Mar 27, 2020 | Uncategorized
Big news for PTs and their patients! For the first time, PTs will be allowed to bill for e-visits under codes associated with online assessment and management services (codes G2061, G2062, and G2063). To determine the reimbursement rates for G2061-G2063, visit the CMS Physician Fee Schedule lookup tool. Medicare coinsurance and deductible would apply to the services. A March 18 CMS MLN Matters article includes more information about the e-visits and telehealth waiver. Read below for more information!nnIn the federal government’s rapidly evolving response to the coronavirus pandemic, the U.S. Centers for Medicare and Medicaid Services has announced that it is easing Medicare telehealth restrictions in ways that could allow PTs to provide “e-visits,” a limited type of service that must be initiated by the patient. Prior to this change, CMS did not recognize PTs among the health care professionals allowed to bill codes associated with the visits.nnThe change, announced midday on March 17, is part of a set of loosened requirements that CMS has adopted to expand the provision of telehealth and patient-initiated digital communications, such as e-visits, to help blunt the spread of COVID-19. For the most part, PTs remain outside the reach of these so-called “1135 waivers” related to telehealth, with one exception: a type of remote interaction CMS calls an e-visit under Medicare Part B.nnIn its 2020 physician fee schedule final rule, CMS describes e-visits as “non face-to-face patient-initiated digital communications that require a clinical decision that otherwise typically would have been provided in the office.” The code descriptors suggest the codes are intended to cover short-term (up to seven days) assessments that are conducted online or via some other digital platform and include any associated clinical decision-making.nnUnder the waivers guidance issued by CMS, Medicare beneficiaries can qualify for e-visits no matter their geographic region or physical location, meaning that the provisions have been expanded to nonrural areas and can take place with patients in their homes. The big news for PTs and their patients is that, for the first time, PTs will be allowed to bill for e-visits under codes associated with online assessment and management services (codes G2061, G2062, and G2063). To determine the reimbursement rates for G2061-G2063, visit the CMS Physician Fee Schedule lookup tool. Medicare coinsurance and deductible would apply to the services. A March 18 CMS MLN Matters article includes more information about the e-visits and telehealth waiver.nnTo qualify as an e-visit, three basic qualifications must be met: the billing practice must have an established relationship with the patient, meaning the provider must have an existing provider-patient relationship; the patient must initiate the inquiry for an e-visit and verbally consent to check-in services, and the communications must be limited to a seven-day period through an “online patient portal.”nnAlthough the patient must initiate, CMS writes in a fact sheet that “practitioners may educate beneficiaries on the availability of the service prior to patient initiation.” For example, if a patient cancels treatment because they can’t come to the clinic or are concerned about leaving home, then the PT may advise the patient that she or her can reach out to the therapists as needed.nnAlice Bell, PT, DPT, APTA senior payment specialist, says that the waiver has some very practical implications for PTs, and offers a possible scenario in which the e-visit could be useful.nn”Let’s say that, as a PT, I’ve been seeing a patient for an orthopedic condition and I am progressing the patient’s exercises,” Bell said. “The patient is unable to come into the clinic but calls me to say she’s having difficulty with one of the exercises and that the other two seem to be too easy. I could arrange an e-visit with the patient and discuss her performance of the exercises. And I could then make a determination — maybe I find that the patient is performing one of the exercises incorrectly — and I could direct the patient on the correct performance. Perhaps I also determine that two of the exercises can be progressed because the patient is improving, so I could instruct the patient in the two new exercises. After that I could advise the patient to contact me for a follow-up e-visit as needed until the patient can return to the clinic.”nnThe HHS Office of the Inspector General has also issued a policy statement that provides guidance on how it interprets the new telehealth waivers. APTA regulatory affairs staff will continue to monitor these waivers and other developments and share news with members.nn”As we’ve seen over the past few weeks, and especially during the past few days, we’re dealing with an extremely fluid situation in terms of response to the coronavirus pandemic,” said Kara Gainer, APTA’s director of regulatory affairs. “This waiver and other changes have the potential to make a difference, and we hope that CMS continues to take steps that can help providers and their patients stay healthy.”nnAPTA has issued a statement on patient care and practice management during the COVID-19 outbreak, and offers a webpage to keep members up to date with the latest news on the pandemic.nnOriginal article published on apta.org
Mar 26, 2020 | Uncategorized
The COVID-19 pandemic is causing problems for everyone around the world. While it is important to pay attention to what is going on, there will be a point in time where everything will go back to normal. Many businesses will have buildup demand during this period and those that are ready to meet that demand will reap the rewards. Read the article below to find out what you need to do to prepare for life post COVID-19. nnPost COVID-19nCOVID-19 is all the buzz right now, but there will be a time after COVID-19 and when that time comes the winners will be those who are ready. No one, at least no one I know, wants to be sick or injured and need medical care, but it happens. Even during this pandemic, people will still need medical care, but the current slowdown, and even stoppage in some markets, of elective procedures, will create a buildup of demand for services. This pent-up demand will still be there as the impact of the virus diminishes and those practices that are ready to meet demand will reap the rewards.nnThings to consider as we weather this storm:n
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- Will you be ready to go back to “life as usual?” Will your facility be ready? Will you have all of the other providers and services needed to treat patients? Be sure to consider other services that may come from outside your practice. Services like: Anesthesiology, Radiology, Blood, and an actual facility to perform the procedure, etc.
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- It’s very likely that at least some hospitals and hospital systems will be swamped with COVID-19 patients, hopefully, many of them recovering. Consider, for example, most employed specialists have employment agreements based on Work RVUs, and they will be hungry to make up for lost RVU’s as the impact of COVID-19 abates; however, because they are tied to a specific hospital or system, there may not be capacity available to support their specialty. This means that the hospitals’ usual case volume may become available! Hospital-based providers may even become available themselves. Do you know which providers are the best candidates to join your practice?
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- As we have learned over the years, the art of commercial payer contracting has much to do about supply and demand! As we see a slowdown in the market to perform elective cases as COVID-19 cases increase, we should understand that this is affecting supply, but not demand. When we begin to see COVID-19 cases going down, access will increase to provide services for the built-up demand. Be ready!
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nWe want to encourage you to weather the storm and prepare for the opportunity on the other side. If you want to discuss appropriate strategies for your practice, please reach out to us. We are here to help!nnTodd Welter, CEO
Mar 24, 2020 | Uncategorized
Below are some updates regarding telehealth providers in Colorado. These are new updates and resources regarding COVID-19 (Coronavirus). Each of these payers has links to its website, for you to learn more about the services they are offering. Keep reading below to see if your provider has made any change to their telehealth program. If you have any questions for us at Welter Healthcare Partners feel free to contact us at 303-534-0388 or by email at info@WHPelter.com. nn
Mar 24, 2020 | Uncategorized
So many of us are now faced with not only the challenges associated with working from home but having the whole family home as well. There are daily news stories about how to cope with kids who want to go see their friends, work-out routines without gym equipment, and virtual dance parties streamed live via social media. But as members of the health care industry, we must always keep the patient’s information as a top concern. Read below for more information!nnWhether you are working off your work computer hauled into your dining room or a laptop on the kitchen table there are steps you can take to make sure personal health information (PHI) stays secure. Just like being at the office make sure you are locking your computer every time you walk away. If you are talking on the phone make sure you are in a closed room where PHI cannot be heard by other members of your household. Keep your internet tabs to a minimum and close out all unnecessary programs while PHI is open.nnClick on the links below for information on working from home during COVID-19:nnCoping With Children During QuarantinenWork Productively from Home in a Time of Social DistancingnnFrom everyone at Welter Healthcare Partners, we wish all of you health and safety during this time.
Mar 19, 2020 | Uncategorized
Welter Healthcare Partners is committed to keeping you up to date with the latest news regarding COVID-19. Beginning April 1st providers can start to use U07.1 for the diagnosis code of COVID-19. Read below to find out more about this coding update. n
Written by: Laura Evans, CPC Mar 18, 2020
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Providers in the U.S. will have a specific ICD-10-CM diagnosis code for the COVID-19 virus beginning April 1.
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During a meeting today, the ICD-10 Coordination and Maintenance Committee announced that it would adopt the World Health Organization (WHO) code, U07.1 (COVID-19), effective April 1.
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Previously, the panel had planned to implement the code beginning October 1 in the U.S. But the committee moved up the adoption date after the WHO declared COVID-19 a pandemic and President Trump declared the spread of the virus a national emergency, explained Donna Pickett, head of the diagnosis coding side of the ICD-10 Coordination and Maintenance Committee. She announced the April 1 implementation date during the March 18 committee meeting.
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Prior to April 1, providers can continue to report based on previously published interim guidelines, which outlines, among other things, how to report illnesses caused by COVID-19.
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Note that code U07.1 should be reported only for confirmed cases. Providers should continue to follow the interim guidelines for unconfirmed cases of suspected exposure or symptoms.
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Code U07.1 is designed to be a primary code, and you are to code also pneumonia and all other manifestations, Pickett advised during the meeting.
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Providers on the call noted that they are seeing testing only for severe cases and asked whether there are specific codes for exposure to COVID-19 or suspected cases of the virus that are symptomatic. Currently, there are not, Pickett responded.
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The ICD-10 Coordination and Maintenance Committee plans to update coding information about the code change on its website by March 20, 2020.
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Editor’s note: This is an unfolding story. Stay tuned for additional coverage.
Mar 18, 2020 | Uncategorized
Dear Valued Welter Healthcare Partners Customer,nnYour team at Welter Healthcare Partners is closely monitoring the developments regarding Coronavirus (COVID-19). We are following the guidance from multiple healthcare authorities, including our own medical director, and implementing policies and procedures to keep our employees healthy so we can uphold our commitment of providing quality services to you. nnWe are currently open and maintaining our operations and delivering services. In the unlikely event we are required to temporarily close our office, we have a business continuity plan in place and are ready to execute it. This includes the ability of our employees to work from home. Our work from home policy includes compliance and security standards to protect your information, including encrypted VPN access to various platforms and data. We are limiting business travel for employees but can ensure continuity of service to our clients in a virtual environment. nnThank you for being a valued client. We are here for you and committed to helping our clients through this very difficult and challenging time. Please contact us if you have any concerns or need any assistance. Your continued success is of the utmost importance to us. Our team will work closely with you and provide necessary updates and information.nnPlease stay safe!nnTodd WelternnCEO
Mar 17, 2020 | Uncategorized
Welter Healthcare Partners is committed to providing you with the most up to date information regarding billing and coding issues regarding COVID-19. For more information regarding this billing update on Medicare read the article below!
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The Trump Administration today announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. Beginning on March 6, 2020, Medicare—administered by the Centers for Medicare & Medicaid Services (CMS)—will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.
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“The Trump Administration is taking swift and bold action to give patients greater access to care through telehealth during the COVID-19 outbreak,” said Administrator Seema Verma. “These changes allow seniors to communicate with their doctors without having to travel to a healthcare facility so that they can limit risk of exposure and spread of this virus. Clinicians on the frontlines will now have greater flexibility to safely treat our beneficiaries.”
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On March 13, 2020, President Trump announced an emergency declaration under the Stafford Act and the National Emergencies Act. Consistent with President Trump’s emergency declaration, CMS is expanding Medicare’s telehealth benefits under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act. This guidance and other recent actions by CMS provide regulatory flexibility to ensure that all Americans—particularly high-risk individuals—are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the spread of coronavirus disease 2019 (COVID-19).
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Prior to this announcement, Medicare was only allowed to pay clinicians for telehealth services such as routine visits in certain circumstances. For example, the beneficiary receiving the services must live in a rural area and travel to a local medical facility to get telehealth services from a doctor in a remote location. In addition, the beneficiary would generally not be allowed to receive telehealth services in their home.
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The Trump Administration previously expanded telehealth benefits. Over the last two years, Medicare expanded the ability for clinicians to have brief check-ins with their patients through phone, video chat and online patient portals, referred to as “virtual check-ins”. These services are already available to beneficiaries and their physicians, providing a great deal of flexibility, and an easy way for patients who are concerned about illness to remain in their home avoiding exposure to others.
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A range of healthcare providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to Medicare beneficiaries. Beneficiaries will be able to receive telehealth services in any healthcare facility including a physician’s office, hospital, nursing home or rural health clinic, as well as from their homes.
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Medicare beneficiaries will be able to receive various services through telehealth including common office visits, mental health counseling, and preventive health screenings. This will help ensure Medicare beneficiaries, who are at a higher risk for COVID-19, are able to visit with their doctor from their home, without having to go to a doctor’s office or hospital which puts themselves or others at risk. This change broadens telehealth flexibility without regard to the diagnosis of the beneficiary, because at this critical point it is important to ensure beneficiaries are following guidance from the CDC including practicing social distancing to reduce the risk of COVID-19 transmission. This change will help prevent vulnerable beneficiaries from unnecessarily entering a healthcare facility when their needs can be met remotely.
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President Trump’s announcement comes at a critical time as these flexibilities will help healthcare institutions across the nation offer some medical services to patients remotely, so that healthcare facilities like emergency departments and doctor’s offices are available to deal with the most urgent cases and reduce the risk of additional infections. For example, a Medicare beneficiary can visit with a doctor about their diabetes management or refilling a prescription using telehealth without having to travel to the doctor’s office. As a result, the doctor’s office is available to treat more people who need to be seen in-person and it mitigates the spread of the virus.
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As part of this announcement, patients will now be able to access their doctors using a wider range of communication tools including telephones that have audio and video capabilities, making it easier for beneficiaries and doctors to connect.
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Clinicians can bill immediately for dates of service starting March 6, 2020. Telehealth services are paid under the Physician Fee Schedule at the same amount as in-person services. Medicare coinsurance and deductible still apply for these services. Additionally, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.
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Medicaid already provides a great deal of flexibility to states that wish to use telehealth services in their programs. States can cover telehealth using various methods of communication such as telephonic, video technology commonly available on smart phones and other devices. No federal approval is needed for state Medicaid programs to reimburse providers for telehealth services in the same manner or at the same rate that states pay for face-to-face services.
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This guidance follows on President Trump’s call for all insurance companies to expand and clarify their policies around telehealth.
nFor more information regarding this update click here.nnComplete and original article published on cms.gov.
Mar 16, 2020 | Uncategorized
Due to the recent outbreak in COVID-19 paired with increased concern for patients to be seen under quarantine conditions, Welter Healthcare Partners is striving to collect all relevant documentation, coding and billing details to help clinicians assure they receive appropriate reimbursement for unique services they are providing. Welter Healthcare Partners recommends checking with your top payors for coverage benefits, limitations and originating site waivers. Your feedback is greatly appreciated. Welter Healthcare Partners will continue to provide updates as we receive them. If you have any questions, please contact us at info@rtwelter.com. nnThe CPT Editorial Panel approved a new CPT® code at a special, expedited meeting held, via telephone, on Friday, March 13, 2020. A new CPT® code has been created that streamlines novel coronavirus testing offered by hospitals, health systems, and laboratories in the United States. nnNEW CPT CODE: 87635 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. nnCPT Assistant has provided a fact sheet for coding guidance for the SARS-CoV-2 (COVID-19) test in relation to the use of the new CPT code. Click here for the fact sheet.nnThere are two new HCPCS codes for healthcare providers who need to test patients for Coronavirus. Providers using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real-Time RT-PCR Diagnostic Test Panel may bill for that test using the newly created HCPCS code (U0001). A second new HCPCS code (U0002) can be used by laboratories and healthcare facilities to bill Medicare as well as by other health insurers that choose to adopt this new code for such tests. HCPCS code (U0002) generally describes 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19) using any technique, multiple types or subtypes (includes all targets). The Medicare claims processing system will be able to accept these codes on April 1, 2020 for dates of service on or after February 4, 2020. Click here for more information.nnTelehealth Evaluation considerations: nnEffective immediately 03/14/2020, United Health Care (UHC) will wave CMS originating site restrictions for Medicare Advantage, Medicaid and commercial members so services can be performed while the patient is in their home, effective until April 30, 2020. United Health care has waived all member cost-sharing, including copays, coinsurance, and deductibles, for COVID-19 diagnostic testing provided at approved locations, in accordance with the Centers for Disease Control and Prevention (CDC) guidelines for all commercial insured, Medicaid and Medicare members. UHC will also reimburse providers for telephone calls to existing patients. nnWe’ve found that most payors advise providers billing telemedicine to use the appropriate evaluative and management CPT code (99201 – 05, 99211-15) along with a GT modifier. nAlthough, MM10152 from January 1, 2018 eliminates the requirement of the use of GT modifier on professional claims. Click here for more information.nnPrivate payors may prefer that you use the telemedicine specific code 99444. It varies based on the payer and the state guidelines.nnMany of the MACs have yet to loosen the reigns on the originating site requirement with the use of “02” Place of Service with an office visit code. There are many other payors, including Medicare Advantage plans that have waived the originating site requirement. nnCMS is recommending the use of G2012 for telehealth services in a recent press release: nnCode G2012 has specific guidelines and documentation requirements to keep in mind when considering the appropriate use of this code: nnG2012 (Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion).nnReimbursement according to the recent MFS is $14.89.n
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- The service is communication technology-based
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- The provider can be a physician or other qualified health care professional who reports E/M services
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- Interaction must be between the patient and billing practitioner, not clinical staff.
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- The communication can’t be related to an E/M service from within the previous seven days.
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- The communication can’t lead to an E/M service within 24 hours (or soonest available): The language in the code descriptor states, “nor leading to an E/M service or procedure within the next 24 hours.” Consequently, Medicare will be watching for an uptick in appointments occurring 25 hours or so after the call. Do not game the system to get around the 24-hour limitation.
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- The code represents five to 10 minutes of medical discussion.
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- The medical record must document verbal consent from the patient for each billed service. Cost-sharing applies, and the beneficiary co-payment isn’t waived.
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- The service is available only to established patients, defined as patients who have “received professional services from the physician or qualified health care professional or another physician or qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past 3 years.”
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nHealth First of Colorado states, “Place of Service 02 should be used to report services delivered via telecommunication, where the member may be in their home and the provider may be at their office.” nnNon-F2F evaluation & management telephone services 99441-99443 may also be a consideration. This category of codes have yet to be recognized as CMS for reimbursement. Many other payors also do not cover these services. Welter Healthcare Partners recommends verifying coverage, limitations and reimbursement with your top payers for these services. nnModifier Considerations: nnUse of GT modifier on Medicare claims was eliminated in 2018. According to CMS, the place of service code 02 is sufficient. See the instructions below for appropriate consideration of CR modifier. nnChange Request (MLN) MM10152 from January 1, 2018 eliminates the requirement to use the GT modifier (via interactive audio and video telecommunications systems) on professional claims for telehealth services. Use of the telehealth Place of Service (POS) Code 02 certifies that the service meets the telehealth requirements. Click here to read the request.nnEffective August 31, 2009, the use of the CR modifier will be mandatory for applicable HCPCS codes on any claim for which Medicare Part B payment is conditioned directly or indirectly on the presence of a “formal waiver.”nnThe CR Modifier: Both the short and long descriptors of the CR modifier are “catastrophe/disaster-related.” The CR modifier is used in relation to Part B items and services for both institutional and non-institutional billing. Non-institutional billing, i.e., claims submitted by “physicians and other suppliers”, are submitted either on a professional paper claim form CMS-1500 or in the electronic format ANSI ASC X12 837P or – for pharmacies – in the NCPDP format. In previous emergencies, use of the CR modifier was entirely discretionary with the billing provider or supplier. It no longer may be used at the provider or supplier’s discretion. Effective August 31, 2009, the use of the CR modifier will be mandatory for applicable HCPCS codes on any claim for which Medicare Part B payment is conditioned directly or indirectly on the presence of a “formal waiver.”nnSee the MLN in its entirety for appropriate consideration of the CR Modifier here.nnDiagnosis (ICD10COM) Coding for COVID-19: Interim coding advice for COVID-19 has been provided by the CDC here. Clinicians are reminded to follow HIPAA mandated diagnosis coding guidance by reporting signs or symptoms until a definitive diagnosis has been made. nn nn
Mar 11, 2020 | Uncategorized
In March 2020, The U.S. Department of Health and Human Services finalized two HHS interoperability rules that give patients access to their healthcare data. With this new system, patients and providers will be able to access their medical records through applications on smartphones. While these new rules sound like a big step forward for the healthcare industry, there have been mixed reviews as some people are worried about patient privacy and provider API cost. Read the article below to find out more about this interesting development. nnThe U.S. Department of Health and Human Services (HHS) has finalized two interoperability rules to give patients direct access to their healthcare data. The first provisions of the rule will impact healthcare systems in as soon as six months.nnThe two rules, issued by the HHS Office of the National Coordinator for Health Information Technology (ONC) and Centers for Medicare & Medicaid Services (CMS), were announced last year, and the final rules were issued today. They are expected to “empower patients around a common aim—giving every American access to their medical information so they can make better healthcare decisions,” according to a release issued by CMS.nn”Americans will now have electronic access to their health information on their smartphone if they choose,” said ONC National Coordinator Don Rucker, MD, during a White House media briefing this morning with multiple government officials. “Our rule requires hospitals and doctors to provide software access points—endpoints if you will—to their electronic medical record databases so that patients can download these records to their smartphones.”nnOne key deadline for health systems occurs six months from today, said CMS Administrator Seema Verma. “We are changing the conditions of participation for hospitals to ensure Medicare- and Medicaid-participating hospitals are supporting care coordination for patients by sending admission, discharge, and transfer notifications so patients receive a timelier follow up, supporting better care and better health outcomes,” she said.nnThe CMS rule also impacts payers. Starting in 2021, Verma said, “all health plans doing business in Medicare, Medicaid, CHIP, and the federal exchanges [must] share their health data with their patients through a secure standards-based API (application programming interface), which represents the link between the data on various systems and [the] consumer’s phone.”nnThe rule also requires payers to make their provider directories publicly accessible through a provider directory API starting in 2021, said Verma. “This will allow innovative third parties to design apps that will help patients evaluate which plan networks are right for them and potentially avoid surprise billing by having a clearer picture of which clinicians are in-network,” she said.nnHHS Secretary Alex Azar said he expects the rules to spawn a new era of innovation in healthcare. “We hope to see a whole ecosystem of condition- or disease-specific apps to help patients monitor and improve their health in real-time, in part, by using data made available from their electronic health record via an API,” said Azar.nnRucker further commented: “We’re going to see a growth in patient-facing healthcare IT markets from an entirely new app ecosystem that’s going to be fueled by transparency about both product and price. We think this health app economy is going to have new services and we see the smartphone—not just as a smartphone—but as a tool to connect other devices to it.”nnAs expected, the ONC rule specifies the API certification criterion requires the use of the Health Level 7 (HL7) Fast Healthcare Interoperability Resources (FHIR) standard Release 4 and references other standards and implementation specifications to support standardization and interoperability.nnPatient Privacy ConcernsnThe ONC rule received more than 2,000 comments from the public, said Rucker. While most pertained to price transparency, concerns about protecting patient privacy rose to the forefront when Verona, Wisconsin, EHR vendor Epic Systems launched an initiative to delay the ONC ruling until certain patient privacy issues were addressed. The company marshaled its health system clients to write a letter to Azar to request the delay.nnDuring the White House media briefing with reporters, Azar said, “I want to emphasize that we’re taking these actions while maintaining and strengthening patient privacy protections. Patient privacy should never stand in the way of patient control.”nnIn a later media briefing on Monday exclusively with ONC representatives, Rucker said the final rule does not offer explicit mandates for third-party app privacy requirements, in part, for legal reasons.nn”Under the HIPAA right of access, [access to your] data is your right,” said Rucker. “We cannot, as a general matter, of course, presume to tell you how you are going to exercise your rights to your data.”nnIn addition, he said that while the U.S. Food & Drug Administration has some regulatory control over consumer apps, the ONC does not want to institute measures that will stifle innovation so early in the app development process. “The future is really unbounded, and we do not want to prospectively clamp off business models … We should really be open to the opportunities, um, that modernity affords us.”nnIn a statement issued Monday to HealthLeaders, Epic said, “The rule is very important to health systems and their patients, so we will read it carefully to understand its impact before making judgments.” In Epic’s statement today, among the issues it said it would closely scrutinize was “transparency for patients into companies’ data use and data handling practices.”nnYet the American Hospital Association still has concerns. In a statement issued after the final rule was released, the organization said, “America’s hospitals and health systems support giving patients greater access and control over their health data … However, today’s final rule fails to protect consumers’ most sensitive information about their personal health. The rule lacks the necessary guardrails to protect consumers from actors such as third-party apps that are not required to meet the same stringent privacy and security requirements as hospitals. This could lead to third-party apps using personal health information in ways in which patients are unaware.”nnIndustry ReactionnThe news received mixed reviews by healthcare systems, healthcare organizations, and observers, but most had not yet had the opportunity to completely review the 1,244-page ONC final rule or the 474-page CMS rule.nnAmong the misgivings expressed:n
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- Disappointment that an interim ONC final rule wasn’t issued: The American Health Information Management Association (AHIMA) issued a statement expressing support for the effort to “eradicate practices that unreasonably limit the access, exchange, and use of electronic health information for authorized and permitted purposes including patient access to their health information. However, given that the rule introduces a number of new definitions and terminologies and the significant economic impact of this rule, we are disappointed the [ONC} did not heed stakeholders’ calls to issue an interim final rule.”
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- Provider API costs: The Medical Group Management Association (MGMA) expressed support for the new opportunities for medical practices to share health information with their patients via user-friendly apps and CMS’s new hospital admission, discharge, and/or transfer notification requirements, but pointed out a significant issue. “MGMA is concerned that the ONC rule permits EHR vendors to push API costs onto providers,” the association said in a statement. “We will lead industry efforts to protect medical groups from potentially excessive EHR upgrade fees to ensure limited practice resources are not diverted from patient care.”
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nOthers embraced the changes.n
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- Cerner: Brent Shafer, CEO of EHR company Cerner, based in North Kansas City, Missouri, also issued a statement to HealthLeaders, saying in part, “Today marks an important milestone in a decades-long pursuit of improving consumers access to their own personal health data and clearing unnecessary hurdles that have stood in the way. The rules announced today will support a seamless and connected health care world where patients are more empowered than ever before.”
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- Intermountain: Stanley Huff, chief medical informatics officer for Intermountain Healthcare, said, “We are excited to see a major step forward in healthcare interoperability that is enabled by releasing the final rules. We anticipate that adoption of the HL7 FHIR Application Programming Interface (API) and encouraging patient-controlled access to their data will lead to healthcare applications that will improve the quality of care we provide while improving access to care and decreasing costs.”
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- Accenture: In a statement to HealthLeaders, Andy Truscott, managing director and technology consulting lead in Accenture’s health practice, said: “With today’s ruling, health systems have a clear compliance timeline to work toward. It does require a gap assessment of existing people, processes, and technologies against the obligations of the new rules and to deliver change. The rules are a boost for health systems in that custodianship of information about patients cannot be used as a way of binding the patient to that provider. Health systems will now look at how to improve the quality of the services they provide patients by leveraging the richer stream of information that can be obtained from other providers under the new rules. The opportunity to provide patients and providers with heightened experiences supported by a rich information fabric is there for the taking of the innovator. A clear statement on FHIR R4 as the backbone now provides certainty to information systems developers. Accenture believes that innovation is even more important now than ever.”
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nOriginal article published on healthleadersmedia.com
Mar 11, 2020 | Uncategorized
CMS has released a second emergency code for the testing of CORVID-19. To find out more about this update, read the article below and click on the links to see how you are covered. nnAs of Friday, March 6th, CMS released a second emergency code for CORVID-19 testing. Unlike HCPCS code U0001, which was released last month, U0002 will be used by laboratories to bill for non-CDC SARS-CoV-2/2019-nCoV (CORVID-19).nnHCPCS code U0001 was enacted to bill for tests and to track new cases of the virus. CMS and Medicare claim processing systems will begin accepting these codes as of April 1st for dates of service on or after February 4th of this year.nCheck with individual payers for guidance based on your contracts with them.nnCMS has also released three different fact sheets related to the virus. Click on the links below for more information regarding these updates from CMS:nnCMS Individual Insurance CoveragennCMS Medicare Coverage & PaymentnnCMS Medicaid Coverage
Mar 4, 2020 | Uncategorized
Anthem has recently finalized its acquisition of Beacon Health. This deal will allow for the expansion of critical behavioral health services, which will provide more care across the country. Read the article below for more information regarding the new changes that will come to Beacon and Anthem.nnAnthem, Inc. on Monday said it has finalized its previously announced acquisition of Beacon Health Options, the nation’s largest independently held behavioral health organization.nnFinancial terms were not disclosed for the sale of Boston-based Beacon, which had been held by Bain Capital Private Equity and Diamond Castle Holdings. The newly acquired BHO will move into Anthem’s Diversified Business Group.nnBeacon serves 36 million people and almost 3 million individuals in comprehensive risk-based behavioral programs. Indianapolis-based Anthem said the acquisition creates an opportunity to combine existing behavioral health capabilities “with Beacon’s successful model and support services in order to enhance whole-person care.”nn”We are pleased to complete the acquisition of Beacon Health Options and are excited to expand our critical behavioral health services to more people across the country as part of our focus on true whole-person care,” Anthem CEO Gail K. Boudreaux said in a media release.nn”Consumers and health plan customers alike will benefit from our ability to scale and integrate physical and behavioral capabilities in new and meaningful ways to improve lives,” she said.nnWhen the deal was first announced last June, Beacon CEO Russell C. Petrella said the acquisition would provide Beacon will scale to expand service options.nn”Together, we will expand access and enhance the quality of care for our mutual members,” Petrella said in a statement. “I am proud of the talented and committed team at Beacon, and we look forward to our future with Anthem.”nnOriginal article published on healthleadersmedia.comnn
Mar 4, 2020 | Uncategorized
When we go to the doctor, someone puts notes into our file. If you see these notes, some entires might be strikingly similar. This is called cloned notes. Below in this week’s Industry Hot Buttons, we go over cloned notes and how they can be an issue. Read the article below to find out more!nnCloned notes, as defined by CMS, are entries in a patient’s health record that are identical or strikingly similar to other entries in the same or another patient’s health record.nnEMR’s have made the lives of health industry professionals easier in so many ways. Unfortunately, they have also created a few headaches.nnMany people may not have known him until his recent passing, but Lawrence “Larry” Tesler was one of the computer scientists who created the “copy/paste” function.nnThis function has completely changed the way that each of us uses technology every day and is a function some of us would be lost without, myself included.nnThe problem is when this is over-utilized in the medical record. It leads to contradictions in our notes, unnecessary information, and often times the needed and pertinent information is left out.nnAs far back as 2013 the OIG has had Cloned Notes on their radar. It can lead to loss of integrity of the documentation and even damage the trustworthiness of the clinicians.nnIn a recent issue of Healthcare Business Monthly from the AAPC, an article entitled “Skirting the Dangers of Cloned Notes in Healthcare Practices”, writer Terry A. Fletcher explores the issues surrounding this and the risks it puts your practices at.
Feb 27, 2020 | Uncategorized
You may have heard that Cofinity.net is being sunset and we’ll no longer be using directprovider.com. These sites have been replaced with a new secured provider portal at firsthealth.com, a self-serve center that’ll support your network needs by offering claim search functionality, a complete client list, access to news and updates, and much more. Read the article below to find out more about this important change.nnIn just a few short weeks you’ll no longer be able to access Cofinity.net at all. Already, you might’ve noticed that the site is no longer interactive, and we aren’t processing password resets or new registration requests. We’re very proud to offer you this streamlined, self-serve, single-portal that connects you to both First Health and Cofinity network resources.nnHere’s a brief description features available on the First Health-Cofinity website:nnSecure LoginnnThe new secure login feature allows providers to access the First Health-Cofinity network portal on FirstHealth.com using their user ID and password. All providers will need to register as first-time users to access this feature.nnDemographic and TIN Updates Registered providers can submit demographic and TIN updates right on the website.nnClaim Activity ReportnnThis feature will allow providers to run ad-hoc reports for claim(s) within a specified time frame.nnClaim SearchnnThe new provider claim search functionality allows registered providers to search for claims by TIN and DOS. Providers will also be able to submit claim appeals if they are questioning the pricing. Appeals will be sent to our customer service team for review.nnClient ListnnProviders will be able to view an online list of all the clients (payers) contracted. Registered providers can even view details, like affiliations, address, and phone number for each client in the list.nnInformation provided by cofinity.net
Feb 27, 2020 | Uncategorized
February is Heart Health Awareness Month, so we all wear red and talk about our hearts, but what are we doing every day to make sure we are keeping it healthy? How many hours each day, week, month do we each spend at our desks without so much as a break to get water? If you’re like us, we can sit at our desks for hours on end. So next time you open a different patient chart, or are waiting for a webinar to start or a webpage to load, here are a few exercises you can do right at your desk to promote heart health.nnJust because you’re at the office, that doesn’t mean you can’t incorporate some desk exercises to keep your cardiovascular health on track. Short bouts of exercise between conference calls and checking emails will help improve fitness levels and heart health while burning a few extra calories. In addition, a minimal amount of extra activity can help limit additional weight gain.n
nnHere are five exercises that you can easily incorporate for a healthier and happier workday:n
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- Stretch – Interlace your fingers and reach up toward the sky, as high as you can – keep your palms facing up towards the ceiling.
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- Triceps dip – Find a solid, stable surface such as your desk. Turn away from the surface, put your feet together and place your palms on either side of you on the surface. Bend your arms to dip and raise yourself.
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- Under desk leg raise – Place your hands on either side of your chair for stability. Begin to slowly lift and lower your legs to engage your abdomen muscles.
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- Squat – Stand in front of your chair with your hands facing out, horizontal from the ground. Slowly and gently move up and down in the sitting position.
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- Calf raises – While standing, make sure you have a stable surface if needed for balance, and lift and lower onto your toes.
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nEach exercise can be performed 10 times for three rounds. That will total about 20 minutes to kick-start your cardio and build strength while at work.nnOriginal article published on blog.mission-health.orgnn
Feb 19, 2020 | Uncategorized
The Trump Administration has released their healthcare spending proposal for FY21. These plans are said to foster cost transparency, break down barriers impeding choice and competition, and reduce regulatory burdens. Read the article below to learn more about the Trump Administrations hospital spending plans for FY21.n
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- Hospitals cuts proposed in the FY21 budget include $117 billion in site-neutral payment cuts for on-campus hospital outpatient departments (HOPDs).
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- Hospitals would lose $87.9 billion over 10 years from limits on bad debt payment increases.
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- Hospitals would lose $47.2 billion from site-neutral payment policies for off-campus HOPDs.
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nIn what could be a 2021 preview if Republicans take control of Congress and retain the White House, the Trump administration included a range of sweeping healthcare policy proposals targeting hospitals in this week’s release of its proposed budget.nnThe Trump administration’s FY21 budget proposal emphasizes healthcare policies that would foster cost transparency, break down barriers impeding choice and competition, and reduce regulatory burdens.nnAlthough the current Congress may ignore the budget, the proposals could come back as last-minute funding sources for big budget packages or as part of major healthcare policy changes in the next Congress.nnThe budget projected savings of $844 billion over 10 years through implementation of a “Health Reform Vision Allowance,” which entailed:n
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- Reforming Medicare’s primary care service payments
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- Implementing a value-based purchasing program for hospital outpatient departments (HOPDs), ambulatory surgical centers and post-acute care facilities
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- Offering incentives to improve quality and health outcomes
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nProposed healthcare funding levelsnnThe Centers for Medicare & Medicaid Services (CMS) is projected to spend $1.2 trillion in FY21, or $47.6 billion more than in FY20. The budget proposes $1.6 trillion in CMS spending cuts over the next decade. Those cuts include $756 billion to Medicare over 10 years, which is projected to extend the Hospital Insurance Trust Fund by 25 years.nnThe budget also includes $920 billion in Medicaid cuts over 10 years, in part through increased eligibility enforcement and anti-fraud measures.nnThe budget would provide $5.7 billion for the 1,400 community health centers, which operate more than 12,000 care delivery locations and serve more than 28 million patients.nnHospital revenue would be significantly affectednnThe budget includes policies that would directly affect hospital revenue in widely varying ways, including:n
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- Limiting uncompensated-care bad debt payment increases to the consumer price index for all urban consumers (87.9 billion in savings over 10 years)
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- Requiring site-neutral payments between on-campus HOPDs and physician offices for services, such as clinic visits, commonly provided in nonhospital settings ($117 billion in savings)
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- Eliminating Medicare bad debt payments for disproportionate share eligible hospitals, exempting rural hospitals ($33.6 billion in savings)
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- Requiring all off-campus HOPDs to be paid under the Physician Fee Schedule ($47.2 billion in savings)
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- Allowing increased Medicaid copayments for nonemergency use of emergency departments ($1.8 billion in savings)
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nThe bad debt payment cuts would principally hit urban safety-net hospitals, said Chad Mulvany, a director of healthcare financial practices with HFMA.nnMeanwhile the site-neutral payment cuts would “blow teaching hospitals out of the water,” Mulvany said.nnAmong savings to Medicare more broadly, the budget projects that already-implemented changes to payment arrangements for Medicare accountable care organizations will save $2.9 billion over 10 years.nnPotential good news for hospitalsnnAmong the administration’s priorities is reducing the regulatory burden for providers. The Department of Health and Human Services (HHS) touted a reduction of $25.7 billion in regulatory burdens between FY17 and FY19.nnThe administration aims to add to that amount by requiring regulators to:n
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- By August 2020, issue finalized regulations on processes and procedures for issuing guidance documents
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- By the end of February 2021, establish a single, searchable database on the HHS website that contains, or links to, all of the agency’s guidance documents currently in effect
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nThe budget proposes medical liability reforms that would save HHS $27.2 billion and the federal government $40.3 billion over 10 years. Those reforms include capping awards for noneconomic damages at $250,000, indexed to inflation.nnAnother proposal would consolidate the four hospital quality payment programs in the form of a 5% payment cut that hospitals could earn back.nnThe budget would risk-adjust payments to HOPDs and ambulatory surgical centers based on the severity of patients’ diagnoses, in a budget-neutral manner.nnA value-based purchasing program for HOPDs and ambulatory surgical centers would be implemented, with 2% of payments tied in a budget-neutral manner to performance on quality and outcome measures.nnFor primary care physicians, the budget would create a risk-adjusted monthly Medicare Priority Care payment for providers who are eligible to bill for evaluation and management services and who provide ongoing primary care to Medicare beneficiaries. That payment would be funded by a 5% cut to all nonprimary care services and procedures.nnThe budget would eliminate the requirement that physicians certify all patients at critical access hospitals (CAHs) who are reasonably expected to be discharged or transferred within 96 hours of admission.nnCAHs could voluntarily convert to an emergency hospital that does not maintain inpatient beds, while receiving the same Medicare payment rates as other emergency departments, plus an additional payment to assist with capital costs.nnImpacts on bundled payments and other value-based payment policiesnnA major cut in the budget that was not targeted at hospitals but could directly affect their performance in value-based payment models was the $101 billion in 10-years savings from the establishment of a unified post-acute care payment system across all four post-acute care settings, including long-term care hospitals.nnSuch cuts could eliminate the source of nearly all of the savings obtained by hospital-led bundled payment participants, Mulvany noted.nn”If you suddenly go site-neutral on post-acute care, I don’t know why I join joint bundles, or really any bundle; there’s no savings there at that point,” Mulvany said about how hospital finance leaders might perceive such a change.nnThe budget would incentivize participation in advanced alternative payment models (APMs) by eliminating the participation thresholds needed for physicians to qualify for the 5% APMs bonus.nnIn another proposed tweak to the physician payment system, the budget would alter the Merit-based Incentive Payment System (MIPS) to assess performance at the group practice level instead of the individual-clinician level during the performance period, to reduce physician reporting burdensnnStriving to shore up rural hospitalsnnRural providers were a big focus of the administration’s budget.nnThe administration aims to build on its 2019 temporary increase in the wage index for hospitals in low-wage areas, which are primarily rural hospitals, with a proposed pilot to implement further changes to the Medicare inpatient hospital wage index.nnThe budget also would build on the expanded use of telehealth for Medicare Advantage plans with a comprehensive package to promote rural access to care and telehealth in Medicare fee-for-service.nnRural hospitals would be exempted from the proposed site-neutral payment cut to on-campus HOPDs.nnA new Medicare prospective payment system would be established for rural health clinics, with annual updates based on a market basket derived from cost report data and rebased periodically. Those changes would save an estimated $1.8 billion over 10 years.nnRural health clinics and federally qualified health centers could become distant-site providers for Medicare telehealth and be paid at a composite rate similar to that for comparable telehealth services under the Medicare Physician Fee Schedule.nn340B targeted with oversightnnThe budget would increase scrutiny of the 340B discount drug program, which is used by about 12,000 safety-net hospitals and clinics. A new $34 million oversight initiative for 340B would be established, funded in part by a new user fee based on 340B sales.nnAnti-fraud initiatives includednnThe administration said it cut the Medicare fee-for-service improper payment rate to 7.25%, the lowest since 2010, and projected that continued savings from anti-fraud program changes will provide another $31.4 billion over 10 years.nnThe budget would garner $20 million over the decade through new administrative fees for filing Medicare appeals, which the administration said is needed due to the filing of “non-meritorious appeals.”nnThe package of program-integrity legislative proposals is projected to improve payment accuracy, enhance provider and program oversight, reduce improper payments and support law enforcement.nnOriginal article published on hfma.org
Feb 19, 2020 | Uncategorized
In a recent release of 2018 benchmarks regarding modifiers 76, 77 and 79, the data of payment vs denials is staggering. For instance, a total of 159 codes reported with 91 and 249 codes that were reported using modifier 77 all had a 100% denial rate. Compared to the 952 codes that were denied when reported with 76 that doesn’t seem so bad. But considering your bottom line and the time it takes your team to resubmit it adds up to money lost. nnHowever when we step back and look at the big picture we see that modifier 76 although the most reported, still had the lowest overall denial rate at just 5%.n
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| Modifier |
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Times Reported |
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Percentage Denied |
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Total Denied |
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Total Paid |
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| 76 |
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119,200,000 |
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5% |
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5,960,000 |
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113,240,000 |
n
n
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| 77 |
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706,223 |
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14% |
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98,871 |
n
607,352 |
n
n
n
| 91 |
n
3,000,000 |
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20% |
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600,000 |
n
2,400,000 |
n
n
n
n nnWatching your reporting trends and utilizing billing reports will help make sure you avoid costly denials. Be aware of National Baselines for your specialty and where you fall within them.
Feb 14, 2020 | Uncategorized
2021 brings us monumental changes to Evaluation and Management coding and reporting! Notable changes will include: Deletion of CPT code 99201, new time reporting guidelines and modifications to criteria for medical decision-making.
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The new guidance also includes a revision to the work relative value units (RVU) for E/M office visits to match up with the AMA’s RVU Update Committee revised rates and increases total payments for most office codes.
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It is important to start planning your transition and training today so your practice is not at risk for delayed or lost revenue. To support your transition and training needs, we have developed the CHIEF Implementation Plan for 2021 E/M Changes! Click here for more details and contact us to get started!
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Feb 14, 2020 | Uncategorized
As Risk Adjustment (RA) and Hierarchical Condition Category (HCC) coding continue to grow and become common practice it is important for not just coders, but also our clinicians to recognize its importance and the effect it has on reimbursement. Below is an example of a procedure and notes regarding coding and why our clinician must be queried in order for the claim to be submitted. Do 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. – Click Here to Submit Redacted Surgery Case Study –nnDATE OF SURGERY: XX/XX/19n
PREOPERATIVE DIAGNOSIS: Left foot necrosis, as well as heel ulcer. PROCEDURES:
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- Left foot transmetatarsal amputation.
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- Left foot heel debridement, extensive.
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nNOTE: Documentation gives the impression that PT may have DM. Per correct coding guidelines, in order to code for peripheral vascular disease, we need to know if this is in relation to a Dx of diabetes mellitus as it effects code selection. Also, in order to code for heel debridement, surface area and depth must be documented (code 11043 can be reported and possibly 11046 if applicable).nnPOSTOPERATIVE DIAGNOSIS: Same.nnASSISTANT: A. SMITH, SA-C. nnANESTHESIA: Peripheral nerve block with MAC. ESTIMATED BLOOD LOSS: 25 mL.nnINTRAVENOUS FLUIDS: One L crystalloid. SPECIMENS REMOVED: Foot sent to path. COMPLICATIONS: None.nnDISPOSITION: To recovery room in good condition.nnFINDINGS: The patient was found to have left near full-thickness heel ulcers with no exposed bone. She also had necrosis of the entire forefoot.nnINDICATIONS: This is a 55-year-old female, with extensive peripheral vascular disease, who was deemed a surgical candidate for the stated procedure. Risks and benefits were discussed at length with the patient, including, but not limited to, infection, bleeding, neurologic injury, vascular injury, pain, stiffness, a possible need for further surgery. I personally marked the patient’s operative extremity prior to proceeding forth to the operating room.nnOPERATIVE REPORT: The patient was brought to the operating room on a gurney. She underwent peripheral nerve block per the anesthesia service. She was placed in the supine position and underwent MAC anesthesia. The left lower extremity was sterilely prepped and draped, using pure alcohol scrub and ChloraPrep.nnFollowing timeout confirming the correct patient, procedure, and extremity, the heel ulcer wounds were debrided. These were through the fascial layer, but not down to the bone. These were debrided back to bleeding tissue.nnWe then performed a transmetatarsal amputation by making a skin incision along viable skin. The subcutaneous tissues were stripped back to a planned osteotomy site with an oscillating saw. There was osteotomy performed along the proximal metatarsals. The specimen was sent to the path lab. We then checked for bleeding. There was bleeding at this level. This was irrigated out with 3 L normal saline mixed with bacitracin. Then with no tension, the plantar fat pad was repaired to the metatarsals. The skin was closed with 2-0 Monocryl and 2-0 nylon along with no tension. A sterile dressing was placed. The patient was then extubated and brought to the recovery room, with no further complications.nnPlease note that A. SMITH, SA-C, a skilled surgical assist, was an absolute requirement due to the complexity of this procedure. He did participate in wound exposure, retraction, and closure at the conclusion of the case.
Feb 7, 2020 | Uncategorized
During the State of the Union address, President Trump discussed the price transparency rule and slammed Medicare for all. Below are some of the main points President Trump made during the speech which included drug pricing plans, association health plans, and more. Read below for more information!nnPresident Donald Trump delivered his third State of the Union address Tuesday night, elaborating on several of the administration’s major healthcare initiatives.nnUnlike his previous two State of the Union speeches, Trump mainly avoided discussing the Affordable Care Act and instead focused on new policies like the administration’s price transparency rule and efforts to lower prescription drug prices.nnTrump also did not discuss the Health Adult Opportunity initiative, which was announced by the Centers of Medicare & Medicaid Services (CMS) last week.nnHe did criticize proposals to institute a ‘Medicare for All’-style system, which has been embraced by several Democratic presidential candidates.nn”To those watching at home tonight, I want you to know we will never let socialism destroy American healthcare,” Trump said.nnBelow are the healthcare policies discussed during Trump’s speech, including reaction from industry stakeholders to his remarks.nnPotential impact of price transparency rulennTrump heralded the administration’s price transparency rule, which will go into effect in 2021, saying it will save families “massive amounts of money for substantially better care.”nnHe also added that experts believe the rule, which is being challenged in a lawsuit by provider organizations, “will be even bigger than healthcare reform.”nnOn the topic of improved price transparency, Trump said patients should never be “blindsided” by medical bills but did not address the issue of surprise medical billing, which has stalled on Capitol Hill in recent months.nnOffensive against Medicare for AllnnTrump attacked Medicare for All proposals that have been put forward by congressional leaders, warning that such policies will “take away your healthcare, take away your doctor, and abolish private insurance entirely.”nn”132 lawmakers in this room have endorsed legislation to impose a socialist takeover of our healthcare system, wiping out the health insurance plans of 180 million very happy Americans,” Trump said.nnIn addition to his critiques of Medicare for All, Trump assailed California Governor Gavin Newsom’s recent proposal to extend public healthcare coverage to undocumented immigrant seniors.nn”These proposals would raid the Medicare benefits of our seniors and that our seniors depend on while acting as a powerful lure for illegal immigration,” Trump said.nnCalls on Congress for bipartisan drug pricing plannnOn the prescription drug front, Trump highlighted the administration’s challenge to the pharmaceutical industry and pointed to the record number of generic drugs to receive approvals from the Food and Drug Administration last year.nnHe said that last year marked the first time in 51 years that prescription drug prices went down but added that Congress can do more to lower prescription drug prices.nnTrump specifically referenced conversations he has had with Senate Finance Chairman Chuck Grassley, R-Iowa, who recently told Stat News that Trump has not advocated enough for a bipartisan drug pricing bill he coauthored with Ranking Member Sen. Ron Wyden, D-Ore.nn”I am calling for bipartisan legislation that achieves the goal of dramatically lowering prescription drug prices,” Trump said. “Get a bill on my desk, and I will sign it into law immediately.”nnSome Democratic House representatives vocally rebuked Trump’s points on drug pricing, expressing support for the Elijah E. Cummings Lower Drug Costs Now Act, which passed in the chamber in December.nnPraise for association health plansnn
Trump mentioned the administration’s move to introduce association health plans (AHP), saying the options are “60% less expensive, and better” than other available forms of coverage.nn”A good life for American families also requires the most affordable, innovative, and high-quality health system on Earth,” Trump said.nnTrump did not mention the ruling by a federal judge last spring that blocked key provisions of AHPs and the administration’s subsequent decision to file an appeal.nnProtect Medicare and patients with pre-existing conditionsnnDespite not mentioning the ACA, or its uncertain status due to a pending legal battle, Trump promised to protect patients with pre-existing conditions.nn”I have also made an ironclad pledge to American family: We will always protect patients with preexisting conditions,” Trump said.nnHe added that the administration will “always protect” Medicare.nnTrump also reiterated the administration’s commitment to improving kidney care and eradicating HIV by 2030.nnIndustry reaction to speechnnFollowing the address, stakeholders weighed in on the president’s remarks, expressing both support and criticism of the administration’s direction on healthcare policy.nnElizabeth Mitchell, CEO of the Pacific Business Group on Health, told HealthLeaders that business leaders are primarily concerned about policy proposals that ensure drugmakers, payers, and providers “don’t use anti-competitive practices to gain market power and raise prices.”nn“Employers are fed up with high drug costs and high healthcare costs generally,” Mitchell said in a statement to HealthLeaders. “They’re doing everything they can to be effective purchasers on behalf of their employees, but they don’t have adequate negotiating leverage with monopoly drug manufacturers. We need policymakers to stop manufacturers from egregious pricing and anti-competitive practices.”nnRep. Greg Walden, R-Ore., Ranking Member on the House Energy and Commerce Committee, said he had not seen a president “lean in further” on “lowering health care costs.”nn”President Trump is committed to driving down the cost of unaffordable prescription drugs; he is committed to helping American families. This stands in stark contrast to the command and control view of many in the Democratic Party today,” Walden said in a statement.nnContrasting Walden’s remarks, Rep. Lloyd Doggett, D-Texas, Chairman of the House Ways and Means Committee, said Trump has “failed to do anything to actually lower prices for anyone.”nn”Instead of slashing prices, Trump slashes Americans’ healthcare. He seeks to terminate Affordable Care for millions, end protections for patients with pre-existing conditions, and wreck Medicaid, while promoting ‘junk insurance’ and claiming to have a secret replacement plan,” Doggett said in a statement.nnThe Campaign for Sustainable Rx Pricing (CSRxP), which includes America’s Health Insurance Plans and the American Hospital Association as members, tweeted its approval of Trump’s call for a plan to lower prescription drug prices.nn”President @realDonaldTrump is right to call on Congress to lower #drugprices and hold #BigPharma accountable,” CSRxP tweeted. “The American people are watching to see if lawmakers can rise above politics and the influence of #BigPharma to pass bipartisan, market-based drug pricing solutions.”nnJack O’Brien is the finance editor at HealthLeaders, a Simplify Compliance brand.nnOriginal article published on healthleadersmedia.com
Feb 7, 2020 | Uncategorized
In the January 23rd edition of the MLN Connects, CMS announced the release of a Comparative Billing Report (CBR) on Shoulder Arthroscopies for Medicare part B claims. This information can be vital for Orthopedic practices during the audit process. Data will be compared based on other providers in your state as well as nationwide. However, this information is not available publicly so you must login to make sure your contact information is up to date. You can also visit the CBR website for more information. Never visited the CBR website? We strongly recommend you do, as this site contains great information about all specialties.nnnThe Comparative Billing Report (CBR) contains data-driven tables with an explanation of findings that compare your billing and payment patterns to those of your peers in your state and across the nation.nnCBRs are not publicly available. Look for an email from cbrpepper.noreply@religroupinc.com to access your report. Update your contact email address in the Provider Enrollment, Chain, and Ownership System to ensure accurate delivery. Visit the CBR website for more information.nnOriginal article published on cms.gov
