTaking proactive steps to ensure compliant use of modifiers pays dividends in the long run, says Elhoms.nnOriginal 
This is a 46-year-old black female. She had prolapsed uterus causing her pressure, but she also had 2 previous bladder repair procedures that we removed the mesh, removed the suture, gave her proper time of healing, give her Estring cream for re-estrogenizing the vagina, and then we decided to go ahead and repair this. So, the patient was prepped and draped in the usual manner. Observing all aseptic technique, she was given a general anesthetic and prepped and draped. We put in a uterine manipulator and a Foley catheter and then we turned our attention to the above. We put in 4 port sites. These port sites were docked to an X1 robot, 1 port was for the camera, 1 port was for the PK bipolar cautery and laparoscopic scissors of the port, and then we had an assist port. The patient was docked to the patient’s side-docking in a steep Trendelenburg position. Then, we turned our attention to the console.nnAfter the patient was docked appropriately, we want on inspecting and saw a large right ovarian cyst that we thought would need to be removed. We looked at the left side. The left side was totally normal. So, we started on the left side at the round ligament. This was cauterized with the PK and then laparoscopically we cauterized and then developed an anterior and posterior aspect of the broad ligament. Then, we looked at the infundibulum and in the ovarian ligament. This was cauterized until secure, and then, laparoscopically we used scissors for cautery as well as to excise the tissue. We skeletonized and want down to the bladder flap anteriorly and went posteriorly and then we skeletonized and saw the uterine vessels they were cauterized until secure.nnThen, we turned our attention to the right side, which was a large ovarian cyst. We took the right ovary by going through the infundibulopelvic pelvic 1igament, IP. This was cauterized and cut until secure and then we went up to the broad ligament inc1uding removing the fallopian tubes and then the round ligament. We excised anteriorly again to deve1op bladder flap posterior1y just to get down to the uterine vessels that were cauterized. Then, once they were cauterized and secure next our attention to pushing the bladder well off the cervix. By using the uterine manipulator, the caudal ligaments were secure and then we circumferentially removed the cervix and then we pulled it out the cervix.nnThe uterus and the right tube and ovary through the vagina, irrigated, and then we used the V-Loc running locked stitch to secure the cuff, running it forward and backwards for good hemostasis. AlloWrap was used to put on the cuff to prevent any adhesive disease, and then we put in a pain pump, On-Q pain pump for pain. This was put in without complications. Then, as my assistant was closing the port site and undocking the robot, I turned my attention to below.nnAt this point, the patient was still in the dorsal lithotomy position, 1.5 cm from the urethral meatus, we did do a vertical incision and removed that 1 stitch that was from a previous surgery and then undermined until we got to the operative fossa. This was done bilaterally and at the level just below the pubic ramus, but also below the obturator fossa and then we used the Co1oplast TOT, and we anchored it on one side to the left side first and then we made sure the sling was lying flat and at the center of the posterior urethrovesical angle and then the second right side was placed and without complications.nnWe secured it and tied it up with tension. Then, we cut the suture and then we reapproximated the incision with 0 and 3-0 Vicryl in a running locked stitch. We took out the catheter. There was no need for cystoscopy since we did not do a TVT or TOT. The urine was clear. There was no air into the Foley catheter. We discontinued the procedure. The patient was transferred to the PACU in satisfactory condition.
Healthcare costs have been an increasingly popular conversation among doctors, patients, insurance companies and even the government. Colorado Governor, Jared Polis is getting involved and proposing the potential of reducing healthcare costs in Colorado. Read the article below from KOAA News5 of his new plan.nnDENVER – Gov. Jared Polis and Lt. Gov. Dianne Primavera announced their plan to reduce healthcare costs for Coloradans Thursday morning in Denver.nnGov. Polis laid out his “Roadmap for saving Coloradans money on healthcare” in an announcement outside Denver Health.nnThe plan featured six main points, which Polis billed as short-term solutions to reducing health care costs.n
nnRecently the Office of Inspector General’s (OIG) website has posted cases of recent penalties that practices and providers have been charged due to incorrect billing of Incident-To. Are you at risk? The numbers are stomach turning and something that every practice should be aware of. We aren’t just talking about the huge hit in penalties, which are in the hundreds of thousands of dollars, but factor in the 15% hit you will take to your reimbursement for claims. With numbers like that it could mean a small practice having to close it’s doors.nnIncorrect submission of these claims is not something any practice aims to do. However, not submitting these claims is leaving money on the table. Read below for the enforcement actions as stipulated by the OIG and contact us today for more information.nn
Welter Healthcare Partners acknowledges the contributions of physicians to the overall health and well being of our communities. We would like to wish all physicians and specialists a very Happy Doctor’s Day, 2019. nnWe value your service and dedication.nn
You’ve just been assigned a major project. Naturally your mind is racing with a million different thoughts on where to start and what you’ll need to get the job done on time. As a result, you start creating a to-do-list that is massively bulky.nnThe problem with these out-of-control to-do-lists is that they’re overwhelming and prevent you from being productive. That’s because you’re multitasking and directing your energy to unimportant tasks and activities.nnInstead, keep your to-to-lists lean and mean by only focusing on your 3 to 5 most urgent, important, and challenging tasks for the day, aka your Most Important Task (MIT). Focus on one task at a time before moving on to less critical tasks. When you do, you’ll feel more productive and less anxious.nnLou Babauta of ZenHabits suggests that at least one of your MITs should be related to your goals and you should work on them in the AM Whether if it’s at home or in the office, tackle your MIT first thing in morning.nnAccording to Lou, “If you put them off to later, you will get busy and run out of time to do them. Get them out of the way, and the rest of the day is gravy!”nn2. Measure your results, not your time.nWhen it comes to productivity we often focus on how long something takes to complete; as opposed to what we actually accomplished in a day. For example, you just spent four hours writing a 1,000-word blog post. You may be be a bit bummed since that took a nice chunk out of your day.nnBut, what if you focused on the smaller parts of the blog post? For example, you broke into five 200-word sections, formatted it properly, added headings, ran a spellcheck and added images. Suddenly you realize you actually completed a lot in that timeframe.nnIn fact, research from the Behance team found “that placing importance on hours and physical presence over action and results leads to a culture of inefficiency (and anxiety).”nn”The pressure of being required to sit at your desk until a certain time creates a factory-like culture that ignores a few basic laws of idea generation and human nature: (1) When the brain is tired, it doesn’t work well, (2) Idea generation happens on its own terms, (3) When you feel forced to execute beyond your capacity, you begin to hate what you are doing.”nnOne way to assist you with measuring results instead of time is by generating done lists. This is simply an ongoing log of everything you completed in a day. By keeping this list you’ll feel more motivated and focused since you can actually see what you accomplished.nnAdditionally, according to Buffer co-founder Leo Widrich, done lists allow “you to review your day, gives you a chance to celebrate your accomplishments, and helps you plan more effectively.”nn3. Have an attitude adjustment.n
The team over at Mind Tools state that we’re more effective at work when we have a “positive attitude.”nn”People with a good attitude take the initiative whenever they can. They willingly help a colleague in need, they pick up the slack when someone is off sick, and they make sure that their work is done to the highest standards.”nnAnd, you’ll never hear them say that their work is “Good enough.” That’s because they go above and beyond.nnFurthermore, a good attitude at work will help you set standards for your work, ensure that you’re taking responsibility for yourself, and make decisions easier since they’re based on your intuition. “This admirable trait is hard to find in many organizations. But demonstrating ethical decision-making and integrity could open many doors for you in the future.”nn4. Communicate, communicate, communicate.nRegardless if you’re freelancer, entrepreneur, or employee, there will be times when you will have to work with others. As such, you should strengthen your communication and collaboration skills. When you do, you’ll eliminate unnecessary rework and wasted time from straightening out any misunderstandings and miscommunications.nnYou can start by enhancing your active listening skills and staying on one topic when communicating. For example, when composing an email, keep it short and to point. Don’t throw too much information in the message since it will only confuse the recipient.nn5. Create and stick to a routine.n”We are creatures of habit, and so are our brains. When we establish routines, we can carry out tasks faster since we don’t have to ‘think’ about the task – or prepare for it – as much, and can work on autopilot,” says Hallie Crawford, a certified career coach, speaker, and author.nn6. Automate more tasks.n
Want to the secret of getting more done? Reduce the amount of decisions you have to make throughout the day. That’s why Mark Zuckerberg wore that same outfit for years. Most days he still does. It prevented fatigue. I will say though, I tried this and it was hard on my relationship with my wife. Make sure you find your balance.nn”The counterintuitive secret to getting things done is to make them more automatic, so they require less energy,” wrote Tony Schwartz, president and CEO of The Energy Project, in the Harvard Business Review.nn”It turns out we each have one reservoir of will and discipline, and it gets progressively depleted by any act of conscious self-regulation. In other words, if you spend energy trying to resist a fragrant chocolate chip cookie, you’ll have less energy left over to solve a difficult problem. Will and discipline decline inexorably as the day wears on.”nnIn other words, build routines and habits so that you’re not deciding. You’re just doing. Hence why Zuck wore the same clothes everyday. By eliminating those silly or frivolous, he could focus all of his energy on more important work decisions.nn7. Stop multitasking.nWe all believe that we’re multitaskers. In fact, humans just aren’t capable of doing multiple things at once.nn”People can’t multitask very well, and when people say they can, they’re deluding themselves,” said neuroscientist Earl Miller. “The brain is very good at deluding itself.”nnInstead, we’re simply shifting our attention from one task to another very quickly.nn”Switching from task to task, you think you’re actually paying attention to everything around you at the same time. But you’re actually not,” Miller said.nn”You’re not paying attention to one or two things simultaneously, but switching between them very rapidly.”nnIn fact, researchers have found that they can actually see the brain struggling when multitasking.nnSo the next time you have the urge to multitask, stop. Take a breather and then go back to focus on the one thing that needs to get done right now. Once that’s done, then you can move on to something else.nn8. Take advantage of your procrastination.nThis may sound counterproductive. But, there’s actually a method to the madness here.nnAccording to Parkinson’s Law, which was named after after historian Cyril Northcote Parkinson, “If you wait until the last minute, it only takes a minute to do.”nnThink about it. You’ve had a deadline at work looming over your head for a month, but you just cranked it during the final week.nnThis doesn’t give you permission to wait until the 11th hour. It does, according to Thai Nguyen of the TheUtopianLife.com, provide “great leverage for efficiency: imposing shorter deadlines for a task, or scheduling an earlier meeting.”nn9. Relieve stress.n
Since stress can cause physical, emotional, and behavioral problems – which can impact your health, energy, well-being, and mental alertness – it’s no surprise that stress hinders your work performance.nnThe good news is that you may be able to relieve that workplace stress.nnAccording to the American Psychological Association, “the most effective stress-relief strategies are exercising or playing sports, praying or attending a religious service, reading, listening to music, spending time with friends or family, getting a massage, going outside for a walk, meditating or doing yoga, and spending time with a creative hobby.”nnThe least effective strategies, however “are gambling, shopping, smoking, drinking, eating, playing video games, surfing the Internet, and watching TV or movies for more than two hours.”nnAnother effective stress management technique is to increase your control of a situation in advance. You can start by planning tomorrow the night before and sticking to your routine. This way you know what to expect in the morning.nn10. Do more of the work you enjoy.nNot everyone is privileged enough to do what you love for a living. Even if you are chasing your dreams and following your passions, there will still be tasks you’re not fond of doing. In either case, focus more on the work that you actually enjoy doing.nnFor example, if you’re a chef, then you obviously have a love for cooking. Instead of spending your days doing administrative tasks, outsource or delegate those tasks so that you can spend more time in the kitchen or at the market finding fresh ingredients.nnWhen you do, you’ll feel more fulfilled, inspired, challenged, and productive.nnOriginal 
With nearly a 10% expected growth rate throughout the medical coding market, there will be a high demand for medical coders within the industry. Coding related jobs are expanding among the business side of healthcare. Are you prepared?nnContact Welter Healthcare Partners today to learn more about our 
Just another piece in the telehealth puzzle, Remote Patient Monitoring, or RPM, is adding to the patient/provider relationship. New CPT codes 99453, 99454, and 99457 allow for reimbursement of services providers can utilize to manage and coordinate care at home. Best yet, code 99457 can be reported by clinical staff such as RN’s and medical assistants.nn99453: Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.nn99454: Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.nn99457: Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.
The Trump administration says offering health insurance across state lines will enhance competition and lower premiums, but states may raise objections if their regulatory authority is challenged.nnKey Takeawaysn
Trump’s 2017 executive order also directs the Secretary of Labor “to consider expanding access to Association Health Plans, which could potentially allow American employers to form groups across State lines.” That would allow health insurance providers to bypass state coverage requirements.nnHealth insurance oversight is left largely to the purview of states, which has created a regulatory patchwork that varies widely from state to state.nnState and federal lawmakers, mostly Republican, have for the past decade pushed to sell health insurance across state lines, but the issue has proved to be nettlesome. The National Association of State Legislatures reports that at least 23 state legislatures have considered the idea over the past 10 years.nnThe National Association of Insurance Commissioners hasn’t taken a firm stand on the idea, because it represents independent state insurance commissioners, many of whom may have varying levels of support for the idea.nnIn 
HISTORY OF PRESENT ILLNESS: A 36-year-old female who underwent a revision microdiskectomy for disk reherniation at which point there was an incidental durotomy. The patient developed evidence of CSF leakage including positional headaches. She was treated with 2 blood patches and the patient seemed to improve. Subsequently, she developed a collection under her skin. This was tapped, demonstrating clear fluid consistent with CSF. Given this and the failure of blood patch for treatment of CSF leak, the patient was brought to the OR for direct repair of the CSF leak. The patient understood the risks of surgery including bleeding, infection, continued CSF leak, need for future operation, and agreed to undergo the operation.nnPROCEDURE IN DETAIL: The patient was brought to the OR, placed under general endotracheal anesthesia. She was flipped into the prone position on a Jackson table, prepped and draped in the usual fashion. The previous small incision on the left side of the back over the lumbar spine was opened with a 10 blade until clear fluid was reached. The fluid was drained, and there was a large cavity consistent with a pseudomeningocele left. The tubular retractor system was then placed down over the previous laminotomy at the site of probable CSF leak. The microscope was brought in. The durotomy and leaking CSF was easily identified, and scar tissue was carefully separated from the dura. Further laminotomy was also performed to provide room for suturing the leak. Once this was complete, a 5-0 Prolene suture was used to suture the dura back together. Valsalva after the initial closure demonstrated l area of leakage. A fat graft was then obtained from the patient’s subcutaneous fat layers, and this was sewn into the leakage area. Subsequent Valsalva maneuver did not demonstrate any leakage of CSF. Given this, it was felt that the repair was adequate to stop the CSF leak. A piece of DuraGen was then placed over the exposed dura, and DuraSeal was placed over the DuraGen. Steroids were also placed over the dura. Prior to placement of the DuraGen, the wound was thoroughly irrigated, and hemostasis was achieved with bipolar cautery and Gelfoam powder. Next, the tubular retractor system was removed. The pseudomeningocele tissue was cut away from the normal tissue using monopolar cautery and removed from the patient. Hemostasis was then achieved with bipolar cautery. Attention was then turned to closure. A watertight closure was performed in the fascial layer using 0 Vicryl sutures. Next attempts were made to close down any potential space between the fascia and fat layer using 0 Vicryl sutures. The fat layer was also reapproximated with 0 Vicryl sutures. Finally, the deep dermal layer was closed with 0 Vicryl sutures and the skin was closed with a running subcuticular Monocryl. Dermabond was placed over the wound. The patient was then flipped into the supine position, extubated, and transferred to the PACU.
UnitedHealthcare is revising the Consultation Services Policy and will no longer reimburse CPT® codes 99241-99255. This change aligns UnitedHealthcare with the Centers for Medicare and Medicaid Services (CMS). We would like to partner with care providers on older fee schedules (2009 and prior) to move to more current fee schedules.nnUnitedHealthcare will take a phased approach to implement this change as follows:nn1. Effective with dates of service of June 1, 2019, UnitedHealthcare will no longer reimburse CPT codes 99241-99255 when billed by any health care professional or medical practice with a participation agreement that includes contract rates determined on a stated year 2010 or later CMS RVU basis.nn2. Effective with dates of service of October 1, 2019, UnitedHealthcare will no longer reimburse CPT codes 99241-99255 when billed by any health care professional or medical practice.nn3. Health care professionals and medical practices should instead bill consultation services in accordance with current evaluation and management guidelines published by CMS.nn4. With respect to telehealth and telemedicine services, the Telehealth & Telemedicine Policy will continue to apply and HCPC codes G0406 – G0408, G0425 – G0427, G0508 and G0509 will be payable pursuant to that policy, the participation agreement and the member’s benefit plan.nn5. Consultation services may still be reimbursed when billed in accordance with the Preventive Care Services Coverage Determination Guideline for services such as lactation counseling.nn6. At this time, we will not be altering the Global Days Policy to apply a reduction to evaluation and management codes submitted with modifiers 25 or 57 as once announced with this Consultation Services policy change.nnCMS ceased reimbursement of consultation services CPT codes in January 2010 and increased the Relative Value Units (RVUs) for E/M codes at that time to offset this shift in its reimbursement methodology.nnFor this reason, UnitedHealthcare encourages providers who are on an older fee schedule to modernize their fee schedules to bring them into alignment with CMS’s current Relative Value Unit methodology, since the older fee schedule reimbursement does not appropriately align with current RVU structure for E/M services and many other procedure codes.nnUnitedHealthcare appreciates this change may have an impact on participating health care professionals and medical practices. So, if you have concerns or questions, or to update your fee schedule to a more current fee schedule, please reach out to your UnitedHealth Network representative.nClick 
2019 has begun a long process to eliminate redundant paperwork for providers and giving greater importance to patient interaction. One of the first changes to this multi-year program is the elimination of some home visit documentation requirements.nnE/M visits in the patient’s private residences (CPT codes 99341-99350) had, in previous years, to justify the home visit by documenting medical necessity. Effective January 1, 2019 CMS, as part of the “Final Rule”, has finalized the policy change and removed the requirement to the medical record documentation for these visits.
nnIn addition, please call your local DEA office and provide them with the details of the call.n
Rural hospitals are suffering and it is scary to those of small communities who rely on them for health care. Studies show that they are closing at a rapid rate because they just don’t have the funds. Read more below on these closings and how people are coming up with solutions for this concerning issue. nnMore than 20% of rural hospitals are at a “high risk of closing” due to wobbly finances, a Navigant analysis of publicly available data shows.nnThe study, released Wednesday, also shows that 64% of these at-risk rural hospitals are considered essential to the health and economic well-being of their communities.nnThe analysis examines the financial viability and community essentiality of more than 2,000 rural hospitals nationwide. It found that 21% of the rural hospitals are at high risk of closing based on their total operating margin, days cash on hand, and debt-to-capitalization ratio. This equates to 430 hospitals across 43 states that employ 150,000 people.nn”Our analysis shines a new light on a rural hospital crisis that must be addressed and could significantly worsen with any downturn in the economy,” study co-author David Mosley, managing director at Navigant, said in a media release.nn”Local, state, and federal politicians, as well as health system administrators, need to act,” he said.nnThe study also reviewed of the “community essentiality” of these cash-strapped rural hospitals, measuring factors such as trauma status, service to vulnerable populations, geographic isolation, and economic impact.nnThey determined that 64% or 277 of these hospitals are considered essential to their community’s health and economic well-being. In 31 states, at least half of these financially distressed rural hospitals are considered essential.nnSouthern and Midwestern states, including Mississippi, Alabama, Kansas, Georgia, and Minnesota, are projected to be impacted the most, the data shows.nnThe study blamed “multiple factors” for the ongoing crisis with rural hospitals, including low rural population growth, payer mix degradation, excess hospital capacity due to declining inpatient care, and an inability for hospitals to leverage technology due to a lack of capital.nnOne possible solution involves collaborations between rural hospitals and academic and regional health systems, that leverages the larger systems’ resources for telehealth, revenue cycle management, human capital, electronic health records, physician training, and clinical optimization.nnThe study also supports supporting legislation that advances telehealth reimbursements, such as the bipartisan Rural Emergency Acute Care Hospital (REACH) Act.nnReintroduced in 2017 by Sens. Chuck Grassley, R-Iowa, Amy Klobuchar, D-Minn., and Cory Gardner, R-Colo., the REACH Act would create a new Medicare classification under which rural hospitals would offer emergency and outpatient services but no longer have inpatient beds.n
Welter Healthcare Partners is excited to present our new Code Spotlight! Each month, Welter Healthcare Partners will spotlight a unique CPT or ICD-10 code to profile and discuss practice applications of the code, as well as pertinent guideline reminders. Today, we focus on two new codes, 99451 & 99452 related to inter-professional Telehealth consultations.nn99451 — Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative timenThe code covers assessment and management services via telephone, Internet, or electronic health record (EHR) and includes a written report to the requesting or referring provider. Report 5 minutes or more of medical consultative time by a consulting physician, typically a specialty physician who receives a written or verbal request from a physician or other qualified healthcare provider to offer an opinion on a case.nn99452 — Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes.nReport 30 minutes of time spent on interprofessional telephone, Internet, or electronic health record (EHR) referral services by a requesting or treating provider, that is, a physician or other qualified healthcare professional who is providing a consulting physician with background information regarding a patient’s condition.nnKeep in mind that in addition to these two new codes that codes 99446-99449 have also been revised. Reporting similar services with a verbal and written report, see 99446, Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified healthcare professional; 5-10 minutes of medical consultative discussion and review and add-on codes +99447, +99448, and +99449 for additional time.nnClick the links below to learn moren
nnMedicare accountable care organizations (ACOs) are not happy that they have a little more than a month to decide on whether to take on more risk or leave the program.nnThe CMS on Wednesday gave new ACOs a Feb. 19 deadline to apply to the Pathways to Success program, which forces them to take on more risk than they did in the Medicare Shared Savings Program. But the National Association of ACOs said on Thursday that the deadline is far too short, coming only two months after the CMS published a final rule for Pathways to Success.nn”ACOs barely have time to understand the new rules, and organizing an application is very complicated and for some it is now a high-risk decision,” NAACOS President Clif Gaus said in a statement.nnThe association, which has fervently fought the changes to the risk-sharing program, wants the deadline moved to late March.nnThe CMS published the Pathways to Success rule on Dec. 19. But CMS did not provide the application deadline when it posted the rule.nnThe CMS told Modern Healthcare there will be two application cycles for ACOs in 2019, and this first deadline is for the July 1, 2019 start date. ACOs joining the second round that starts Jan. 1, 2020 will have a summer deadline.nnThe Feb. 19 deadline only applies to new ACOs that want to join the program or ACOs that have an existing agreement that has expired. An ACO that has a three-year agreement that expires in either 2019 or 2020 can finish that contract before moving to the new program.nnPathways to Success represents a radical departure from the prior Shared Services Program.nn
An ACO entering the new five-year program can only be in a one-sided risk track for two to three years depending on how much they earn, with ACOs that generate a low amount of revenue staying in the track longer. After the initial period, they must start to pay the federal government if they don’t save enough money in healthcare costs or meet quality requirements.nnUnder the previous program, an ACO could be in a one-sided risk track for the duration of the five-year contract and not have to pay the federal government anything if they don’t meet quality benchmarks or cost metrics.nnExisting ACOs also will have to participate in programs that require them to take on more risk in subsequent years.nnThe NAACOS said that ACOs won’t be able to make “several critical decisions,” before the Feb. 19 deadline, such as what physicians will participate and signing agreements.nn”Setting an application deadline two months after passing the final rule does not give ACOs that have expiring agreements the necessary time to vet the decision internally,” Jennifer Moore, chief operating officer at MaineHealth ACO in Portland, Maine, said in a statement.nnThe CMS told Modern Healthcare that it is providing ACOs with documents and sample applications.nnOnly a third of ACOs will be subject to the February deadline, according Ashley Ridlon, vice president of health policy for the consulting firm Evolent Health.nnThere are 561 ACOs that are responsible for 10.5 million Medicare patients, according to data from the CMS.nnRidlon conceded that “the timeline is indeed very tight.”nnThe short turnaround means that hospitals and providers are going to not have a lot of time to think through the pros and cons of whether to apply, said David Muhlestein, chief research officer for the firm Leavitt Partners.nn”The timeline is quite short, though doable,” Muhlestein said. “Potential participants will need to prioritize this and get their boards, leadership and physicians aligned in a hurry.”nnOriginal 
32652-RT J94.2, J98.4nnSurgeon: Surgeon(s) and Role:n* XXXXX, XXXXXXX, MD – PrimarynnCase Length: 3 Hr 2 Min 20 SecnnPre-Operative Diagnosis: right retained hemothoraxnnPost-Operative Diagnosis: SamennOperation Performed: Right Video Assisted Thoracic Surgery (VATS) and total lung decorticationnwith removal of large retained old hematomannFindings (Normal + Abnormal): Large amount of old organized thrombus in the right hemithorax with trapped and scarred portions of the lung. Hematoma removed, trapped lung was released. At the end the lung was completely expanding. Good hemostasisnnOperation Description:nThe patient was brought into the operating room and was placed in a supine position. A time out procedure was carried out identifying a correct patient and site. Then general endotracheal anesthesia with a double lumen tube was placed. The patient was placed in a left lateral decubitus position. Then, the first port was placed along the posterior axillary line. A laparoscope was placed the lung was down. Then the second 5 mm port of was placed in a 5th intercostal space in the posterior axillary line. The third incision was placed in the anterior axillary line in the 5th intercostal space. All the ports were placed under a direct visualization. The soft adhesions were carefully released with a blunt laparoscopic grasper. There were soft clots in the apex that were suctioned. There was an area of the lung that was attached to the chest wall which was gently released with blunt dissection. The chest cavity was irrigated with a warm saline. Then we inspected the right chest for bleeding and meticulous hemostasis was obtained. Then a 36French chest tube was placed through the incision on the 7th intercostal space. The chest tube was secured with a #1 silk sutures. The other incisions the muscle was closed with a silk suture. Then the 2-0 Vicryl for a deep dermal tissue and a 4-0 Monocryl for skin was used. Then, glue applied. All the sponge and instrument counts were correct. The patient was extubated and was transferred to the post operative anesthesia care unit.nnRapid Frozen Section Telephone Diagnosis: NonennSpecimens Removed: NonennWound Classifications: Clean Contaminated