Archive for July, 2016

CMS Opens Door to Possible Delay of MACRA Implementation

During Senate proceedings on July 13, CMS Acting Administrator Andy Slavitt and senators showed that they have heard and understand the AAFP’s sharp call to slow down plans for implementing the Medicare Access and CHIP Reauthorization Act (MACRA).
Speaking before the Senate Finance Committee(www.finance.senate.gov), Slavitt said he knows small physician practices might not have enough time to prepare for the important changes in Medicare payment if they go into effect on Jan. 1 as planned.
A final rule on new payment models under MACRA is expected to be announced in November. Sen. Orrin Hatch, R-Utah, chairman of the committee, noted the short period between then and the planned implementation date.
“Physicians will only have about two months before the program goes live,” Hatch said. “This seems to be a legitimate concern. What options is CMS considering to make sure this program gets started on the right foot?”
Slavitt responded that CMS is open to alternatives that include postponing implementation and establishing shorter reporting periods. He acknowledged several times during the hearing that the more time physicians have to spend reporting data, the less time they can devote to patient care.
“We’re putting in an awful lot of change,” Slavitt told the committee. “Too much change on top of an already burdened physician practice is not where we should be going.”
Slavitt’s stance is a good start for family physicians. The AAFP sent CMS a detailed letter on June 24 that called on the agency to, among other changes, delay implementation of MACRA until 2018 and set aside 2017 as a preparation year. The AAFP was also critical of the agency’s decision to delay formation of virtual groups until 2018; the groups would be a crucial support tool for smaller physician practices.
Slavitt also suggested that reporting requirements could be adjusted to ease the burden on physicians. For instance, CMS could obtain data through an automated database such as a registry. He also said practices that demonstrate strength in a particular area of care might not have to report those data and that physicians who do not see a high volume of Medicare patients might not be required to report data.

Dont Miss Your Chance to Win $10,000

The 3rd Annual GHFA $10,000 Draw Down will be held Thursday, November 10, 2016 during the GAFP Scientific Assembly Welcome Reception at the Westin Buckhead in Atlanta. Last year 3 lucky winners split the grand prize. Email  your ticket order to ksinkule@gafp.org or fax to 404-321-7450.

2016 Draw DownTicket Form

00001

 

Georgia Academy Leaders Shine at Primary Care Summit

Primary Care Summit

The Georgia Academy supported this day-long event and was a Gold Sponsor of this initiative.

Several emerging trends in health care and health care delivery that may have an impact on primary care workforce training initiatives were discussed. These included:

  • Impact of Hospital System(s) merging on training of primary care providers
  • Impact of adoption of Primary Care Medical Home (PCMH) model on primary care workforce needs
  • Impact of emergence of hospitalists as a specialty area on primary care practice environment and workforce
  • Impact of the closure and /or fragility of rural health facilities on the primary care workforce and rural populations

 

The Georgia Academy serves on the Steering Committee for the Primary Care Summit and will continue to work on these issue throughout the year, as well as, support legislative initiatives next winter.

Are You Coding Pre-Operative Clearances Correctly?

Steve Adams, MCS, COC, CPC, CPMA, CPC-I, PCS, FCS, COA

The Issue

This article will outline the three things we need to see in your documentation when billing a preoperative medical evaluation:

1. Reference to the request for a preoperative medical evaluation

2. The specific medical condition you were asked to address during the preoperative evaluation (e.g. from a cardiovascular or respiratory standpoint); and

3. Proof that you have returned your opinion and advice to the requesting provider.

The Past

Prior to 2001, most Medicare carriers were denying preoperative medical evaluations, both examinations and diagnostic tests, on the grounds that they were “routine physical checkups” and thus excluded from Medicare coverage by law. Even carriers who did not deny payment on this basis had conflicting policies about which ICD-9 codes should be used for these claims. Some required physicians to use one of the V codes for preoperative evaluations, some required the codes for the reason for surgery, and still others accepted only codes for comorbid conditions (e.g., hypertension) that necessitated a physician evaluation.

The Present

The purpose of this article is to clarify what the central billing office is requesting from our providers. Medical preoperative examinations and diagnostic tests done by, or at the request of, the attending surgeon should be paid, assuming, of course, that the insurance carrier determines the services to be “medically necessary.”

All such claims must be accompanied by the appropriate ICD-10 code for preoperative examination (i.e., Z01.810 – Z01.818). Additionally, you must document on the claim the appropriate ICD-10 code for the condition that prompted surgery. If there are other diagnoses and conditions affecting the patient, you should also document those on the claim.

Putting It All Together

Let’s say an ophthalmologist requests a preoperative clearance from you for a patient who has diabetes and hypertension and is scheduled for cataract surgery, right eye.

You document the requesting provider’s name and the reason for the preoperative medical evaluation. Then you perform an evaluation and management service and forward a copy of your findings and recommendations to the ophthalmologist clearing the patient for surgery.

When you bill for this service, the primary diagnosis on the claim, and the one attached to the EM code on the line item, will be a Z code (e.g., Z01.818, “Encounter for other preprocedural examination”).

The secondary diagnosis will be the reason for the surgery, the cataract in the right eye (e.g., H25.031, “Anterior subcapsular polar age-related cataract, right eye”).

Finally, if appropriate, you would also code the patient’s diabetes (e.g., E11.9, controlled, type 2 diabetes) and hypertension (e.g., I10, hypertension, benign).

Free Webinar: The (re)Purpose of Food: Reducing Food Waste at Home

 

food%20waste

Reducing Food Waste at Home

Nearly one third of the food we purchase ends up in the trash. This food waste stems from a variety of reasons:

  • We bought food for a specific recipe and have some remaining
  • We ate out rather than cooked, we forgot we had it
  • We think the food is almost too old to use or repurpose

Regardless of why, the loss in dollars and impact on the environment add up. Conserving food is part of our history. In World War I, Americans were challenged to avoid wasting food as part of the war effort. Based on this conservation theme, this food-focused webinar highlights how we can use and eat food responsibly, such as “buy wisely, cook carefully, eat completely.” From purchase to cooking, this session will address proper food storage, food solutions to maximize food use and minimize waste while maximizing nutrition.

Judy Barbe, an award winning registered dietitian, who will lead the webinar hosted by the Southeast Dairy Association, has been bringing realistic nutrition solutions to Mountain States tables since 1992. Judy is the founder of LiveBest, the immediate past chair of the Academy of Nutrition and Dietetics’ Food and Culinary Professionals Dietetic Practice Group, a spokesperson for the Wyoming Dietetic Association and has been recognized as Outstanding Dietitian. She is the author of Your 6-Week Guide to LiveBest, Simple Solutions for Fresh Food & Well-Being and LiveBest Seasonally, a Fresh Approach to Living with Vitality. She also is a long-time regional newspaper columnist, an experienced speaker and an avid traveler; she’s visited 26 countries and is planning a trip around the world.

Date: Thursday, August 4

12 – 1 p.m. EST

Objectives:

1.Describe how food waste is generated throughout the food chain and the impact on the environment.

  1. Provide shopping, storage and preparation tips for people to efficiently use food.
  2. Deliver consumer-friendly messages about reducing food waste.
  3. Identify food donation priorities.

Register here by Wednesday, August 3.

Additional Resources:

Southeast Dairy Association