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Physician Practice Perspectives is filled with Medicare news, coding and billing compliance tips, and ideas to bring in new patients, improve staff retention and performance, and save money through effective billing and cost management.
- Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2017
On December 29, CMS posted a Correction Notice in the Federal Register regarding the 2017 Physician Fee Schedule Final Rule. The corrections address technical and typographical errors that appeared in the final rule published in the November 15, 2016, Federal Register.
- Payment Reform Expert Pans MSSP Track 1+
A healthcare payment reform advocate is calling on Medicare officials to shift away from agency's biggest shared savings program and to foster more alternative payment models that generate value for patients and taxpayers.
- Time is of the essence for reporting complex chronic care management
Patients eligible for chronic care management services (CPT code 99490) are generally chronically ill and have continuous and/or ongoing episodic, chronic medical diagnoses. The majority of these patients are receiving these services within an assisted living facility, while some still reside at home, and others are in a full-service nursing care center.
Complex chronic care management is not reported by location, but provided in coordination with other care providers and, at times, performed by clinical staff that is not necessarily an MD or DO. It is not uncommon to see the clinical staff document, develop, implement, and revise care plans for these complex, chronically ill patients. However, this takes place under the direction of the physician and/or other qualified health care professionals such as a physician assistant or nurse practitioner.
In the 2017 CPT Manual, we have code 99487 with add-on code 99489 for the reporting of complex chronic care management codes (note: code 99488 has been deleted). Providers often document the acronym "CCCC," which stands for complex chronic care coordination, to report these services. Patients needing complex care coordination often have many providers involved with their care, which can include physical therapy, psychiatric and behavioral services, social and home care services, in addition to ongoing internal medicine, and specialty services for cardiology, orthopedics, neurology, urology, etc.
Think of codes 99487 and 99489 as similar to those codes for critical care services, as they are reporting a time-based service, in addition to other qualifiers that must be met.
These codes have been created to assist physicians in billing for time spent coordinating the many different services and medical specialties needed to effectively provide for these complex patients and their medical condition(s), psychosocial needs, and everyday activities.
When billing for complex chronic care management services, we have very specific CPT guidelines. These guidelines state that complex chronic care management services are provided during a calendar month timeframe and include criteria to be met.
- Q&A: You’ve got questions! We’ve got answers!
Q: What is Medicaid CHIP?
- Study finds one free meal can influence physicians
A new study has found that physicians can be swayed to prescribe new prescription drugs for pharmaceutical companies after the pharma company buys the physician just one meal.
The study, published in the June issue of JAMA Internal Medicine, found that even one meal costing less than $20 can help influence a physician to prescribe a new medication being marketed by a pharmaceutical firm. The results of the study, conducted by researchers at UC San Francisco, were criticized by pharmaceutical manufacturers, who suggested that researchers deliberately chose data that would skew the results.
“Whether it’s a formal dinner or a brief lunch in a doctor’s office, these encounters are an opportunity for drug company representatives to discuss products with physicians and their staff,” says Adams Dudley, MD, MBA, professor of medicine and director of the Center for Healthcare Values at UC San Francisco and a senior scientist on the study. “The meals may influence physicians’ prescribing decisions.”
The study, titled Pharmaceutical Industry-Sponsored Meals and Prescribing Patterns for Medicare Beneficiaries, investigated the association between industry-sponsored meals and the rate of prescribing brand-name drugs promoted to physicians by the pharmaceutical companies.