In 2011, the Centers for Medicare and Medicaid (CMS) unveiled a new benefit to address the need for annual care for seniors. It was widely hailed as a wonderful thing for Medicare patients who previously had no preventive care unless they paid out-of-pocket for a “complete physical.” What some people overlook is that the new Medicare benefit includes no actual physical examination of any kind.
Posts Tagged CPT
Some of the highlights of the semi-annual report:
- Code 90653 – has been ACCEPTED for inclusion in the 2013 codebook production cycle
“Influenza virus vaccine, inactivated, subunit, adjuvanted, for intramuscular use”
- Code 90739 – has been ACCEPTED for inclusion in the 2013 codebook production cycle
“Hepatitis B vaccine, adult dosage (2 dose schedule), for intramuscular use”
- Code 90672 – has been ACCEPTED for inclusion in the 2013 codebook production cycle
“Influenza virus vaccine, quadrivalent, live, for intranasal use”
- Codes 90685, 90686, 90687, 90688 were ACCEPTED for inclusion in the 2014 codebook production cycle
- Codes 90655, 90656, 90657, 90658, and 90660 will include the term “trivalent”, meaning “conferring immunity to three different pathogenic strains or species”
You can learn more about the changes for July 2012 at the AMA’s Category I Vaccine Code Page
There is no one, and I do mean no one, in your medical practice who does not need to know the basics of coding. Here is why:
- Providing services to patients is the business of healthcare. Every person who relies on healthcare for their living should understand something about the business they are in. This should not outweigh the fact that we are privileged to care for patients, but as the saying goes “No money, no mission.”
- It takes a team to produce care. The silos of front desk, billing, nursing and scheduling must come together to share their knowledge and produce a high-quality, reimbursable patient visit. Here are the roles each member of the team plays:
- The patient calls for an appointment and the scheduler matches the patient’s problem to an appropriate appointment type. The scheduler finds out if the patient is new or established and what the patient’s appointment is for.
- The patient arrives for the appointment and the front desk assures that all current demographic and insurance information is collected.
- The nurse rooms the patient, taking vitals, reviewing medications and reviewing the reason for the visit – the chief complaint.
- The physician or mid-level provider cares for the patient, documenting the visit and choosing the appropriate service and diagnosis codes.
- The patient completes the visit by paying any deductibles or co-insurance due and making any future appointments needed. The checkout staff enters the payments and/or charges if the service codes have not already been posted via the EMR.
- The biller “scrubs” the claim, checking for any errors and electronically submits the claim to the payer. The hope is that the claim is clean and will be accepted and paid immediately (within 30 days.)
When staff understands how important their contribution is to the financial viability of the practice and how all the pieces fit together, they are more incentivized to perform.