Healthcare Trends

telehealth resource center

Telehealth Resource Center for Revised PHE Coding & Billing Policies Due to COVID-19

By YES HIM Consulting / June 30, 2020 /

The Center for Medicare & Medicaid Services (CMS) expanded the payment guidelines for professional telehealth services provided to Medicare beneficiaries during the Public Health Emergency (PHE) declared for COVID-19 (CMS, 2020). The temporary protocol expansion was deemed necessary to aid healthcare reimbursement, and will be active only during the PHE. To keep coders and auditors up-to-date on the expanded services and reimbursement guidelines, YES HIM Consulting has gathered all the latest updates to form a telehealth resource center.

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antigen testing

COVID-19 Antigen Testing Code 87426 Available for Immediate Use from AMA

By Teri Jorwic / June 29, 2020 /

The American Medical Association (AMA) has released a new code for antigen testing of patients suspected to have been infected with COVID-19 (AMA, 2020). The CPT code for antigen testing was approved at a special meeting of the CPT Editorial Panel and released with a June 25, 2020, effective date. The special meeting and action by AMA was designed to react rapidly to the urgent need for the code. AMA President Susan R. Bailey M.D. commented, “Moving quickly during this crisis to meet the medical coding needs of the health care industry has enhanced the reporting of innovative tools now available to advance medicine’s overarching goals of reducing the COVID-19 disease burden, improving health outcomes and reducing long-term care costs” (AMA, 2020).

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fee for service

Updates for Medicare Fee For Service (FFS): CMS MLN Matters Special Edition Article

By YES HIM Consulting / June 23, 2020 /

The Centers for Medicare & Medicaid Services (CMS) has updated Special Edition (SE) MLN Matters® article SE20011 Medicare Fee for Service response to address the changes made for the issuance of additional guidelines and waivers regarding the 2019 Novel Coronavirus, COVID-19 (CMS, 2020). This MLN Matters® Special Edition Article is for providers and suppliers who bill Medicare Fee For-Service (FFS). This includes blanket waivers for providers and suppliers, a CMS telehealth video regarding coverage of services, guidance on Beneficiary Notice Delivery, and expansion of Ambulance origins and destination modifiers.

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hcc coding

Implement These Best Practices to Improve HCC Coding

By Mari Cely / June 12, 2020 /

Every healthcare organization that has Medicare patients who receive coverage and benefits through the Medicare Advantage program uses HCC coding. CMS established the HCC coding risk-adjustment model in 2004 to better predict healthcare costs for every patient and increase the accuracy in risk adjustment data for reimbursement claims (AAFP, 2020). But, what is HCC coding? Hierarchical condition category (HCC) coding utilizes the ICD-10 code set to identify risks for each patient and assign risk values, or RAF scores, in value-based care models. If your coding team needs HCC coding help, here are 4 HCC coding best practices you can implement right now to see a positive impact immediately.

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telehealth policies

Review the Temporary Physician-Based Telehealth Policies & Regulatory Revisions for COVID-19

By YES HIM Consulting / June 10, 2020 /

Due to the ongoing PHE regarding the 2019 Novel Coronavirus (COVID-19) outbreak, CMS has issued an interim final rule (IFC) to provide guidance on the updated telehealth policies and other services (CMS, 2020). The current PHE has relaxed many supervision requirements, allowing for supervision to be provided through audio/video telecommunications. Telehealth policies and procedures have been expanded further, and now include E/M services for emergency department visits, critical care services, nursing facilities, End State Renal Disease (ESRD) services, psychological/neuropsychological testing, and radiation treatment management (CMS, 2020).

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screening for COVID-19

COVID-19 Explained: Screening for Suspected COVID-19 Infection

By YES HIM Consulting / May 26, 2020 /

This article offers guidelines on how to code screening tests for suspected COVID-19 infection. There are two different kinds of tests for COVID-19: a viral test to detect a current Coronavirus infection, and an antibody test to confirm is the patient previously had COVID-19 (CDC, 2020). The CDC has issued guidance on conducting screening tests for COVID-19 and other recommendations for viral testing (2020).

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CMS guidelines for telehealth

CMS Guidelines for Telehealth Coding & Billing During PHE

By YES HIM Consulting / May 21, 2020 /

The Centers for Medicare & Medicaid Services (CMS) has decided to update the CMS billing and coding guidelines for telehealth or in-home provider services due to the urgency of the current 2019-Novel Coronavirus (COVID-19) pandemic (CMS, 2020). CMS has broadened the scope for reimbursement for virtual check-ins and other digital communications with patients to safely and effectively respond to this Public Health Emergency (PHE). In the interim, telehealth services will not be limited by program restrictions put in place by Medicare (Federal Register, 2020). Evaluation and management (E/M) service codes cover these remote and communication technology-based services performed by a physician or non-physician practitioner (NPP).

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How to Improve the DNFB Benchmark for a Positive Impact on Revenue Cycle

By YES HIM Consulting / May 21, 2020 /

One of the biggest revenue-killers for healthcare providers is DNFB accounts. DNFB (DNFB meaning “discharged, not final billed”) – defines unbilled accounts where the patient has been discharged from the healthcare facility, but the final bill from the encounter has not been submitted. The cost effects of outstanding DNFB accounts and claims denials are staggering, and can negatively impact the providers’ cash flow and potential net revenue. So, what are the best practices to reduce DNFB days and claims denials?

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medicare telehealth services

Medicare Telehealth Services Now Included In Expanded Payment Protocol

By YES HIM Consulting / May 14, 2020 /

The Centers for Medicare & Medicaid Services (CMS) has decided Medicare will expand its payment protocol for professional Medicare telehealth services provided to beneficiaries in all areas of the country, in all settings. “Telehealth, telemedicine, and related terms generally refer to the exchange of medical information from one site to another through electronic communication to improve a patient’s health” (CMS, 2020). Due to the current Public Health Emergency (PHE) declared for 2019 Novel Coronavirus (COVID-19), this expansion was considered a necessary step to assist in healthcare reimbursement and only designed to last as long as this emergency

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coding covid-19

COVID-19 Explained: Coding COVID-19 Possible Infection & Symptoms

By YES HIM Consulting / May 12, 2020 /

This article offers guidelines on Coding COVID-19 suspected Infection & Symptoms. Symptoms of the Coronavirus, according to the CDC, include cough, shortness of breath, fever, chills, muscle pain, headache, sore throat, and loss of taste and smell (2020). The reporting guidelines dictate: In patients with acute bronchitis that has been caused by COVID-19, use codes U07.1 and J20.8. For lower respiratory infection due to COVID-19, assign codes U07.1 and J22.

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