President’s Day Quiz
President Lincoln and Washington,which codes goes to which president?nnQ87.40 – Marfan’s SyndromenK08.109 – Edentulismnn nnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2014 implementation date. Please don’t hesitate to contact us for all of your training and education needs!
Patient Affordable Care Act Changes That Occurred in 2010nIndoor tanning services were assessed a 10% excise tax.nnA re-insurance program offset the costs of health benefits for workers age 55-64 who were forced into early retirement.nnMedicare beneficiaries who fell into the Medicare Part D Prescription Drug “donut hole” received a $250 rebate. They received a 50% discount on brand name drugs in 2011, and the doughnut hole is eliminated in 2020.nnChildren were allowed to stay on their parents’ health insurance until they turn 26.nnNew private plans were required to cover preventive services with no co-payments, and they are exempt from deductibles. Consumers who applied to new plans have access to an external appeals process if coverage is denied.nnInsurance companies were prohibited from dropping coverage if someone got really sick. They couldn’t create lifetime coverage limits. They could no longer deny coverage to children with pre-existing conditions. The same will apply to adults in 2014. Until then, adults with pre-existing conditions who have been denied coverage will get access to temporary 
Changes in 2013nMedical expenses must be at least 10% of income before they are deductible for those under 65. Manufacturers and importers of medical devices will pay a 2.3% excise tax. Federal funds will increase to allow Medicaid to offer free preventive services, and to extend CHIP for an additional two years. The Federal government will fund states to pay primary care physicians 100% of the Medicare fee. Medicare will start a pilot program to encourage hospitals to bundle services before submitting for payment. (Source: 
Worst V-Day diagnosis code:nI51.81 – “Broken heart syndrome”nnStruck by Cupid’s arrow:nS26.99xA – Other injury of heart, initial encounternW21.89xA – Struck by arrow, initial encounternnThe only kind of chocolate you DON’T want on V-Day:nN80.1 – Chocolate cystnnMost common ICD-10 diagnosis code reported at Mardi Gras in New Orleans:nW52.XXXA – Crushed by crowdnnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2014 implementation date. Please don’t hesitate to 
Seminar Title: ICD-10: A Coder’s PerspectivenSeminar Cost: FREE – Don’t miss out on this excellent opportunity!nnSeminar Description: An informative seminar to give a coder’s viewpoint of the ICD-10 transition and to alleviate fears of what the new code set will mean to coders and billers. We will review guideline changes, new concepts and problematic code sets, along with in-depth discussions of the impact to outpatient coders, tips on how to begin the education and training process, and tips on how to avoid potential pitfalls during the implementation process.nnThis program has the prior approval for 2.0 CEU’s from the American Academy of Professional Coders (AAPC) and American Health Information Management Association (AHIMA).nnSeminar Dates and Locations:nEnglewood, CO: Swedish Medical CenternSpruce C Conference Roomn501 E Hampden AvenuenEnglewood, CO 80113nnDate: Wednesday April 10, 2013nTime: 2-4pmnn
nnW04.XXA – Fall while being carried by other personsnnY90.1 – Evidence of alcohol involvement determined by blood alcohol level, 20-39 mg/100 mlnnZ72.820 – Sleep deprivationnnZ72.6 – Problems relating to gambling and bettingnn nnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2014 implementation date. Please don’t hesitate to 
Asphyxiation due to smothering under another person’s body (in bed), initial encounter, 
CERTIFIED PROFESSIONAL CODER (CPC) PREPARATION COURSE & CERTIFICATIONnn
nnIn response to the government’s continued focus on improving quality of care through payment policy, several changes to new and existing regulatory requirements recently came about through the 2013 Inpatient Prospective Payment System (IPPS), Outpatient Prospective Payment System (OPPS), and the Medicare Physician Fee Schedule (MPFS) Final Rules (“Final Rules”). As a result, hospitals will be faced with new challenges in 2013 and beyond.nnWhat Hospitals Should DonnIn 2013, hospitals should pay particular attention to these requirements in the Final Rules:n
January 14, 2013 — FOR IMMEDIATE RELEASE:nnDenver, Jan 14, 2013 — Welter Healthcare Partners, Inc. (WHP) is very proud to announce the addition of Rebekah S. Gatti (CCS-P, CPC, CPC-I, CEDC, CPMA) to our healthcare management and consulting organization. WHP is an industry leader in providing healthcare facilities with consulting and medical coding services.nnRebekah S. Gatti has 30 years experience in the healthcare industry, both inpatient and outpatient (hospitals and physicians), with specialty in Emergency Medicine, General Surgery, OB/GYN, Cardiology, Orthopedics, Oral Surgery, Pain Medicine, Mental Health and Occupational Medicine. She holds multiple certifications from both the AAPC and AHIMA.nnMs. Gatti has extensive experience with medical practice management, including revenue enhancement, reimbursement analysis, collection issues, compliance plans, chart auditing, and personnel management issues. She provides educational seminars for physician groups and hospitals on coding, auditing, modifiers, evaluation and management, documentation issues and ICD-10 preparation and financial neutrality. She also provides instruction in medical coding, having successfully completed the PMCC instructor certification course. Ms. Gatti is an AHIMA-approved ICD-10-CM/PCS Trainer. She is the author of “Introduction to Inpatient Procedural Coding Using ICD-10-PCS.”nnPrior to employment at Welter Healthcare Partners, Ms. Gatti was the ICD-10 Manager for a healthcare software company supervising the Content Team, and Coding Supervisor at a large multi-practice company in Virginia where she provided documentation training for over 300 physicians and physician extenders.
Medicaid Primary Care Payment IncreasennThe Affordable Care Act (ACA) enacted changes to Medicaid primary care reimbursement. Eligible physicians will receive supplemental payments for services rendered between January 1, 2013 and December 31, 2014. These supplemental payments will raise the Medicaid reimbursement to Medicare rates. To be eligible for the supplemental payments, physicians must self-attest as having a specialty in family medicine, general internal medicine, and/or pediatric medicine. Only physicians can complete the attestation! Staff or other representatives are not allowed to complete the attestation on the provider’s behalf. 
Per AMA guidelines, the new code set should be used for claims filed as of January 1, 2013. Practices are advised to check with their local payers to verify payer implementation date of the new codes, to avoid any unnecessary claims denials and delays in payments!nn
CERTIFIED PROFESSIONAL CODER (CPC) PREPARATION COURSE & CERTIFICATIONnnCertified coders are in high demand! Advance your career in the medical field and get certified now!nnThis course will be offered as a combination live and web-based class to offer maximum flexibility for any student. It is designed to offer the most comprehensive and complete coding information to prepare students for the CPC examination and a career in the medical field. This course will include a brief overview of medical terminology, anatomy, CPT, ICD-9 CM and HCPCS manuals, and coding scenarios for practical application in the work environment.nnUpon completion of this course, participants will be prepared to sit for the nationally accredited American Academy of Professional Coders (AAPC)/Certified Professional Coder (CPC) coding certification examination.nnThis examination will be offered to class participants at the completion of the course.n
Congress passed The American Taxpayer Relief Act of 2012, to avert the “fiscal cliff.” President Obama is expected to sign the legislation shortly.nnIn addition to various tax and spending measures, the legislation includes provisions of direct importance to medical group practices. The legislation:n
A new report from the Agency for Healthcare Research and Quality (AHRQ) highlights the cumulative experiences of more than 100 grantees that implemented major health IT projects between 2004 and 2007.nnThe report, Effective Teamwork and Sustainability in Health IT Implementation, reviews grantee experiences related to planning, long-term use, partnerships, vendor relationships, and end-user perceptions a few years after the end of the project period. According to the grantees, the most important factors affecting the sustainability of health IT were the ability to demonstrate benefits from health IT to grantees’ organizations, clinician support, and cost–related issues. Grantees said that most health IT products that were implemented and upgraded during the study continue to be used. However, they reported that in order for health IT projects to be successful, clinician buy-in and support must be established early in the planning period and be sustained during implementation and maintenance phases. Effective planning, including completing a detailed workflow analysis, implementation plan and process re-design assessment prior to implementation, were strong markers of long-term viability.nn
ceive a 26.5 percent reduction in payments starting Jan. 1 unless Congress intervenes. Action to avert the cut is being considered as part of broader fiscal cliff negotiations on tax and spending policies. However, these discussions remain up in the air, creating uncertainty over the timing of a solution.nnThe latest estimates from the Congressional Budget Office (CBO) indicate that a one-year patch to prevent the SGR cut would cost $25 billion. While most members of Congress agree that the current Medicare payment system must be repealed, the cost is daunting. Details should emerge in the coming week.
nnOn Nov. 15, CMS posted its FY 2012 financial report. CMS CFO Deborah Taylor, a certified public accountant, prepared the 202-page document, which is required by law every year. Here are 10 of the biggest takeaways from the report.nnWhat the nation’s healthcare dollar looked like in 2012. Government health programs consume the largest parts of the U.S. healthcare system, and CMS’ report broke down the different healthcare payors and how much money they represented in FY 2012. Here’s how much each sector represented for every dollar spent on the U.S. healthcare last year:nn• Private insurance: 31.6 centsn• Medicare: 21 centsn• Medicaid: 16.3 centsn• Other government programs: 13.3 centsn• Out-of-pocket: 11.1 centsn• Other private programs: 6.7 centsnnFurthermore, Medicare and Medicaid, including state funding, represented 54 cents of every dollar spent on nursing homes, 49 cents of every dollar received by hospitals and 33 cents of every dollar spent on physician services.nnMedicare Part A Benefit Payments. Inpatient hospital spending accounted for 54 percent of Medicare Hospital Insurance, or Part A, benefit outlays in FY 2012. Managed care represented the next-highest total at 25 percent, while skilled nursing facilities received 12 percent of Part A payments.nnMedicare Part B Benefit Payments. Medicare Part B, or Supplementary Medical Insurance, covers all physician, hospital outpatient, home health, lab test and other services not covered by Part A. Physicians services accounted for the largest slice of Part B at 24 percent. Prescription drugs accounted for 21 percent, while hospital outpatient services represented 11 percent.nnMedicaid Enrollees. Children represented the largest portion of Medicaid beneficiaries in FY 2012 at 50 percent. The remaining enrollees were adults (23 percent), disabled (18 percent) and elderly (9 percent).nnFederal Medicaid costs. State and federal medical assistance payments and administrative costs totaled $452.5 billion last year. CMS’ share of Medicaid outlays totaled $260.1 billion of that total.nnMedicare and Medicaid Recovery Auditors. Medicare RACs recovered $2.3 billion in over–payments in FY 2012, as reported earlier. However, that figure does not include dollar amounts related to claims in the appeals process or claims that had been successfully appealed by providers.nnMedicaid RACs were supposed to go live Jan. 1, 2012, although not all states have finalized their programs. According to the report, “states that have been unable to implement Medicaid RAC programs by Jan. 1, 2012, have been submitting [state plan amendments] to CMS requesting implementation delay exceptions.” CMS released a Medicaid RAC final rule in September 2011, projecting savings of $2.1 billion over the next five years. Roughly $910 million of that total would be returned to states.nnSource: www.beckershospitalreview.com Bob Herman; December 7, 2012.
nnThere is no single, universal definition for ACOs. In its census, Oliver Wyman counted not just participants in Medicare’s various ACO programs, but also commercial ACOs and healthcare delivery organizations that apply some other name to themselves but follow the basic elements of the accountable care organization: They are healthcare providers that take responsibility for the full healthcare needs of a defined population, receiving savings payments based on cost savings and quality.nnThe ACA directed Medicare to create ACO programs – today there are 150 Medicare ACOs, and the number is expected to more than double in January, when Medicare announces the next class of participants in its Shared Savings Program. Because it is difficult to operate a single organization under a fee-for-service and an ACO model at the same time, most participants in Medicare ACO programs eventually shift their non-Medicare patients to ACO models as well.nnA total of 25 to 31 million U.S. patients currently receive their care through ACOs. They include:n
At the 98th meeting of the Radiological Society of North America in Chicago on Nov. 26, 2012, Keith J. Dreyer, DO, PhD, vice chairman of radiology at Massachusetts General Hospital in Boston and associate professor of radiology at Harvard Medical School, discussed the future of imaging informatics in the face of meaningful use.nnCMS’ meaningful use program is one of the ways the federal government is focusing on quality, safety and access with healthcare, said Dr. Dreyer. By urging providers to use certified electronic health record technology, the federal government is hoping that safety and quality of healthcare will increase while the cost of healthcare will decrease. According to Dr. Dreyer, physicians and radiologists need incentives to have a patient-centric focus in their healthcare decisions and that is what meaningful use is — an incentive.nnDr. Dreyer pointed out that more than 50 percent of physicians and 80 percent of hospitals have enrolled in the meaningful use program, with payments passing $7 billion, from when meaningful use legislation as part of the HITECH Act was first passed in February 2009 to when the most recent regulations — stage 2 of meaningful use — were released.nn”What does this mean for radiologists? Well, nearly all radiologists are eligible for the program. In 2011, 32 percent of radiologists said they planned to participate, and in 2012, that percentage has doubled,” said Dr. Dreyer. “While meaningful use can be a challenge for radiologists, there are various exclusions and temporary exemptions available. The thing to remember is that the stages of meaningful use are important.”nnThe stage 2 regulations for meaningful use have two specific objectives for imaging:n
nna coordinated team can deliver a consistent experience, regardless of where this patient experience begins and ends. A clinic can either take the opportunity to define its own reputation through its approach to patient engagement or have its reputanntion determined by its patients, who will talk to each other about what should have happened and why and why.nnAccessibility of electronic health information is already changing the nature of the patient-clinic interaction. We all know of the reputations of the clinics in our neighborhoods that have evolved over time. And these reputations I’m referring to have had little to do with their online or “digital” reputation. The experiences that patients and clinic staff have shared over the years (perhaps even generations) that have established these reputations are those that have occurred between people in the face-to-face interactions in the clinic. However, as the patient experience continues to grow in terms of population health outcomes and the individual’s day-to-day experience, it is an important time for physicians and their staff to recognize how to participate in the culture of care that is defined by the brand that is the physician as well as the clinic as a whole.nnJust as the accessibility of health information continues to expand from the patient’s personal history to general educational material in digital form, so too is the nature of the interaction between patient and clinic expanding. Now we are seeing the convergence of those longstanding reputations built upon one-on-one encounters and digital reputation established by connecting with patients in convenient formats and online.nnThis evolution demands a new level of reception in the clinic, one requiring a sustained and fully engaged dialogue among the entire clinic staff. The conversation about traditional and digital patient experiences is one that represents a great opportunity to accept the gratitude of each patient. Whether it’s an unconditional “thank you” or even one that is qualified with a comment or concern for future encounters, this is the reputation of the clinic as a whole and each individual physician. What’s more, because this patient experience is happening in so many ways well beyond the walls of the exam room, a fully engaged staff members will find themselves contributing to this reputation more every day.nnWhereas in the past the patient experience was defined by the coveted clinic appointment, what happens before and subsequent to that encounter has now become equally important in terms of the reputation of the clinic and physician. The challenge is to keep in mind within conversations about and interactions related to EHR and health IT that this converged clinic reputation is driven by a well-defined patient experience supported by a fully engaged clinic staff.nnSource: www.ehrintelligence.com; Robert Green, November 20, 2012.
The Centers for Medicare & Medicaid Services (CMS) issued a final rule with comment period on November 1, 2012 for Medicare’s payments for physician fees for 2013. It includes a new policy to pay a patient’s physician or practitioner to coordinate the patient’s care in the 30 days following a hospital or skilled nursing facility stay. Recognizing the work of community physicians and practitioners in treating a patient following discharge from a hospital or nursing facility will ensure better continuity of care for these patients and help reduce patient readmissions. The changes in care coordination payment and other changes in the rule are expected to increase payment to family practitioners by seven percent—and other primary care practitioners between three and five percent—if Congress averts the statutorily required reduction in Medicare’s physician fee schedule.n(