Jan 25, 2019 | Uncategorized
Exciting new opportunities have emerged for virtual check-in services. CMS is now stating there are coverage and reimbursement opportunities for providers that render, document, and bill for the virtual check-in services. There are some specific communication technology requirements that organizations will need to implement prior to claims submission. These new codes reflect the key role non-verbal communication technology plays in care coordination between consulting and treating physicians, according to the AMA.nnThe new codes are:nnHCPCS Code G2012 – Virtual Check-InnA physician or other qualified health care professional conducts a virtual check-in, lasting five to 10 minutes, for an established patient using a telephone or other telecommunication device to determine whether an office visit or other service is needed. The service may be provided when a related evaluation and management (E/M) service has not been provided in the previous seven days and it may not lead to an E/M service within the next 24 hours or soonest available appointment.nnHCPCS Code G2010 – Remote Evaluation of recorded video and/or images submitted by an established patientnPhysicians or other qualified practitioners review photos or video information submitted by the patient to determine if a visit is required. The service may be provided to an established patient when a related evaluation and management (E/M) service has not been provided in the previous seven days and may not lead to an E/M service within the next 24 hours or soonest available appointment.
Jan 18, 2019 | Uncategorized
Spotlight analysis finds progress made on numerous fronts, recommends next steps for policymakers, insurers and physiciansnnThe American Medical Association (AMA), Colorado Medical Society (CMS) and Manatt Health released a report today that shows Colorado has implemented meaningful reforms in response to the opioid epidemic though further steps are needed to save even more lives.nnThe Colorado spotlight analysis found that progress is being made to increase access to evidence-based treatment for substance use disorders, several pilot projects have improved care for patients with pain, and increased access to the opioid overdose-reversing drug naloxone has resulted in thousands of lives saved.nn“We conducted this analysis because it’s essential that policymakers know what is working, and where additional progress can be made,” said AMA President-elect Dr. Patrice A. Harris, who also chairs the AMA Opioid Task Force. “Colorado has implemented many important policies that are impacting patients’ access to care. Using this momentum, we think Colorado can go even further to save lives of those affected by opioid use disorder.”nnColorado is the second in a series of individual state studies. The AMA released a study on Pennsylvania last month.nnBased on available data, review of policies, and discussions with key policymakers, the analysis found four key areas where Colorado is succeeding:n
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- Adoption of policies and funding to increase access to medication assisted treatment, including initial steps to reduce administrative barriers, increased funding to address workforce issues, and plans to increase Medicaid coverage in residential settings.
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- Examining compliance with mental health and substance use disorder parity laws through the Colorado Division of Insurance’s review of insurers’ conduct and the establishment of an ombudsman’s office to assist patients in accessing behavioral health care.
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- Increasing Medicaid patients’ access to non-opioid alternatives for pain management, including coverage of non-opioid prescription medications and alternative therapies such as physical therapy, occupational therapy and additional behavioral health care treatment options.
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- Expanding access to naloxone with early legislation and implementation of a standing order for naloxone, Good Samaritan protections, and elimination of prior authorization for naloxone under Medicaid.
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n“This analysis comes at an important time for Colorado,” said Dr. Debra Parsons, CMS President. “Over the last six years, Colorado has developed policies, enacted laws and made important strides to have all stakeholders work together to reverse the opioid epidemic. While we continue these successful initiatives, we must closely evaluate how they are working so we can ensure we are putting our efforts in the right places.”nn
nnThe analysis also highlighted the work of the Colorado Consortium for Prescription Drug Abuse Prevention, which has brought together several hundred stakeholders and continues to develop a data-driven, county- and state-level data dashboard that can be used to help direct resources to areas of greatest need.nnThe analysis also found areas where additional progress could be made:n
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- Eliminating barriers to treatment, including further steps to increase enforcement of mental health and substance use disorder parity.
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- Expanding access to providers of medication assisted treatment, especially in the state’s rural areas.
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- Leveraging successful state pilots to increase access to multimodal pain care and comprehensive benefit and formulary designs.
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- Linking those whose lives have been saved by naloxone with follow-up treatment to begin and sustain recovery.
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- Evaluating state policies and programs to determine what is improving patient care and reduce opioid-related harms, including whether current policies may be resulting in unintended consequences.
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n“Many of the recommendations in this report related to commercial insurance—such as strengthening our market conduct examinations to better enforce mental health parity and more comprehensive front-end reviews of the number of addiction professionals in insurers’ networks—are fair and reasonable approaches that are within our authority to immediately tackle,” said Michael Conway, Colorado Insurance Commissioner and head of the state’s Division of Insurance. “We look forward to working with Colorado’s health insurers and physicians to implement solutions that help ensure consumers receive the care that they need to help end our state’s opioid epidemic.”nnClick here to read original article published on cms.org.
Jan 18, 2019 | Uncategorized
As most medical practices are aware, not all cases are easy to navigate using the latest medical standards. The information below highlights a complicated surgical case along with the correct CPT and ICD-10 codes. Do you have a complicated surgery case need 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 —nn
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- PREOPERATIVE DIAGNOSIS: Perforated descending colon diverticulitis.
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- POSTOPERATIVE DIAGNOSIS: Same.
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- PROCEDURE:
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- Laparoscopic extended left hemicolectorny with colorectal anastornosis.
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- LaparoScopic Splenic flexure mobilization.
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- ANESTHESIA: GeneralnCOMPLICATIONS: None.
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- FINDINGS: Inflammation in the descending colon with perforation.nCOMPLICATIONS: None.
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nINDICATIONS FOR PROCEDURE:nThe patient is a 52-year-old female who presented with worsening pain for several days. She was found to have significant inflammation of the descending colon with extraluminal air and early peritoneal signs on exam. Risks and benefits were discussed with the patient who understood and agreed with the treatment plan.nnDESCRIPTION OF PROCEDURE:nAfter obtaining proper informed consent, the patient was taken to the operative suite where she was prepped, draped and positioned in the usual fashion. Preoperative antibiotics were given, SCDs were placed prior to induction of general anesthesia. A timeout was performed and was correct.nnA 2 cm infraumbilical incision was made and carried through skin and subcutaneous tissue. The fascia was identified, was incised and a 12mm Hasson trocar was inserted. The abdomen was insufflated with carbon dioxide gas. Under direct vision a 12mm trocar was placed in her lower midline in the previous C section scar, and-a 5 mm was placed in the right lower quadrant. The colon was identified. There was some inflammation on the descending colon. Mobilization occurred laterally to medially, starting at the sigmoid colon. The retroperitoneal attachments were taken down. The left ureter was identified over its full course. Dissection occurred proximally up through the splenic flexure. The splenic flexure was taken down from the gastrocolic attachments and the oriental attachments, getting adequate mobilization to anastomose the distal transverse colon down to the rectum.nnDissection occurred distally to the reclosigmoid junction. The mesentery was transected with the Harmonic scalpel from the sigmoid artery, and the left colic artery were taken. This was carried down to the rectosigmoid junction. Using an Endo-GIA 45mm blue load staple, the rectosigmoid junction was transected. Dissection of the mesenteric occurred proximally through the splenic flexure. There was adequate mobilization, and it reached easily down into the pelvis.nnAt this point in lime, a 4 to 5 inch Pfannenstiel incision was made in her previous C-section scar. This was carried down through skin and subcutaneous tissue. The fascia was incised. The muscle was split in the midline. An Alexis wound protector was inserted and the Colon was externalized. There was an area of perforation with a small piece of stool that was exiting the colon. Proximal to this was normal appearing transverse colon. A 2-0 Prolene pursestring was applied. The colon was transected and the specimen was sent to pathology. A 29 EEA anvil stapler was put in the open end of the colon, and the pursestring was tied down and cut. This was then internalized again. The fascia was closed with a #1 PDS. The abdomen was reinsufflated. A 5 mm trocar was placed under direct vision in the Iower midline. Again, it was-checked to make sure there was adequate length to make a tension-free ariastomotis, and there was.nnThe EEA stapler was brought through the anus and brought up anterior to the staple line. The anvil was deployed. The 2 ends were mated and closed. The stapler was fired and removed. Two complete donuts were seen. A proctoscope was then inserted and a leak test was performed with air 3 different times with no air leak that was seen. The pelvis and the left hemi-abdomen were irrigated with a liter of normal saline. There was no other sign for any pathology. A 10 flat JP drain was placed in the pelvis and brought out through the right lower quadrant incision. The abdomen was then desufflated, trocars were removed under direct vision. The fascia of the umbilical incision was closed with an 0 Vicryl suture. Skin was closed with 4-0 Monocryl. Dermabond was applied. The patient tolerated the procedure well. She was extubated and taken to recovery in stable condition.nnCPT Codes:n
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- 44207 – Laparoscopy, surgical; colectomy, partial, with anastomosis, with coloproctostomy (low pelvic anastomosis)
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- 44213 – Laparoscopy, surgical, mobilization (take-down) of splenic flexure performed in conjunction with partial colectomy (List separately in addition to primary procedure)
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nDX Codes:n
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- K57.20 – Diverticulitis of large intestine with perforation and abscess without bleeding
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Click Here to View Full Case
Jan 11, 2019 | Uncategorized
Welter Healthcare Partners, Inc. is one of a select number of organizations in the country which provides Corporate Integrity Agreement (CIA) reviews and is designated as an Independent Review Organization (IRO) on behalf of the Office of Inspector General (OIG).nn Welter Healthcare Partners Consultants are subject matter experts with RAF coding. We have worked with payers, hospitals and physician-owned practices which are dependent on risk adjustment payment models and Hierarchical Condition Categories (HCCs).nnOur specific areas of expertise include:n
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- Risk Adjustment Factor (RAF) program implementation
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- External oversight of existing internal RAF compliance
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- Risk Adjustment Data Validation Audits (RADV)
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- Physician and Coder Education/Support on accurate diagnosis code capture
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- Physician Education on Clinical Documentation Improvement (CDI)
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n Welter Healthcare Partners’s RAF educational services incorporate providers own clinical documentation and one on one assistance to help them meet medical record documentation requirements and complete reporting of diagnosis coding to the highest level of specificity.nnClick here to learn more about the WHP Risk Adjustment Factor Approach and how our certified specialists can help you!
Jan 3, 2019 | Uncategorized
Written By: Toni Elhoms, CCS, CRC, CPC, AHIMA-Approved ICD-10-CM/PCS TrainernDirector of Coding/Compliance nn
It’s that time of the year again! The new 2019 CPT code changes took effect January 1st. Understanding the myriad of upcoming changes is crucial to obtaining the proper reimbursement for your services! The changes for 2019 address a number of interrelated issues. The AMA updated 335 codes to reflect scientific and technological advances in various services including medical, surgical, and diagnostics. Several additions reflect the real possibility of expanding coverage for connected health tools and other new delivery systems to improve healthcare quality. There were many code revisions with guideline, description and instructional note changes. CPT 2019 offers changes that affect nearly every specialty.nn*Please note, this article is not an all-inclusive list; review your 2019 CPT book for complete descriptions of all changes. Appendix B of 2019 CPT provides a summary of additions, deletions, and revisions. — Click here for more informationnnAlso, CLICK HERE to review the final rule for the 2019 Medicare Outpatient Prospective Payment System (OPPS).nnHighlights of the most significant changes:n
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- Exciting new opportunities for telemedicine expansion and coveragen
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- These new codes reflect the key role non-verbal communication technology plays in care coordination between consulting and treating physicians, according to the AMA.
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- CMS will pay for 2 newly defined physicians’ services furnished using communication technologyn
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- HCPCS Code G2012 – Virtual Check-In
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- HCPCS Code G2010 – Remote Evaluation of recorded video and/or images submitted by an established patient
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- 3 new codes for remote chronic care patient monitoring servicesn
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- New CPT codes 99453 and 99454 should be used to report remote physiologic monitoring services during a 30-day period.
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- CPT code 99457 requires live, interactive communication with the patient/caregiver and 20 minutes or more of clinical staff/physician or other qualified health care professional time in a calendar month.
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- 2 new interprofessional internet consultation codesn
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- New codes 99451 and 99152 should be used to report assessment and management services. The codes are based on medical consultative time.
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- 2 new codes added to the Ophthalmology CPT sectionn
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- CPT 92273 should be used to report global response of photoreceptors of the retina
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- CPT 92274 should be used to report photoreceptors in multiple separate locations in the retina and macula
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- Revisions and Additions to FNA and skin biopsy codesn
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- CPT codes 11102-11107 should be used to report skin biopsies based on method of removal including tangential (shave, scoop, saucerize, curette), punch and incisional.
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- Fine needle aspiration (FNA) codes received new instructional updates including the clinical distinction between a fine needle aspiration and a core needle biopsy. Imaging guidance is now inclusive to the nine new codes. Guidelines also instruct that codes are selected based in guidance (included) and add on-codes are appended for each additional lesion.
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- CPT codes 10005-10012 were added to report the specific imaging guidance (ultrasound, fluoroscopic guidance, CT and MRI).
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- Revisions and Additions to psychological and neuropsychological testingn
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- 8 CPT codes 97151-97158 and guidelines were added to Adaptive Behavioral services to address deficient adaptive behaviors.
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- New guidelines and new CPT codes were added to the Central Nervous System Assessments/Tests including 96112 and 91113 for developmental test administration based on time. CPT add on code 96121 for a neuro behavioral status examination for ab additional hour was added. Under Testing Evaluation Services CPT codes 96130-96133 were added for neuropsychological testing evaluation services based on time.
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- CPT codes 96136-96139 were added to report psychological or neuropsychological report testing and scoring. Codes are based on time and whether the service was performed by a technician or clinician. CPT code 96146 is used to report psychological or neuropsychological automated testing using an electronic platform.
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- 4 new breast MRI procedures were addedn
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- CPT Codes 77046-77049
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- Codes are selected based on laterality (unilateral vs. bilateral) and with or without contrast material.
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- 2 new gastrostomy tube placement codes added to define simple versus complex replacement of a percutaneous gastrostomy tube.n
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- CPT 43762 is reported for the percutaneous gastrostomy tube placement including removal without imaging or endoscopic guidance not requiring revision of the gastrostomy tract
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- CPT 43763 requires revision of gastrostomy tract
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- 3 new codes for allograftsn
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- CPT Codes 20932-20934
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- CPT 20932 includes templating, cutting, placement and internal fixation; osteoarticular
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- CPT 20933 includes hemicortical, intercalary, partial
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- CPT 20934 includes hemicortical, complete.
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nContact Welter Healthcare Partners for assistance on 2019 CPT changes.
Dec 20, 2018 | Uncategorized
MERRY CHRISTMAS & HAPPY NEW YEARn——————n
nThe team at Welter Healthcare Partners has been celebrating this joyous season and would like to send our greatest wishes to you this holiday season. We hope you enjoy the joy and cheer that Christmas brings and that you will create memories that will last a lifetime. We are thankful for the joy that each of our clients has brought us over the last year and we are excited for what 2019 has in store.nnAll of us at Welter Healthcare Partners would like to wish you and your families a very Merry Christmas and Happy New Year!nn
Dec 13, 2018 | Uncategorized
To successfully transition to value-based care, health systems must engage their physicians in the process.nnFiguring out the best way to engage physicians, however, is often one of the toughest challenges for organizations as they move from traditional fee for-service (FFS) models to models based on the efficient delivery of high-quality care.nnPhysicians drive the bulk of utilization decisions that influence health outcomes, which is one reason their buy-in is critical for transforming care delivery. Success in this new model requires physicians to adapt to a new way of practicing medicine, as well as to adjust to a new compensation model that rewards clinicians for providing high-quality care and containing costs, rather than on the volume of care provided.nnThe transition may be particularly tough for primary care physicians (PCPs) who are now called to serve as care quarterbacks. In this new world, PCPs will be tasked not only with serving the patients in front of them, but also starting to manage entire patient panels outside of the four walls of their clinics. Unfortunately, physicians are not always prepared to take on these additional tasks and must first overcome a number of systemic hurdles.nnUnderstanding current hurdlesnHealth systems attempting to engage physicians in the transition to value should be cognizant of factors that add to the challenge. For example, until recently most physicians have not been educated on the principles of newer care models based on the delivery of cost-effective outcomes, nor on population health management. Only now are medical schools beginning to incorporate these subjects into their curricula—but the impact remains to be seen. They also must address the ongoing challenge of how to influence physician behavior during the gradual shift away from FFS. Because physicians are still mostly paid on a fee-for-service basis, rather than for coordinating care and quality improvement, they have remained focused on providing more services that drive higher reimbursements.nnPhysicians must also adapt to new care coordination requirements. Traditionally no one provider has been responsible for tracking a patient’s care across all provider types and care settings. What makes it even more challenging is that technologies were not built to support this effort—they were built to sustain the FFS model. Physicians haven’t had to worry about financial penalties for duplicating care, nor for missing opportunities to improve patients’ health. Furthermore, physicians have lacked technologies to help advance care coordination efforts because legacy IT systems were designed primarily to support FFS billing functions and lack interoperability. Value-based care models, however, require PCPs and their care teams to manage care more effectively.nn
In addition, the pressure of these many hurdles is magnified for PCPs because of the historical undervaluation of their services in comparison to their specialist counterparts – despite the complexity and variety of conditions seen in primary care. Meanwhile, physicians are overburdened with regulatory and administrative requirements that squeeze them financially and reduce the amount of time spent on patient care. Attempts by payers and purchasers to enforce value-based behaviors using diverse metrics and proprietary programs add to the overload – particularly if physician compensation is not properly aligned. With all these pressures, it’s little wonder that physicians are experiencing widespread career dissatisfaction and burnout.nnTaking a programmatic approach to drive changenGiven all these challenges, how can a health system successfully engage physicians in value-based initiatives? Ideally organizations should adopt a holistic, prescriptive methodology that is supported by people, processes and technology and strives to achieve the Triple Aim plus One – that is, improved clinical outcomes, lower costs and higher patient satisfaction, plus better physician engagement.nnTo successfully engage physicians and drive change, consider this programmatic approach:n
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- Analyze opportunities and measure the organization’s baseline capabilities to identify targets for initial improvement efforts.
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- Establish physician-led governance, a strong clinical leadership team, and a network of high-performing physicians who share a common vision for better care at a lower cost. It’s key to creating a culture of accountability and implement mechanisms for financial outcome accountability.
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- Align incentives by revamping physician contracts at the group and individual physician levels to emphasize value over volume, to encourage physicians to meet quality and cost goals, and to support higher risk models over time.
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- Enhance care improvement by structuring the care model to deliver accountable primary care. Assess current care management programs and add new offerings as needed.
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- Enable behavior change among physicians and care team members through effective training, education and workflows. In addition, implement technology and tools that provide actionable clinical and financial information at the patient and population level.
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- Build on successes by leveraging data, programs and knowledge resources to find and act upon new opportunities for financial and clinical improvement. Monitor internal and external factors so the organization can adapt to changes in the patient population, the market and government regulations.
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nFor systems to succeed in value-based contracts, physicians must be engaged partners in the process. Health systems and payers must view physicians as strategic assets that deserve the necessary training, operational support and technology investments to succeed in a value-based world.nnA comprehensive physician engagement strategy is critical. Organizations must consider information technology needs, create the right governance structure and provide clinicians with educational and mentoring options. The strategy must also align physician payment and provider workflows with the organization’s financial and clinical goals that drive cost-effective, high-quality outcomes.nnThe transition to value-based care can be challenging – and more so if physicians are not engaged in the process. However, organizations can position themselves for value-based success by embracing a comprehensive and prescriptive strategy that addresses the needs of physicians and positions them for success.nnOriginal article published on beckershospitalreview.com.
Dec 6, 2018 | Uncategorized
In the 2019 proposed rule on the Medicare Physician Fee Schedule (PFS), the Centers for Medicare and Medicaid Services (CMS) proposed revisions to the E/M documentation guidelines intended to reduce administrative burden on physicians. In addition, the federal CMS proposed coding and payment changes to new and established office visit services. The AMA led the development of a joint comment letter from 170 physician and other health professional organizations calling for the agency to finalize several proposed changes to E/M documentation guidelines for CY2019.nn“The AMA is pleased to report that the federal CMS is implementing the documentation policies, which will significantly reduce administrative burden and allow all physicians to spend more time with their patients,” the AMA stated. The agency has also acknowledged the work of the AMA’s CPT/RUC Workgroup on E/M and has postponed any coding and payment-related changes for E/M office visit services until CY2021. This delay in implementation will allow the CPT Editorial Panel to consider the workgroup’s proposal in February 2019 prior to prompt consideration by the AMA/Specialty Society RVS Update Committee (RUC).nnOn page 584 of the rule, the federal CMS states:nn“We recognize that many commenters, including the AMA, the RUC, and specialties that participate as members in those committees, have stated intentions of the AMA and the CPT Editorial Panel to revisit coding for E/M office/outpatient services in the immediate future. We note that the 2-year delay in implementation will provide the opportunity for us to respond to the work done by the AMA and the CPT Editorial Panel, as well as other stakeholders. We will consider any changes that are made to CPT coding for E/M services, and recommendations regarding appropriate valuation of new or revised codes.”nnRemoving restrictions on E/M codingnnThe federal CMS finalized several changes to E/M documentation guideline which were strongly supported by the AMA and other members of the federation.n
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- The requirement to document medical necessity of furnishing visits in the home rather than office will be eliminated.
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- Physicians will no longer be required to re-record elements of history and physical exam when there is evidence that the information has been reviewed and updated.
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- Physicians must only document that they reviewed and verified information regarding chief complaint and history that is already recorded by ancillary staff or the patient.
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nThese changes will take effect Jan. 1, 2019.nnThe original proposal condensing office visit payment amounts and documentation requirementsnnIn the 2019 proposed rule, the federal CMS proposed to implement a single payment rate for level 2 through level 5 office visits and to reduce documentation requirements for this collapsed payment to that of a level 2 CPT visit code. The agency proposed to continue to use existing CPT structure for office visit codes 99201-99215, though proposed to change guidelines and only enforce certain aspects of the CPT structure by allowing physicians to choose the method of documentation, among the following options:n
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1995 or 1997 Evaluation and Management Guidelines for history, physical exam and medical decision making (current framework for documentation).n
- Medical decision-making only.
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- Physician time spent face-to-face with patients.
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nThe federal CMS had also proposed an add-on code to each office visit performed for primary care purposes and an add-on code for specialties with inherently complex E/M visits. The agency relayed that commenters overwhelmingly opposed this proposed payment collapse. The federal CMS will not finalize the proposal for CY 2019.nnOther coding/payment proposals related to E/MnnThe following policies were also opposed by the AMA and will not be implemented by the federal CMS:n
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- Payment reductions by 50 percent for office visits that occur on the same date as procedures (or a physician in the same group practice). The AMA brought attention to the fact that duplicative resources have already been removed from the underlying procedure through the current valuation process.
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- In addition, the federal CMS proposed to no longer allow for podiatry to report CPT codes 99201-99215 and instead would use two proposed G-codes for podiatry office visits as well as a new prolonged service code that would have been implemented to add-on to any office visit lasting more than 30 minutes beyond the office visit (i.e., hour-long visits in total).
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- Condensed practice expense payment for the E/M office visits, by creating a new indirect practice expense category solely for office visits, overriding the current methodology for these services by treating Office E/M as a separate Medicare Designated Specialty. This change would also have resulted in the exclusion of the indirect practice costs for office visits when deriving every other specialty’s indirect practice expense amount for all other services that they perform, which would have resulted in large changes in payment for many specialties (i.e., a greater than 10 percent payment reduction for chemotherapy services).
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nProposals for CY 2021 and the CPT/RUC Workgroup on E/MnnFor CY 2021, the agency conveyed its intention to propose two basic payment rates for office visit services, one for straightforward visits and another for complex visits. In addition, the federal CMS noted their intention to propose add-on codes for primary care and inherently complex specialty E/M visits.nnCMS noted they will also consider input from the AMA and the CPT/RUC Workgroup on E/M as well as input from across the medical community. In response to the Medicare Proposed Rule, the chairs of the AMA CPT Editorial Panel and the AMA/Specialty Society Relative Value Update Committee (RUC) formed the CPT/RUC Workgroup on E/M to:n
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- Capitalize on the CMS proposal and solicit suggestions feedback on the best coding structure to foster burden reduction, while ensuring appropriate valuation.
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- Consider a code change application to be submitted to the CPT Editorial Panel for consideration at their Feb. 7-9, 2019 meeting.
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nThe workgroup is comprised of 12 experts in both coding and valuation (six members each from each of the CPT and RUC processes). In addition to the 12 workgroup members, roughly 300 additional stakeholders from national medical specialty societies, the federal CMS and other health-care-related organizations have participated.nnThe workgroup has expressed their appreciation of the agency’s efforts to address long-standing issues with E/M services and has worked tirelessly over the past several months to establish a long-term, stable CPT coding solution. Listening to the federal CMS and other stakeholder concerns, the workgroup has worked to build consensus around modernizing the office and outpatient E/M CPT codes to simplify the documentation requirements and better focus code selection around medical decision-making and physician time. The workgroup proposal will be formally reviewed by the national medical specialty societies via the CPT Advisory Committee process. The CPT Editorial Panel will review the proposal, and related comments, at the Feb. 7-9, 2019 meeting.nnClick here for more information on the Medicare PFS portion of rule.nnOriginal article posted on cms.org.
Nov 29, 2018 | Uncategorized
CMS has proposed to reward physicians who consult electronically/by phone with other physicians in 2019. The agency also proposed starting to pay physicians to review photos that patients text/e-mail to them. Telehealth is now playing a new role for appropriating medical services and giving providers the helping hand to create connected care platforms!nnUnderstand Medicare telehealth requirements—including coverage, coding, and documentation rules—and ensure your telehealth program and claims comply.nnBank on TCI’s all-new, end-to-end Telemedicine & Telehealth Handbook for Medical Practices 2018 to equip you to plan and implement your telehealth services, weigh the cost of care and technology, and master payment aspects, compliance, and other legal requirements.nnOur experts take the guesswork out of best practices and government regulations, laying out in-depth information on Medicare and Medicaid reimbursement. Capitalize on insightful answers to readers’ questions. Get the inside scoop on coding, billing, compliance, and everything between to launch your telehealth services without a hitch.nnGrow your patient population—and improve outcomes—with a vital telemedicine program:n
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- n
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- Capitalize on new telemedicine options from CMS
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- Telehealth Medicare payment policy, with Part B fee-for-services guidance on originating sites, distant site practitioners, telehealth services, and billing and payment services
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- Master the new 2018 telemedicine codes
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- Nail down telemedicine terminology with comprehensive list of terms and definitions
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- Wield social marketing for telehealth
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- Measure telehealth patient outcomes
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- Get modifier updates and other expert documentation tips
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- Use this telemedicine primer to prep for coding opportunities
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- Capitalize on new telemedicine options from CMS
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- Ace coding for your E/M telemedicine services
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- Apply these telehealth indicators to recoup for your distance treatment services
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- Discover telemedicine interventions for chronic disease management
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- Navigate the ins and outs of telemedicine and telehealth
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- Nail down where telehealth services can take place
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- Tackle HIPAA and compliance issues for telemedicine and telehealth
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- Get to know the basics on telehealth reimbursement
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- Ace accurate coding for telemedicine and telehealth
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- Power up your claim submittals for services furnished via telehealth
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- Conquer inpatient telehealth consultations
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- Lock down appropriate licensure
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- Are you eligible for a geographic waiver?
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- Soar to success with telemedicine and telehealth at your facility
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- Gain tips for managing the rapidly changing telehealth technology
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- Make the grade with these consumer-centered telehealth design principles
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- And so much more!
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nBONUS features include a glossary of telemedicine and telehealth terminology, TOOLKIT for proposing new telehealth services to CMS, and easy look-up to find telehealth services and codes either alphabetically or by code number.nnORDER NOW!nnInformation originally provided by TCI Handbooks.
Nov 20, 2018 | Uncategorized
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As many of us reflect on the things in life we are thankful for, all of us at Welter Healthcare Partners would like to say Happy Thanksgiving to our clients, business partners, families and friends! We are extremely grateful for each of you and appreciate your continuous support!nnIn observance of the holiday, we will be closed on Thursday, November 22nd to give our employees time to enjoy the day with their loved ones. We hope you have a wonderful Thanksgiving!nn
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Nov 15, 2018 | Uncategorized
Changes to the 2019 PFS include the following:n
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- Elimination of the requirement to document the medical necessity of a home visit in lieu of an office visit.
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- For established patients, when relevant information is already in the medical record, practitioners can focus documentation on what has changed since the last visit. Practitioners don’t need to re-enter the defined list of required elements if there so long as they have reviewed and updated the previous information as needed.
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- Practitioners need not re-enter information on the patient’s chief complaint and history that has already been entered by ancillary staff or the patient.
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- Removal of the potentially duplicative requirements for notations in medical records that may have previously been included by residents or other members of the medical team for E/M visits furnished by teaching physicians.
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nThe final 2019 PFS rule also adds payments for some telemedicine services, as follows:n
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- Brief communication technology-based service, e.g. virtual check-in (HCPCS code G2012)
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- Remove evaluation of recorded video and/or images submitted by an established patient (HCPCS code G2010).
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nAccording to CMS, practitioners could be separately paid for the brief communication technology-based service when the patient checks in via phone or other telecommunication device to decide whether an office visit or service is needed. Similarly, the remote evaluation of video or images submitted by an established patient would allow payment for reviewing the information to determine the necessity of an office visit.nnOne proposal that did not make it in the 2019 final rule involved the collapsing of E/M codes. CMS proposed paying a single rate for E/M office/outpatient visits with levels two through four while maintaining the payment rate for level five, among other changes. These E/M changes have been deferred to 2021, but the Medical Group Management Association (MGMA) says the proposal needs more refining.nn“We welcome CMS’s deferral and revision of the collapsed E/M codes to 2021, but there’s more work to be done,” MGMA said in a statement. “Blending payments rates in 2021 won’t necessarily reduce burden, especially with CMS’ newly required add-on codes. MGMA will continue to examine the rule, leverage feedback from members, and work with CMS to create meaningful burden reduction for physician practices across the country.”nn
Lopez said the ACP has reservations about paying level four visits, the second most complex visit, at the same amount as levels two and three. “Internists appreciate CMS’ decision not to finalize changes in payments for evaluation and management services until 2021. We are hopeful that the additional two calendar years leave time for physicians and other health care stakeholders to work together with regulators to develop and test alternatives that preserve higher payment for more complex, cognitive care,” she said.nnThe American Medical Association also supported with the delay. “The AMA also is grateful that the Administration is not moving forward in 2019 with the payment collapse of E/M codes,” said AMA President Barbara L. McAneny, MD, in a statement. “A two-year window for implementation of the proposal will give the AMA-convened workgroup—comprised of physicians and other health professionals —time to make recommendations on this complicated topic.”nnOverall, William S. Mayo, DO, president of the American Osteopathic Association, said he is pleased CMS listened to commenters’ feedback. “The AOA is grateful that CMS heeded the concerns expressed by practicing physicians about the proposed rule and looks forward to advancing the dialogue on how physician payment policy can be modified for the betterment of both physician practice and the patients we care for,” Mayo said in a statement.nnOriginal article published on medicaleconomics.com.
Nov 8, 2018 | Uncategorized
CMS has issued its final 2019 rule for both the Physician Fee Schedule (PFS) and the Quality Payment Program (QPP), which includes the Merit-based Incentive Payment System (MIPS).nn“Today’s rule finalizes dramatic improvements for clinicians and patients and reflects extensive input from the medical community,” CMS Administrator Seema Verma said in a statement. “Today’s rule offers immediate relief from onerous requirements that contribute to burnout in the medical profession and detract from patient care. It also delays even more significant changes to give clinicians the time they need for implementation and provides time for us to continue to work with the medical community on this effort.”nnUnder the final QPP rule, MIPS-eligible clinicians will be required to use a 2015 Edition certified EHR as of Jan. 1, 2019. CMS says this change is necessary so patients can more easily access their data and information can more easily be shared among doctors and other providers. But Ana Maria Lopez, MD, MACP, president of the American College of Physicians, has concerns, especially with the short implementation timeline. “Rushing implementation of these upgrades to meet a reporting deadline can have serious patient safety risks and is a major expense and burden, particularly to small practices,” Lopez said in a statement.nn
CMS also added an additional low-volume threshold exemption to MIPS for next year. To be excluded, providers or groups need to meet at least one of the following conditions:nn• Have $90,000 or less in Medicare Part B allowed charges for covered professional services.n• Provide care to 200 or fewer Part B-enrolled patients.n• Provide 200 or fewer covered professional services under the PFS.nnThe minimum period for each performance category remains unchanged, so quality and cost stay at 12 months while improvement activities and promoting interoperability remain at a continuous 90-day period.nnHowever, the weighting to the final score of the cost and quality categories have both changed. Cost increases from 10 percent to 15 percent of the total score, and quality drops from 50 percent to 45 percent.nnOriginal article published on medicaleconomics.com.
Nov 2, 2018 | Uncategorized
If you have been following our recent series of how to improve your bottom line, hopefully you have read some valuable information that you found insightful for your practice. Whether you have looked at your finances personally or not, Welter Healthcare Partners is available to help! We want you to be profitable, just as much as you do!nnFor over 20 years, Welter Healthcare Partners has helped physicians and practices increase revenue and thrive! We understand that proper revenue cycle management is the Lifeline of your practice! We have successfully helped thousands of practices increase revenue by 10 – 20%!nnDue to the unprecedented challenges you face, we will perform… nA FREE REVENUE ASSESSMENT AND FREE FOLLOW UP CONSULTATION WITH NO OBLIGATIONnnAllow us to quickly, professionally and confidentially assess your practices’ revenue cycle. There is absolutely no obligation! If we can help you we will Let you know how, and why. If we can’t help, we will be straight-up and tell you. You have nothing to lose, and possibly a lot more reimbursement to gain!n
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- Analysis of Charges, Payments, and Write-offsnWhat we need: 12 month report (reported by month)
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- Provider Coding AnalysisnWhat we need: List of all CPT codes used and number of times reported (12 month report, by provider)
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- Fee Schedule AnalysisnWhat we need: List of all CPT codes and fees (what you charge)
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- Insurance Contracts AnalysisnWhat we need: List of major insurance contracts, rates, and when last negotiated
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- A/R AnalysisnWhat we need: Insurance and patient aging summary reports
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nTo set up your free revenue assessment, please contact: Jennifer Heuer, COO, at 877.825.8772 or jh@rtwelter.com.nnIf you missed any of the articles in our series, click the links below to ensure you are getting the most out of your practice!n
Oct 25, 2018 | Uncategorized
Our weekly series of “Getting Back to Basics with Your Business Systems” is designed to help ensure you are running a profitable business. This week we will review how to look at your finances to ensure you are managing them correctly. Read below and follow over the next few weeks as we reveal new pointers that will allow you to take an “outside” look at your business systems and encourage you to make changes if needed. nnImprove Your Bottom LinennAccounting and financial controls are the backbone of any practice and are essential to its success. At all levels of a medical practice, risk must be managed. Proper controls and checks and balances must be in place to help protect your practice from loss or threats (yes, embezzlement still happens at an alarming rate!). Good financial reporting will enable you to make good strategic decisions and set appropriate goals. For larger, multiple providers practices, a simple Profit and Loss (P&L) report tells you nothing. You need better, more accurate, drilled-down data that enables you to make the best decisions possible for your practice.nnAs practice transformation continues, think well into the future to plan for significant expenses, such as new hardware or system upgrades. Being aware of large expenses down the road will help you better manage your finances now to comfortably spend on those purchases or make it through a rough patch.nnYou can get started TODAY with Welter Healthcare Partners’s FREE revenue assessment. Offered with no obligation, you will receive a free revenue assessment and free follow up consultation to see where and how much you might be losing. CLICK HERE to learn more about the assessment and contact us to schedule your review!nnClick the links below, from our “Getting Back to Basics” series, to ensure you are getting the most out of your practice!n
Oct 18, 2018 | Uncategorized
Our weekly series of “Getting Back to Basics with Your Business Systems” is designed to help ensure you are running a profitable business. This week we will review the potential money you are losing due to the demand of patient management and reporting. Read below and follow over the next few weeks as we reveal new pointers that will allow you to take an “outside” look at your business systems and encourage you to make changes if needed. nnGet paid for EVERYTHING you do!nnThe market is changing and your reimbursement models should be changing with it.nnIt’s no longer all about Fee for Service. Patient and population management and reporting is more demanding and time intensive than ever. You should be paid for this management! After all, you are ultimately footing the bill for it (i.e. personnel, training, risk, etc).nnManaged Care Contracting does include fee-for-service (FFS) payments and likely always will. But increasingly and especially for Primary Care Specialties there can be an element of Capitation (Per Member Per Month) payments in addition to the FFS. What the health plans do not talk about, as much as they should, is that your cost of doing the business of Population Health is paid for by the PMPM dollars …but very little any more. They are trying as best they can to make it a zero sum game. You saving them money on the FFS side and the Population health costs them noting – they win, you lose.nnTake heart, there are lots of ways to win. It takes experience, industry knowledge and…often more than anything the willingness to ask, what may feel like, a lot of dumb questions and demand answers! Remember, payers do not provide health care, they sub-contract it to you! Believe it or not, you have all the power, you and your colleagues often times just don’t know what exactly and how to wield it.nnYou can get started TODAY with Welter Healthcare Partners’s FREE revenue assessment. Offered with no obligation, you will receive a free revenue assessment and free follow up consultation to see where and how much you might be losing. CLICK HERE to learn more about the assessment and contact us to schedule your review!nnClick the links below, from our “Getting Back to Basics” series, to ensure you are getting the most out of your practice!n
Oct 11, 2018 | Uncategorized
Our weekly series of “Getting Back to Basics with Your Business Systems” is designed to help ensure you are running a profitable business. This week we will review how new payer credentialing requirements are putting more pressure on medical practices and how easily you can get behind. Read below and follow over the next few weeks as we reveal new pointers that will allow you to take an “outside” look at your business systems and encourage you to make changes if needed. nnProtect the Integrity of Your Revenue!nnProvider credentialing management is more cumbersome, technical and time intensive than ever! New payer credentialing requirements imposed more regularly (government payer vendor changes, increased monitoring of providers, etc.) is wreaking havoc on practices. Failure to meet deadlines, lack of follow up, and allowing things to fall through the cracks will create disruptions in your revenue stream, cash flow and patient care. These are unnecessary disruptions you simply cannot afford! The days of an office manager, biller, medical assistant or receptionist being able to stay on top of provider credentialing are over – you simply don’t have time to focus on it!nnDon’t get behind… Let us help! You can get started TODAY with Welter Healthcare Partners’s FREE revenue assessment. Offered with no obligation, you will receive a free revenue assessment and free follow up consultation to see where and how much you might be losing. CLICK HERE to learn more about the assessment and contact us to schedule your review!nn
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Oct 4, 2018 | Uncategorized
Our weekly series of “Getting Back to Basics with Your Business Systems” is designed to help ensure you are running a profitable business. This week we will review how one code variation can cost you a lot of money! Don’t leave potential money on the table… Read below and follow over the next few weeks as we reveal new pointers that will allow you to take an “outside” look at your business systems and encourage you to make changes if needed. n
Maximize Revenue!
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Don’t leave money on the table! Understand what constitutes a codeable/billable service for your organization. Coding and billing rules change quarterly and it’s important to stay up-to-date on those changes.
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We have identified through tens of thousands of post-payment compliance audits that 68% of providers we audit are under-coding and under-valuing their work based on the services actually rendered. This results in substantial lost revenue! For example:
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If all office visits are coded and billed as 99213 “to be safe” but 99214 should have been coded and billed, and this documentation and coding error occurred with 50 patient visits per month, this results in over $21,000 in lost revenue annually for one provider. And that’s just one coding error and one provider!
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Of the 68% of the providers who we find under-code, the vast majority of those providers are under-coding in multiple E/M scenarios! Lost revenue can easily add up to over $50,000 per year per provider.
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How much revenue are you losing?
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nnAre you ready to learn more now? You can get started TODAY with Welter Healthcare Partners’s
FREE revenue assessment. Offered with no obligation, you will receive a free revenue assessment and free follow up consultation to see where and how much you might be losing.
CLICK HERE to learn more about the assessment and
contact us to schedule your review!nn
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In case you missed last week’s report… Review initial article from this series at the link below!n
Sep 27, 2018 | Uncategorized
Overwhelmed? It’s important to get back to the basics and we are here to help! Welter Healthcare Partners is producing a series of articles with tips to help your business thrive. We will be sharing pointers that you should consider to ensure you are running a profitable business. Over the next few weeks, new information will be released that will allow you to take an “outside” look at your business systems and encourage you to make changes if needed. nn———-nnIt is all about the money! After all, without it, you cannot provide the patient care services you currently do! While today’s healthcare landscape definitely presents obstacles it also presents a lot of opportunities. Internal business systems and patient care systems must work like a well-oiled machine for any practice to maximize profitability. The implementation of new patient care reporting requirements (i.e. MACRA, MIPS, APMs), new payment models, and other operational issues tend to demand everyone’s attention on a day to day basis. Unfortunately, too many practices are losing sight of maintaining sound business systems (the “foundation”) which can interfere with their ability to take advantage of the many opportunities out there. While providing top notch patient care and maintaining reporting requirements is at the top of everyone’s priority list, practices must regain focus on their internal business systems in order to maximize revenue and profitability, but more importantly avoid lost revenue.nnIndependent physician practices should not only survive, but thrive! It’s time to get back to basics! It’s time to work smarter, not harder!nnShow Me the Money!nnRevenue Cycle Management is the lifeline to any and all practices. Practices are hemorrhaging money due to the inability to properly manage the revenue cycle. Dirty claims, increased claims denials, delays in payments, subtle but increasingly important credentialing issues and other increased insurance “games” are wreaking havoc on the ability of practices to maintain consistent revenue and cash flow. Insurance companies are banking on the fact that with increased games (i.e. “lost” claims, records requests, inappropriate denials, etc.) and time, practices and providers will lose sight of unpaid claims (i.e. over 90 days) and therefore they don’t have to pay a penny. Failure to keep claims timely due to lack of resources and proper RCM processes and protocols results in tens of thousands of dollars in lost revenue per provider. How much money are you losing?nn nnAre you ready to learn more now? You can get started TODAY with Welter Healthcare Partners’s FREE revenue assessment. Offered with no obligation, you will receive a free revenue assessment and free follow up consultation to see where and how much you might be losing. CLICK HERE to learn more about the assessment and contact us to schedule your review!
Sep 20, 2018 | Uncategorized
Anthem (Blue Cross Blue Shield) is preparing for the fall provider seminars and we encourage you to sign up today. There will be important topics covered as we look forward and plan for 2019.
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In-person sessions are available on various dates at different locations, beginning October 2. Webinar registrations are also available for your convenience.
n—————nnThe sessions include important updates and information about doing business with us. Topics include:n
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- Product overview for 2019
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- Affordable Care Act updates for 2019
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- Medicare Advantage PPO
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- CU Exclusive updates
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- WellChoice overview
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- New Provider newsletter/communication template
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- Anthem.com Provider website enhancements
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- Availity Portal enhancements
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- plus more!
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nIf you haven’t registered already, please save your spot today. For locations and dates, see our Provider Seminar Invitation.nnOnline registration that’s quick and easy!nOur registration process is available online for both our “In-person” meetings, as well as “webinars”. nn n
n nnOriginal article published on providernews.anthem.com.
Sep 13, 2018 | Uncategorized
2019 ICD-10-CM updates will soon go into effect on October 1st. These changes will impact encounters for dates of service October 1, 2018 through September 30, 2019. It is imperative that your organization has up-to-date coding resources and a keen understanding of the changes that will impact your reimbursement! The new updates can also influence your organization’s MACRA quality reporting scores.nnThis year’s ICD-10-CM updates include 473 code changes (279 new codes, 51 deleted codes, and 143 code revisions).nnHere are notable highlights of the 2019 updates:n
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- Increased specificity to more accurately reflect Postpartum Depression and Puerperal Psychosis
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- Expansion of Codes for Eye/Eyelid Conditions
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- Eyelid cancers now contain laterality
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- Expansion of Codes for Acute Appendicitis
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- Severity of illness now specified for appendicitis – perforation, gangrene, peritonitis (10 new codes)
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- New codes to describe exploitation of children and adultsn
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- Psychological abuse
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- Bullying
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- Forced sexual exploitation
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- Forced labor exploitation
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- New codes to describe cannabis withdrawal
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- Increased specificity to more accurately depict postoperative infections
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- Increased specificity to capture the high risk nature of multiple pregnancy
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- Ability to capture severity of condition in patients with cholecystitis and cholangitis
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- Increased specificity for Muscular Dystrophy
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- Increased specificity for Urethral Strictures
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- Increased specificity in the Hyperlipidemia condition category
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n*Please note this list is not all-inclusive. For a comprehensive list of all 2019 ICD-10-CM changes, please CLICK HERE to visit the CMS website.nnContact Welter Healthcare Partners to learn more about ICD-10 assistance and how we can help your organization!nn
