MicroMD – PM and EMR
Award winning MicroMD version 7.6 is ready! If you are on MicroMD PM and/or EMR and not on version 7.6 please call our sister company Medical Data Management Group at 303.396.6485 or log on at www.
Billing and Accounts Receivable Tactics
Todd Welter talks about getting back to the basics for accounts receivable and your processes. Learn what does not work and stop doing it… Ensure each member of your team is playing a significant role in the efficiency of operating your business to run a successful practice.nn
Healthcare Reform Spending; SGR
There is a lot of activity with healthcare reform with healthcare spending 17-18% of the gross domestic product. Listen to Todd Welter talk about the healthcare reform and sustainable growth rate (SGR) method. For more information on how Welter Healthcare Partners can help your practice, contact us today.nn
ICD-10 Quickinar
As you may already know, the ICD-10 deadline has been extended for possibly up to one year. Listen to Todd Welter, president of Welter Healthcare Partners, to discover how often you use ICD-9 codes and to learn how to effectively teach your team the significance of ICD-10.nn
Tips for Implementing an Effective Compliance Program
ICD-10 October 1st, 2014
There is another delay in the works! Looks like October 1, 2014 is now the go-live date. This is bigger than Y2K! Don’t wait to get ready, start working on it now! This change will affect every part of your practice, facility and the relationships you have with ALL you medical provider partners in your medical community.
AAPC Conference ICD-10 Seminars
AAPC Conference Preview
nnMedical coding and billing has come a long way over the past 20-plus years and is currently one of the most vital pieces to a smooth-running medical facility. AAPC, which will hold its 20th national conference from April 1 to 4 at the Rio Hotel and Convention Center in Las Vegas, has helped expand the industry since its inception and is always looking to push the industry into the future with hot topics such as ICD-10.nnThe annual conference addresses the “hot button” issues in our arenas as well as reviews the concepts that are basic to the industry. This year, the lineup includes more physician presenters than ever before as well as a host of business and industry professionals who are experts in their field.nnConference attendees begin the festivities with the annual AAPC president’s address with Chairman and CEO Reed Pew. Following the president’s address is the keynote presentation “Got Magic.” After the two general sessions conclude to open the conference on Monday, each attendee heads to his or her specific breakout sessions for three days filled with education, networking, and fun. Each day holds incredible information and learning opportunities in many areas of healthcare. The AAPC conference website (www.aapc.com/medical-coding-education/conferences/national/lasvegas/index.aspx) has the entire speaking agenda and activities for the week.nnWith the implementation of ICD-10 just around the corner, the conference’s signature session, the Anatomy Expo, has never been more valuable. In this three-hour session, attendees will gather to celebrate the wonders of the human body. This fast-paced event offers an in-depth look into this complex machine. Here, participants have a chance to learn the various parts of human anatomy, taught exclusively by physicians to small groups. The eight physician presenters will use anatomical models, devices, and videos to provide instruction as each group moves from station to station. Attendees will get from an insider’s look at the anatomic and physiologic nuances of the human body. Whether attendees are novices or experts, the Anatomy Expo is fun, informative, and always a highlight for conference goers.nnFor the first time, there also will be a track of sessions focused on EMRs and revenue cycle management, a track of sessions on auditing and compliance issues, and a full track focused on outpatient hospital facility coding. As always, AAPC offers a wide variety of sessions dedicated to different coding specialties and general healthcare issues.nn— Melanie Mestas is director of conferences for AAPC.nnSource: 2012 AAPC National Conference
By Melanie Mestas –
HHS Sponsors Contest For Web App to Identify Local Health Trends
Federal officials are challenging developers to design Web-based applications that use Twitter to track health trends in real time. Health 
officials may be able to use knowledge of these trends as an early indicator of emerging health issues and a warning of public health emergencies in a community.nnThe U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response (ASPR) today issued the challenge, a developers’ contest called Now Trending – #Health in My Community. The online challenge runs through June 1, 2012.nnSocial media trends can be powerful indicators of community health issues. However, current Web-based apps look backward, collating social media data to show how trends developed. The ASPR challenge would create a Web-based app to use social media data as an advance signal of a public health emergency.nn“When we looked back at the H1N1 pandemic, we saw that, in some cases, social media trends provided the first clues to flu outbreaks,” said Dr. Nicole Lurie, assistant secretary for preparedness and response and a rear admiral in the U.S. Public Health Service. “Based on that 2009 pandemic experience, local health officials asked for our help in developing a Web-based tool that could make social media monitoring useful as part of the surveillance systems in place now to identify new diseases early.”nnWith early identification, health officials can respond quickly, including advising people how to protect their health and minimize the spread of the disease. Minimizing the spread of disease could help the community bounce back quickly from an outbreak or a public health emergency – or potentially prevent a public health emergency, such as a pandemic, from occurring.nnTo win the challenge, the application must be innovative, scalable, dynamic, and user-friendly. The app must use open-source Twitter data to deliver a list automatically of the top five trending illnesses over a 24-hour period in a specified geographic region. The application must be able to send the data to state and local health agencies. These agencies, in turn, can cross-reference the data with traditional biosurveillance systems, build a baseline of trends, determine emerging public health threats, and advise the public on how to protect their health.nnThe person or team developing the best application will receive $21,000 from ASPR as well as a $1,000 travel stipend to attend an event announcing the winner. In addition, the winner will be invited to present the winning tool at a Fusion Forum, a discussion series sponsored by ASPR’s Fusion Cell for state and local health officials to help identify pioneering ways to move from open source information into use as a public health response. The winning application will be made available to state, territorial, tribal and local health agencies across the nation for use in their communities.nnTo register to participate in the Now Trending – #Health in My Community Developer Challenge, visit http://challenge.gov/HHS/334-now-trending-health-in-my-community. Upon submission participants must warrant that they are the sole authors and owners of the final product.nnFederal employees, federal contractors, and recipients of federal grants may not participate in the challenge using time paid by federal funds. Winners must be at least 18 years old, U.S. citizens, permanent U.S. residents or businesses incorporated in and maintaining their primary place of business in the United States.nnThe Now Trending – #Health in My Community challenge is the second sponsored by ASPR in the past year. Through the first challenge, the ASPR Facebook Lifeline App Challenge, developers designed a new Facebook application that could enhance individual and community resilience by establishing social connections in advance of an emergency. The winning lifeline app is expected to be available on Facebook this spring to help people create and share preparedness plans and get support from friends and family in any type of emergency.nnHHS is the principal federal agency for protecting the health of all Americans and providing essential human services, especially for those who are least able to help themselves. The Office of the Assistant Secretary for Preparedness and Response (ASPR) leads HHS in preparing the nation to respond to and recover from adverse health effects of emergencies, supporting communities’ ability to withstand adversity, strengthening health and response systems, and enhancing national health security.nnASPR’s Fusion Cell manages the large volumes of disparate internal and external data sources necessary for situational awareness, rapid decision support, and ultimately the discovery of new indicators and warnings of events of public health significance. This ensures that decisionmakers are better informed, better prepared, and better able to rapidly respond to protect people’s health during emergencies and save lives.nnVisit www.phe.gov to learn more about ASPR, its Fusion Cell and other aspects public health and medical emergency preparedness, response, and recovery. Follow us on Twitter @PHEgov .
Understanding Health Information Privacy
The HIPAA Privacy Rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes.nnThe Security Rule specifies a series of administrative, physical, and technical safeguards for covered entities to use to assure the confidentiality, integrity, and availability of electronic protected health information.nnSource – Learn More Here: hhs.gov
Bundled Payment – Episodic Care Methodologies
WHPelter Managed Care consultants are currently working with national payers to create Episodic Care/Bundled Payment programs. We are currently in the Pilot Project phase and have been given the green light to expand into several different specialties.
CPC Certification Course
Susan Whitney is currently teaching a CPC Certification course here at the classroom facility at WHPelter headquarters. 25 newly minted CPC’s will be ready for the coding universe in the early summer of 2012. We will soon have a CPC Certification Course on-line.
Advanced Medical Revenue Specialists
nnLearn more about medical billing and how the services of AMRS can help improve your revenue.nnAdvanced Medical Revenue Specialists (AMRS) is a total access billing and revenue service for physicians offering an unparalleled level of experience, support, reporting and client access to real time data. It has been designed from the ground up to be a high touch, detail oriented revenue service primarily focused on specialty medicine. AMRS purposely accepts a limited number of clients so as to concentrate their efforts on every detail of billing, revenue collections, appeals and above all, customer service.
Choose The Right Billing Software Provider
What is a Medical Billing Software?
Medical Billing Software is a computer application that manages the financial and administrative functions of a healthcare organization. This usually includes patient management, insurance management & billing, patient & insurance statements, reporting, scheduling, electronic billing and collections. This customizable software with many user definable features enables the office manager and billing staff to also check in/check-out patients, verify eligibility, submit claims. To support this workflow, the system will maintain a comprehensive set of payor rules and policies.
What are some of the questions that you can ask the vendor?
If you are considering purchasing an EMR in the near future, ensure to work with a software vendor that also offers a Medical Billing Software system. Also keep in mind some of the below questions prior to your purchase:nn n
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- Which claims forms does the system support?
- Can the system support durable medical equipment billing?
- Does the system maintain payer rules for the practice’s accepted insurance?
- Does the practice prefer an on-premise or web-based system?
- Is the system easy-to-use and easy-to-learn?
- Does the system offer a patient portal?
- What is the total cost of ownership over the system’s life?
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nSource: Questions from Health Technology Review:
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AMA Urges Congress to Update Medicare Physician Payment System
The AMA wrote a letter to congressional leaders to urge them to reconsider the Medicare physician payment system. Continue reading to learn why this is important.nnFollowing a recent Medicare Payment Advisory Commission (MedPAC) report, the American Medical Association (AMA) has asked Congress to update the Medicare physician payment system to include a stable annual payment rate that keeps up with inflation and practice costs.nnIn a letter to congressional leaders, the organization expressed concerns about the MedPAC recommendation to continue the freeze on Medicare physician payment rates and the lack of an adequate annual update for the payment system.nnThe MedPAC report, sent to Congress on March 15, 2022, recommended that federal officials maintain Medicare reimbursement rates for physicians and not provide any increases for 2023. According to AMA, this would hurt patient access to care as it becomes more expensive for physicians to practice medicine.n“Although clinicians have experienced declines in their Medicare service volume and revenue due to the pandemic, Congress has provided tens of billions of dollars in relief funds to clinicians during the PHE, and we expect volume and revenue to rebound to pre-pandemic levels (or higher) by 2023,” MedPAC stated in the report.nnHowever, AMA affirmed that financial challenges for physicians persist.nn“Physicians have been enduring an increasing financial instability of the Medicare physician payment system due to a confluence of fiscal uncertainties related to the COVID-19 pandemic, statutory payment cuts, consistent lack of inflationary updates, and significant administrative barriers,” the letter stated.nnAdditionally, AMA noted that MedPAC cannot justify freezing Medicare physician payment rates as CMS projects an 80 percent increase for Medicare Advantage plans in 2023.nnData from the Medicare Trustees showed that Medicare physician pay has increased by only 11 percent between 2001 and 2021. Around one-third of that increase includes the temporary 3.75 percent update set to expire this year.nnIn contrast, Medicare hospital and skilled nursing facility payments rates increased by more than 60 percent over the same period.nnAfter being adjusted for inflation, Medicare physician payment rates have declined 20 percent over the last two decades, the letter noted. Meanwhile, the cost of running a medical practice—including physician office rent, employee wages, and liability insurance premiums—has increased 39 percent since 2001.nnMedicare physician fee schedule spending per enrollee has also declined by 1 percent over the last ten years or 0.1 percent each year, while other Medicare benefits spending has increased. For example, Part B fee-for-service (FFS) spending per enrollee, excluding physician fee schedule spending, increased by 42 percent over the last decade. Part A FFS spending increased by 3.6 percent, Part C spending rose 29.4 percent, and Part D spending increased 20 percent.nnThe Medicare physician payment freeze is scheduled to last until 2026. Once the freeze ends, payment updates are set to resume at a rate of 0.25 percent per year, which is significantly below the rate of medical or consumer price index inflation, AMA stated in the letter.nnUnless Congress provides Medicare physicians with an update that reflects inflation, the gap between physician payment rates and rising inflation in medical practice costs will widen, AMA said.nnThe organization also referenced a May 2021 study that revealed that it costs physician practices around $12,800 and more than 200 hours per physician per year to comply with the Medicare Merit-Based Incentive Payment System (MIPS). Additionally, physicians have not been able to receive annual incentive payments for Medicare Advanced Alternative Payment Models (AAPM), as they have not had the chance to transition into a model.nnAMA stressed that financial hardships, burnout, and stress, are pushing physicians to consider leaving their practice within two years.nnWhile AMA expressed its gratitude to Congress for providing financial relief during the pandemic and preventing the 10 percent physician payment cuts in 2022, the organization urged officials to work with the physician community to develop solutions to the systematic problems with the Medicare physician payment system.
‘THE PARTY IS WINDING DOWN’: STATES AND INSURERS RESURRECT BARRIERS TO TELEHEALTH, PUTTING STRAIN ON PATIENTS
Work Place Stress Management
2021 ICD-10CM Update Effective October 1,2020
One of the biggest changes to our ICD-10-CM books for the upcoming new year will be the addition of Chapter 22: Codes for special Purposes (U00-U85). Although this new chapter only consists of two codes and these codes were actually created and valid as early as April 2020, the creation of this chapter is proof that lessons from our current pandemic have been learned. nnHere are the codes, and their guidelines as printed in the Official ICD-10-CM FY 2021 Guidelines;
ICD-10 2021 Updates
The ICD-10 2021 updates include over 500 significant changes. These updates, set to take effect on October 1, 2020, include 490 new codes, 47 revised codes, and 58 codes deemed invalid. We will also see increased instructions on reporting manifestations of COVID-19. New guidance on social determinants of health, insulin use & acute kidney failure. See Welter Healthcare Partners’s summary of these changes in the information below!nnWith over 500 diagnosis coding changes just around the corner, the FY 2021 ICD10CM Official Guidelines bring updates that are set to be significantly larger than the FY2020 update brought to us last year.nnUpdates that are set to take effect October 1st, 2020 include 490 new codes, 47 revised codes and 58 codes deemed invalid (see table below), additional instructions on reporting manifestations of COVID-19, as well as new guidance on social determinants of health, insulin use and acute kidney failure, among several other changes.nnBelow is a summary of the anticipated FY2021 ICD10CM Updates by Chapter:nnChapter 1: Certain Infectious & Parasitic Disease brings a new section 1.g for reporting Coronavirus infections.nnChapter 3: Diseases of Blood & Blood-forming organs has eighteen new, detailed codes available for sickle cell anemia. These new codes describe complications associated with sickle- cell and hemoglobin-C (Hb-C) diseases. For example, a note for new sickle-cell thalassemia code D57.418 (Sickle-cell thalassemia, unspecified, with crisis with other specified complication) instructs the coder to code any identified complications such as cholelithiasis (K80.-) or priapism (N48.32).nnChapter 4: Endocrine, Nutritional & Metabolic Disease includes new coding instructions to follow for diabetic patients treated with insulin, oral hypoglycemics and injectable non-insulin drugs. For example, if the patient is taking both insulin and an injectable non-insulin antidiabetic drug, assign both Z79.4 (Long term [current] use of insulin) and Z79.899 (Other long term [current] drug therapy). If the patient is taking oral hypoglycemic drugs and an injectable non-insulin antidiabetic drug, assign code Z79.84 (Long term [current] use of oral hypoglycemic drugs) in addition to code Z79.899.nnChapter 5: Mental, Behavioral and Neurodevelopmental Disorders contains twenty-one new codes that describe withdrawal from substances including alcohol, cocaine, and opioids. For example, F10.932 (Alcohol use, unspecified with withdrawal with perceptual disturbance).nnChapter 6: Diseases of the Nervous System has added “pseudotumor” as a clarifying term to G93.2 (Benign intracranial hypertension) and coders are instructed to code G98.81- (intracranial hypotension) with G96.0 (Cerebrospinal fluid leak) when applicable.nnChapter 9: Diseases of the Circulatory System contains many revisions to the includes and excludes notes for existing codes. For example: Atherosclerosis of native arteries of the legs with ulceration (I70.2-) now includes both critical and chronic ischemia of native arteries with ulceration. Hypertensive Heart Disease (I11) has been revised to exclude Takotsubo Syndrome (I51.81), also known as “broken heart” syndrome.nnA new hypertension guideline provides instruction that when a patient has hypertensive chronic kidney disease and acute renal failure, code both conditions and sequence the codes based on the reason for the encounter.nnChapter 10: Diseases of the Respiratory System now has code also instructions for cases of acute laryngitis and tracheitis (J04) and acute obstructive laryngitis (croup) and epiglottitis (J05). Coders are instructed to code also influenza if present, including influenza due to identified novel influenza A virus with other respiratory manifestations (J10.1). This chapter also has a new section 10.e specifically for vaping-related disorders.nnChapter 13: Musculoskeletal System found several updates this year including twelve new codes to capture other pathological fractures (M80.8AX- and M80.0AX-). Updates include an expanded list of codes for rheumatoid arthritis, as well as primary and secondary arthritis, and arthritis caused by trauma. New codes in the M24 category for other articular cartilage disorders, disorders of ligament, pathological dislocation, recurrent dislocation, contracture and ankylosis.nnChapter 14: Disease of Genitourinary brings two new sub-stages to Stage 3 chronic kidney disease (CKD). The new codes are: N18.30 (Chronic kidney disease, stage 3 unspecified), N18.31 (Chronic kidney disease, stage 3a) and N18.32 (Chronic kidney disease, stage 3b).nnChapter 15: Pregnancy, Childbirth and the Puerperium contains new language that warns coders they should not report O85 for sepsis that follows an obstetrical procedure. A notenpoints them to the Sepsis due to a postprocedural infection of Chapter 1 Certain Infectious and Parasitic Diseases (A00-B99), U07.1.nnA new section 15.s provides instruction on reporting COVID-19 infections in pregnancy, childbirth, and the puerperium. E.g. when a newborn tests positive for COVID-19 and the provider has not documented a specific method of transmission, assign code U07.1 and the appropriate codes for associated manifestations. Code P35.8 (Other congenital viral diseases) followed by U07.1 when the provider documents that the newborn contracted the disease in utero or during birth.nnChapter 16: Certain Conditions Originating in the Perinatal Period has a new section 16.h for reporting COVID-19 Infections in Newborn.nnChapter 18: Symptoms, Signs and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified contains several changes. Code R51 (Headache) will be split into two codes: R51.0 (Headache with orthostatic component, not elsewhere classified) or R51.9 (Headache, unspecified).nnAnother source of new headache coding will come from five new codes for intracranial hypotension – the severe orthostatic headache that is a common symptom of a cerebral spinal fluid (CSF) leak: For example, G96.810 (Intracranial hypotension, unspecified), G97.83 (Intracranial hypotension following lumbar cerebrospinal fluid shunting) and G97.84 (Intracranial hypotension following other procedure). Five new codes for CSF leaks can now be found in place of the current code G96.0 (CSF leak).nnChapter 19: Injury, poisoning & certain other consequences holds 128 additions that include new codes for adverse effects and poisoning by fentanyl and tramadol as well as other synthetic narcotics.nnChapter 21: Factors influencing health status and contact with health services includes new observation language. The new language creates a second exception to the rule that observation codes are primary. The GL state, “An observation code may be assigned as a secondary diagnosis code when the patient is being observed for a condition that is ruled out and is unrelated to the principal/first-listed diagnosis.”nnNEW Chapter 22: Codes for Special Purposes (U00-U85) includes just two codes: U07.0 Vaping- related disorder and U07.1 COVID-19, these codes took effect in the earlier this year.nDeletions from the 2021 ICD-10-CM code set include: Q51.20 (Other doubling of uterus, unspecified), and the entire code family of T40.4X- (Poisoning by adverse effect of and underdosing of other synthetic narcotics).nnThe general coding guidelines clarify that social determinants of health may be coded if self- reported by patients, “as long as the patient self-reported information is signed off by and incorporated into the health record by either a clinician or provider.” Social determinants of health, found in code categories Z55-Z65, report potential health hazards related to socioeconomic and psychosocial circumstances that may complicate the care of the patient (e.g., the patient is unemployed).nn
ReferencesnnInternational Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) nnICD-10-CM Official Guidelines for Coding and ReportingnnProposed 2021 ICD-10-CM update flashes nearly 500 new codes, additional changes