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


nn

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

    n

  • Encourage Private Exchanges for purchase of individualized products across state lines
  • n

  • Create federal Grants for States to create high-risk pools
  • n

  • Eliminate individual Mandate
  • n

  • Comprehensive Medical Liability Reform allowing conformity to clinical guidelines to serve as an affirmative defense to liability
  • n

  • Claims Transparency from insurers to employers and individuals
  • n

  • Freedom of choice for any patient to contract directly with any willing provider
  • n

  • Anti-trust Exemption for non-economically aligned physicians to negotiate collectively with insurers (except Medicare, Medicaid, SCHIP, FEHB, or Indian Healthcare)
  • n

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

    n

  • Moderate Sedation
  • n

  • Chronic Care Management
  • n

  • Flu Vaccinations
  • n

  • Spinal Instrumentation
  • n

  • Orthopedics
  • n

  • Physical and Occupational Therapy
  • n

  • Diagnostic and Interventional Radiology
  • n

  • Spinal Steroid/Epidural Injections
  • n

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

    n

  • 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
  • n

  • 99152 – Initial 15 minutes of intraservice time, patient age 5 years or older
  • n

  • 99153 – Each additional 15 minutes intraservice time
  • n

  • 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
  • n

  • 99156 – Initial 15 minutes of intraservice time, patient age 5 years or older
  • n

  • 99157 – Each additional 15 minutes intraservice time
  • n

  • G0500 – Moderate sedation services provided by the same physician or other qualified health care professional performing a gastrointestinal endoscopic service that sedation supports
  • n

n

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

    n

  • 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)
  • n

  • 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)
  • n

  • 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)
  • n

nAdditional codes have been created to replace temporary codes for interspinous process decompression devices (IPD).n

    n

  • 22867 – Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level
  • n

  • 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)
  • n

  • 22869 – Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level
  • n

  • 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)
  • n

n

Go Back To CPT Code Change Directory

2017 CPT Code Changes: Flu Vaccinations

2017 CPT Code Changes: Flu VaccinationsInfluenza codes received a makeover with this year’s CPT update. The codes are no longer classified based on age. The descriptions of these codes now reflect dosage amounts. Codes now state “becomes 0.25 mL dosage” in place of “when administered to children 6-35 months of age” and “becomes 0.5 mL dosage” in place of “when administered to individuals three years and older”. These changes affect codes 9065590661 and 9068590688.nn

Go Back To CPT Code Change Directory

2017 CPT Code Changes: Physical and Occupational Therapy

2017 CPT Code Changes: Physical and Occupational TherapyPhysical and occupational therapy codes received a major overhaul with this year’s CPT update. Codes have been expanded to take into account the overall evaluation complexity. The new codes incorporate a tiered level of complexity for physical and occupational therapy as well as athletic training evaluations. These new codes also require a substantial increase in the volume and quality of clinical documentation needed to capture these services compliantly.n

    n

  • 97161 – Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact the plan of care; An examination of body system(s) using standardized tests and measures addressing 1-2 elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with stable and/or uncomplicated characteristics; and Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 20 minutes are spent face-to-face with the patient and/or family.
  • n

  • 97162 – Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures in addressing a total of 3 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; An evolving clinical presentation with changing characteristics; and Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 30 minutes are spent face-to-face with the patient and/or family.
  • n

  • 97163 – Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/or comorbidities that impact the plan of care; An examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures and functions, activity limitations, and/or participation restrictions; A clinical presentation with unstable and unpredictable characteristics; and Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 45 minutes are spent face-to-face with the patient and/or family.
  • n

  • 97164 – Re-evaluation of physical therapy established plan of care, requiring these components: An examination including a review of history and use of standardized tests and measures is required; and Revised plan of care using a standardized patient assessment instrument and/or measurable assessment of functional outcome Typically, 20 minutes are spent face-to-face with the patient and/or family.
  • n

  • 97165 – Occupational therapy evaluation, low complexity, requiring these components: An occupational profile and medical and therapy history, which includes a brief history including review of medical and/or therapy records relating to the presenting problem; An assessment(s) that identifies 1-3 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of low complexity, which includes an analysis of the occupational profile, analysis of data from problem-focused assessment(s), and consideration of a limited number of treatment options. Patient presents with no comorbidities that affect occupational performance. Modification of tasks or assistance (eg, physical or verbal) with assessment(s) is not necessary to enable completion of evaluation component. Typically, 30 minutes are spent face-to-face with the patient and/or family.
  • n

  • 97166 – Occupational therapy evaluation, moderate complexity, requiring these components: An occupational profile and medical and therapy history, which includes an expanded review of medical and/or therapy records and additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment(s) that identifies 3-5 performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of moderate analytic complexity, which includes an analysis of the occupational profile, analysis of data from detailed assessment(s), and consideration of several treatment options. Patient may present with comorbidities that affect occupational performance. Minimal to moderate modification of tasks or assistance (eg, physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component. Typically, 45 minutes are spent face-to-face with the patient and/or family.
  • n

  • 97167 – Occupational therapy evaluation, high complexity, requiring these components: An occupational profile and medical and therapy history, which includes review of medical and/or therapy records and extensive additional review of physical, cognitive, or psychosocial history related to current functional performance; An assessment(s) that identifies 5 or more performance deficits (ie, relating to physical, cognitive, or psychosocial skills) that result in activity limitations and/or participation restrictions; and Clinical decision making of high analytic complexity, which includes an analysis of the patient profile, analysis of data from comprehensive assessment(s), and consideration of multiple treatment options. Patient presents with comorbidities that affect occupational performance. Significant modification of tasks or assistance (eg, physical or verbal) with assessment(s) is necessary to enable patient to complete evaluation component. Typically, 60 minutes are spent face-to-face with the patient and/or family.
  • n

  • 97168 – Re-evaluation of occupational therapy established plan of care, requiring these components: An assessment of changes in patient functional or medical status with revised plan of care; An update to the initial occupational profile to reflect changes in condition or environment that affect future interventions and/or goals; and A revised plan of care. A formal reevaluation is performed when there is a documented change in functional status or a significant change to the plan of care is required. Typically, 30 minutes are spent face-to-face with the patient and/or family.
  • n

  • 97169 – Athletic training evaluation, low complexity, requiring these components: A history and physical activity profile with no comorbidities that affect physical activity; An examination of affected body area and other symptomatic or related systems addressing 1-2 elements from any of the following: body structures, physical activity, and/or participation deficiencies; and Clinical decision making of low complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 15 minutes are spent face-to-face with the patient and/or family.
  • n

  • 97170 – Athletic training evaluation, moderate complexity, requiring these components: A medical history and physical activity profile with 1-2 comorbidities that affect physical activity; An examination of affected body area and other symptomatic or related systems addressing a total of 3 or more elements from any of the following: body structures, physical activity, and/or participation deficiencies; and Clinical decision making of moderate complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 30 minutes are spent face-to-face with the patient and/or family.
  • n

  • 97171 – Athletic training evaluation, high complexity, requiring these components: A medical history and physical activity profile, with 3 or more comorbidities that affect physical activity; A comprehensive examination of body systems using standardized tests and measures addressing a total of 4 or more elements from any of the following: body structures, physical activity, and/or participation deficiencies; Clinical presentation with unstable and unpredictable characteristics; and Clinical decision making of high complexity using standardized patient assessment instrument and/or measurable assessment of functional outcome. Typically, 45 minutes are spent face-to-face with the patient and/or family.
  • n

  • 97172 – Re-evaluation of athletic training established plan of care requiring these components: An assessment of patient’s current functional status when there is a documented change; and A revised plan of care using a standardized patient assessment instrument and/or measurable assessment of functional outcome with an update in management options, goals, and interventions. Typically, 20 minutes are spent face-to-face with the patient and/or family.
  • n

n

Go Back To CPT Code Change Directory

2017 CPT Code Changes Spinal Steroid: Epidural Injections

2017 CPT Code Changes Spinal Steroid:Epidural InjectionsThere are 8 new CPT codes to reflect epidural spinal injections. These new codes are classified by both anatomy and whether imaging guidance was used and replace codes 62310 – 62319.n

    n

  • 62320 – Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance
  • n

  • 62321 – Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie, fluoroscopy or CT)
  • n

  • 62322 – Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance
  • n

  • 62323 – Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT)
  • n

  • 62324 – Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance
  • n

  • 62325 – Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie, fluoroscopy or CT)
  • n

  • 62326 – Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance
  • n

  • 62327 – Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT)
  • n

n

Go Back To CPT Code Change Directory

2017 CPT Code Changes: Orthopedics

2017 CPT Code Changes OrthopedicsBunionectomy codes underwent expansion and revision in this year’s CPT update. Two new codes were added to reflect more accurate procedural options as well as many revisions to the technical descriptions of existing bunion correction codes.n

    n

  • 28291 – Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant
  • n

  • 28295 – Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal metatarsal osteotomy, any method
  • n

n

Go Back To CPT Code Change Directory

2017 CPT Code Changes Diagnostic and Interventional Radiology

2017 CPT Code Changes Diagnostic and Interventional RadiologyThe most significant changes this year for diagnostic and interventional radiology involve mammography bundling, ultrasound screenings for AAA, and fluoroscopy services. Fluoroscopy codes 77002-77003 are now subject to the global period concept and are designated add-on codes.nnMammography services now include computer – aided detection (CAD), which eliminated the add-on codes reported in previous years. CMS is still requiring the use of HCPCS G-codes and will not eliminate these codes until 2018.n

    n

  • 77065 – Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral
  • n

  • 77066 – Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral
  • n

  • 77067 – Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed
  • n

  • G0202 – Screening mammography, producing direct digital image, bilateral, all views
  • n

  • G0204 – Diagnostic mammography, producing direct 2D digital image, bilateral, all views
  • n

  • G0206 – Diagnostic mammography, producing direct 2D digital image, unilateral, all views
  • n

nA new code has been created to specifically screen for an abdominal aortic aneurysm. This CPT code will replace G0389, which has been used in previous years.n

    n

  • 76706 – Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA)
  • n

n

Go Back To CPT Code Change Directory

What is The Bottom Line? Commercial Health Plans and Controlling Your Costs

What is The Bottom Line? Commercial Health Plans and Controlling Your CostsAt the end of the day, contracting in this day of pay–for–performance and adding value to the relationship is about the bottom line. What is the bottom line? The Spend!nnIn most states, including Colorado, the commercial health plans have to tell the state what their premiums are. Their premiums come from their estimate as to what their network and covered population will cost. I find it fascinating to look and see what the various payers are declaring! You can tell a lot about a network and its management by looking at these numbers.nnCan a provider help a payer lower its spend? Can you control costs? Not necessarily your own costs but the costs of those you refer to? You may be surprised!n

The bottom line, don’t give it (this ability) away!

n

Stay tuned for more Todd’s Tips!

nnn


nn

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.

Transition to the Colorado InterChange and New Provider Web Portal

Transition to the Colorado InterChange and New Provider Web PortalTransition InformationnOn March 1, 2017, Hewlett Packard Enterprises (HPE) will assume fiscal agent operations on behalf of Health First Colorado (Colorado’s Medicaid program) and Child Health Plan Plus (CHP+). These operations include the transition to the Colorado interChange (a new claims payment system) and a new provider Web Portal.nnYou must be enrolled in the new Colorado interChange. All providers must be enrolled (and approved) in the Colorado interChange system by March 1, 2017. Those who are not enrolled and approved will not be able to submit claims or receive payments. Visit Colorado.gov/HCPF/Provider-Enrollment for more information.nnAll ordering, prescribing, or referring (OPR) providers must be enrolled in the new Colorado interChange. The Affordable Care Act (ACA) now requires physicians and other eligible practitioners to enroll in the Medicaid program to order, prescribe, and refer items or services for Medicaid members, even when they do not submit claims to Medicaid. Claims listing an OPR provider that is not enrolled cannot be paid. Visit Colorado.gov/HCPF/OPR for more information.nnClearinghouse Enrollment & TestingnIf you utilize a Clearinghouse to submit batch claims or eligibility transactions, your Clearinghouse MUST apply for an interChange Trading Partner ID (TPID) and pass test transactions for HIPAA compliance. Clearinghouses without an interChange TPID will not be able to submit batch claims or receive reports beginning March 1, 2017.nnPlease check this list to see if your Clearinghouse has enrolled and passed testing. If your Clearinghouse has not started or has not completed their testing, we recommend that you reach out and remind them to do so immediately. Your Clearinghouse can learn more information about applying for a new TPID at: Colorado.gov/HCPF/EDI-support.nnContact UsnIf you need assistance with your revalidation or enrollment application, please call the Health First Colorado Enrollment and Revalidation Information Center at: 1-844-235-2387. Standard operating hours are 8am – 5pm MT, Monday – Friday.nnPlease Note: For billing, claims and Provider ID questions regarding the current Xerox system, please continue to call Xerox State Healthcare at: 1-800-237-0757.nnThis article originally posted on Colorado.gov.

HHS Nominee Tom Price

HHS Nominee Tom Price

Photo Courtesy of Healthleadersmedia.com.

nnThe medical establishment is praising the appointment of Tom Price, MD, to lead the Department of Health and Human Services. That enthusiasm is not shared by women’s health advocates and some Democrats in Congress.nnPresident-elect Donald Trump’s nomination of Rep. Tom Price, (R-GA), an orthopedic surgeon and avowed opponent of Obamacare, was greeted with high praise by the major professional lobbies in the healthcare sector. “As healthcare continues to evolve and as care becomes more patient centered, Dr. Price’s experience both as a surgeon, along with practicing at Emory University and Grady Memorial Hospital, makes him uniquely qualified to lead the Department of Health and Human Services,” said American Hospital Association CEO Rick Pollack.nn”He has spent most of his career working in hospitals as an orthopedic surgeon, and his experience as a provider of care will serve patients well in this new role. We have worked with him as a member of the House Ways and Means Committee and as Chairman of the House Budget Committee. His clinical knowledge along with his congressional experience make him an impressively qualified candidate for HHS secretary.” Patrice A. Harris, MD, chair of the American Medical Association Board of Trustees, urged the Senate to “promptly consider and confirm Dr. Price for this important role.”nn”The American Medical Association strongly supports the nomination of Dr. Tom Price to become the next Secretary of Health and Human Services. His service as a physician, state legislator and member of the U.S. Congress provides a depth of experience to lead HHS,” Harris said. “Dr. Price has been a leader in the development of health policies to advance patient choice and market-based solutions as well as reduce excessive regulatory burdens that diminish time devoted to patient care and increase costs.”nnMarilyn Tavenner, president and CEO of America’s Health Insurance Plans, said that Price has for years “been committed to ensuring that patients and consumers are well-served. He will bring a balanced and thoughtful perspective to his role as Secretary of HHS. We look forward to working with him to promote competition, increase choice, and lower costs for every consumer.”n

Click Here To Read More

nThis article was originally posted on Healthleadersmedia.com.

Overtime Pay: Federal Judge Blocks Obama Administration’s Rule

Federal Judge Blocks Obama Administration's Overtime Pay RuleWith just over a week before it was scheduled to take effect, a federal judge blocked the implementation of an Obama administration overtime pay rule that would have extended overtime eligibility to some 4 million Americans.nnThe Labor Department’s sweeping overhaul to the overtime rule required employers to pay time-and-a-half to their employees who worked more than 40 hours in a given week and earned less than $47,476 a year. That salary threshold is about twice what currently allows workers to be exempted from overtime. As NPR’s White House Correspondent Scott Horsley told our Newscast Unit, supporters of the rule called it “long overdue” as inflation took its toll on overtime protection.nn”The rule was one of the administration’s most far-reaching efforts to boost pay for workers at the lower end of the income ladder. It’s one of many administrative actions that was already facing the threat of reversal from the incoming Trump administration.” The measure, which had been set to take effect Dec. 1, was intended to send a jolt to slow-growing U.S. incomes.nnOn Tuesday, U.S. District Judge Amos Mazzant III issued a preliminary injunction in the case, siding with plaintiffs who said the new overtime rules would have caused an uptick in government costs in their states and made it mandatory for businesses to pay millions in additional salaries. Business groups said the new rule changes would have eventually led to layoffs.nnThe timing of the block brings an early answer for workers who were wondering about the rule’s fate after the election. As NPR’s Business Correspondent Yuki Noguchi reported earlier this month: “In any presidential transition, previous policies are subject to review. Trump has pledged to undo President Obama’s executive orders, dismantle the Affordable Care Act, reverse policies on clean air, immigration and on Dodd-Frank financial reform. This [month], the Congressional Budget Office said canceling the overtime rule would reduce employers’ compliance costs and boost profits, a point advocates refute. This leaves businesses wondering how they should proceed on rules that might be unwound.”nnWith Republicans controlling both houses in Congress and the Trump administration set to take office in less than two months, the new overtime rule’s long-term future remains in limbo. The Department of Labor issued the following statement regarding the federal court’s preliminary injunction.n

Click Here To Read More

nThis article was originally posted on Npr.org.

Happy Thanksgiving From Welter Healthcare Partners

Happy Thanksgiving From  Welter Healthcare PartnersHappy Thanksgiving! We are very happy whenever the season of Thanksgiving is fast approaching because we consider this as a wonderful holiday that permit us the best opportunity to thank all our valued friends, supporters and clients. These previous years have really been good to our company, and so we thank all of you for continuing to patronage us and for experiencing our remarkable service.nnWishing you and your family a wonderful Thanksgiving!n— Welter Healthcare Partners