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- JustCoding’s E/M Essentials Toolkit
JustCoding’s E/M Essentials Toolkit is the essential resource for every physician practice, perfect for educating coders and billers—as well as physicians themselves. The toolkit, written by HCPro regulatory specialist Peggy S. Blue, MPH, CPC, CCS, CCS-P, CEMC, provides the core pieces for E/M coding education, simplifying Medicare guidelines, providing updates on the latest changes, and giving healthcare professionals the tools they need to help ensure accurate reimbursement.
This toolkit includes five E/M coding pocket guides, an E/M coding resource compendium, an E/M reference guide to the latest changes and developments, and a downloadable E/M audit tool sheet.
- State opioid database links with EHR in pilot program
Despite the growing number of online prescription drug databases that aim to counter the misuse of opioids and other controlled substances, many physicians don't use them.
- 2017 CPT update overhauls moderate sedation reporting
Coders prepared for 2017 with numerous changes to the Official Coding Guidelines for the ICD-10-CM and the addition of many new codes. Quietly waiting in the wings was the updated CPT® Manual for 2017 with its changes waiting to be discovered.
The moderate sedation codes live in the same Medicine subsection as previous years, however 99143-99150 have been deleted and replaced with 99151-99157. Looking at these new codes in more depth, the definitions are similar. Prior to 2017, codes 99143, 99144, and 99145 identified moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service and further specified by age of patient and intraservice time. The new codes for moderate sedation provided by the same physician are 99151, 99152, and 99153, differentiated by the age of the patient. However, the intraservice time has decreased from the initial 30 minutes to 15. Additional intraservice time increments remain at 15.
The old codes for moderate sedation provided by a physician or other qualified healthcare professional other than the physician performing the procedure were 99148, 99149, and 99150, with the same specificity of patient age and intraservice time. These have been replaced with 99155, 99156, and 99157, with the intraservice time decreasing to an initial 15 minutes from 30.
- Q&A: You’ve got questions! We’ve got answers!
Q: In a provider-based department (PBD), when an injection is provided by a registered nurse (RN), is the admin fee billed on the hospital’s UB claim form with the drug or under global billed on the 1500?
- Concierge medicine model continues to grow
Concierge medicine is still a niche industry, but in an era of decreasing reimbursements and increasing government regulation, it has become a more attractive option for some physicians running a small practice.
The concierge business model, which operates under several names including “direct pay,” has been around for 20 years and once catered to wealthy clients in affluent urban and suburban areas. But changes in the way small practices operate—and the proliferation of high-deductible health plans—is prompting physicians and consumers to give the model a second look.
“Back in 2001, when I started out in Richmond, Virginia, most people had $20 copays and nobody saw the rationale of directly contracting with a doctor,” says Tom Blue, chief strategic officer for the American Academy of Private Physicians (AAPP). “Back then, it smacked of elitism and healthcare for rich people, but now, things have changed.”
Analysts say some physicians looking to escape the pressures of an independent practice are migrating to the concierge business instead of selling their practice.
“A lot of physicians are frustrated with things getting in the way of patient care like MACRA and MIPS,” says Kurt Mosley, vice president of strategic alliances for Merritt Hawkins-AMN Healthcare. “Many doctors are spending more time on paperwork and administrative duties than they are with patients, and they’re looking to do something different.”
- Physician groups sound off on ACA repeal and replace
Physician groups have weighed in on the American Health Care Act (AHCA), introduced by Republicans in the House of Representatives March 6.
The proposed legislation has stirred a storm of controversy from all sides, with some critics raising concerns about the Congressional Budget Office’s (CBO) predicted rise in the number of uninsured individuals and others saying the AHCA doesn’t go far enough to remove subsidies, tax credits, and other programs to help lower-income individuals obtain health insurance, CNN reported March 14. The AHCA would repeal the individual and employer mandates, restructure Medicaid, and delay the tax on high-value, employer-sponsored health plans. As politicians, lobbyists, and the public weighed in on the AHCA, the Medical Group Management Association (MGMA), the American Academy of Family Physicians (AAFP), and the American Medical Association (AMA) released statements on their positions.
The MGMA took a neutral position, saying that it's difficult to predict what the proposed legislation will look like when, or if, it's passed by the House. The AAFP and the AMA, however, sounded the alarm on changes to Medicaid and tax credits, and cuts that would impact women's healthcare services, mental health and substance abuse treatment programs, and public health.