Colorado TriCare is Changing!

Colorado TriCare is Changing!

CLICK TO ENLARGE IMAGE

nnTriCare is changing contractors! TriCare’s new carrier/contractor will be Health Net Federal Services. In the process of changing they are re-contracting and re-credentialing the provider network. Please be careful to fully read the new TriCare contract and make your on-going participation decision. If you need assistance, please do not hesitate to call us. We are always happy to help!nnAs the longest serving managed care support contractor for TRICARE, the Department of Defense’s (DoD) uniformed health care program, Health Net Federal Services, LLC (HNFS) is honored to provide health care services to active and retired military service members and their families.nnTRICARE is currently managed in three regions in the United States (North, South, West), with HNFS managing the TRICARE North Region since 2004. In 2017, these regions will condense to two – TRICARE East (merges the current North and South regions) and TRICARE West – under the next iteration of TRICARE known as T2017.nnIn July 2016, the DoD awarded the T2017 TRICARE West Region contract to HNFS, with health care delivery expected to start mid-2017. We welcome the opportunity to support our service members and their families in the TRICARE West Region and invite you to join our provider network as we carry on the vital mission of the TRICARE program. TRICARE covers a wide range of health care benefits you can help us deliver. Together, we can continue to provide health care excellence for our nation’s best.nnHealth Net Federal Services currently completes processing of clean claims for our TRICARE North Region providers in less than five days and offers online self-service tools to streamline your TRICARE transactions. Our TRICARE network providers agree to use Web-based tools to check beneficiary eligibility, validate whether a service requires prior authorization, submit prior authorization and referral requests, and submit claims electronically. In addition, network providers must agree to accept a discount off the TRICARE maximum allowable charge.nnPlease review the T2017 Frequently Asked Questions (FAQs) on the back side of this letter (see flier, right) and the enclosed Join Our Network form. To join the HNFS network, complete and return the form to request a T2017 Network Provider Agreement. Health Net Federal Services greatly values your commitment to the health and well-being of our active and retired service members and their families. Please contact us at HNFST2017ProvRel@Healthnet.com with questions not addressed in the FAQs.

Fee-For-Service Reimbursement

Fee-For-Service ReimbursementIt is still out there alive and well.nnDon’t take your eye off the ball when it comes to contracting with your payers.nnManaged Care Contracting is a continual process. It should be done constantly and consistently. For a well–managed process you should be seeing 4-5% increases every year.nnWhat is it worth? How much did you receive in total reimbursement last year? Multiply it by 5%. Is it worth it? Of course it is!n

Managed Care contracting is one of those 20 to 1 Return on Investment services we do and do well!

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Todd150About 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.

General Surgery Case — Surgical Coding Series: WHP Coding Conundrums

General Surgery Case — WHP Medical Billing, Medical Coding ConundrumsAs part of the new coding format for our newsletter, Welter Healthcare Partners is excited to offer you a new surgery coding series in which we want to help you! The 2nd week of every month we will highlight a complicated surgical case. This week we are highlighting a general surgery case. We want to hear from you! If you have a complicated surgery case and need help with coding, 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. Click Here To Submit Redacted Surgery Case StudynnPreoperative Diagnosis:nRecurrent colorectal cancer at the anastomotic site.nnPostoperative Diagnosis:nRecurrent colorectal cancer at the anastomotic site.nnProcedures:n

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  1. Partial colectomy with end colostomy.
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  3. Small bowel resection with primary anastomosis.
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  5. Flexible sigmoidoscopy.
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nIndications: The patient is a 54-year-old gentleman who presented with colorectal cancer over a year ago. He had a resection and was just finishing chemotherapy and had some GI problems that necessitated a colonoscopy. He was found to have a stricture at the anastomosis, which was biopsied and found to have recurrent colorectal cancer. Risks and benefits were discussed with the patient who understood and agreed with the treatment plan.n

Click Here To View Full Case

Free Revenue Assessment Available with Welter Healthcare Partners Associates

Free Revenue Assessment Available with  Welter Healthcare Partners

CLICK TO ENLARGE FLIER

nnAs you know, the new era of healthcare and the Affordable Care Act (ACA) has brought monumental changes and challenges to physician reimbursement and operations—expanded insurance coverage, threats of decreased reimbursement, increased patient cost share, data collection, and payer audits to ensure proper provider coding and documentation are just a few!nnFor 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! After all, it’s a $2 Trillion industry. There is plenty of money; it’s just in different places than it used to be.nnDue to the unprecedented challenges you face, we will perform… a free revenue assessment and free follow up consultation.nnAllow 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-offsn
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    • What we need: 12-month report (reported by month)
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  • Provider Coding Analysisn
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    • What we need: List of all CPT codes used and number of times reported (12-month report, by provider)
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  • Fee Schedule Analysisn
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    • What we need: List of all CPT codes and fees (what you charge)
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  • Insurance Contracts Analysisn
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    • What we need: List of major insurance contracts, rates, and when last negotiated
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nTo set up your free revenue assessment, please contact Connor Beer, Director of Sales, at 720.879.3621 or cbeer@rtwelter.com.nnFor more information about Welter Healthcare Partners and our services, please visit our website at www.WHPelter.com.

MIPS and MACRA

MIPS and MACRAAnother set of scary acronyms! As with all of these roll outs, take it one step at a time! It is really not scary IF you have been keeping up on coding and documentation and have a reasonably up to date EMR. There is a lot of help out there and as always we are ready willing and able to do the same.nnThe absolute worst things to do: Bury your head in the sand and hope it will go away. It is not going away.nn nn nn


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Todd150About 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.

Industry Hot Buttons – MACRA & Modifier 25

Industry Hot Buttons- MACRA & Modifier 25Week 1 – Industry Hot Buttons!nnMACRA: As a result of Congress repealing the historic SGR (Sustainable Growth Rate) reimbursement formula last year, a new pay–for–performance model has been introduced that will directly impact Part B reimbursement. Physician practices across the country will either be incentivized or penalized via reimbursement based on performance and quality care outcomes. The new model, specific to Part B providers, called MIPS (Merit–Based Incentive Payment System) will consolidate all other CMS alternative merit-based incentive programs (PQRS, VBM, EHR incentives) and provide bonus payments to participating providers of eligible APMs (alternative payment models). MIPS helps link fee-for- service payments to quality and value. This epic change became effective on January 1, 2017, so it imperative that your practice is ready to comply with these new requirements.nnModifier 25: Modifier 25 landed itself on both private payer and the OIG hit lists again this year for overuse and blatant misuse leading to millions in overpayments – and everyone wants their money back! Applying Modifier 25 incorrectly can cost your practice tens of thousands of dollars! Understanding this modifier’s appropriate application can be very tricky.nnHere are a few questions to consider before sticking that modifier on your next claim:n

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  • Was the patient scheduled to come in for a planned study or procedure only? Did any notable events occur that would affect the service beyond the study or procedure?
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  • Was the evaluation and management service provided significant and separately identifiable to the procedure or diagnostic study provided at the same encounter?
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  • Is active management of a significant and separately identifiable illness/ailment with preventive services for additional problems identifiable in the provider’s documentation?
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CLICK HERE TO SUBMIT A CASE STUDY TO THE SURGERY CODING SERIES, DEBUTING NEXT WEEK!

Welter Healthcare Partners Associates & AMRS Proudly Launch New Websites!

 Welter Healthcare Partners Proudly Launches New Website! Welter Healthcare Partners is pleased to announce that our brand new website is launched and LIVE!! nnThat’s right, you can head over to WHPelter.com right now to explore our new, and polished website! This is a massive step forward for Welter Healthcare Partners. A huge amount of work has been put into this launch, and we are thrilled to share the results.nnMoving to this new website means we now have easier navigation and access to new features, plugins, a new format for coding information, and everything in between. We have published a plethora of resources outlining our capabilities and services relating to credentialing, recruiting, interim management, and medical billing and coding.nnWe offer personalized accounting services designed to help you identify opportunities for increased profitability and growth. Our recruitment team is ready to find the perfect, qualified personnel at a lower cost.  Welter Healthcare Partners practice management consultants can immediately step in to maintain day to day operations, provide experienced leadership and keep the current processes and systems in place during the transitional period. Our complete coding services can help you navigate through the complicated coding maze to maximize your revenue and stay current with the constantly changing coding rules and guidelines.nnFor your convenience, you will find a revamped newsletter featuring:nnWeek 1 – Industry Hot Buttons!n

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  • Welter Healthcare Partners is excited to provide insight and guidance on complex and obscure topics in healthcare. Including the OIG work plan, Modifier 25, Incident To, HCC, etc.
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nWeek 2 – Surgery Coding Series!n

nWeek 3 – Code Spotlight!n

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  • Welter Healthcare Partners will pick a unique CPT or ICD-10 code to profile for that week and discuss practice applications of the code as well as pertinent guideline reminders.
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nWeek 4 – Professional Development Tidbit!n

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  • Welter Healthcare Partners will share helpful career advancing tips and strategies to sharpen the skills prospective employers look for in a coder!
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AMRSCO.com Is Officially Live!

nAMRSCOOn top of this, we also launched the new AMRS website! AMRS is a team of advanced medical billing specialists offering comprehensive revenue cycle management services. They pride themselves in accurate and effective coding, billing, and collecting in order to boost company profitability. Boasting over 50 years of coding and billing experience, AMRS already knows how to bill and—above all—fight for due payments in a timely fashion! AMRS’ medical billing services increase current revenue by 10% or more, with our team of experts working hard to increase cash flow and prevent volatile ups and downs.

Colorado Medical License MUST be Renewed by April 30, 2017

Colorado Medical License MUST be renewed by April 30, 2017This serves as a reminder that the Colorado Department of Regulatory Agencies (DORA) has designated April 30, 2017 as the expiration date for all physician medical licenses. Therefore, if Centura hospitals are unable to verify that your license has been renewed, your clinical privileges will be suspended effective May 1, 2017.nnNo grace period will be accepted and DORA will need time to process your application, so please take actions now to ensure you are able to meet this deadline.nnVerifications must be completed via the DORA website, so you do not need to submit a copy of your wallet card.nnA few bullet points from the DORA website regarding licensure renewal are referenced below:n

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  • If you received a renewal notice recently, your license is open for renewal. To review renewal fees and to check the Division of Professions and Occupations renewal schedule, please CLICK HERE.
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  • Click the “Start Your Renewal” button below and use the log in information provided in your renewal notice email to access your account or CLICK HERE.
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  • All future communication from DORA will be electronic, please keep your email address current in DORA’s online services system. Licenses renewed after the expiration date will be charged a $15.00 late fee by DORA.
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CLICK HERE TO START YOUR RENEWAL

National Doctors Day

National Doctors DayMarch 30th marks the annual observation of National Doctors Day. nnThis day was established to recognize physicians, their work and their contributions to society and the community. On National Doctors Day, we say “thank you” to our physicians for all that they do for us and our loved ones.nn


nnThank Eudora Brown Almond, a Winder, Ga., doctor’s wife, who, in 1933, led the charge to set aside a special day for MDs. Why? Because they take care of us. Why March 30? Because it was a painless choice; it commemorated the day in 1942 when anesthesia was first used in surgery. In 1990, President George H.W. Bush signed legislation establishing the date as a national day for Marcus Welbys.nnThis article originally posted on NYDailyNews.com.

ICD-10

ICD-10We are done right? We made it, we are ok… keep rolling on… NOT so fast!nnICD-10 is key to a lot of the new regulations that are rolling out—MIPS and MACRA being great examples. As always it is all about documentation of services. ICD-10 has a lot more granularity, lots more codes to describe conditions and causes. It is this level of granularity that is so powerful. It is incredibly important to accurate HCC (Hierarchical Condition Category) scoring. This is an absolute MUST when it comes to Medicare Advantage plans! Good and especially thorough ICD-10 coding and documentation helps better define conditions. This directly affects HCC scoring. HCC scoring is the Golden Nugget in the MA world.nn


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Todd150About 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.

Providers Still Dealing With Prior Authorization Problems

Providers Still Dealing With Prior Authorization ProblemsA recent survey conducted by AMA reveals that practices are reporting an average of 37 prior authorization requests each week, eating up an average of 16 hours of both physician and staff time. Check out the article, below, by Health Leaders Media, outlining the results of the survey.nnThe healthcare industry hasn’t eliminated the hassles for providers that prior authorization often entails, but they’re getting closer, several speakers said here at Healthcare Information and Management Systems Society (HIMSS) annual meeting.nn“Studies have shown that prior authorization is the biggest ‘pain point’ among providers,” Pam Jodock, senior director of healthcare business solutions at HIMSS, said at a Tuesday morning meeting session. “The issue is not automation; it’s the business processes to which automation would be applied.”nnThe six groups represented at the morning session are hoping to develop consistency in the requirements for getting a prior authorization and reducing the number of treatments and procedures that require it, she added. “The fact that we have six [groups represented] is because this is a critical issue of everybody on the stage today.”nnCLICK HERE TO READ MORE.nnThis article originally posted on HealthLeadersMedia.com.

Former Aetna CEO Claims Obamacare is Flawed

Former Aetna CEO Claims Obamacare is FlawedFormer Aetna CEO claims Obamacare is flawed, read more below about what former Aetna CEO Ronald William’s has to say about Obamacare. nnSince the Affordable Care Act became law in 2010, making the math work has been a real challenge. For Obamacare to be sustainable, the insurance “risk pool” equation has to work. Premiums from young, healthy consumers have to exceed medical care costs for older people. Was there a problem with the formula?nn”I think it was flawed,” former Aetna CEO Ronald Williams told CNBC’s On The Money in an interview.nn”In health care you really need a balance of people who need health care today, tomorrow and in the future,” he said. “And the rate structure was set in a way that those who needed health care today got the most affordable premiums. That means typically older citizens got a much better deal.”nnWhile the Affordable Care Act was being created, Williams often met with President Obama or his staff, and testified before Congress as Aetna CEO from 2006 to 2010. Obamacare has a “structural imbalance” that resulted in higher costs for healthier, younger people, Williams said, but lower costs for those who are “older and more likely to need care.”nnAs a result, “Younger participants in the exchanges and who purchase individual insurance paid more and they just didn’t see the value, and therefore they did not come forward and sign up,” he said. Williams said that because young adults chose not to sign up for ACA, the insurance industry is “missing their premiums and that’s causing the overall rate of increase to be greater.”nnThat, in turn, is helping “make the insurance pool unsustainable financially,” he said.nnSince stepping down as Aetna’s chief executive in 2010, Williams has been CEO of his own consultancy, RW2 Enterprises. He’s also a director of American Express, Boeing, and Johnson & Johnson. With President Trump vowing to dismantle the Affordable Care Act, the public doesn’t yet know what will replace it.nnWilliams said what is needed is “much more competition” and lower cost, more flexible plans so that consumers have “a range of options as opposed to a ‘one-size-fits-all’ approach.”nnWhile we hear a lot about repealing ACA, the jury is still out on what comes next. The process of getting Obamacare created took years of negotiating and planning from various and multiple parts of the health care system. Is the same thing going to have to take place again to remake the Affordable Care act?nn”I think it does,” Williams said. “We need to make changes in a thoughtful way. We need the input of hospitals, physicians, pharmaceutical companies, health insurers and consumers.”nnThis article was originally posted on Cnbc.com.

Anthem CEO Joseph R. Swedish Appeal Decision To Merge With Cigna

Anthem CEO Joseph R. Swedish Appeal Decision To Merge With CignannAnthem CEO Joseph R. Swedish appeals the federal judge’s decision to merge with Cigna and claimed merger would save consumers $2 billion in medical costs. Read more about the Anthems appeal below.nnAnthem CEO Joseph R. Swedish said he was “significantly disappointed” with the federal judge’s decision and claimed the merger would save consumers more than $2 billion in medical costs annually.nnAlmost immediately after the court ruling that shut down its plans to merge with Cigna in a $54 billion deal, Anthem announced Thursday that it will appeal the decision.nnOn Wednesday Judge Amy Berman Jackson of the D.C. District Court agreed with antitrust regulators that the merger would create an insurance giant that would unfairly control much of employer-provided health coverage in the country.nn”The company promptly intends to file a notice of appeal and request an expedited hearing of its appeal to reverse the Court’s decision so that Anthem may move forward with the merger, which was approved by over 99% of the votes cast by the shareholders of both companies,” the company said in a statement.nnJoseph R. Swedish, chairman, president and chief executive officer of Anthem, said he was “significantly disappointed” and claimed the merger would save consumers more than $2 billion in medical costs annually.nn”If not overturned, the consequences of the decision are far-reaching and will hurt American consumers by limiting their access to high quality affordable care, slowing the industry’s shift to value-based care and improved outcomes for patients, and restricting innovation which is critical to meeting the evolving needs of healthcare consumers,” Swedish said.nn”Moving forward, Anthem will continue to work aggressively to complete the transaction while remaining focused on serving as America’s valued health partner, delivering superior health care services to our approximately 40 million members with greater value at less cost.”nnIn the parallel case argued on the same grounds, a federal judge last month blocked the proposed $37 billion merger of Aetna and Humana. It is not known if that decision will be appealed.nnThis article was originally posted on Healthleadersmedia.com.

Federal Judge Blocks Proposed Health Insurer Aetna-Humana Merger

Federal Judge Blocks Proposed Health Insurer Aetna-Humana MergerThe proposed merger of Aetna Inc. and Humana Inc. was blocked by a United States Federal Judge earlier this week. Read more about this in the article below. nnA U.S. judge blocked on Monday health insurer Aetna Inc’s proposed $34 billion acquisition of smaller peer Humana Inc, raising the stakes for rival Anthem Inc as it battles to close a $54 billion deal to buy Cigna Corp. The ruling is another victory for the U.S. Justice Department, whose antitrust enforcement became much more aggressive during former U.S. President Barack Obama’s eight years in office, which ended last week.nnObama’s successor, Donald Trump, and a Republican-controlled legislature are seeking to undo much of the Affordable Care Act, better known as Obamacare. The law reshaped the U.S. healthcare industry by mandating health insurance and creating online exchanges where consumers can shop for individual policies and get subsidies. Aetna, Humana, Anthem and Cigna had cited Obamacare as one of the main reasons their industry needed to consolidate to cope with the costs of expanding coverage. Their shares ended trading on Monday at levels that suggested that investors continued to see little chance that the two mergers would happen.nnThe U.S. Justice Department filed a lawsuit last July to block Aetna’s acquisition of Humana and Anthem’s acquisition of Cigna, arguing that the two deals would lead to higher prices. Anthem and Cigna are still waiting for a judge to rule on whether their merger can proceed. Investors have long been skeptical that this deal can be approved, and Leerink Research analyst Ana Gupte reiterated on Monday that she expected to also see this deal blocked. In his ruling, Judge John Bates of the U.S. District Court for the District of Columbia said the proposed deal would “substantially lessen competition” in the sale of Medicare Advantage plans in 364 counties in 21 states that the Justice Department had identified in its complaint, and on the Obamacare exchange in three Florida counties.n

Click Here To Read More

nThis article was originally posted on Reuters.com.

Affordable Care Act In Trouble: How It Can Affect Your Taxes

Affordable Care Act In Trouble: How It Can Affect Your TaxesThe Affordable Care Act (Obama Care) looks to be the first target of a Republican dominated House, Senate and President!nnMuch in the ACA is entangled in the current tax code. It will not be as simple as defunding it. The employer and individual mandates, the premium tax credit, the (so called) Cadillac Tax, the earned income surtax (just to name a few examples) will all have to be revisited.nnBe on the lookout for big and potentially complicated tax changes as our President and legislators unwind this enormous law we now call Obama Care.nnWhile we are at it, just an FYI: The shorter depreciation schedule for race horses appears to be expiring!nnPlease consult your tax professional for more details and information prior to making any changes!nn


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Todd150About 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.

Tom Price, MD. Trump’s Incoming Secretary of HHS

Tom Price, MD. Trump’s Incoming Secretary of HHSTom Price’s Vision – Commercial & Individualn

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  • Encourage Private Exchanges for purchase of individualized products across state lines
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  • Create federal Grants for States to create high-risk pools
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  • Eliminate individual Mandate
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  • Comprehensive Medical Liability Reform allowing conformity to clinical guidelines to serve as an affirmative defense to liability
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  • Claims Transparency from insurers to employers and individuals
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  • Freedom of choice for any patient to contract directly with any willing provider
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  • Anti-trust Exemption for non-economically aligned physicians to negotiate collectively with insurers (except Medicare, Medicaid, SCHIP, FEHB, or Indian Healthcare)
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2017 CPT Code Changes

2017 CPT Code ChangesWritten 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 2017 CPT code changes take effect January 1st. Understanding the myriad of upcoming changes is crucial to obtaining the proper reimbursement for your services! The changes for 2017 address a number of interrelated issues. Clinical practice and technology have evolved and several issues required much needed CPT expansion and clarification. CPT 2017 offers the most changes in spine and orthopedic procedures, chronic care management, physical and occupational therapy, as well as significant changes in the reporting of moderate sedation services.n*Please note, this article is not an all-inclusive list; review your 2017 CPT book for complete descriptions of all changes. Appendix B of 2017 CPT provides a summary of additions, deletions, and revisions.nnHighlights of the most significant changes:n

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  • Moderate Sedation
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  • Chronic Care Management
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  • Flu Vaccinations
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  • Spinal Instrumentation
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  • Orthopedics
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  • Physical and Occupational Therapy
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  • Spinal Steroid/Epidural Injections
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2017 CPT Code Changes: Moderate Sedation

2017 CPT Code Changes: Moderate SedationModerate sedation services have historically always been bundled into the majority of all applicable CPT procedures. More than 400 codes that were previously defined as including moderate sedation have been deleted from Appendix G. In addition to six new CPT codes and one new endoscopy-specific HCPCS code, CMS intends to create a “uniform methodology for valuation of the procedural codes that currently include moderate sedation as an inherent part of the procedure” with this year’s CPT updates. Providers who perform moderate sedation with a procedure must report the appropriate new moderate sedation codes to receive full reimbursement. As a result of removing this long time bundling edit, many procedures will see a slight reduction in RVU.n

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  • 99151 – Moderate sedation services provided by the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the monitoring of the patient’s level of consciousness and physiological status; initial 15 minutes of intraservice time, patient younger than 5 years of age
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  • 99152 – Initial 15 minutes of intraservice time, patient age 5 years or older
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  • 99153 – Each additional 15 minutes intraservice time
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  • 99155 – Moderate sedation services provided by the physician or other qualified health care professional other than the physician performing the diagnostic or therapeutic service that the sedation supports; initial 15 minutes of intraservice time, patient younger than 5 years of age
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  • 99156 – Initial 15 minutes of intraservice time, patient age 5 years or older
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  • 99157 – Each additional 15 minutes intraservice time
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  • G0500 – Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports
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Go Back To CPT Code Change Directory

2017 CPT Code Changes: Chronic Care Management

2017 CPT Code Changes: Chronic Care ManagementEffective Jan. 1st, CMS will begin paying for complex CCM services (99487-99489) in addition to normal CCM (99490). These CPT codes have been around for a while, but CMS has always refused to reimburse for them. Keep in mind, to get paid, you must be able to properly note all the moving parts of this service in the medical record as indicated by the coding guidelines.nnCMS has also created a new add-on G code — G0506 (Comprehensive assessment of and care planning for patients requiring chronic care management services [List separately in addition to primary monthly care management service]).nnIt covers the additional work associated with assessing CCM services and generating a care plan. This used to be bundled into payment for an office visit (99201-99215), but in 2017 you can get paid EXTRA for it if you nail down your documentation. You’ll also find relaxed billing rules for CCM services in 2017, which include getting rid of a beneficiary consent form and removing the requirement for 24/7 access to care.n

Go Back To CPT Code Change Directory

2017 CPT Code Changes: Spinal Instrumentation

2017 CPT Code Changes: Spinal InstrumentationSeveral new codes will replace long time spinal biomechanical device code 22851. The new codes are more specific regarding the type and location of the biomechanical devices.n

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  • 22853 – Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure)
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  • 22854 – Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)
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  • 22859 – Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)
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nAdditional codes have been created to replace temporary codes for interspinous process decompression devices (IPD).n

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  • 22867 – Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level
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  • 22868 – Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; second level (List separately in addition to code for primary procedure)
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  • 22869 – Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level
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  • 22870 – Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; second level (List separately in addition to code for primary procedure)
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Go Back To CPT Code Change Directory