Aug 18, 2016 | Uncategorized
Problems…everyone has them. Every practice has them. A good manager knows problems and setbacks are out there and does h/her best to get in front of issues before they become major and even worse, destructive. It starts with honest assessments. An honest look at ones own shortcomings first and then the issues which do or could affect the practice and those within it. issues within a practice or department no matter how small and seemingly in consequential become destructive and even career ending when they are allowed to!nn
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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.
Aug 18, 2016 | Uncategorized
W16.111A – Fall into natural body of water striking water surface causing drowning and submersion, initial encounternnV92.06XA – Drowning and submersion due to fall off (nonpowered) inflatable craft, initial encounternnY93.16 – Activity, rowing, canoeing, kayaking, rafting and tubing
Aug 18, 2016 | Uncategorized
Medicare pays for clinical diagnostic laboratory tests (CDLTs) under the CLFS. The CLFS provides payment for approximately 1,300 CDLTs, and Medicare pays approximately $7 billion per year for these tests. As of July 6th, 2016, some of the medicare & medicaid rules and policies are changing. Read Below for some facts and information about the upcoming changes:n
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- The 2017 Medicare physician fee schedule conversion factor will drop slightly, from 35.8043 to 35.7551.
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- Family Medicine looks to be the big winner this year with a 3% increase
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- Interventional Radiology will take a huge 7% hit.
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- Pathology and Vascular surgery will also decrease by an average of 2%
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- Telehealth will see an expansion of coverage there will be new codes for these services
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- Zero-day global services are under increased study. These are the codes which are commonly billed with an E&M code along with the modifier -25
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nProposed Hospital Outpatient Payment Changes for 2017nnOn July 6, 2016, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2017 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System policy changes, quality provisions, and payment rates proposed rule (CMS-1656-P). CMS is proposing a number of outpatient prospective payment policies that will improve the quality of care Medicare patients receive.nnA key proposal in this year’s rule is to implement Section 603 of the Bipartisan Budget Act of 2015, which will affect how Medicare pays for certain items and services furnished by certain off-campus outpatient departments of a provider (hereinafter referenced as off-campus “provider-based departments” (PBDs)). In addition, CMS has listened to concerns raised by health care providers on the patient experience survey questions about pain management and is proposing to remove the Pain Management dimension of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey for purposes of the Hospital Value Based Purchasing Program. In addition to the payment provisions and quality reporting program changes for the OPPS/ASC proposed rule, CMS has created other propositions.n
Click Here to Read More
nThis article was originally posted on CMS.gov.
Jul 27, 2016 | Uncategorized
The Justice Department is suing to block two proposed mergers between major health insurance companies, saying the deals violate antitrust laws and would lead to higher health care costs for Americans.nnU.S. Attorney General Loretta Lynch explained the decision at a press conference:n
“If allowed to proceed, these mergers would fundamentally reshape the health insurance industry. They would leave much of the multitrillion-dollar health insurance industry in the hands of three mammoth insurance companies, drastically constricting competition in a number of key markets that tens of millions of Americans rely on to receive health care.nn”Among other consequences, the number of health insurance options available to nationwide employers would shrink from four to three. Two of the largest and fastest-growing providers of Medicare Advantage plans, which millions of seniors rely on for crucial medical coverage, would combine into just one. And competition would be substantially reduced for hundreds of thousands of families and individuals who buy insurance on the public exchanges established under the Affordable Care Act.”
nThe lawsuits filed Thursday morning challenged a $37 billion merger between Humana and Aetna, which the Justice Department alleges “would lead to higher health-insurance prices, reduced benefits, less innovation, and worse service for over a million Americans,” and a $54 billion acquisition of Cigna by Anthem, which the court filing states would be the largest merger in the history of the health insurance industry.n
CLICK HERE TO READ MORE
nThis article originally posted on NPR.org.
Jul 27, 2016 | Uncategorized
T67.0XXD — Heatstroke and sunstroke, subsequent encounternnY93.02 — Activity, runningnnY92.414 — local residential or Business Street as the place of occurrence of the external cause
Jul 26, 2016 | Uncategorized
On July 7, 2016, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that updates payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2017. This year, CMS is proposing a number of new physician fee schedule policies that will improve Medicare payment for those services provided by primary care physicians for patients with multiple chronic conditions, mental and behavioral health issues, and cognitive impairment or mobility-related disabilities.nnCMS is proposing to expand the Diabetes Prevention Program model starting January 1, 2018. This is the second CMS Innovation Center – and first preventive services – model that has been certified for expansion. Expansion of this model will enhance access to these important services for Medicare beneficiaries who are at risk for developing diabetes.nnIn addition CMS is also:n
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- Proposing modifications to the Medicare Shared Savings Program to update the quality measures set and align with the proposals for the Quality Payment Program, changes to take beneficiary preferences for ACO assignment into consideration, and changes that would improve beneficiary protections when ACOs are approved to use the skilled nursing facility (SNF) 3-day waiver rule;
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- Requiring health care providers and suppliers to be screened and enrolled in Medicare in order to contract with Medicare Advantage health plans to provide Medicare-covered items and services to beneficiaries enrolled in Medicare Advantage;
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- Increasing transparency of Medicare Advantage pricing data and medical loss ratio (MLR) data from Medicare health and drug plans, and;
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- Continuing to implement Appropriate Use Criteria for advanced diagnostic imaging services, including proposals for priority clinical areas and clinical decision support mechanism (CDSM) requirements, among other proposals as detailed in this fact sheet.
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nThe CY 2017 PFS proposed rule is one of several proposed rules that reflect a broader Administration-wide strategy to create a health care system that results in better care, smarter spending, and healthier people.n
CLICK HERE TO READ MORE
nThis article originally posted on CMS.gov.
Jul 25, 2016 | Uncategorized
S62.035A — Non–displaced fracture of proximal third of navicular [scaphoid] bone of left wrist, initial encounter for closed fracturennY93.18 — Activity, surfing, windsurfing and boogie boardingnnY92.832 — Beach as the place of occurrence of the external causenn
Jun 21, 2016 | Uncategorized
Novitas Solutions Update: Automated Claim Correction via the Interactive Voice Recognition (IVR) Unit – Coming Soon!
nAutomated Claim Correction via the Interactive Voice Recognition (IVR) unit is coming soon, which will allow you to conduct an unlimited number of telephone claim corrections for select Medicare Part B claims via the IVR. In order to ensure the best possible automated claim correction tool to valued customers, Novitas Solutions has revised their implementation schedule as follows:nn
nnLearn More – Webinars Coming Soon!nnWant to know more and be prepared for your implementation? Visit the Novitas Solutions website for webinar dates and more information!
Jun 17, 2016 | Uncategorized
Learn All About Colorado Medicaid’s New Name
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nCheck out this release from Colorado Medicaid on their re-branding. You won’t want to miss out on this interesting opportunity to learn more about upcoming changes to the Colorado Medicaid program. nnnColorado Medicaid is changing its name to Health First Colorado (Colorado’s Medicaid Program) this summer. Join the Colorado Department of Health Care Policy & Financing for a webinar exclusively for health care providers to learn about this exciting change! Two dates are available for the webinar. Pick the date below that works best for you and your team.nnWednesday, June 22, 2016n12:00 – 1:00 pm MTnClick here to register-June 22nnTuesday, June 28, 2016n12:00 – 1:00 pm MTnClick here to register-June 28 Who Should Attend?nnHealth care providers and office staff who interact with Medicaid patients or the Department of Health Care Policy & Financing should attend this webinar to learn about the name change and what is affected by the change.nnWhy Attend?nnLearn about why Colorado Medicaid is changing its name, and how this affects your patients and practice. We will also direct you to helpful resources to educate your patients about the change.nn*Presentation Materials will be available for download following the webinar.
Jun 17, 2016 | Uncategorized
F10.982 — Alcohol use with other alcohol-induced disordernnT75.3XXA — Motion sickness, initial encounternnY93.18 — Activity, water skiing and wake boarding
Jun 13, 2016 | Uncategorized
S93.411A — Sprain of calcaneofibular ligament of right ankle, initial encounternnY93.E5 — Activity, floor mopping and cleaningnnY92.010 — Kitchen of single-family (private) house as the place of occurrence of the external cause
Jun 13, 2016 | Uncategorized
Make sure you are prepared for the new MFA login authentication!nnThe CMS Enterprise Identity Management System (EIDM) is implementing a Multi-Factor Authentication (MFA) requirement to help improve CMS’ ability to ensure system security.nnAs of June 19, 2016, all Novitasphere Portal users will need to use MFA when logging into both EIDM and the Novitasphere website.nnTo prepare for this new level of security and avoid log in issues on June 19, we are strongly encouraging customers to set up their MFA device NOW. Once your device is registered, you will be required to enter a security code from your device each time you log in to Novitasphere and EIDM.nnWhat is MFA?n
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- MFA is a type of login authentication that, in addition to a User ID and Password, requires another “factor” such as a PIN. To comply with the CMS Policy, Novitasphere users will need to establish a second login “factor” to meet this level of security.
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nWho does this affect?nNovitasphere Portal customers who:n
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- Have a Novitasphere role that was approved before May 8, 2016
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- Do not have any EIDM roles which already require MFA
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nNovitasphere customers who are approved after May 8, 2016:n
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- You will be able to set up your MFA device as of the Friday following your Novitasphere role approval.n
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- Example: For a customer whose Novitasphere role is approved on May 31, 2016, they will be able to set up MFA starting on June 3, 2016.
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How do I add an MFA device?nFor your reference, a document titled “Existing Novitasphere Portal Users Adding Multi-Factor Authentication (MFA)” has been added to the Novitasphere Center, with detailed instructions for an existing user to add an MFA device. If you have questions on the MFA process and registering a device, please review the guide to learn more.nnYou may also wish to view CMS’s EIDM Training Video: MFA Registration and Use. (This video is hosted by YouTube, a 3rd party vendor not affiliated with Novitas Solutions, Inc. In order to view YouTube videos, your company must allow this. If you receive a message that the video is blocked, please contact your network administrator to request an exception. YouTube videos are also accessible via mobile devices, which is an alternate method you may choose to view these.)nnWe strongly encourage you to register more than one type of device, with one of them being the IVR option. Due to known latency issues with the e-mail option, we do not suggest having this as your sole MFA device.nnCustomers who have a role which already requires the use of MFA should follow the instructions here:n
Jun 13, 2016 | Uncategorized
MCO/BHO Provider Enrollment/Revalidation FAQ
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Learn the answers to frequently asked questions about MedicaidnnImportant Notes:nnRevalidation is required for all currently enrolled Medicaid providers (those with a Medicaid ID). MCO/BHO providers that are enrolled in Medicaid as well as credentialed into a plan network must complete the revalidation process.nnMCO/BHO and CHP+ network providers who are currently not enrolled in Medicaid must complete enrollment no later than October 31, 2016. Although the Centers for Medicare and Medicaid (CMS) has extended its deadline for provider revalidation to September 24, 2016, it is critical that Colorado providers complete revalidation and/or enrollment as soon as possible. The Department is launching its new enrollment and claims management system, the Colorado interChange, on November 1, 2016. Starting on that date, claims and encounters submitted by providers who have not enrolled and/or revalidated will be denied. Questions regarding provider revalidation and enrollment should be addressed to Provider.Questions@state.co.us. Please be patient, as response time may run 10-14 days.nnFrequently Asked Questionsnn[vc_toggle title=”1. What is the purpose of this initiative?” size=”sm” el_id=””]New federal regulations established by the Centers for Medicare and Medicaid Services (CMS) require enhanced screening and revalidation of all Medicare, Medicaid, and CHP+ providers. Beginning Sept. 15, 2015, all Colorado providers who want to continue, or begin, providing services to Medicaid and CHP+ members after March 31, 2016, will be required to enroll and revalidate their licensure and business information under new federal enrollment screening criteria. The Department of Health Care Policy and Financing (HCPF) has posted more information on the provider screening rule on their website; click on the Federal Provider Screening Regulations link.[/vc_toggle]nn[vc_toggle title=”2. With revalidation, we understand the providers will keep their existing Medicaid IDs, but may be assigned additional IDs depending on how they’re currently set up. How will the providers and Plans be notified if the existing Medicaid ID changes?” size=”sm” el_id=””]With revalidation, we understand the providers will keep their existing Medicaid IDs, but may be assigned additional IDs depending on how they’re currently set up. How will the providers and Plans be notified if the existing Medicaid ID changes? Current providers will continue to use their Medicaid ID numbers through October 31, 2016. Starting on November 1, all Medicaid and CHP+ providers will be identified in the interChange system either by their NPI or by a system-assigned ID number (for providers not eligible for an NPI). Providers identified by a system-assigned number will be notified shortly before full implementation, hopefully by mid-October. Current/existing Medicaid ID numbers will remain in the system as legacy identifiers but will not be used to pay claims with a DOS of 11/1/16 or later.[/vc_toggle]nnn[vc_toggle title=”3. Plans have to put a process in place to identify providers that have either not revalidated or are up for revalidation (every 3-5 years). In this process, there needs to be a way the MCOs/BHOs can verify the revalidation. How will the MCO/BHO know which providers have been revalidated?” size=”sm” el_id=””]Plans have to put a process in place to identify providers that have either not revalidated or are up for revalidation (every 3-5 years). In this process, there needs to be a way the MCOs/BHOs can verify the revalidation. How will the MCO/BHO know which providers have been revalidated?” The Department is still working on an outreach plan for providers who have not revalidated within established time frames. A spreadsheet was distributed to MCOs/BHOs in mid-January 2016 that listed providers, by county, who had not started revalidation by 12/31/15. MCOs/BHOs should compare this list to their list of network providers that are currently enrolled in Medicaid. An updated list will be provided by the end of February 2016. These providers should be outreach targets. Providers will be notified by the interChange system several months prior to their next revalidation period, which will be either 3 years or 5 years, depending on provider type.[/vc_toggle]nnn[vc_toggle title=”4. Will there be a lookup on the State’s portal (or other mechanisms) similar to verifying eligibility for members, where plans can verify revalidation for providers?” size=”sm” el_id=””]Will there be a lookup on the State’s portal (or other mechanisms) similar to verifying eligibility for members, where plans can verify revalidation for providers?” Not at this time. Providers will be notified of their next required validation.[/vc_toggle]nnn[vc_toggle title=”5. Will there be a list of validated providers available to the plans?” size=”sm” el_id=””]The Department is able to pull a list of providers who have revalidated by NPI number, but cannot pull a list of providers by health plan.[/vc_toggle]nnn[vc_toggle title=”6. We understand providers will get a confirmation letter when they’re revalidated. Can the plans get a copy of this letter template?” size=”sm” el_id=””]The current letter is being revised and a new letter with additional information will be published in the near future. We will provide a copy of both letters. The date for distribution of the new letter is still pending.[/vc_toggle]nnn[vc_toggle title=”7. Can the Plans be a cc on the letter to the providers?” size=”sm” el_id=””]No. Letters are sent directly to the email address submitted by the provider in its revalidation application. A costly systems change would be required to include a cc for health plans in these letters.[/vc_toggle]n
Click Here to Read More
Jun 7, 2016 | Uncategorized
The American Medical Association is pursuing solutions to developed issues in medical liability reforms.
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nnMedical liability reforms are likely to be advanced and challenged in 2016, according to a report published by the American Medical Association. nnTo address existing and developing issues in medical liability, the AMA is pursuing legislative solutions at the federal and state levels. To expedite the resolution of meritorious claims, provide more consistent damage awards, and reduce defensive medicine, 3 states recently passed new bills to create early disclosure system. Other states are likely to design systems to engage in early discussion with patients following adverse health care incidents. States will also work to establish and protect existing medical liability reforms, with implementation of caps on noneconomic and total damages.nnThe report also addresses new movements underway to adopt a no-fault patient compensation system for medical liability in which patients would be compensated automatically; many, including the Physician Insurers Association of America, are not in favor of the no-fault system. Legislation that the AMA will be advocating for in 2016 includes the Sports Medicine Licensure Clarity Act, which would protect sport medicine professionals when they travel with teams across state lines, and the Good Samaritan Health Professionals Act, which will protect health care professionals who volunteer during a federally declared disaster. Lastly, physicians are also supporting medical liability reforms in the midst of legal challenges, including cases that threaten physician-patient confidentiality and cases questioning the admissibility of expert evidence and testimony.n
Click Here to Read More
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This article is originally posted on Endocrinologyadvisor.com.
Jun 7, 2016 | Uncategorized
S01.02XA — Laceration with foreign body of scalp, initial encounternnW61.33XA — Pecked by chicken, initial encounternnY92.72 — Chicken coop as the place of occurrence of the external cause
May 24, 2016 | Uncategorized
Creating comprehensive patient payment plans makes it painless for staff and members.
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nnIf you think it’s tough to create a comprehensive patient payment plan among the staff members of your own practice, imagine doing it with 115 physicians and staff spread across six locations in Utah, who process more than 1,000 claims per day. nnGranger Medical Clinic (GMC), the largest independent multi-specialty medical clinic group in Utah’s Salt Lake Valley. GMC was facing the same issues as smaller practices: an increasing number of patients responsible for a higher financial burden of their healthcare through high deductibles and copays. What’s more, they were losing money once those patients walked out the door, mostly because of a soft or absent payment policy and training for staff.nn“We had opportunities to collect missed and it forced things to the back end when a lot could have been resolved on the front end (of operations),” said Tim Ledbetter, former director of revenue cycle operations for GMC. Ledbetter discussed GMC’s collections transformation at a session during this year’s Health Information and Management Systems Society (HIMSS) conference in Las Vegas. Ledbetter noted that across healthcare today, out-of-pocket spending for patients is on the rise, not only among plans affiliated with the Affordable Care Act, but also those sponsored by employers. Add to that rising medical debt among patients and practices are facing a tough situation with those who actually show up for treatment.nnA 2014 Bankrate survey indicated that 55 percent of patients worry they won’t have enough savings to pay their medical bills. “You have more than half of patients walking into a clinic not just worried about their care and services, but also paying that bill.” Ledbetter continued, “That’s a lot of stress walking in the door.” To collect more on the front end of patient visits, GMC gathered its internal stakeholders (physicians, front-desk staff, etc.), as well as its health IT vendors to not only come up with a standardized policy for its six locations, but a technology process to both manage and streamline it.n
Click Here to Read More
nThis article is originally posted on Physicianspractice.com.
May 24, 2016 | Uncategorized
S73.015A — Posterior dislocation of left hip, subsequent encounternnS62.162A — Displaced fracture of pisiform, left wrist, initial encounter for closed fracturennW00.1XXA — Fall from stairs and steps due to ice and snow, initial encounternnX37.2XXA — Blizzard (snow)(ice), initial encounter
May 2, 2016 | Uncategorized
The Centers for Medicare & Medicaid Services (CMS) is beginning Cycle 2 of the provider and supplier revalidation process as required under the Affordable Care Act. Providers and suppliers will receive a revalidation notice 2-3 months prior to the revalidation date, either by mail or email. Failure to revalidate on time will result in deactivation of your billing privileges and your payments will come to a screeching halt!nnIf you need assistance with the revalidation process (we have done thousands!), please contact us immediately.n
For more information on the revalidation process and what to watch for, click here.
May 2, 2016 | Uncategorized
A92.8 — Other specified mosquito-borne viral feversnnR50.9 — Fever with chillsnnR53.83 — Other fatigue
May 2, 2016 | Uncategorized
nnAre you a hardcore NBA fan who sits at the television screaming and shouting as your favorite NBA team scores the winning basket? As if you didn’t know professional sports players get paid the big money, learn more by reading the article below.nnOur heroes of professional sports are paid and often paid very big! If I could only have been a wide receiver, quarterback, or maybe a professional hockey player or basketball star! Whatever your sport, you know who they are and how well they are paid. The NBA’s average player salary is $5.15 million…I just Googled it! Why? Because they have mastered their trade, they have become elite actors (some more than others) of their craft and they are a relative few.nnPhysicians are the professional athlete of healthcare! Why? Same reason, you have mastered the trade, you are the elite actors of your craft and you are a relative few. I didn’t go to medical school, do a residency or become fellowship trained – you did! AND, just like professional athletes, your working life span is shorter than the rest of us. In your case it started late because of your training. It will end early because of the physical demands of being a provider and the occasional “heebie jeebies” you pick up along the way. Therefore, using my logic, you should be paid well, very well. Get to the point, Todd… Ok, here is the point: STOP giving it away!!!!! BE PAID FOR IT!!nn
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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.
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