ALERT: Closing or Relocating Your Physician Practice

ALERT: Closing or Relocating Your Physician Practice

You have spent over thirty years diligently treating your patients, and retirement has finally arrived. The RV or boat is gassed up, the grandkids can’t wait to have a new pal, and you are set to finally shave five strokes off your golf game. However, despite your long, successful, and untarnished career, you receive a last letter from your Department of Health informing you that when you closed your medical practice you failed to follow the proper procedures under you STATE OR FEDERAL law. Can the your State Department of Health really fine me, after I have retired, for failing to comply with the protocol established for Closing or Relocating a Physician Practice? The counterintuitive answer is “yes”.

Administrative Complaint shows, that Department of Health for any State may prosecute a physician for failure to perform “any statutory or legal obligation placed upon a licensed physician”, including certain legal requirements in the event a physician closes, sells, or relocates his or her medical practice.

For more information, or assistance in Closing or Relocating Your Physician Practice, please contact our office:

Paul G. Silverio-Benet

Healthcare Consultant

305-975-1171

sbhealthcaremgmnt@gmail.com

UPDATES FOR 2018

UPDATES For 2018

UPDATE: Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma recently announced a new approach to quality measurement, called “Meaningful Measures.” The Meaningful Measures Initiative will involve identifying the highest priorities to improve patient care through quality measurement and quality improvement efforts.

UPDATE: ICD-10 and Other Coding Revisions to National Coverage Determinations (NCDs)

The translations from ICD-9 to ICD-10 are not consistent one-to-one matches, nor are

all ICD-10 codes appearing in a complete General Equivalence Mappings (GEMs) mapping

guide or other mapping guides appropriate when reviewed against individual NCD policies. In

addition, for those policies that expressly allow MAC discretion, there may be changes to those

NCDs based on current review of those NCDs against ICD-10 coding. For these reasons, there

may be certain ICD-9 codes that were once considered appropriate prior to ICD-10

implementation that are no longer considered acceptable.

UPDATE: Medicare Part B Premiums/Deductibles

Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and other items.

The standard monthly premium for Medicare Part B enrollees will be $134 for 2018, the same amount as in 2017. Some beneficiaries who were held harmless against Part B premium increases in prior years will have a Part B premium increase in 2018, but the premium increase will be offset by the increase in their Social Security benefits next year.

CMS also announced that the annual deductible for all Medicare Part B beneficiaries will be $183 in 2018, the same annual deductible in 2017. Premiums and deductibles for Medicare Advantage and Medicare Prescription Drug plans are already finalized and are unaffected by this announcement.

UPDATE: MACRA 2018 final rule

On November 2, 2017, the Centers for Medicare & Medicaid Services (CMS) released a final rule for Year 2 of the Quality Payment Program (QPP), otherwise known as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA, as you might recall, is currently in its first year, and the 2018 final rule is an attempt to make things easier for smaller, independent, and rural practices during the 2018 performance period.

UPDATE: Patient debt varies by specialty and location

Should certain medical specialties or locations be particularly watchful? Yes, according to research from various medical practices (via Practice Analysis), which shows that both the percent of revenue from patients and the percent of patient bad debt vary by specialty and by location across the provider network.

Healthcare Consultant  ~ Our Services

HEDIS Compliance

MACRA-MIPS Compliance

Coding & Reimbursement

Local/State/Federal Compliance

Medicare and Medicaid Audits

Practice Administrator

Provider Contracting

Provider Credentialing

Practice Analysis

HCC- MRA Compliance

Opening Medical Office

Retiring, closing, or relocating a practice

For more details contact :  

Paul G. Silverio-Benet

305-975-1171

sbhealthcaremgmnt@gmail.com

Preparing For 2018

227 HCPCS code changes for 2018

New for 2018 includes 141 new codes and 11 new modifiers; 48 revised codes, 2 revised modifiers; 38 deleted codes, 2 deleted modifiers.

HCPCS CODE CHANGES:

19 new J codes, 81 new G codes for quality reporting.

Two new modifiers related to the OPPS reimbursement change for drugs purchased through the 340B program -- one new modifier for non-digital computed radiography technology and one new modifier related to Medicare’s new coverage of diabetes prevention programs, which begins in 2018.

New patient relationship modifiers X1-X5 added for 2018 are for informational, voluntary use only in 2018. These modifiers will be mandatory beginning in 2019.

A new modifier QQ, to confirm that providers are complying with Medicare’s new appropriate use criteria, which early adopters can begin reporting in July 2018. The policy will be required in 2020.

CMS deleted bilateral screening mammography code G0202, as well as diagnostic mammography codes G0204-G0206, all of which included computer-aided detection. Instead, practices should use CPT mammography codes 77065-77067.

Ready for 2018 ?

The time to prepare is now. Providers are urged to review the quality reporting for 2018. Quality measures span four domains: patient/caregiver experience, care coordination/patient safety, preventive health, and at-risk populations.

State and federal governments increasingly are moving toward a health care industry driven by quality. Health care practitioners likely have noticed increased activity among Medicare Advantage payers regarding quality initiatives.

SILBEN Health Services, Inc.,  is your solution and a quality resource to assist providers with today’s healthcare. For more details, please contact:

Paul G. Silverio-Benet

305-975-1171

sbhealthcaremgmnt@gmail.com

  

 Our Services:

HEDIS Compliance

MACRA-MIPS Compliance

Coding & Reimbursement

Local/State/Federal Compliance

Medicare and Medicaid Audits

Practice Administrator

Provider Contracting

Provider Credentialing

Practice Analysis

HCC- MRA Compliance

Opening Medical Office

Retiring, closing, or relocating a practice

Retiring, closing, or relocating a practice…

Retiring, closing, or relocating a practice…

Physician practices undergo closure for many reasons, including physician illness, death, or relocation, or the physician’s decision to sell, practice solo, join another group, or retire.

Who should be notified if it is a nonemergent closure?

Is there a time limit for sending the closure notice?

What other responsibilities should be undertaken by the practice that is closing?

For example, Florida Providers:

Florida Statutes, sets forth the requirements that must be followed when a physician retires, closes his office or relocates his practice.  The statute adopts the concept of a “records owner.”  A “records owner” may or may not be a physician.  A “records owner” means any health care practitioner who generates a medical record after making a physical or mental examination of, or administering treatment or dispensing legend drugs to, any person; any health care practitioner to whom records are transferred by a previous records owner; or any health care practitioner’s employer, including, but not limited to, group practices and staff‑model health maintenance organizations, provided the employment contract or agreement between the employer and the health care practitioner designates the employer as the records owner.

Please note that ALL states have rules and regulations for the closing of a medical office.

Avoid penalties and/or sanctions for FAILURE to comply Rules in Closing A Medical Office.

Paul Silverio-Benet, a Healthcare Consultant , is familiar with all the requirements for you the provider to be in compliance.

For more details, please contact:

Paul G. Silverio-Benet

305-975-1171

sbhealthcaremgmnt@gmail.com

Mediciad Update

Medicaid Update

Verma Outlines Vision for Medicaid, Announces Historic Steps Taken to Improve the Program 

New Policies Help Ensure States Can Focus More Resources, Time Achieving Positive Health Outcomes for Beneficiaries

Today, Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma discussed her vision for the future of Medicaid and unveiled new CMS policies that encourage states to propose innovative Medicaid reforms, reduce federal regulatory burdens, increase efficiency, and promote transparency and accountability during a plenary session at the National Association of Medicaid Directors (NAMD) Fall Conference in Arlington, Virginia.

During her first major speech on the subject, Verma noted that when the federal government established Medicaid, it was intended to be a partnership with state governments to care for society’s most vulnerable citizens. With the growth of the program over the last several years came increased federal and state spending, which naturally meant increased federal oversight and regulation, said Verma.

“Our vision for the future of Medicaid is to reset the federal-state relationship and restore the partnership, while at the same time modernizing the program to deliver better outcomes for the people we serve,” said Administrator Verma. “We need to ensure that we are building a Medicaid program that is sound and solvent to help all beneficiaries reach their highest potential.”

Verma emphasized her commitment to “turn the page in the Medicaid program” by giving states more freedom to design innovative programs that achieve positive results for the people they serve and pledged to remove impediments that get in the way of states achieving this goal. She announced several new policies and initiatives that break down the barriers that prevent state innovation and improvement of Medicaid beneficiary health outcomes:

Web Site Content on Section 1115 Demonstrations: CMS updated Medicaid.gov to give states a clearer indication of how their reform strategies might align with a core objective of the Medicaid program: serving the health and wellness needs of the nation’s vulnerable and low-income individuals and families. The revised web site content signals a new, broader view of Section 1115 demonstrations, in which states can focus on evidence-based interventions that drive better health outcomes and quality of life improvements. The update signals CMS’s willingness to work with state officials requesting flexibility to continue to provide high quality services to their Medicaid beneficiaries, support upward mobility and independence, and advance innovative delivery system and payment models.

In a significant shift from prior policies, in speaking about the new approach to Section 1115 demonstrations, Verma emphasized the agency’s commitment to considering proposals that would give states more flexibility to engage with their working-age, able-bodied citizens on Medicaid through demonstrations that will help them rise out of poverty. As Medicaid has expanded to able-bodied individuals, the needs of this population are even more imperative, she said. During her remarks, the Administrator made it clear that CMS will openly consider proposals that promote community engagement and work activities.

“Every American deserves the dignity and respect of high expectations and as public officials we should deliver programs that instill hope and say to each beneficiary that we believe in their potential,” said Administrator Verma. “CMS believes that meaningful work is essential to beneficiaries’ economic self-sufficiency, self-esteem, well-being, and health of Americans.”

Streamline and Improve 1115 Demonstration, State Plan Amendments, and 1915 Waiver Processes: CMS released several new policies that improve federal and state program management, specifically through improvements in the review, approval process, and monitoring of 1115 Demonstrations and Medicaid and Children’s Health Insurance Program (CHIP) state plan amendments (SPA) and 1915 waivers. Taken together, these policies include provisions that will allow states to:

• Request approval for certain 1115 demonstrations for up to 10 years;
• More easily pursue “fast track” federal review, which makes it easier for states to continue their successful demonstration programs;
• Spend time administering innovative demonstrations by reducing certain 1115 reporting requirements;
• Expedite SPA and 1915 waiver efforts through a streamlined process and by participating in a new “within 15-day” initial review call with CMS officials.

In addition, the policies will improve how waivers and demonstration projects are monitored and evaluated. Waivers and demonstration projects that are less complex and have been running smoothly will require much less reporting, and waivers and demonstration projects that have a good track record of producing positive results will find an easier path to renewal. In her remarks, the Administrator underscored that these new policies were intended to relieve the regulatory burden on states, avoid increasing administrative costs for taxpayers, and refocus time and resources on improving the health outcomes of Medicaid beneficiaries.

Creation of First-Ever Medicaid and CHIP Scorecards: CMS is in the early stages of developing Scorecards that will provide greater transparency and accountability of the Medicaid program by tracking and publishing state and federal Medicaid outcomes. In her remarks, Verma said that the Scorecards were a “historic opportunity” to demonstrate to taxpayers that their hard-earned tax dollars were being spent appropriately. In addition, the reporting will provide validation to Medicaid beneficiaries that the $558 billion spent on Medicaid is producing positive results and improved health outcomes.

To close her remarks, Administrator Verma noted that federal and state officials have a higher purpose than “just handing out Medicaid cards and being a financier of healthcare.” She stressed that the Administration’s new vision for Medicaid, and the new policy changes outlined today represented the results of a promise to Medicaid beneficiaries and to the American people that fund the program.

“We will not just accept the hollow victory of numbers covered [in the program], but will dig deeper and demand more of ourselves and of you,” said Verma. “For those unable to care for themselves, we will create sustainable programs that will always be there to provide the care you need, to provide choices and allow you to live as independently as possible. For those that just need a hand up, we will provide you the opportunity to take charge of your health care and assist and empower you to rise out of poverty and government dependence to create a better life for yourselves and your family.”

For more information regarding this article or about our services, please contact :

sbhealthcaremgmnt@gmail.com

Paul Silverio-Benet

305-975-1171

ER Visits on The Rise ~ Review of Audits

Key Notes For The Week  10/27/2017

Nearly half of medical care comes from emergency rooms, study shows

Nearly half of all medical care in the U.S. is delivered by emergency departments, according to a new study by researchers at the University of Maryland School of Medicine. And in recent years, the percentage of care delivered by emergency departments has grown.

In 2010, the study found there were nearly 130 million emergency department visits, compared with almost 101 million outpatient visits and nearly 39 million inpatient visits. Inpatient visits typically involve a hospital stay, but are planned ahead, as opposed to emergency department visits, which are generally at least somewhat unexpected.

Over the 14-year period of the study, more than 3.5 billion healthcare contacts -- emergency department visits, outpatient visits and hospital admissions -- took place. During that time, emergency care visits increased by nearly 44 percent. Outpatient visits accounted for nearly 38 percent of contacts, while inpatient care accounted for almost 15 percent of visits.

Certain groups were significantly more likely to use the emergency department as their method of healthcare. Black patients were much more likely to have emergency department visits than patients in other racial groups; patients in the "other" insurance category, which includes those without any type of insurance, were significantly more likely to have emergency department visits than any other group. And patients living in the South were much more likely to have emergency department visits than patients living in other areas of the country.

African Americans used emergency departments at a higher rate than other groups. In 2010, this group used the emergency department almost 54 percent of the time. The rate was even higher for urban African-American patients, who used emergency care 59 percent of the time that year. Emergency department use rates in the south and west were 54 percent and 56 percent, respectively. In the Northeast, use was much lower: 39 percent of all visits.

Certain groups accounted for increasing percentages of overall emergency room use: blacks, Medicare and Medicaid beneficiaries, residents of the south and west, and women. The authors said these findings point to increasing use by vulnerable populations -- no surprise, since socioeconomic and racial inequality creates barriers to the use of healthcare.

The use of emergency care resources for non-emergency cases has been controversial, since initial emergency care patients often end up being seen for non-emergency medical issues. Some experts argue that emergency departments are covering for deficiencies in inpatient and outpatient resources, and for a lack of effective prevention strategies, the report said. This could contribute to the high rate of emergency department use. These experts contend that emergency room use should be reduced.

Providers should consider:

·       Review and Urge Health Plans to develop contracts with Urgent Care Centers

·       Educate Patients on usage of ER and Urgent Care

·       Consider longer hours on certain days

769 hospitals fined for medical errors, infections, by CMS

The federal government has cut payments to 769 hospitals with high rates of patient injuries, for the first time counting the spread of antibiotic-resistant germs in assessing penalties.

The punishments come in the third year of Medicare penalties for hospitals with patients most frequently suffering from potentially avoidable complications, including various types of infections, blood clots, bed sores and falls. This year the government also examined the prevalence of two types of bacteria resistant to drugs.

Based on rates of all these complications, the hospitals identified by federal officials this week will lose 1 percent of all Medicare payments for a year -- with that time frame beginning this past October.  While the government did not release the dollar amount of the penalties, they will exceed a million dollars for many larger hospitals. In total, hospitals will lose about $430 million, 18 percent more than they lost last year, according to an estimate from the Association of American Medical Colleges.

The reductions apply not only to patient stays but also will reduce the amount of money hospitals get to teach medical residents and care for low-income people.

Providers should consider:

·       This penalty is being reviewed  to extend further , and apply to Providers

·       Review DISCHARGE Summary / Orders

·       Consider working with Case Managers

·       Implement Discharge Care

·       Require patient to be seen within 7-10 Days after DISCHARGE

Learn More About Field Testing of Episode-Based Cost Measures by November 15

The Centers for Medicare & Medicaid Services (CMS) is conducting a field test for eight episode-based cost measures before consideration of their potential use in the cost performance category of the Merit-based Incentive Payment System (MIPS) of the Quality Payment Program. 

Rehab Services are being Audited

We have created a checklist that serves as a documentation guide to assist providers and therapists when responding to requests for medical documentation pertaining to therapy services. This is only a guide, and it is ultimately the responsibility of the provider of services to ensure the correct submission of legible documentation for all dates of service on the claim(s) in question. Please ensure that the medical records submitted provide proof that the services were ordered, services were rendered, and that the documentation provided justifies medical necessity. If classified as a CORF/ORF, you must provide a coordinated, comprehensive, skilled rehabilitation program that includes at least the three “core” services listed:

1. Physician's services

2. Physical therapy services

3. Social and/or psychological services

For more information regarding this article or about our services, please contact:

SILBEN Health Services, Inc

Paul Silverio-Benet

305-975-1171

sbhealthcaremgmnt@gmail.com

Our Services:

·       HEDIS Compliance

·       MACRA-MIPS Compliance

·       Coding & Reimbursement

·       Local/State/Federal Compliance

·       Medicare and Medicaid Audits

·       Practice Administrator

·       Provider Contracting

·       Provider Credentialing

·       Practice Analysis

·       HCC- MRA Compliance

Bill it Right the First Time 10/19/2017

Bill it Right the First Time

19 October 2017

This blog is designed to provide education on how to avoid common billing errors and other erroneous activities when dealing with the Medicare Fee-For-Service (FFS) Program and/or other carriers.

Provider Types Affected: Physicians

Background: The rotator cuff is a frequent location of shoulder pain which can result in weakness and shoulder instability. Arthroscopic rotator cuff repair is a procedure to repair tears of the rotator cuff. Description of Special Study:

The CERT review contractor conducted a special study of claims with lines for arthroscopic rotator cuff repair procedures billed with Healthcare Common Procedure Coding System (HCPCS) code 29827 (arthroscopy, shoulder, surgical; with rotator cuff repair) submitted from January through March 2016.

Finding: Insufficient Documentation Causes Most Improper Payments Most improper payments for HCPCS code 29827 in this special study were due to insufficient documentation errors. Insufficient documentation means something was missing from the medical records. For example, claims with insufficient documentation lacked one or more of:

• Supporting documentation for the medical necessity of the procedure

• Procedure note

• Physician’s signature, or signature attestation, on a procedure note or diagnostic report

The CERT review also concluded on other services for the same period:

Improper Payments due to Insufficient Documentation - Missing documentation to support medical necessity

Sample of Claims Reviwed:

#1

The submitted records were missing the provider’s order for the B-12 injection and documentation supporting the medical necessity of the medication. The CERT review contractor scored this claim as an insufficient documentation error and the MAC recovered the payment from the provider

#2

A provider billed an APC payment line for HCPCS code 96372 (Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular) with APC code 00437 (Level II Drug Administration). The service of HCPCS code J3420 (Vitamin B-12 injection) was a packaged service under APC code 00437. The provider submitted the following:

• Medication administration record

And additional request for documentation returned no documentation.

The submitted records were missing the provider’s order for the B-12 injection and documentation supporting the medical necessity of the medication. The CERT review contractor scored this claim as an insufficient documentation error and the MAC recovered the payment from the provider.

Providers and/or Suppliers are encouraged to be familiar with the details of Medicare Coverage Policy , Medicaid Coverage Policy and Commercial Health Insurance Coverage . Providers and/or Suppliers should carefully review the medical record documentation to assure proper use of codes and medical necessity.

Avoid the request to Recover payments.

For more information regarding this blog or to inquire about our Consulting Services , please contact us:

Paul G. Silverio-Benet

305-975-1171

sbhealthcaremgmnt@gmail.com

Our Services:

·       HEDIS Compliance

·       MACRA-MIPS Compliance

·       Coding & Reimbursement

·       Local/State/Federal Compliance

·       Medicare and Medicaid Audits

·       Practice Administrator

·       Provider Contracting

·       Provider Credentialing

·       Practice Analysis

·       HCC- MRA Compliance

Delivery System Reform, Medicare Payment Reform

Delivery System Reform, Medicare Payment Reform

What's the Quality Payment Program?

The Quality Payment Program makes Medicare better by helping you focus on care quality and the one thing that matters most – making patients healthier. The Quality Payment Program ends the Sustainable Growth Rate formula and gives you new tools, models, and resources to help you give your patients the best possible care. You can choose how you want to take part based on your practice size, specialty, location, or patient population.

The Quality Payment Program has 2 tracks you can choose from:

1.      The Merit-based Incentive Payment System (MIPS)

2.      Advanced Alternative Payment Models (APMs)

Virtual Groups

As proposed in the CY 2018 Quality Payment Program proposed rule, if you’re a solo practitioner or a group with 10 or fewer eligible clinicians who participates in the Merit based Incentive Payment System (MIPS) as a virtual group, you’ll need to engage in an election process.  CMS will provide technical assistance, to the extent feasible and appropriate, to help practitioners with the election process.  Looking ahead to 2020, the third year of the Quality Payment Program, CMS hopes to be able to offer you an electronic election process.

The election period for virtual groups to make an election is from October 11, 2017 to December 1, 2017.

Episode-Based Cost Measures 

The eight episode-based cost measures are:

1.      Elective Outpatient Percutaneous Coronary Intervention (PCI)

2.      Knee Arthroplasty

3.      Revascularization for Lower Extremity Chronic Critical Limb Ischemia

4.      Routine Cataract Removal with Intraocular Lens (IOL) Implantation

5.      Screening/Surveillance Colonoscopy

6.      Intracranial Hemorrhage or Cerebral Infarction

7.      Simple Pneumonia with Hospitalization

8.      ST-Elevation Myocardial Infarction (STEMI) with (PCI)

How do episode-based cost measures relate to the Quality Payment Program?

MACRA established a process to enhance the infrastructure for resource use measurement, including for the purpose of developing cost measures for the MIPS cost performance category. MACRA requires cost measures implemented in MIPS to include consideration of patient condition groups and care episode groups (referred to as “episode groups”). As a result, eight episode-based cost measures are currently under development and are being field tested. These 8 measures are being developed with extensive input from 7 Clinical Subcommittees (CS), a Technical Expert Panel, and public comment: • Elective Outpatient Percutaneous Coronary Intervention (PCI) • Knee Arthroplasty • Revascularization for Lower Extremity Chronic Critical Limb Ischemia • Routine Cataract Removal with Intraocular Lens (IOL) Implantation Screening/Surveillance Colonoscopy • Intracranial Hemorrhage or Cerebral Infarction • Simple Pneumonia with Hospitalization • ST-Elevation Myocardial Infarction (STEMI) with PCI.

The eight episode-based measures currently being field tested and are not included in the 2017 or 2018 MIPS performance years.

For more details regarding this article or about our Consulting services , please feel free to contact :

Paul G. Silverio-Benet

305-975-1171

sbhealthcaremgmnt@gmail.com

Preparing For 2018

As we prepare to say good bye to 2017, it is that the time of the year where we need to review and prepare for the New Year 2018.

End of Year:

·       Final Chance to COMPLETE HEDIS Measurements

·       Review of MACRA – MIPS

·       Review of HCC ( MRA ) Coding

·       Review of Contracts  ( Renewals ? )

·       Review of Licenses and/or Renewal

·       Compliance Spot Check

Start 2018

·       Correct reporting and billing of medical procedures and services begins with CPT 2018. Know the deletions / additions / change

·       Review your Fee Schedules

·       Review Contracts for Profit and Losses

·       HIPAA Compliance – Business Associates Agreements in place?

·       Compliance for Meaningful Use 3

For more details inquire about our Consulting Services:

Paul G. Silverio-Benet

305-975-1171

sbhealthcaremgmnt@gmail.com

Coding It Right

Coding It Right

The NCCI program includes two types of edits: NCCI edits (also known as Procedure to Procedure (PTP) edits) and Medically Unlikely Edits (MUEs) (Units of Service). ... Each PTP edit has a column one and column two HCPCS/CPT code and a Correct Coding Modifier Indicator (CCMI).

Quality Measures

Transition Year 1

Exclude individual MIPS eligible clinicians or groups who bill <$30,000 in Part B allowed charges OR provide care for <100 Part B enrolled beneficiaries during the performance period or a

prior period.

Note: For the 2017 and 2018 MIPS performance periods, individual MIPS eligible clinicians and groups who are excluded may voluntarily participate in MIPS, but would not subject to the MIPS payment adjustments.

Year 2 Transition

Exclude MIPS eligible clinicians or groups who bill <$90,000 in Part B allowed charges OR provide care for < 200 Part B enrolled beneficiaries during the performance period or a prior

period.

Note: Starting with the 2019 performance period, individual MIPS eligible clinicians and

groups who are excluded, but exceed one of the low-volume thresholds, would be able to optin

to MIPS and be subject to the MIPS payment adjustments.

CPT II Codes

It provides an overview of the performance measures, a listing of CPT Category II codes that may be used with each measure, as well as any applicable reporting instructions.

Have you captured the appropriate ICD-10 , to meet the HCC Coding?

Did you code to indicate the appropriate measure has been performed?

Have you chosen the correct E&M level of service?   Is it under coding or over coding?

Is the practice in compliance with all FEDERAL / STATE / LOCAL requirements?

We are a consulting firm helping physicians and payers since 1983. For more details regarding this article or about our services , please feel free to contact us at :

SILBEN Healthcare Services, INC.

Paul G. Silverio-Benet

Phone: 305-975-1171

Email:  sbhealthcaremgmnt@gmail.com

2018 Coding Updates

2018 Coding Updates

A new year brings new code changes. With 2018 just around the corner, there is little time to get ready for all the changes that will be taking place.

A number of new codes and guideline revisions will be implemented for 2018.  As in past years, many of the new codes have been created as a result of bundling mandates from the AMA’s Relativity Assessment Workgroup (RAW) for the purpose of identifying potentially misvalued services.

Diagnostic Radiology

Chest X-ray Codes 

Chest x-ray codes 71010, 71015, 71020, 71021, 71022, 71023, 71030, 71034, and 71035 will be deleted and four new codes created to report chest x-ray procedures described by the number of views vs view-specific descriptors. 

Chest x-ray codes were identified in the 2016 Medicare Physician Fee Schedule (MPFS) Notice of Proposed Rule Making, Potentially Misvalued Codes Identified through High Expenditure by Specialty Screen.  After the Relative Value Scale Update Committee’s (RUC) mandate to revise these codes, the ACR requested an update in the descriptor language in order to increase the flexibility and accuracy for coding customized exams, which currently are coded with view-specific descriptors.

2018 Orthopedics Coding Updates

With the new year just around the corner, there’s little time to get ready for all the changes that are taking place in the 2018 CPT Coding. New appearances of physical therapy and grafting codes will affect coding in the orthopedic office, and nerve repair codes are changing as well.

·       New trends in CPT codes for orthopedics in 2018

·       Review of new orthopedics CPT codes

·       4 code additions in CPT codes for orthopedics in 2018

·       9 code revisions in CPT codes for orthopedics in 2018

·       7 code deletions in CPT codes for orthopedics in 2018

·       Updated NCCI guidelines for 2018

·       Documentation and modifier use issues and other issues resulting in denials

Medicine

Vaccines

Although effective July 1, the following changes will appear in the 2018 CPT manual to indicate the vaccine schedule changes.

#▲90621 Meningococcal recombinant lipoprotein vaccine, serogroup B (MenB-FHbp), 2 or3 dose schedule, for intramuscular use

#▲90651 Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (9vHPV), 2 or 3 dose schedule, for intramuscular use

The following influenza vaccine codes were added to the 2018 CPT manual; CPT code 90756 took effect in January 2017.

● 90682 Influenza virus vaccine, quadrivalent (RIV4), derived from recombinant DNA, hemagglutinin (HA) protein only, preservative and antibiotic free, for intramuscular use

# ● 90756 Influenza virus vaccine, quadrivalent (ccIIV4), derived from cell cultures, subunit, antibiotic free, 0.5mL dosage, for intramuscular use

Evaluation and management

Observation care services

The term “outpatient hospital” was added to all observation care services descriptors to clarify that these codes are to be reported when a patient is admitted to outpatient hospital observation status.

Special Note:  The revised guidance would focus on medical decision-making and time as the key indicators for a give level of service. This resembles the last comments made by CMS about finalizing E&M guidelines back in 1999, when they were to have come up with a 'weighted' system that valued decision-making more than the other E&M components.

For more information regarding this article or our consulting services, please contact us:

SILBEN Healthcare Services, INC.

Paul G. Silverio-Benet

Phone: 305-975-1171

Email:  sbhealthcaremgmnt@gmail.com

·       Facility Management

·       HEDIS Compliance

·       HCC ( MRA ) Compliance and Coding

·       Quality Measure Compliance

·       Practice Management

·       Risk Compliance

·       Coding & Reimbursement