Oct 29, 2020 | Uncategorized
The VA and its third-party administrators are now able to consider some denied claims for payment. Continue reading below for more information about reconsideration eligibility.nnVA and its third-party administrators (TPA), Optum and TriWest, will reconsider payment to providers who had a claim denied for simple routing errors. Providers whose claims were denied because they were submitted to the wrong VA payer (VA or a TPA) are eligible for reconsideration if the original claim was filed with a VA payer on time (within 180 days of the date of service). The provider must resubmit a reconsideration request to the correct VA payer within 180 days of the initial denial. A copy of the remittance advice from a claim that was submitted to a VA payer within 180 days of date of service satisfies this requirement.nnOptum and TriWest also have the authority to process provider payment requests that were previously denied prior to this direction and over 180 days after the date of the remittance advice if the original claim was submitted on time. The 180 days from the date of the remittance advice was through Dec. 1, 2020. In addition, claims not submitted because of missing affiliation/network information on the VA referral are also eligible to be reconsidered if the claim is within 180 days of the date of the referral allocation. VAMC staff will send the provider an offline referral created in Health Share Referral Manager (HSRM) to the community provider with the authorization number. The HSRM offline referral will also explain who to correctly bill.nnIn-network providers can view the authorization number and original received date in HSRM. Providers in Optum’s network can also find the original received date in the Optum Provider PortalnnFor more information, visit VA’s “File a Claim for Veteran Care” web page or call the Community Care Contact Center, 877-881-7618.nn
Oct 29, 2020 | Uncategorized
Aside from the highly discussed 2021 Evaluation and Management changes that are set to take effect on January 1, 2021, we find the CPT® code set continues to see growth in new and novel areas of medicine. Read below to find out more about these changes.nnCPT® has recently updated their data file to contain 329 editorial changes; including 206 new codes, 54 deletions, and 69 revisions. A majority (63%) of new codes involve new technology services described in Category III codes and the continued expansion of the Proprietary Laboratory Analyses (PLA) section.nnAlthough there are not a record number of new codes, it is evident there are changes to CPT® 2021 in nearly every section. As we start to read through the 2021 CPT® text, you see that illustrations have been updated, allowing users to have a better anatomical understanding. With the notable green text indicated throughout the new codebook, you will find many guidelines and instructions that have also been updated. Correct coding will rely on having the most up‐to‐date coding resources and paying particular attention to these important guideline revisions. The following paragraphs summarize some of the exciting updates headed this way!nThe Introduction section starts with clarifying details about the release of CPT codes and provides a new CPT Code Set Update Calendar table. Several links referencing AMA resources on specific updates are also included.nnThe Evaluation and Management (E/M) section reveals a significant overhaul for the office visit and other outpatient services codes (99202 – 99215). This section provides entirely new guidelines and instructions for documenting and reporting these frequently used services, including definitions of commonly used terms. A new prolonged services code +99417 provides opportunity for clinicians to capture additional encounter time when appropriate.nnAdditional instructions clarify when reporting a preventive visit and an illness encounter on the same date of service should be considered.nCare Management Services, Chronic Care Management and the Behavioral Health Integration Care Management section all have new clarifying guidelines to help understand the type of work that should be performed and documented to report these unique services.nnThe Surgery section starts with updates to instructions in the Integumentary Section for Repairs and/or Reconstruction.nYou will find new instructional guidelines and three new codes (33741,33745, +33746) for shunting procedures in the Cardiovascular System section.nnThe updates in the Medicine section illustrate how the CPT code set continues to be modified to respond to how fast‐paced innovative digital services can improve access to health care and improved health outcomes for patients. A great example of this is the addition of code 92229 for retinal imaging with automated point‐of‐care, and the revision to the descriptions of codes 92227 and 92228.nCodes 93241, 93242, 93243, 93244, 93245, 93246, 93247, 93248 have been also updated along with associated guideline revisions. These codes replace Category III codes 0295T, 0296T, 0297T and 0298T, which were deleted. These new codes utilize an innovative algorithmic technology that works in collaboration with a patch that is easier to wear for patients and provides more accurate and complete data for clinician interpretation.nDon’t miss the updated guidelines in the Dialysis section, if that is a service that impacts your organization.nnA quick glance at Appendix C reveals significant changes to the Clinical Examples used to assist clinicians in understanding the meaning of the descriptors and selecting the right code. It is important to notice that each example in the text was developed by physicians in the specialties shown. Clinical examples of Office visit services have been removed from the 2021 edition as the CPT Editorial Panel continues to monitor and update these new services.nnSARS‐CoV‐2 related CPT codes:n
n
- Code 86318, effective April 10, 2020, is used to report immunoassay for infectious agent antibody(ies) and to be a parent to 86328; addition of code 86328 to report single step antibody testing for severe acute respiratory syndrome coronavirus 2; addition of child code 86769 to report multiple‐step antibody testing for severe acute respiratory syndrome coronavirus 2; and revision of the Immunology guidelines.
n
- PLA code 0202U, effective May 20, 2020, is used to report the BioFire® Respiratory Panel 2.1 (RP2.1) test.
n
- Code 87426 is used to report infectious agent antigen detection by immunoassay technique of SARS‐CoV and SARS‐CoV‐2.
n
- PLA codes (0223U and 0224U) were accepted for detection of SARS‐CoV‐2. ∙ Codes 86408 for reporting coronavirus 2 (SARS‐CoV‐2) neutralizing antibody screen and 86409 for reporting coronavirus 2 (SARS‐CoV‐2) neutralizing antibody titer were effective Aug. 10, 2020.
n
- PLA codes (0225U and 0226U) were accepted for detection of SARS‐CoV‐2. ∙ Code 99072, effective September 8, 2020, is used for additional supplies and clinical staff time required to mitigate transmission of respiratory infectious disease while providing evaluation, treatment, or procedural services during a public health emergency, as defined by law.
n
- Code, 86413, was created for reporting quantitative antibody detection of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2).
n
nAccording to the AMA, the substantive need created by the unique circumstances of the SARS‐CoV‐2 pandemic provides justification to create specific codes to designate certain respiratory viral panels and expand upon code 87631:n
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- Code 87635, effective March 13, 2020, is used to report infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) (Coronavirus disease [COVID‐19]), amplified probe technique.
n
- Code 87636 for reporting combined respiratory virus multiplex testing for either SARS‐CoV‐ 2 with Influenza A&B and code 87637 for combined respiratory virus multiplex testing for either SARS‐CoV‐2 with Influenza A&B and RSV and 87811 for antigen detection of SARS‐ CoV‐2 by direct optical (i.e., visual) observation was added October 6, 2020.
n
- Two new PLA codes (0240U and 0241U) were accepted for detection of SARS‐CoV‐2, Influenza A and Influenza B; code 0240U also detects RSV. Additionally, Microbiology, Immunology guidelines were also revised, along with codes 87301, 87802 and their subsidiary codes.
n
- Per AMA: Please note that, per the standard early release delivery process for CPT codes, you will need to manually upload these code descriptors into your EHR system. Most of these CPT codes will arrive as part of the complete CPT code set in the data file for 2021 later this year. However, as updates are released further into CY 2020, please ensure your systems are updated with the COVID‐19‐related code releases on this page.nReview and download the full CPT code descriptor release: Category I/Pathology and Laboratory
n
- Coronavirus (SARS‐CoV‐2): Long descriptors (PDF)
n
- Coronavirus (SARS‐CoV‐2): Medium descriptors (PDF)
n
- Coronavirus (SARS‐CoV‐2): Short descriptors (PDF)
n
nCPT Assistant fact sheets for coding guidance for new SARS‐CoV‐2 (COVID‐19)‐related testing codes can be found in the following links. These fact sheets include the following information:n
n
- Codes, descriptors and purpose
n
- Clinical examples
n
- Description of the procedures
n
- FAQs
n
nDownload the Oct. 6, 2020 CPT Assistant guide (PDF, codes 87636, 87637, 0240U, 0241U)nnDownload the Sept. 8, 2020 CPT Assistant guide (PDF, information on code 99072)nnDownload the Aug. 10, 2020 CPT Assistant guide (PDF)nnDownload the June 25, 2020 CPT Assistant guide (PDF, information on code 87301)nnDownload the May 20, 2020 CPT Assistant guide (PDF)nnDownload the April 10, 2020 CPT Assistant guide (PDF, codes 86602, 86635)nnDownload the March 13, 2020 CPT Assistant guide (codes 87631, 87632, 87633, 0098U, 0099U, 0100U)nnAMA Coding Advice and Testing Scenarios can be found on the following links: nnQuick reference flow chart for CPT reporting for COVID‐19 testing (PDF)nnCoding scenarios and how to apply best coding practices (PDF)nnAMA CPT public websitennAMA Press Releasesnn
Oct 23, 2020 | Uncategorized
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Welter Healthcare Partners is offering a webinar training for the 2021 E/M guideline changes. Join us as Ginger Avery, CPC, CPMA, CRC covers various topics to prepare you for the changes coming in 2021. Your entire practice can join for one set price and employees will learn the new documentation requirements, how to appropriately document and more! Read more below and complete the form to reserve your spot today!nnnThe American Medical Association (AMA) and the Center for Medicare and Medicaid Services (CMS) have partnered together to release significant guideline revisions for office and outpatient E/M services effective January 1, 2021. Let WHP’s coding and compliance experts walk you through what you need to know about these important changes, including how to correctly document time-based services versus level of medical decision making and appropriate application of prolonged service codes. nnThis training will compare current and future E/M service guidelines, help you understand how these changes will affect day to day operations, and provide key strategies to prepare. In addition, the training will include interactive exercises, practice scenarios will be evaluated and discussed, and live Q&A will be included. Coding tools will also be provided for reference.[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column width=”1/2″][vc_column_text]At the end of these sessions, attendees will be able to:n
n
- Recognize 2021 documentation requirements for EM Services
n
- Understand appropriate application of time-based reporting versus level of medical decision making
n
- Determine the level of service based on documented details
n
- How to appropriately document/capture prolonged services
n
- Appreciate the multifactorial impact of well-written note and accurate coding
n
n[/vc_column_text][vc_column_text]Webinar Training Dates and Times:n
n
- November 18, 2020 12:00pm – 1:30pm MST
n
- December 2, 2020 12:00pm – 1:30pm MST
n
- December 16, 2020 12:00pm – 1:30pm MST
n
n
n[/vc_column_text][vc_column_text]Webinar Cost: nn$149.00 per practice/organization[/vc_column_text][vc_column_text]About the Presenter: Ginger Avery, CPC, CPMA, CRCnn
Ms. Avery has over 25 years of experience in the healthcare industry including auditing, abstract coding, coding education and training, regulatory compliance, revenue cycle management, EMR/EHR advisement, reimbursement models, and has been extensively involved in major third-party HCC projects. She is a nationally known speaker and educator with expertise in a wide range of provider specialties and with various organizational types including Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). nnAfter obtaining her coding certification (CPC) in 2005, Ms. Avery worked for the medical practice division of a large hospital, and while she specialized in cardiology, she also worked closely with hospitalists and family practice providers. During that time, she also served as a member of the compliance committee and was responsible for writing policies and procedures related to billing, coding and auditing. In 2014, Ginger obtained her Certified Professional Medical Auditor (CPMA) credential and has served the coder-community in many ways including past President and Vice President of her local American Academy of Professional Coders (AAPC) chapter. Ms. Avery’s most recent accomplishment was obtaining AAPC’s Certified Risk Coder (CRC) credential in December 2019. n
n[/vc_column_text][vc_column_text]Additional Training Opportunities:nn Welter Healthcare Partners’s Customized Group Training allows study of clinic’s production data, practice scenarios from client’s current medical records, and dedicated Q&A time. This customized web-based training runs 2 hours, all staff is encouraged to attend. This option allows the client to set training dates and times. Please contact Jennifer Heuer at jh@rtwelter.com for more information including cost.[/vc_column_text][/vc_column][vc_column width=”1/2″][dt_fancy_title title=”Sign Up Now” title_size=”h3″ title_color=”custom” custom_title_color=”#0f2a96″][gravityform id=”17″ title=”false” description=”false” ajax=”false”][/vc_column][/vc_row]
Oct 23, 2020 | Uncategorized
There has been a new category of codes that can report both COVID-19 and the seasonal flu at the same time. Continue reading below for more information.nnAs of October 7th, in preparation for the upcoming flu season, the American Medical Association (AMA) released new codes to address the multi-virus testing that clinicians and the health care industry will be testing for in the coming months. These new codes, 87636, 87637, 87426 and 87811, have been approved for immediate use. Long code descriptions are as follows;nn87636 – Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) and influenza virus types A and B, multiplex amplified probe techniquenn87637 – Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), influenza virus types A and B, and respiratory syncytial virus, multiplex amplified probe techniquenn87426 – Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], fluorescence immunoassay [FIA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative; severe acute respiratory syndrome coronavirus (eg, SARS-CoV, SARS-CoV-2 [COVID-19]) In accordance with the above revision, the CPT Editorial Panel approved a new category I code,nn87811, to report infectious agent antigen detection by immunoassay with direct visual observation. 87811 – Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) The complete press release is available through the AMA’s website.
Oct 15, 2020 | Uncategorized
CMS announced new recoupment terms that allow providers and suppliers one additional year to start loan payments. For more information on the extended repayment schedule and the new terms continue reading below for more information.nnThe Centers for Medicare & Medicaid Services (CMS) announced amended terms for payments issued under the Accelerated and Advance Payment (AAP) Program as required by recent action by President Trump and Congress. This Medicare loan program allows CMS to make advance payments to providers and are typically used in emergency situations. Under the Continuing Appropriations Act, 2021 and Other Extensions Act repayment will now begin one year from the issuance date of each provider or supplier’s accelerated or advance payment. CMS issued $106 billion in payments to providers and suppliers in order to alleviate the financial burden healthcare providers faced while experiencing cash flow issues in the early stages of combating the coronavirus disease 2019 (COVID-19) Public Health Emergency (PHE).nn“In the throes of an unprecedented pandemic, providers and suppliers on the frontlines needed a lifeline to help keep them afloat,” said CMS Administrator Seema Verma. “CMS’ advanced payments were loans given to providers and suppliers to avoid having to close their doors and potentially causing a disruption in service for seniors. While we are seeing patients return to hospitals and doctors providing care we are not yet back to normal,” she added.nnCMS expanded the AAP Program on March 28, 2020 and gave these loans to healthcare providers and suppliers in order to combat the financial burden of the pandemic. CMS successfully paid more than 22,000 Part A providers, totaling more than $98 billion in accelerated payments. This included payments to Part A providers for Part B items and services they furnished. In addition, more than 28,000 Part B suppliers, including doctors, non-physician practitioners, and Durable Medical Equipment (DME) suppliers, received advance payments totaling more than $8.5 billion.nnProviders were required to make payments starting in August of this year, but with this action, repayment will be delayed until one year after payment was issued. After that first year, Medicare will automatically recoup 25 percent of Medicare payments otherwise owed to the provider or supplier for eleven months. At the end of the eleven-month period, recoupment will increase to 50 percent for another six months. If the provider or supplier is unable to repay the total amount of the AAP during this time period (a total of 29 months), CMS will issue letters requiring repayment of any outstanding balance, subject to an interest rate of four percent.nnThe letter also provides guidance on how to request an Extended Repayment Schedule (ERS) for providers and suppliers who are experiencing financial hardships. An ERS is a debt installment payment plan that allows a provider or supplier to pay debts over the course of three years, or, up to five years in the case of extreme hardship. Providers and suppliers are encouraged to contact their Medicare Administrative Contractor (MAC) for information on how to request an ERS. To allow even more flexibility in paying back the loans, the $175 billion issued in Provider Relief funds can be used towards repayment of these Medicare loans. CMS will be communicating with each provider and supplier in the coming weeks as to the repayment terms and amounts owed as applicable for any accelerated or advance payment issued.nnOriginal article published on cms.govnn nn
Oct 15, 2020 | Uncategorized
Implantable glucose monitor requests are becoming more frequent from those who have diabetes mellitus. Continue reading below to find out more about the recently updated guidance from Centers for Medicare & Medicaid. nnAs requests for implantable glucose monitors continues to rise among diabetes mellitus (DM) patients, continued guidance from Centers for Medicare & Medicaid Services (CMS) continues.nEffective October 11, 2020, CMS released the newest round of guidance with article A58110 and Local Coverage Determination (LCD) L38617.nThese documentations revealed indications for coverage, limitations, and exceptions.nTherapeutic I-CGMs are considered medically reasonable and necessary by Medicare when all of the following coverage criteria (1-5) are met:n
n
- The beneficiary has diabetes mellitus (Refer to the related Billing and Coding Article [A58110] for applicable diagnoses); and,
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- The beneficiary is insulin-treated with multiple (three or more) daily administrations of insulin or a Medicare-covered continuous subcutaneous insulin infusion (CSII) pump; and,
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- The beneficiary’s insulin treatment regimen requires frequent adjustment by the beneficiary on the basis of blood glucose monitor (BGM) or CGM testing results; and,
n
- Within six (6) months prior to ordering the I-CGM, the treating practitioner has an in-person visit with the beneficiary to evaluate their diabetes control and determined that criteria (1-3) above are met; and,
n
- Routine recommended follow-up care is expected.
n
nOriginal article published on cms.gov
Oct 8, 2020 | Uncategorized
nnAs 2021 approaches and new E/M changes are being implemented, it’s time to prepare your practice and sign up for training. Read below for more information on the webinar training from Welter Healthcare Partners. Sign up today with the form on this page to register your practice!nnThe American Medical Association (AMA) and the Center for Medicare and Medicaid Services (CMS) have partnered together to release significant guideline revisions for office and outpatient E/M services effective January 1, 2021. Let WHP’s coding and compliance experts walk you through what you need to know about these important changes, including how to correctly document time-based services versus level of medical decision making and appropriate application of prolonged service codes. nnThis training will compare current and future E/M service guidelines, help you understand how these changes will affect day to day operations, and provide key strategies to prepare. In addition, the training will include interactive exercises, practice scenarios will be evaluated and discussed, and live Q&A will be included. Coding tools will also be provided for reference.nnAt the end of these sessions, attendees will be able to:n
n
- Recognize 2021 documentation requirements for EM Services
n
- Understand appropriate application of time-based reporting versus level of medical decision making
n
- Determine the level of service based on documented details
n
- How to appropriately document/capture prolonged services
n
- Appreciate the multifactorial impact of well-written note and accurate coding n
n
n
nWebinar Training Dates and Times:n
n
- November 18, 2020 12:00pm – 1:30pm MST
n
- December 2, 2020 12:00pm – 1:30pm MST
n
- December 16, 2020 12:00pm – 1:30pm MST
n
nWebinar Cost: nn$149.00 per practice/organizationnnAbout the Presenter: Ginger Avery, CPC, CPMA, CRCnnMs. Avery has over 25 years of experience in the healthcare industry including auditing, abstract coding, coding education and training, regulatory compliance, revenue cycle management, EMR/EHR advisement, reimbursement models, and has been extensively involved in major third-party HCC projects. She is a nationally known speaker and educator with expertise in a wide range of provider specialties and with various organizational types including Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs). nnAfter obtaining her coding certification (CPC) in 2005, Ms. Avery worked for the medical practice division of a large hospital, and while she specialized in cardiology, she also worked closely with hospitalists and family practice providers. During that time, she also served as a member of the compliance committee and was responsible for writing policies and procedures related to billing, coding and auditing. In 2014, Ginger obtained her Certified Professional Medical Auditor (CPMA) credential and has served the coder-community in many ways including past President and Vice President of her local American Academy of Professional Coders (AAPC) chapter. Ms. Avery’s most recent accomplishment was obtaining AAPC’s Certified Risk Coder (CRC) credential in December 2019. nnAdditional Training Opportunities:nn Welter Healthcare Partners’s Customized Group Training allows study of clinic’s production data, practice scenarios from client’s current medical records and dedicated Q&A time. This customized web-based training runs 2 hours, all staff is encouraged to attend. This option allows the client to set training dates and times. Please contact Jennifer Heuer at jh@rtwelter.com for more information including cost.
Oct 8, 2020 | Uncategorized
The National Committee for Quality Assurance (NCQA), the Alliance for Connected Care, and the American Telemedicine Association (ATA) have assembled the Taskforce on Telehealth Policy to work together to advocate for the healthcare industries continued use of technology in patient care. Read more below!nnOverall, the Taskforce focuses on three main areas: expanding telehealth and its effect on the total cost of care, enhancing patient safety and program integrity in remote care services, and data flow, care integration, and quality measurement.nnThe Taskforce released a proposal on September 15th addressing the retention of telehealth throughout the industry. This proposal sited several areas within the healthcare industry that have seen positive influences on patient care, including skilled nursing facilities and rural areas with geographic restrictions.nnThe full report is available here, along with a webinar recording covering their findings and suggestions.nnClick here to read more from the NCQA
Oct 2, 2020 | Uncategorized
Welter Healthcare Partners is sharing updated information regarding Colorado COVID Telehealth and coding. Read below to find out more about these new CPT codes and new deadlines for Telehealth and benefits.nnClick here for the most recent COVID-19 updates from the Colorado payers. As you can see, most of the commercial payers have extended the deadlines for Telehealth and other expanded benefits through December 31st, 2020. These deadlines are still subject to change and our team will continue to monitor the market for these updates. This update serves as the highlights for each of the payers to keep your team up to date with the notes. The links for the full updates are included on Page 3 for your reference.nnIn addition to these changes with the commercial payers, there are some new CPT codes that have been released in response to the PHE, 99702, and 86413. For quick reference, the long descriptors for these codes are:n
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- 99072 – Additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service(s), when performed during a Public Health Emergency as defined by law, due to respiratory-transmitted infectious disease
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- 86413 – Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative
n
nThe above codes went into effect on 9/8/2020 and it is clear in the CPT assistant information that it is for use once a PHE is declared. Colorado’s PHE was declared 3/13/2020, so it meets that description. While these new codes have been released, effective immediately, we have yet to see the payers adopt these codes and outline expected reimbursement. We suspect it will be based on the calculation of supplies (like 99070) but CMS is currently silent on this topic. You can find additional information included in the link below from AMA with the release notes for these new codes. Our team will continue to monitor the coming changes with these codes to update you accordingly.nn
Oct 2, 2020 | Uncategorized
Just when we thought the past 6 months of 2020 have been hard enough, we now are quickly approaching our annual flu season. According to the CDC, flu season occurs in fall and winter with recommendations for flu shots administration in September and October. Read below to find out more.nnIn the past few years, flu vaccine administration has been increasing among adults 18 and older, and with the added concern and uncertainty of COVID-19, experts are optimistic that this flu season will not only persuade patients who have been hesitant about vaccines but also encourage them to reestablish care with a primary care provider (PCP).nnWith so many national and local pharmacies administering vaccines, clinicians and private practices are being encouraged to ramp up their team for the uncertain road ahead. Start with offering immunizations to your patient populations. Begin a marketing campaign to get the word out about your vaccines. Offer vaccines to your patient’s curbside. And continue to care for patients with telehealth opportunities.nnCMS even has a Flu Vaccine Partner Toolkit that can help you and your practice prepare. Click here to read it!
Sep 24, 2020 | Uncategorized
Recently, stakeholders have come forward to urge CMS to drop their proposed ACO quality changes. Since this is a time of uncertainty and challenges, many believe these changes are significant and are concerned with mandating these changes during a pandemic. Read the article below to find out more.nnCiting concerns about mandating sweeping new reporting requirements in the middle of a pandemic, some of the nation’s largest physician and hospital associations on Wednesday asked the federal government to drop changes on how Medicare accountable care organizations are assessed for quality.nn”The ACO quality changes proposed are significant and come at a time when ACOs are continuing to deal with challenges and uncertainty caused by the COVID-19 pandemic,” the American Medical Association and nine other stakeholder groups wrote in a joint letter to Centers for Medicare & Medicaid Services Administrator Seema Verma.nn”Just as CMS has proposed to delay moving forward with the MIPS Value Pathways approach due to concerns with COVID-19, CMS should also postpone such a drastic and significant change to the way ACO quality is measured, assessed, reported and scored for purposes of both the MSSP and MIPS programs,” the letter said.nn”The proposed rule, set to take effect in 20201, mandates of how ACOs and other alternative payment models are assessed on quality in the Medicare Shared Savings Program and Merit-Based Incentive Payment System.nnThe stakeholders also complain that the delayed release of the final rule cuts into the time ACOs and other APMs would have to implement the changes.nnSpecifically, the stakeholders urged Verma to reconsider:n
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- Ending the use of the Web Interface reporting mechanism, which has been used since the MSSP’s inception.
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- Removing the pay-for-reporting year currently provided to ACOs beginning an initial MSSP contract as well as individual measures that are newly introduced to the measure set.
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- Changes to the quality measure set ACOs must report under the APM Performance Pathway.
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- Replacing the existing MIPS APM Scoring Standard, which the stakeholders claim “allows each APM to have its own set of unique quality measures and scoring approaches that best fit the particular model.”
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nThe letter was signed by the AMA, American College of Physicians, America’s Essential Hospitals, America’s Physician Groups, AMGA, Association of American Medical Colleges, Federation of American Hospitals, Medical Group Management Association, National Association of ACOs, and Premier.nnOriginal article published on healthleadersmedia.com
Sep 24, 2020 | Uncategorized
It is always a good idea to update your resume, so why not take the initiative now since September is international update your resumé month. Read below for more!nnOne of my favorite things to wake up to in the morning is our local newscasters telling us what is today’s “Nation Day of”. As a connoisseur of mac n’ cheese, and French fries, I especially like to keep an eye on when these days are coming up so that indulgence is less guilt-ridden. In addition to these seemingly underappreciated days, we all know of some of the greater know awareness months out there like breast cancer in October and Heart disease in February. But with so many worthy causes, each month is stacked with a plethora to choose from. Here is one I bet you were not aware of.nnSo be sure to mark your calendars moving forward and use September to reflect on your accomplishments over the previous year and update your resume to include all of your achievements!nnFor more information on updating your resumé, click here!
Sep 17, 2020 | Uncategorized
The AMA has released new COVID-19 CPT codes that healthcare providers can use as a response to additional expenses. Read below for more information on the CPT codes and what each code entails.nnThe American Medical Association (AMA) on September 8 published two new CPT codes for novel coronavirus (COVID-19)-related services, including one that accounts for additional supplies and clinical staff time used to mitigate spread of the virus.nnHealthcare providers can now use CPT code 99072 (additional supplies, materials, and clinical staff time over and above those usually included in an office visit or other non-facility service[s], when performed during a public health emergency as defined by law, due to respiratory-transmitted infectious disease) to describe the additional supplies and staff time required to support safe in-person interactions with patients during the COVID-19 public health emergency (PHE).nnThis new code was established in response to the significant, additional practice expenses related to activities required to safely provide medical services to patients during the PHE, according to the AMA.nnAs explained in a special edition of CPT® Assistant, providers should use code 99072 only when safety measures are over and above those usually included during an office visit or service. Notably, the new code may only be reported for services rendered in the non-facility place of service settings.nnThe AMA also released a new laboratory testing code 86413 (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [COVID-19] antibody, quantitative) for laboratory testing that provides quantitative measurements of SARS-CoV-2 antibodies.nnOther laboratory testing codes for COVID-19 describe qualitative assessments (positive/negative) of SAR-CoV-2 antibodies.nnBoth new codes went into effect immediately and remain effective until end of the COVID-19 PHE.nnHealthcare professionals can find additional information, including clinical examples for the appropriate use of the new codes, in the accompanying CPT Assistant.nnOriginal article published on healthleadersmedia.com
Sep 17, 2020 | Uncategorized
nnOne 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. Read below for more!nnHere are the codes, and their guidelines as printed in the Official ICD-10-CM FY 2021 Guidelines;nn
Sep 10, 2020 | Uncategorized
As 2021 approaches and new E/M changes are being implemented, it’s time to prepare your practice and sign up for training. Contact Welter Healthcare Partners and sign up today to have these new policies under your belt before 2021.nn Ginger Avery, CPC, CPMA, CRC, is the Coding and Compliance Manager at Welter Healthcare Partners, Inc. Below, she is providing fourteen operational extremities on how to plan ahead in order to be ready for these administrative changes!nnThe 2021 E/M code changes are set to deliver a powerful mix of updates to help streamline documentation practices and reduce administrative burden. Medical practices are encouraged to start planning now for operational and administrative workflow adjustments that will be a result of this momentous occasion.nn1. Identify/Assign Project Lead. This transition will affect everyone in the organization including coders, billers, other non-clinical staff, clinical staff, and clinicians. A designated project lead will help assure your clinic is prepared to streamline processes before the changes take effect on January 1, 2021.nn2. Make Time for Meetings. Schedule time for meetings to review the changes and address questions. Track goals and milestones during the transition process. Organizations are encouraged to recognize the significance of this event and prioritize time to prepare for changes.nn3. Make a List of Necessary Changes. Forms, templates, and contracts need updated, electronic health records and practice management systems need upgraded, several experts will be noted.nn4. Update Policies, Procedures, Practice Protocols & Compliance Plan. Policies, Procedures, Protocols should all be in alignment with the new guidelines.nn5. Review Medical Malpractice Liability. Although the “counted” documentation requirements have lessened with the updates, clinicians are reminded to tell clear stories, documenting the clinically relevant details of each encounter. The new guidelines state that office visits include “a medically appropriate history and/or physical examination when performed.” Regardless of the changes, it is important to remember that the burden of proof lies within the documented details. Supportive documentation will help guard against fraud & abuse law infractions.nn6. Assess Financial Impact. Guard against an unanticipated financial impact by understanding the rules in advance and performing a prospective payment analysis. Be prepared to adjust business practices depending on practice needs.nn7. Check with EHR vendors. Check with EHR vendors to assure their systems are updated appropriately prior to Jan 1st.nn8. Consider Coding Support. Establish strong coding/auditing resources and expertise early in the planning process.nn9. Conduct Current Coding/Documentation Assessment. Review current documentation practices and system functionality to address specific areas of interest for education development. This small audit sample should be conducted by an outside auditing source to provide an unbiased evaluation with appropriate recommendations.nn10. Provide Education. Educate clinicians appropriately about documentation that impacts medical decision making and how to become proficient with recognizing complexity in alignment with the new guidelines. The new guidelines provide definitions and descriptions that clarify many details that were previously left subject to interpretation. For example, an Undiagnosed new problem with uncertain prognosis is defined in the 2021 guidelines as, “A problem in the differential diagnosis that represents a condition likely to result in a high risk of morbidity without treatment. An example may be a lump in the breast.”nn11. Conduct a Time Study. Have clinicians track the total time related to each patient encounter for the day to determine whether current processes are set to capture total encounter time appropriately.nn12. Understand Employer and Payor Requirements. Employers or payors may still require documentation of additional information above and beyond the new E/M office visit coding guidelines. Careful evaluation of the flexibilities allowed under the new guidelines will ensure that the documentation satisfies any other obligations and requirements that they may be expected to fulfill within their contracts.nn13. Consider How the New E/M Guidelines Impact Your Specialty. For example, pain management practices will use the new E/M guidelines for office visits, but they’ll need to stick to the current guidelines for codes such as subsequent hospital visit code 99232 and subsequent nursing facility code 99308, which were among the top 10 E/M visit codes for the specialty according to the latest Medicare Part B utilization data.nn14. Download and study the materials the AMA has published. The guidance includes a new medical decision making (MDM) table, new coding guidelines for office visits and prolonged service codes and a detailed list of relevant definitions.nnResourcesnnImplementing CPT® Evaluation and Management (E/M) revisionsnnTable 2 – CPT E/M Office Revisions Level of Medical Decision Making (MDM)nn10 tips to prepare your practice for E/M office visit changes
Sep 10, 2020 | Uncategorized
The report below describes a patient undergoing a transcatheter aortic valve replacement. The entire procedure has been documented in detail, describing the step by step process used by doctors to carry out the surgery. Keep reading for more on how this procedure was performed.nnDo you have a complicated surgery case that needs help with coding? Welter Healthcare Partners would love to help! Please upload the operative note by clicking on the link below. Remember to remove ALL patient protected health information and organization identifiers. Welter Healthcare Partners will not use any medical records submitted in which PHI is not removed and protected. nn– Click Here to Submit Redacted Surgery Case Study –nnDate of Procedure: XX/XX/20nnReferring Physician: A.M., MDnnPerforming Physicians: L. V., MD and S. P., DO. Both co-surgeons participated jointly in this catheter-based procedure.nnAssisting Physician: S. L., MD. A second interventional cardiologist was required for this procedure due to complex anatomic factors resulting in the need for a second operator with complex catheter training.nnAnesthesiologist: A. T., MD and R.S., MDn
Pre-Procedure Diagnoses:
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- Severe, symptomatic aortic valve stenosis
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Post-Procedure Diagnoses:
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- Successful transcatheter aortic valve replacement 23 mm Sapien Ultra
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- No significant paravalvular regurgitation.
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- Transvalvular mean gradient was reduced from 57 mmHg to 3 mmHg
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- Aortic valve pathology: Tricuspid
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Procedures Performed:
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- Transfemoral transcatheter aortic valve replacement
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- Balloon aortic valvuloplasty using an 18 mm Z-med balloon
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- Ultrasound guidance for arterial and venous access.
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- Aortography
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- Perclose Proglide deployment
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nIndications 89 year old female with a history of severe, symptomatic aortic stenosis. The patient was evaluated by a multidisciplinary team and deemed an appropriate candidate for TAVR.n
Description of Procedures:
nThe patient was brought to the hybrid operating room in the fasting and non-sedated state. The patient underwent monitored anesthesia care and was prepped in the usual sterile fashion. Transthoracic echocardiography was obtained for baseline assessment. Using ultrasound guidance and a micropuncture needle, the left femoral artery and left femoral vein were punctured and a 6 Fr sheath and 6 Fr sheath were, respectively, placed using the Seldinger technique. The right femoral artery was punctured and pre-close with Perclose devices was performed. Unfractionated heparin (UFH) was administered to achieve a goal activated clot time (ACT) > 250 sec. A 14 Fr E-Sheath was placed without difficulty.nnA transvenous pacemaker was placed in the right ventricle and threshold testing was performed. A pigtail catheter was advanced into the aortic root and aortography was performed to confirm co-planar angles. The aortic valve was crossed with a AL1 catheter and simultaneous aortic and ventricular pressures were obtained. Next, a Safari wire was placed in the left ventricle. After aortography was performed, an 18-mm Z-med balloon was delivered. After rapid pacing started, balloon aortic valvuloplasty was performed using the Z-med balloon, which was inflated at nominal pressure, and deflated. This was removed via the sheath.nnA 23 mm Sapien Ultra Valve was prepped according to manufacturer’s recommendations. The delivery system was introduced into the descending aorta and the valve was mounted onto the balloon in the usual fashion. The Sapien valve was then advanced across the stenotic aortic valve and carefully positioned during aortography. The valve was deployed during rapid pacing at 180 bpm. The delivery system was removed and transthoracic echocardiography revealed no significant paravalvular leak and a mean gradient of 3 mmHg.nnThe pacemaker was removed and iliofemoral aortography revealed absence of vascular complications (e.g. dissection, perforation). The E-sheath was removed and hemostasis was achieved with application of the Perclose Proglide devices. The contralateral arterial sheath was removed and hemostasis was achieved with application of a Perclose Proglide device. The venous sheath was removed and hemostasis was achieved with application of a Perclose Proglide device.n
Hemodynamics:
nBaseline aortic valve gradient: Mean 57 mmHg Final aortic valve gradient: Mean 3 mmHgnnEchocardiography: Refer to the separate TTE note for full details of the findings. Briefly, there is severe aortic stenosis at baseline. Following implant of a 23 mm Sapien Ultra valve, the gradient improved from 57 mmHg (from previous echo) to 3 mmHg. There is no significant paravalvular regurgitation. No new pericardial effusion at the conclusion of the procedure.nnEstimated Blood Loss: < 50 cc nnComplications: None apparent nnImplantations: 23 mm Sapien Ultra Valve nnContrast: 100 ccn
Summary:
nThe patient underwent successful balloon aortic valvuloplasty and transfemoral transcatheter aortic valve replacement for severe, symptomatic aortic stenosis using a 23 mm Sapien Ultra valve. The procedure was without apparent complication.n
Recommendations:
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- Transfer to the ICU in stable condition.
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- Bedrest for 6 hours.
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- Aspirin 81 mg daily starting tomorrow morning.
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- Restart Eliquis 5 mg po BID in 6 hours if no bleeding issues.
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- Transthoracic echocardiogram to be performed tomorrow to re-evaluate valvular hemodynamics
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Sep 3, 2020 | Uncategorized
Please find the latest updates from the major commercial health insurance payers in Colorado with more information on how they will be handling COVID-19 moving forward. As you very well know, the health plans have been changing their policies and procedures in response to COVID-19 as the Public Health Emergency (PHE) continues to unfold. These rolling changes will impact benefits for members and will also influence some of the services you may provide.
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This update has information from each health plan to keep you informed on any updated timelines, member cost-sharing responsibility, and covered services for the remainder of the PHE. As you can see, most of the dates for telehealth services have been pushed back to allow continued services for members at home.
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Your team at WHP will continue to monitor the coming changes to keep you up to date any new timelines or rule updates. Based on the current track record, we suspect this will all change again. Click here to download and print the PDF.
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Sep 3, 2020 | Uncategorized
It is not breaking news that COVID-19 is affecting every aspect of society and our overall health. In an August 14, 2020 release from the American Medical Association (AMA), the under-reported issue of opioid-related overdoses is discussed. Read below to find out more.nnAccording to this brief, “More than 40 states have reported increases in opioid-related mortality as well as ongoing concerns for those with a mental illness or substance use disorder in counties and other areas within the state”. Included in this brief are links for individual state reports regarding substance abuse and the AMA’s request for action by governors and state legislatures.nnWhen managing patients with chronic pain who have been prescribed opioid treatments there are certain requirements these patients must adhere to in order to remain on opioid treatment. These requirements, like almost every other aspect of our lives has been interrupted. What is your practice and clinical staff doing to stay compliant with opioid prescriptions?nnClick here to read more from the American Medical Association
Aug 27, 2020 | Uncategorized
Laws regarding physician self-referral and anti-kickback have been delayed due to the need for revisions. This delay has prevented physicians from being able to implement new solutions without the concern that they could be in violation of the law. Read the article below to learn more.nnThe much-anticipated final rule updating physician self-referral and anti-kickback laws has been pushed back for one year, the Department of Health and Human Services announced this week.nn”We are still working through the complexity of the issues raised by comments received on the proposed rule,” HHS Deputy Executive Secretary Wilma M. Robinson wrote in a public notice, “and therefore we are not able to meet the announced publication target date.”nnInstead, she said, the timeline has been pushed back to August 31, 2021.nnThe news was a disappointment for the American Hospital Association, which earlier this month had urged the Office of Management and Budget for an “expeditious review and release of the Physician Self-Referral and Anti-Kickback Statute final regulations” that the Centers For Medicare & Medicaid Services had submitted in July.nnThe AHA has long complained that the Stark Law prohibiting physician self-referrals is a major hindrance in the transition to value-based care, and that the proposed reforms would “provide space for the types of innovative arrangements among hospitals and physicians that can enhance care coordination, improve quality and reduce costs.”nnThe proposal would create new and permanent exceptions to the 30-year-old Stark Law for value-based arrangements, permitting physicians and other providers to try innovating solutions without fear that their legitimate efforts to coordinate care might violate the law, according to an agency fact sheet.nnThose new exceptions would apply for Medicare and non-Medicare populations alike.nnAHA General Counsel Melinda Hatton on Wednesday “strongly urged CMS to move more quickly to finalize these improvements.”nn”This is an extremely disappointing setback for hospital and health system efforts to continue to innovate coordinated care arrangements, which have great potential to benefit patients, lower costs and make care more accessible for everyone,” she said.nnThe proposed rule was first unveiled in October 2019, as part of the Trump administration’s “Patients Over Paperwork” initiative.nn”We serve patients poorly when government regulations gather dust in the attic: they become ever more stale and liable to wreak havoc throughout the healthcare system,” CMS Administrator Seema Verma said at the time.nnOriginal article published on healthleadersmedia.com
Aug 27, 2020 | Uncategorized
With COVID-19 being a huge concern when considering sending your kids back to school, educational facilities are advised to be extra diligent in their cleaning, disinfecting, and social distancing procedures. Still though, sending your child to school during a pandemic can cause your stress levels to increase. Take a look at the articles provided below to gather some back to school advice from medical professionals.nnAny parent will tell you that stress levels leading up to the start of a new school year are bad enough in a normal year. Now enter COVID-19, and parents, teachers, administrators and even students can increase stress levels to dangerous levels.nnSo here are a few great links we think can help you make informed decisions regarding your children.n
