Apr 26, 2018 | Uncategorized
nn
Physicians complain that a “severe delay” in updating the CMS Quality Payment Program interactive website, and other eligibility notification breakdowns have left them “in the dark on their status.”nnThe American Medical Association and more than 40 physician specialty associations are calling for the federal government to reduce from one year to 90 days the reporting period for 2018 Merit-based Incentive Payment System.nnIn a
letter to Centers for Medicare & Medicaid Services Administrator Seema Verma, the physicians’ associations say the curtailed reporting period is needed because:n
n
- CMS failed to provide timely notification on physician eligibility for the program
n
- The agency’s “severe delay” in updating its Quality Payment Program interactive website means it won’t be ready this summer
n
nThe physicians say that the modifications to the Medicare Access and CHIP Reauthorization Act under the Bipartisan Budget Act exclude Medicare Part B drug costs from MIPS payment adjustments. Because of that, physicians cannot rely on any previous “historic” estimates to determine if they’re excluded under the low-volume threshold.nn”Thus, despite being held accountable for data tracking and collection as of January 1, 2018, physicians were not informed of basic eligibility information until early April to determine whether they must participate in the MIPS program,” the physicians told Verma.nn”Furthermore, in order to determine whether they are eligible for the MIPS program, a physician must actively go on to CMS’ website. Previously, CMS has mailed letters to practices to inform them of their eligibility status, which many practices were waiting on this year.”nn”Without direct outreach by CMS to physicians and group practices, many physicians will be left in the dark on their status,” the letter said.nnOriginal article posted on healthleadersmedia.com.nn
Apr 19, 2018 | Uncategorized
As online reviews become an increasingly popular way for patients to choose care providers, 82 percent of patients use online reviews to evaluate physicians and nearly half of patients (48 percent) would go out of their insurance network for a physician with better reviews, according to a Software Advice survey.nnTo determine how patients use online reviews for physicians, Software Advice surveyed more than 2,000 U.S. patients.nnHere are four survey findings:n
n
- The majority (72 percent) of patients use online reviews as their first step in choosing a new physician, while 19 percent use online reviews to validate choosing a physician they have tentatively selected.
n
- More than half (54 percent) of patients reported using reviews sites “often” or “sometimes,” while just over 25 percent of respondents use them “rarely.”
n
- Only 7 percent of patients said they leave “very negative” or “somewhat negative” feedback on reviews sites, while a combined 52 percent of patients reported leaving “very positive” or “somewhat positive” feedback. Eleven percent of patients said they write “neutral” reviews.
n
- Sixty-five percent of patients feel it is “very” or “moderately important” for physicians to respond to online reviews.
n
nOriginal article posted on beckershospitalreview.com.
Apr 12, 2018 | Uncategorized
According to an article presented by Novitas Solutions, new Medicare cards will be mailed to qualifying patients, beginning April 2018. See below for complete article and schedule information.nnBeginning in April 2018, the Centers for Medicare & Medicaid Services (CMS) will mail new Medicare cards to all Medicare beneficiaries on a flow basis by geographic location and other factors.nnMailing Schedulen
n
- April – June 2018nJurisdiction L – Pennsylvania, Maryland, Delaware and the Washington D.C. Metro Area (Arlington and Fairfax counties in Virginia, the city of Alexandria, VA, the District of Columbia, and Montgomery and Prince George’s counties in Maryland)
n
- After June 2018nJurisdiction L – New Jersey, andnJurisdiction H – Colorado, Oklahoma, New Mexico, Texas, Arkansas, Louisiana, Mississippi, Indian Health Service and Veterans Affairs
n
nAdditional details on timing will be available as mailings progress.nnStarting in April 2018, beneficiaries can check the status of card mailings in their area on Medicare.gov.nn Transition PeriodnA transition period will begin no earlier than April 1, 2018 and run through Dec. 31, 2019. During the transition period, you can use either the new Medicare Beneficiary Identifier (MBI) or the old Medicare Health Insurance Claim Number (HICN).nnStarting Jan. 1, 2020, you must use MBIs on claims regardless of the date of service.nnCMS Educational EffortsnTo prepare the health care industry for this change, CMS provided extensive outreach to the provider community and will continue to do so throughout the transition period. CMS holds regular Open Door Forum teleconferences to help you prepare your systems and business processes for a successful transition.nnCMS also initiated extensive education and outreach to Medicare beneficiaries and their agents to help them prepare and understand the change in Medicare cards and numbers. CMS produced flyers, posters, tear-offs and conference cards in multiple languages to assist providers when talking to their patients with Medicare about the new Medicare cards.nnFor the latest news and updates regarding the new Medicare cards, please visit the CMS’ New Medicare cards page on the CMS website.nnOur Educational EffortsnWe are committed to helping you and your Medicare patients successfully transition to the new Medicare card. We will continue to include important updates in our educational symposiums, webinars, face-to-face events, newsletters, and publications.nnFor upcoming educational opportunities, please visit our Education & Training Center (JH) (JL).nnFor more information, please review “New Medicare Cards and Numbers are coming – Beginning April 2018.”nnThis article and all information provided by novitas-solutions.com.
Apr 5, 2018 | Uncategorized
Its threat alone has helped speed consolidation, and consumers may suffer. nnWithout having done much yet, Amazon.com Inc. is already transforming U.S. health care — and not necessarily for the better.nnThe mere threat of the online giant getting into the health business prompted the country’s two largest pharmacy benefit managers — CVS Health Corp. and Express Scripts Holding Co. — to join forces with two of its largest insurers, Aetna Inc. and Cigna Corp. These deals will put more U.S. health care under the control of fewer companies. The merging companies say this will lower costs for consumers and the country. But the reality will likely be less rosy and more complicated.nnThat these companies can even make such deals is due partly to the Federal Trade Commission and the Department of Justice, which blocked the mergers of Anthem Inc. with Cigna and Aetna with Humana Inc. Those mega-insurers would have been too busy digesting to make big vertical deals and too large to be acquired by other insurers.nnUnitedHealth Group Inc. has been another major motivator for these mergers. It successfully pioneered a strategy of aggressive diversification by buying a large PBM in 2015 and with its Optum health-services unit. The gravitational pull of its success — it leads peers in patient enrollment, revenue growth, and market valuation — has inspired copycats. Profit pressure on PBMs, meanwhile, likely helped make them receptive to merging with insurers.nnBut Amazon’s long shadow also helped instigate these deals. With its technological prowess, long investment horizon, bottomless appetite for new business and tolerance for thin margins, any mention of its interest in health care rattles investors, particularly in the industry’s middlemen.nnIf the deals go through, the result will be an unprecedented level of market concentration.nnAll three of the biggest U.S. PBMs will be tied to three of the country’s biggest insurers. CVS, Express Scripts, and UnitedHealth process more than 70 percent of all U.S. prescriptions. Post-merger, three companies will insure more than 90 million people in some capacity, process more than 3.5 billion prescription claims, and generate more than $500 billion in revenue.nnNot every American will have both their medical and drug benefits managed by the same company. But many more will in the years to come. These integrated companies have more information about their customers and more ability and incentive to manage the totality of their health spending.nnUnitedHealth is already all-encompassing, with its continuing investment in everything from ambulatory surgery centers to physician groups. CVS and Aetna — which will add retail pharmacies and primary care clinics to the equation — could have an unprecedented role in patient lives. Read More >>nnCLICK HERE to view original article in it’s entirety, including informational charts, graphs and author info.
Mar 30, 2018 | Uncategorized
In celebration of National Doctors Day, we would like to honor and recognize the physicians who have made a difference in our lives and local communities. Doctors of all specialties do so much for us and we don’t often realize how much they contribute to our daily activities and overall well-being. From minor scrapes and viruses, to complete home health care when needed, doctors provide valuable information that allows us to take care of ourselves and our families. National Doctors Day is celebrated by showing special appreciation for physicians and displaying red carnations, the symbolic flower of Doctors’ Day.nnWhile we are thankful for all doctors, we would like to send a special “THANK YOU” to our clients as we celebrate YOU on this special day!
Mar 23, 2018 | Uncategorized
Welter Healthcare Partners has partnered with the Colorado Department of Public Health and Environment (CDPHE) Family Planning Program to provide training and technical assistance in cost setting activities to current Title X contractors and clinics. Our training and technical assistance will assist CDPHE and Title X contractors in updating fee schedules, developing sliding fee scales, identifying costs, and negotiating contracts with health plans. This 3 part web-based training series allows agencies to make informed decisions about the costs of doing business.n
Cost Analysis/Rate Setting
n
Mar 15, 2018 | Uncategorized
CTCi group, the center for transformative coaching, is offering two sessions to help management teams and other professionals understand the importance of effective management. These web based sessions are developed in a way to help you and your employees succeed!nnnRead more about each individual program and click the link below each description for more information or to register.nn nn
nn
12-week, Virtual Course — “Coach-Approach™” to Effective Management
nLike two wings of a plane; one being technical skills and the other people skills, we oftentimes focus so much on the technical skills that we fail to develop our staff in the “people skills of good business”. And yet, it takes both wings to fly a plane or both skill sets to build a “good to great” organization. Ironically, it is the failure in people skills that typically “brings the plane down” (or the major project!). But it doesn’t have to be this way!nnInvest in yourself and/or your managers today by taking CTCi’s “Coach-Approach™” to Effective Management 12-week, virtual course. Learn the 11-Core Competencies of coaching and discover how to draw out the “greatness and giftings” of your staff to build high-powered; synergistic teams. What should you do next?n
n
- Click here to find additional, detailed, information including the date and time of the next available cohort.
n
n
30 Minute FREE Webinar — Why Professionals Hire a Coach, and Why They Don’t!
nCoaching is one of the fastest growing professions with revenues in excess of $2B annually. But why? Why are professionals oftentimes hiring coaches and perhaps just as importantly, why are many not? In this 30-minute live webinar, John Seville, CEO of CTCi Group, will explore these questions and host a dynamic Q&A session with attendees. If you’re considering hiring a coach, this is a “must-attend” webinar you don’t want to miss!n
Mar 7, 2018 | Uncategorized
Health and Human Services Secretary Alex Azar said Monday that value-based healthcare “needs to accelerate dramatically” in the U.S., calling for a range of changes to the healthcare system that he said would provide more tools to give consumers more control over their care.nn“This is no time to be timid — today’s healthcare system is simply not delivering outcomes commensurate with its cost,” said Azar, speaking at the public policy conference for the Federation of American Hospitals in Washington.nnAzar’s speech focused on value-based care, an approach in which doctors and hospitals are reimbursed by private health insurance and the government for how well patients emerge after a medical procedure versus the amount of care provided. That method was also cited by the Obama administration as a priority, and Azar during his speech called out that work, saying that value-based care was “taken seriously by President Barack Obama’s administration as well.”nnHe noted that while policymakers had been discussing such potential changes since the early 2000s, the shift was just getting started and was “still far from reaching its potential.”nnHe laid out areas the Trump administration plans to emphasize, promising to deliver “disruptive” changes in healthcare, including giving consumers more control over their health information, encouraging more transparency from healthcare providers and payers, using experimental models in Medicare and Medicaid, and removing government burdens.nn
Azar stressed the need for patients to better understand what medical care will cost them, citing examples such as knowing the price of a medical procedure or a prescription drug. He also cited examples in which providers spend an extensive amount of time reporting their outcomes, which can limit the amount of time they can deliver care.nn”Our current system may be working for many, but it’s not working for patients and it’s not working for taxpayers,” Azar said.nnAzar was sworn in as secretary five weeks ago and will be speaking at the policy conference for America’s Health Insurance Plans on Wednesday. Chip Kahn, president of the Federation of American Hospitals, called Azar the “perfect pick for the times” in remarks ahead of Azar’s speech.nnHe reiterated his overall priorities Monday were to focus on value-based care, combat the opioid crisis, bring down the cost of prescription drugs and to lower the cost of health insurance for people who do not receive coverage through the government or through work.nn“This administration, and this president, are not interested in incremental steps,” Azar said. “We are unafraid of disrupting existing arrangements simply because they’re backed by powerful special interests.”nnThis article originally posted on washingtonexaminer.com.
Mar 7, 2018 | Uncategorized
No is a request for informationnIn all things inter-personal, No means No. In managed care contracting, No is a request for information. In other words, if you have a reasonable request which makes sense, don’t take no for an answer. It may take time, it may take a different approach but stay on it, fight for what you believe in and keep working it until you get the desired result.nn Welter Healthcare Partners does Managed Care Contracting and we do it well. We interpret “no” from the health Plans as a request for Information.nnHealth Care Provider’s IncomenYou have to find ways to “make money while you sleep.” Being a health care provider is a great profession and all the rest of us appreciate your education, experience, skills and talents but in the current fee-for-service world and even most risked based reimbursement models you have to be working to get paid. I don’t care how much you make, it is not enough if you only get paid when you actually are working.n
Stay tuned for more Todd’s Tips!
nnn
nn
About R. Todd Welter • MS, CPCnFounder and President of Welter Healthcare Partners
nMr. Welter has over 25 years of healthcare industry experience assisting physicians and other providers, hospitals and other facilities with the business side of medicine. Through strategic planning and analysis, Mr. Welter’s main focus is to strategically increase revenues and profitability in this radically changing health care environment.
Mr. Welter has a Masters Degree in Organizational Leadership from Regis University in Denver where he has had an appointment as affiliate faculty in the School for Professional Studies for over ten years. In addition, Mr. Welter holds a faculty appointment at the University of Denver’s University College. In the Health Care Leadership program he teaches Macro Economics in Health Care and Innovative Strategies and Change in Health Care to graduate students.
Feb 26, 2018 | Uncategorized
nnAs many of you have been following this story, a new update has been released regarding the Anthem payment cut. Read the latest update below, including quotes from Anthem Executive Vice President and Chief Clinical Officer, Craig Samitt.nn
nnThe company had planned to reduce by 25 percent payments for evaluation and management services reported with modifier.nnAnthem has dropped its plan to reduce by 25 percent payments for certain evaluation and management codes.nnThe policy was to have gone into effect on March 1 across the company’s commercial health insurance businesses.nnThe insurer made the policy change in response to strong opposition from the American Medical Association and other physician groups, the AMA said on Friday, the same day it heard from Anthem.nnAnthem Executive Vice President and Chief Clinical Officer Craig Samitt told AMA Board Chair Jack Resneck, Jr., MD, that Anthem is rescinding plans to implement the policy to reduce payments by 25 percent for evaluation and management codes reported with a current procedural terminology modifier 25.nnAnthem had made the move to avoid duplicate payment for fixed or indirect practice expenses when physicians bill an evaluation and management service appended with modifier 25 along with a minor surgical procedure performed on the same day.nnHowever, Anthem said it believed that making a meaningful impact on rising healthcare costs required a different dialogue and engagement between payers and providers.nnAnthem plans to formally notify its contracted providers within the next few days of its decision.nn”Anthem’s decision to drop its planned modifier 25 policy is a positive step forward, demonstrating again that when doctors and health plans work together, the best outcome for patients can be achieved,” Resneck said. “This policy is one of a number of issues that the physician community has been working on with Anthem, and the AMA looks forward to continuing these efforts to find ways to collaborate on strategies to deliver affordable, high-quality, patient-centered care.”nnThe other issues include Anthem’s policies on the retrospective denial of payment for emergency room visits, restrictions on advanced imaging in hospital outpatient facilities, and the denial of payment for monitored anesthesia care or general anesthesia for cataract surgery.nn”Anthem remains committed to continuing to work with the AMA, state medical associations and national medical specialty societies to address physician concerns with the company’s policies and guidelines,” Samitt said, adding he looked forward to together tackling rising healthcare costs in a meaningful way.nnOriginal article posted on healthcarefinancenews.com.
Feb 22, 2018 | Uncategorized
Recent news released by The Colorado Medical Society shares the response from Anthem regarding the reduction of payment for services that are provided on the same day. Read below for more information on the correspondence between CMS and Anthem:nnThe Colorado Medical Society, American Medical Association and other state medical societies have been actively advocating against a plan by Anthem Blue Cross Blue Shield to reduce payment for significant, separately identifiable evaluation and management (E/M) services that are provided on the same day a procedure is performed or a wellness exam is conducted.nnThe company announced in December that it would reduce the size of its planned pay cut from 50 percent to 25 percent and move the implementation date to March 1, 2018. CMS sent a letter on Dec. 15, 2017, from CMS President M. Robert Yakely, MD, to Elizabeth Kraft, MD, medical director of Anthem BCBS in Colorado.nnIn her Jan. 29 response, Kraft defended the pay cut citing duplication of the fixed/indirect practice expense when performing a minor surgery and E/M service on the same day by the same provider. “To redress the duplicative payment, Anthem’s Policy reduces the office visit reimbursement by 25 percent and, thereby, reduces the double payment for fixed/indirect practice expenses.”nnYakely responded on Feb. 12 that there is no overlap of indirect practice expense and that “by providing two separate and distinct services during the same visit the physician can be more efficient, streamline care for the patient and facilitate a prompt diagnosis, potentially avoiding additional out-of-pocked expense for the patient” – particularly for those in rural areas or seeking certain types of specialty care that have long wait times for non-emergency appointments. He continued, backing up his point that codes are already adjusted by the Relative Value Scale Update Committee (RUC) and that further reductions are inappropriate.nnCMS stands by its original request that Anthem retract the new modifier 25 policy without delay. Watch for more information as this issue develops.nnNews updates provided by Colorado Medical Society, February 19, 2018.
Feb 16, 2018 | Uncategorized
Leading insurance company, Aetna has been under investigation for insurance claim reviews by former medical director for the company. Health insurance is a tough industry to navigate to ensure proper charges and reimbursement but Welter Healthcare Partners is ready to help! Contact us today to see how we can help your practice so you can get back to treating patients!nn
nn nnCalifornia’s insurance commissioner has launched an investigation into Aetna after learning a former medical director for the insurer admitted under oath he never looked at patients’ records when deciding whether to approve or deny care.nnCalifornia Insurance Commissioner Dave Jones expressed outrage after CNN showed him a transcript of the testimony and said his office is looking into how widespread the practice is within Aetna.nn”If the health insurer is making decisions to deny coverage without a physician actually ever reviewing medical records, that’s of significant concern to me as insurance commissioner in California — and potentially a violation of law,” he said.nnAetna, the nation’s third-largest insurance provider with 23.1 million customers, told CNN it looked forward to “explaining our clinical review process” to the commissioner.nnThe California probe centers on a deposition by Dr. Jay Ken Iinuma, who served as medical director for Aetna for Southern California from March 2012 to February 2015, according to the insurer.nnDuring the deposition, the doctor said he was following Aetna’s training, in which nurses reviewed records and made recommendations to him.nnJones said his expectation would be “that physicians would be reviewing treatment authorization requests,” and that it’s troubling that “during the entire course of time he was employed at Aetna, he never once looked at patients’ medical records himself.”nn”It’s hard to imagine that in that entire course in time, there weren’t any cases in which a decision about the denial of coverage ought to have been made by someone trained as a physician, as opposed to some other licensed professional,” Jones told CNN.nn”That’s why we’ve contacted Aetna and asked that they provide us information about how they are making these claims decisions and why we’ve opened this investigation.”nnThe insurance commissioner said Californians who believe they may have been adversely affected by Aetna’s decisions should contact his office.nnMembers of the medical community expressed similar shock, saying Iinuma’s deposition leads to questions about Aetna’s practices across the country.nn”Oh my God. Are you serious? That is incredible,” said Dr. Anne-Marie Irani when told of the medical director’s testimony. Irani is a professor of pediatrics and internal medicine at the Children’s Hospital of Richmond at VCU and a former member of the American Board of Allergy and Immunology’s board of directors.nn”This is potentially a huge, huge story and quite frankly may reshape how insurance functions,” said Dr. Andrew Murphy, who, like Irani, is a renowned fellow of the American Academy of Allergy, Asthma and Immunology. He recently served on the academy’s board of directors.nnClick here to read original article in it’s entirety on cnn.com.
Feb 8, 2018 | Uncategorized
New information has been released by the Centers for Medicare and Medicaid Services, for new medicare cards, being sent beginning April 1, 2018. Read below for complete details so you can stay informed and know what to expect.nnNew Medicare Card: Web UpdatesnTo help you prepare for the transition to the Medicare Beneficiary Identifier (MBI) on Medicare cards beginning April 1, 2018, review the new information about remittance advices.nnBeginning in October 2018, through the transition period, when providers submit a claim using a patient’s valid and active Health Insurance Claim Number (HICN), CMS will return both the HICN and the MBI on every remittance advice. Here are examples of different remittance advices:n
nFind more new information on the New Medicare Card provider webpage.nnNew Medicare Card: When Will My Medicare Patients Receive Their Cards?nStarting April 2018, CMS will begin mailing new Medicare cards to all people with Medicare on a flow basis, based on geographic location and other factors. Learn more about the Mailing Strategy. Also starting April 2018, your patients will be able to check the status of card mailings in their area on Medicare.gov.nnFor More Information:n
nThis article provided by Centers for Medicare and Medicaid Services.
Feb 1, 2018 | Uncategorized
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.nnCorrect CPT and ICD-10 Codes with modifiers and units:nn27658 (LT modifier) – Repair, flexor tendon, leg; primary, without graft, each tendonnnS86.312A – Strain of muscle(s) and tendon(s) of peroneal muscle group at lower leg level, left leg, initial encounter
Jan 25, 2018 | Uncategorized
nFederal funding to run through September 2023nnDenver, CO – Congress approved a long-term, six-year funding extension for the Children’s Health Insurance Program known as Child Health Plan Plus (CHP+) in Colorado. CHP+ covers more than 75,000 kids and nearly 800 pregnant women in Colorado.nnThe Department of Health Care Policy and Financing (Department) will be notifying members that the program will continue after the bill is signed into law by the President.nn”Congress took an important step forward and found a long-term solution to restore federal funding for the Children’s Health Insurance Program,” said Kim Bimestefer, executive director for the Department. “We look forward to the President signing this bill as it will lift the burden of uncertainty from families throughout Colorado and allow them to continue to access the health care services that children and pregnant women need.”nn
The Department will be posting copies of the CHP+ member notification letters and additional information over the coming week to its “Future of CHP+” web page at CO.gov/HCPF/FutureCHP.nnIf a CHP+ family receives a letter stating it is time to renew their CHP+ benefits, they should follow the instructions in the letter and pay their enrollment fee, if they owe one. Failure to pay their enrollment fee, may result in not having coverage.nnAbout the Colorado Department of Health Care Policy and Financing:nnThe Department administers Health First Colorado (Colorado’s Medicaid Program) and Child Health Plan Plus as well as a variety of other programs for Coloradans who qualify. For more information about the Department, please visit Colorado.gov/hcpf.
Jan 19, 2018 | Uncategorized
In the new 2018 Quality Payment Program (QPP) Final Rule, the Centers for Medicare and Medicaid Services (CMS) has outlined a wide range of changes to its value-based care programs. Are you and your EHR vendor prepared?nn2018 marks the second year of the Merit-Based Incentive Payment System (MIPS), and the requirements are definitely ramping up and posing more of a challenge. However, MIPS is nothing to be too scared of—as long as your practice has the right technology to streamline your MIPS data collection and submission.nnSo what’s specifically changing? In case you don’t have time to read all 1,653 pages of the 2018 QPP Final Rule yourself, here’s an overview:n
n
- Payment adjustment increases to +/-5%nCMS is raising the stakes for 2018—if only by 1%. This past year, providers could earn up to a 4% positive or negative adjustment on their Medicare reimbursements (applied in 2019) depending on their performance, but that percentage increases to +/-5% for 2018 (applied in 2020).This means that if your practice bills $1,000,000 in Medicare per year, then your MIPS performance could earn you a $50,000 bonus or penalty in 2020. And since the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires MIPS to be budget-neutral, that bonus could increase by an additional adjustment factor if more providers earn a negative adjustment than anticipated.
n
Low-volume threshold goes upnIn 2018, providers with ≤$90,000 in Part B allowed charges or ≤200 Part B beneficiaries will not be subject to MIPS. Compared to the 2017 MIPS threshold of ≤$30,000 in charges or ≤100 beneficiaries, this is a significant increase. The 2017 threshold already exempted a large proportion of Medicare Part B providers, and this 2018 change will exempt even more.n
n
n
- Performance threshold increases to 15nFor the 2017 performance period, providers could avoid the negative payment adjustment in 2019 with a MIPS Composite Performance Score (CPS) of just three points. This could be easily achieved by submitting either one Quality measure, one Improvement Activity (IA) or all Advancing Care Information (ACI) base measures.For the 2018 performance period, you’ll need 15 points or more to avoid the negative adjustment in 2020. While this is a 400% increase, it could still be as simple as completing 2-3 Quality measures, four IAs or all ACI base measures. For practices that are already strong MIPS performers, this minimum threshold change will have little impact. The exceptional performance threshold required for positive adjustments will remain at 70 points.
n
n
n
- Cost category takes effectnIn its first year, MIPS scored providers on three categories: Quality, ACI and IA, with the Cost category weighted at 0%. Starting in 2018, MIPS adds a 10% weight for the Cost category, which is based on Medicare Part B claim submissions. Because eligible clinicians (ECs) already submit this claims data to CMS, they will not need to send any additional data to report the Cost category.More specifically, Cost scoring is based on the Medicare spending per beneficiary (MSPB) and the total per capita costs for all attributed beneficiaries measure. This could have an enormous impact on the scores of clinicians who frequently prescribe expensive Part B drugs, such as ophthalmologists, rheumatologists and oncologists. We’ll take a closer look at the Cost category in an upcoming blog post, so stay tuned!
n
n
n
Category weights changenThe Quality category was originally proposed to remain at 60% of the MIPS CPS in 2018, with Cost not factoring in until 2019. However, the 2018 QPP Final Rule introduced Cost this year at 10%, so CMS is decreasing Quality’s weight to 50% to compensate. The ACI and IA categories will remain at 25% and 15%, respectively.n
n
n
- Virtual groups participation option introducednWith many small practices concerned about their ability to succeed independently under MACRA, CMS has introduced a virtual groups option that can allow ECs to benefit from group reporting without actually joining a group or selling their practice.To form a virtual group, a solo practitioner or group of 10 or fewer ECs must come together virtually with at least one other solo practitioner or group to participate in MIPS for a year. Group members do not need to be in the same specialty or location. CMS simply requires that they report as a group across all performance categories and meet the same MIPS requirements as non-virtual groupsOnce reporting is complete, all group members will receive the same score and payment adjustment percentage. The idea is that by sharing the reporting burden and combining their strengths, providers may be able to earn higher scores together than individually.The deadline for selecting the 2018 virtual group option is December 31, 2017, so time is running out if you’re interested in participating. To learn more, download CMS’ Virtual Groups Toolkit.
n
n
n
- Extreme and uncontrollable circumstances exemption addednIn the wake of Hurricanes Harvey, Irma and Maria, CMS has added new hardship exemptions for physicians who cannot meet reporting requirements due to hurricanes, natural disasters or public health emergencies. These will apply to the 2017 performance year as well as 2018, and the application deadline for hardship exceptions will be December 31 each year.How does it work? If affected clinicians don’t submit any data, they will be exempt from penalties. Meanwhile, those who do submit data will be scored on the data they submit, but the categories will be reweighted. If you were impacted in 2017, you may submit an application for reweighting of the ACI category. Even if you don’t submit an ACI application, CMS will automatically exempt you from Quality, Cost and IA for 2017.
n
n
n
- Small practice bonus institutednIn an effort to further reduce the burden for small practices, CMS will automatically award qualifying practices a bonus of up to 5 points. Practices must have 15 or fewer ECs and submit data on at least one performance category to be eligible.
n
n
n
- 2014 CEHRT permitted and 2015 CEHRT bonus creatednOriginally, CMS planned to allow 2018 data submission only from 2015 Certified Electronic Health Record Technology (CEHRT). Instead, it has now decided to continue allowing ECs to use 2014 CEHRT—a relief for both vendors and providers. However, CMS is offering a 10% bonus in the ACI category to providers who report with 2015 CEHRT.
n
n
n
- New ePrescribing and HIE exclusions established starting 2017nTo allay concerns about the difficulty of meeting certain measures involving ePrescribing and health information exchange (HIE), CMS has introduced new exclusions that would allow ECs to claim the exclusion from one or both of those measures and still earn a base score. It’s important to note that these exclusions are being applied to the 2017 performance year as well as 2018.Who’s eligible? To claim the eRx exclusion, a provider or group must write fewer than 100 permissible prescriptions during the reporting period. For the HIE exclusion, they must refer or transition fewer than 100 times during the reporting period.
n
n
Analysis
nWith these new rules, CMS is continuing to ramp up the reporting requirements as planned, building up to full MIPS implementation in 2019. In response to concerns from the healthcare community about the burden of reporting, CMS is also focusing heavily on easing the transition and accommodating real clinical workflows.nnEspecially for small practices, the new QPP rules provide additional flexibility and incentives in a wide variety of areas. As a result, some organizations have actually criticized CMS for not challenging providers enough to substantially improve health outcomes or reduce costs. However, for many physicians and industry associations, this relative leniency comes as a major relief.nnTo learn more and view the full list of calendar year (CY) 2018 MIPS changes, check out CMS’ 2018 QPP Final Rule fact sheet.n
The Bottom Line
nValue-based care is here to stay, but it’s reassuring to see that CMS continues to listen to feedback from the healthcare community. And ultimately, meeting these new MIPS requirements doesn’t have to require an enormous amount of time and resources—it just comes down to whether you have the right tools.nnWith the performance periods for Quality and Cost beginning on January 1st for all MIPS-eligible clinicians, now is a good time to evaluate whether your current EHR will be able to support your MIPS success in 2018. A robust MIPS solution should be able to collect reportable MIPS data during the exam, track and benchmark your CPS in real time and submit your data directly to CMS. Plus, consider augmenting your technology with personal guidance from certified MIPS coaches who are also experts in your EHR system. When you’re equipped with comprehensive MIPS support tools from a proven value-based care performer, you can gain peace of mind while increasing your income.nnWe wish you the best of luck with your MIPS reporting in the new year!nnThis article originally posted by Jayne Collard, CMUP CPHP CMUA, Advisory Services Manager, modmed.com.
Jan 11, 2018 | Uncategorized
Hospitals across Colorado must begin posting self-pay prices Monday for the most common procedures and treatments they offer — a potential first step in bringing more cost transparency to a sector whose pricing ambiguity has frustrated consumers and public officials alike.nnThe move is mandated by Colorado Senate Bill 65, a 2017 measure from Republican Sen. Kevin Lundberg of Berthoud aimed at requiring health-care providers to be able to tell people who are paying bills without the help of insurance what a procedure will cost before they get those services. Medical pricing transparency demans are gaining traction on both state and local levels.nnUnder the new law, health-care facilities such as hospitals must post the self-pay prices for the 50 most used diagnosis-related group codes — the most common reasons for hospitalizations — and the 25 most-used current procedural technology billing codes. Those prices can reflect the most frequent charge over the past 12 months for a service, the highest charge from the lowest half of all the charges for the service or a range that includes the middle 50 percent of all charges for the service. The facility must have performed a service at least 11 times in the past year.nnPhysicians’ offices and other individual health-care providers, meanwhile, are required just to post the prices for their 15 most common procedures.nnThe prices, however, are only those that apply to people who are paying on their own without the help of public or private insurance in a state where less than 7 percent of the population is uninsured. At University of Colorado Hospital in Aurora, the self-pay population represents only 2 percent of the patients coming through its doors and generates just 0.2 percent of its revenue.nnThus, some hospital officials worry that the new requirements will confuse patients even more than they will provide for more transparency. Prices for insured individuals will be vastly different and will depend on the contract each facility has negotiated with each insurer, and even the prices charged to most uninsured individuals can be discounted by hospitals depending on their income level.nn
“I definitely think we’re concerned that this might confuse patients even more,” acknowledged Dan Weaver, senior director of public and media relations for UCHealth. “Because prices are based so much on individual patients, their needs and their insurance plans, I think providing estimates really comes down to the individual patient level.”nnThe newest requirement is not the first attempt at transparency for many hospitals, however. The Colorado Hospital Association adopted a resolution in July saying that hospitals should post facility-fee charges for emergency-department visits and for the most common outpatient diagnostic tests and procedures by the end of 2017. Like SB 65, that sought conspicuous posting of prices online or in the facility’s main office.nnJulie Lonborg, CHA vice president of communications and media relations, said that hospitals across the board are committed to the idea of transparency, even if some are struggling to meet the deadline. That is particularly true of rural medical centers, some of which may not have 50 procedures that they performed at least 11 times in the past 12 months.nn“I think it will help the patients’ relationships with the hospitals, especially the trust part of those,” Lonborg said, referencing growing concern that hospital pricing can be so opaque that some patients question whether there is rationale for it. “I think to the extent that patients couldn’t find that easily, it could have put a chink in the trust relationship.”nnSarah Ellis — a spokeswoman for SCL Health, which operates Saint Joseph Hospital, Lutheran Medical Center and Good Samaritan Medical Center locally — called the efforts to list both the procedure prices and the emergency and outpatient fees “a work in progress” and said the health system hopes to learn more over time about what is most important to customers. Her organization will continue to seek advice from patient advisory groups about any changes that could help to simplify the information.nnChildren’s Hospital Colorado already has the emergency-department fees listed on its website and will post the other required and CHA-encouraged information on Jan. 1, said Heidi Baskfield, vice president of population health and advocacy for the Aurora hospital. However, she, like other system officials, will encourage in the price listings that anyone who has insurance should continue to work through their insurers to understand not just the cost of services but their responsibilities for deductibles and co-pays.nnThis article originally posted on bizjournals.com.
Jan 5, 2018 | Uncategorized
Written By: Toni Elhoms, CCS, CPC, AHIMA-Approved ICD-10-CM/PCS Trainern Director of Coding/Compliance Consulting ServicesnnIt’s that time of the year again! The new 2018 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 2018 address a number of interrelated issues. Clinical practice and technology have evolved and several issues required much needed CPT expansion and clarification. CPT 2018 offers changes that affect nearly every specialty.nn*Please note, this article is not an all-inclusive list; review your 2018 CPT book for complete descriptions of all changes. Appendix B of 2018 CPT provides a summary of additions, deletions, and revisions.nn
n
Highlights of the most significant changes:
n
New CPT Modifiers
nTwo new modifiers were added to this year’s CPT update. They should be reported with services that are identified as being either habilitative or rehabilitative in nature, such as physical medicine and rehabilitation codes. This will allow the payer the ability to differentiate habilitative from rehabilitative services. This differentiation is required by the Patient Protection and Affordable Care Act (PPACA).nnModifier 96 – Habilitative Services: When a service or procedure that may either be habilitative in nature or rehabilitative in nature is provided for habilitative purposes. Such services help an individual learn skills and functioning for daily living that the individual has not yet developed, and then keep or improve those learned skills. Habilitative services also help an individual keep, learn, or improve skills and functioning for daily living.nnModifier 97 – Rehabilitative Services: When a service or procedure that may be either habilitative or rehabilitative in nature is provided for rehabilitative purposes. Rehabilitative services help an individual keep, get back, or improve skills and functioning for daily living that have been lost or impaired because the individual was sick, hurt, or disabled.n
Observation Care Services
nCPT 2018 added the verbiage “outpatient hospital” to the code descriptions for observation care services (CPT codes 99217 – 99220). These changes affect one observation discharge code and three observation care codes. The intent behind this revision was to clarify that observation services are specific to outpatient status (Place of Service Code 22). These codes should not be reported for a patient that was admitted to the hospital.n
Evaluation & Management Services
n
There are 3 new codes for psychiatric collaborative care management services. There is one new code for general behavioral health integration care service. INR monitoring services were also revised deleting 2 codes and creating 2 new codes for INR home and outpatient INR monitoring services.n
n
- 99483 (Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home).n
n
- For cognitive-assessment services, report 99483 instead of G0505.
n
n
n
- 99492 (Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional).n
n
- For collaborative care management (CoCM) services, report 99492, 99493 and 99494 in place of G0502, G0503 and G0504.
n
n
n
- 99493 (Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities).n
n
- For collaborative care management (CoCM) services, report 99492, 99493 and 99494 in place of G0502, G0503 and G0504.
n
n
n
- 99494 (Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities).n
n
- For collaborative care management (CoCM) services, report 99492, 99493 and 99494 in place of G0502, G0503 and G0504.
n
n
n
- 99484 (Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month).n
n
- For care management-focused behavioral health integration (BHI), report 99484 instead of G0507.
n
n
n
- 93792 – Patient/caregiver training for initiation of home international normalized ratio (INR) monitoring under the direction of a physician or other qualified health care professional, face-to-face, including use and care of the INR monitor, obtaining blood sample, instructions for reporting home INR test results, and documentation of patient’s/caregiver’s ability to perform testing and report results
n
- 93793 – Anticoagulant management for a patient taking warfarin, must include review and interpretation of a new home, office, or lab international normalized ratio (INR) test result, patient instructions, dosage adjustment (as needed), and scheduling of additional test(s), when performed
n
n
Flu Vaccinations
n
Two new flu-vaccine codes were added in 2018. Both CPT codes pertain to quadrivalent vaccinations. There is also a new CPT code for intramuscular Shingles vaccine.n
n
- 90756 – Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use
n
- 90682 – Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use
n
- 90750 – Zoster (shingles) vaccine (HZV), recombinant, sub-unit, adjuvanted, for intramuscular use
n
n
Anesthesia
nAnesthesia services underwent expansion in this year’s CPT update. There are 2 new CPT codes for upper GI endoscopic procedures and 3 new codes for lower and upper/lower intestinal endoscopic procedures. There were several deletions of low volume codes.n
n
- 00731 – Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified
n
- 00732 – Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; endoscopic retrograde cholangiopancreatography (ERCP)
n
- 00811 – Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified
n
- 00812 – Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy
n
- 00813 – Anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscope introduced both proximal to and distal to the duodenum
n
n
Spine Surgery
nBone marrow aspiration codes underwent revision in this year’s CPT update. A new code was added to reflect more accurate procedural options. CPT code 20939 was added to replace CPT code 38220 when performing bone marrow aspiration for spine surgery only.n
n
- 20939 – Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision (List separately in addition to code for primary procedure)
n
nPre-Sacral Interbody Fusion category III code 0309T was deleted. CPT now instructs coders/surgeons to report CPT code 22899 for unlisted spinal procedure in place of 0309T.n
Diagnostic Radiology
nThe most significant changes this year for diagnostic radiology involve chest x-ray and abdominal x-ray codes. For chest x-rays, there are 4 new CPT codes to replace 9 code deletions. CPT codes for chest x-rays are now selected based on the number of views instead of the type of radiologic view.n
n
- 71045 – Radiologic examination, chest; single view
n
- 71046 – Radiologic examination, chest; 2 views
n
- 71047 – Radiologic examination, chest; 3 views
n
- 71048 –Radiologic examination, chest; 4 or more views
n
nAbdominal x-rays also received revisions with this year’s CPT update. There are 3 new CPT codes to replace 3 code deletions. CPT codes for abdominal x-rays are now selected based on the number of views instead of the type of radiologic view.n
n
- 74018 – Radiologic examination, abdomen; 1 view
n
- 74019 – Radiologic examination, abdomen; 2 views
n
- 74021 – Radiologic examination, abdomen; 3 or more views
n
Dec 21, 2017 | Uncategorized
All of us at Welter Healthcare Partners, we would like to extend our warmest wishes for you this holiday season! As we spend time with family and friends, we reflect on the joyous year we have had due to our clients and those who support and appreciate the work that we do. Our office will operate on a “holiday schedule” as shown below to celebrate the holidays and allow our staff time to spend with their family and friends.n
n
- December 22 – Closing at Noon
n
- December 25 – Closed
n
- January 1 – Closed
n
nIt has been a wonderful year with all of you and we hope you have a very Merry Christmas and Happy New Year!
Dec 14, 2017 | 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
nn n
n
- PREOPERATIVE DIAGNOSES: Peroneal Tendon Tear, left foot.
n
- POSTOPERATIVE DIAGNOSES: Peroneal brevis tendon tear.
n
- PROCEDURE: Peroneal brevis tendon repair, left ankle.
n
- PATHOLOGY: None
n
- ANESTHESIA: General with local.
n
- HEMOSTASIS: Thigh tourniquet at 300mmHg.
n
- ESIMATED BLODD LOSS: 25mL.
n
- COMPLICATIONS: None.
n
- MATERIALS: 4-0 Prolene. An amniotic tissue layer.
n
nDESCRIPTION OF PROCEDURE:nAfter informed consent was obtained from the patient, the patient was brought to the operating room, placed on operating table in a partial lateral decubitus position. A prep block was then performed utilizing 0.5% Marcaine. The left lower extremity was then cleaned, prepped and draped in usual aseptic manner. The left lower extremity was then elevated before a pneumatic tourniquet was inflated to 300 mmHg.nn n
Click Here to View Full Case
n nnCorrect CPT and ICD-10 Codes with modifiers and units:nn27658 (LT modifier) – Repair, flexor tendon, leg; primary, without graft, each tendonnnS86.312A – Strain of muscle(s) and tendon(s) of peroneal muscle group at lower leg level, left leg, initial encounter
Page 16 of 38« First«...10...1415161718...30...»Last »
