Effective January 1, 2013, Medicare and other payers will pay for two new CPT codes (99495 and 99496) that are used to report physician or qualifying non-physician practitioner transitional care management (TCM) service for patients, following a discharge from a:
- Skilled Nursing Facility (SNF)
- Community Mental Health Center (CMHC)
- Outpatient observation
- Partial hospitalization
and including a transition to:
- Rest Home
- Assisted Living
These two codes require the medical decision-making to be of moderate to high complexity. Each code encompasses one face-to-face visit and non face-to-face services, for instance, arranging home health agencies for patient care.
Codes are selected based on medical decision-making associated with the patient’s condition, the time when the communication is initiated with the patient, and the time when the face-to-face encounter occurs following discharge. The first face-to-face encounter is included. The codes may be reported only once per 30 calendar days. See the full code description at the end of this article.
When I come across a product or a service that I think is interesting, I want to write about it. When I connected recently with VibrantUSA, I found a service I never knew existed – an insurance broker specializing in Medicare plans! Here’s my interview with VibrantUSA’s CEO Rob Solberg.
Mary Pat: Your business is a family business – can you tell me your story?
Mary Pat: Your business is called “Health Security Solutions.” People often confuse privacy with security. Can you clear up the confusion for us?
Steve: The Privacy rules refer to the broad requirements to protect the confidentiality of Protected Health Information (PHI) in all its forms. So for example, a physician talking loudly on the phone in the lobby of a restaurant about a patient by name is a violation of the privacy rules. PHI on paper records is covered under the privacy rules.
The security rules are specifically concerned about protecting the confidentiality (i.e. privacy), integrity and availability of electronic PHI, or PHI that exists in a digital form. So once you are dealing with electronic health records and information systems, violations tend to fall under the security rules. (more…)
The Part B Medicare deductible for 2013 is $147.00.
What should you do with this information? You should avoid taking a big financial hit in the first quarter of 2013 by collecting deductibles at time of service. How do you do that?
- Let all patients know in advance that you collect deductibles by making it part of your communication with them. Put it in your financial policy (get a copy of my preferred financial policy below), put it on your website, and let patients know when you schedule their appointment, or make an appointment reminder with verbiage like:
“We look forward to seeing you at your appointment. Please bring your insurance cards and all medications to your visit. We will collect your co-pay, your deductible, and any co-insurance required by your insurance plan.”
- Explain what a deductible is. Get my sample patient handout explaining deductibles below.
- Train front desk staff on deductibles and get them comfortable discussing deductibles with patients and answering their questions.
- Do not collect deductibles for Medicare patients who also have Medicaid, or for Medicare patients with supplemental insurance as there most likely will not be a balance that the patient will owe.
- It is ideal to use a Credit Card On File program to charge the patient’s credit card at time of service, or when the EOB (Explanation of Benefits) arrives in 15 days.
Changes in health-care policy, new regulations, financial incentives and penalties have a direct effect on all healthcare organizations. As we round the corner towards 2013, take a few minutes to create an agenda of Medicare Incentive Programs and a few management initiatives to review with your physicians and leadership team.
Electronic Health Record (EHR)
Most practices have an EHR but often times it is not fully implemented:
- Are all of your physicians using the EHR?
- Do you have the latest version?
- Are all of your employees and providers trained properly?
- Are you utilizing all of the available functionality?
Meaningful Use (MU)
Announcement from the CDC
The Centers for Disease Control and Prevention (CDC) with state and local health departments and the Food and Drug Administration (FDA) are investigating a multi-state meningitis outbreak of fungal infections among patients who have received a steroid injection of a potentially contaminated product into the spinal area. This form of meningitis is not contagious. The investigation also includes fungal infections associated with injections in a peripheral joint space, such as a knee, shoulder or ankle. The CDC is offering advice online to healthcare professionals here.
The Centers for Medicare and Medicaid Services (CMS) just announced that the Quality Reporting Communication Support Page (where you go to apply for one of the four hardship exemptions from the 2013 1.5% Medicare payment reduction) will re-open November 1, 2012 through January 31, 2013 for Medicare 2013 Electronic Prescribing (eRx) Payment Adjustment Hardship Exemption Requests.
Beginning November 1, 2012, CMS will re-open the Quality Reporting Communication Support Page to allow individual eligible professionals and CMS-selected group practices the opportunity to request a significant hardship exemption for the 2013 eRx payment adjustment. Significant hardship request should be submitted via the Quality Reporting Communication Support Page (Communication Support Page) on or between November 1, 2012 and January 31, 2012. CMS will review these requests on a case-by-case basis. All decisions on significant hardship exemption requests will be final.
Important — Please note that this is for the 2013 eRx payment adjustment only. Hardship exemption requests for the 2014 payment adjustment will be accepted during a separate time frame later in calendar year 2013.
Are you already exempt from the 2013 1.5% payment cut?
The 2013 eRx payment adjustment only applies to certain individual eligible professionals. CMS will automatically exclude those individual eligible professionals who meet the following criteria:
The 2013 Work Plan for the OIG has been released and here are some of the top items that relate to medical practices. This is a great list to use for review and discussion – Is your medical practice doing this correctly?
Incident-To Services Performed by Nonphysicians
Reasons why practices are not billing these services correctly:
- Lack of understanding of incident-to
- Trying to avoid the 15% reduction in reimbursement for services provided by credentialed nonphysicians
- Difficulty in documenting who provided the services for charge entry
Medicare pricing for flu vaccines were released September 28th and appear below for all HCPCS codes which were published with fees. For more information on billing for these vaccines, see our post here.