Keith A. Reynolds

Adhering to the following expert coding tips can help practices supercharge their revenue.

Bill Dacey, M.H.A./MBA, president and CEO of The Dacey Group in Palm Harbor, Florida, says that when some people consider supercharging their coding practices, they think of including smaller things for which they are not already billing. He warns that this approach may not be as effective as expected.

“My approach to this has always been to stop working the corners and the little $3 codes and counting all that little stuff,” he says. “Why don’t you just make sure you’re doing the stuff that you do 99% of the time? That will probably get your revenue where it’s supposed to be.”

Dacey says mastering the new outpatient coding guidelines, released last year, can help shore up revenues by enabling practices to bill for what the new guidance allows. He gives the example of code 99213 for an evaluation and management visit.

“It’s the most commonly reported code in the country, and it’s been a 99213 for 30-odd years, but with the changes that came in 2021, it makes it a whole lot easier to call that a 99214,” he says. Dacey says this feels off to longtime physicians because it has been an evaluation and management level three for so long, but now it is a level four.

“If (a practice) wanted to supercharge their coding, I would do it with the codes that had the real money,” Dacey says. “You’re doing the exact same thing you did two years ago, but now it’s worth 50% more.”

This change can be uncomfortable to implement, but Dacey says it is lucrative. “There (are) only five established patient codes … and the 99213, which has been the workhorse code forever, has now kind of slipped down a notch,” he explains. “Family medicine alone did $3 billion in 99214s last year and internal medicine another $3 billion. And that’s where the money is … most all of the money.”

Nancy Enos, FACMPE, CPC-I, coding consultant with Enos Medical Coding in Warwick, Rhode Island, says the key to getting the most revenue through coding is proper documentation of time spent. “It’s all about the documentation,” she says.

A focus on extensive documentation allows practices to keep track of all time spent on a patient session, enabling efficient billing. She recommends that physicians receive brief internal or external training on documentation.

“(This) will pay off in spades, because if they write certain elements, certain parts of their note, they will translate to the higher codes,” she says. Enos says this documentation becomes very important when billing for nonpatient-facing activities.

Enos also recommends that practices understand which nonpatient-facing activities still count for time. “There are several different things that count as reportable time as long as they’re performed by a billing provider on the same date as the billable visit,” she says. “It can’t be the day before, it can’t be the medical assistant — it has to be a billing provider and it has to be the same date.”

“There are so many things that they can just confirm, like the patient history and labs that were collected by their support staff,” she says. “Then when they review it on the day of the service before they see the patient, that could be another 20 minutes that is billable time toward the level of service, as well as after the patient leaves — any calls to physicians to put in place any coordination of care, (and) documenting and updating the medical record itself is now billable time that never was counted before 2021.”

Enos also recommends ensuring a practice keeps track of time when it comes to telehealth appointments. “There are instances where a telemedicine visit results in advice to come into the office because the patient does need to be seen,” she says. “You can only bill one visit per patient per day, so it’s just the office visit. The telemedicine visit is separately billed, but you can bill for total time spent on the day of the encounter. If you’re coding based on time, then you could add the time together for the telemedicine visit and the in-office visit.”

She notes that this is also a good reason to get your practice’s documentation in order, because properly documented activities are more likely to withstand scrutiny from insurance companies. Enos says that over the past year of audits she had seen some bullet statements listing only the total time spent on one or more of a list of the activities that count without a specific time accounting of time spent on each task. “I would not want insurance companies to audit that I may have done one of the following,” she says. “That doesn’t seem very provable.”

This article originally appeared on Medical Economics®.

Articles

A physician’s goal is to care for patients, but a key part of being able to provide that care is the eternal quest for payment. One way to ensure that a practice maximizes its coding regimen is to make sure each session can be efficiently billed.

Expert coding tips to maximize revenue

 topped the list of issues hospitals faced last year.

 from the American College of Healthcare Executives (ACHE), this is the first time in 18 years that financial challenges was supplanted from the top spot on the rankings coming in second and patient safety and quality ranked third.

“This is the first time since 2004 that financial challenges have moved from the most significant challenge to the second position. Both long- and short-term solutions are needed to address the shortages in critical front-line staff shown in our study to ensure hospitals have workforces that can meet the demands for safe, high-quality care both today and in the future,” Deborah J. Bowen, president and CEO of ACHE, says in the release. “Longer term solutions include increasing the pipeline of staff to these positions, as well as organization-level efforts to increase staff retention. More immediate solutions include supporting and developing all staff, building staff resilience and exploring alternative models of care.”

Other top challenges included behavioral health/addiction issues, governmental mandates, access to care, and patient satisfaction.

 with 94 percent of respondents saying they have been able to find registered nurses, 85 percent say they can’t find technicians, and 67 percent say they can’t find therapists. Meanwhile, 45 percent say they’re having difficulty finding primary care physicians, 43 percent can’t find physician specialists, and 31 percent can’t find physician extenders and specially certified nurses such as physician assistants, nurse practitioners, and certified nurse midwives, the release says.

Increased costs seem to be driving a vast majority of the financial challenges facing hospitals with 87 percent of respondents citing the costs for staff and supplies. A further 53 percent cite reducing operating costs, 52 percent cite Medicaid reimbursement, and 44 percent cited managed care and other commercial insurance payments, according to the release.

This article was published by our sister publication Medical Economics.

This is the first time in 18 years that financial challenges were not the top issue.

Personnel shortages top list of issues facing hospitals

 from the American Medical Association (AMA), a 

 of 1,004 practicing physicians found that 51 percent of respondents reported that the 

 process has interfered with their patients’ ability to perform their job responsibilities. A further 34 percent say that 

 has led to a serious adverse event such as hospitalization, disability, or even death for a patient in their care.

“Health insurance companies entice employers with claims that prior authorization requirements keep health care costs in check, but often these promises obscure the full consequences on an employer’s bottom line or employees’ well-being,” AMA President Gerald Harmon, MD, says in the release “Benefit plans with excessive authorization controls create serious problems for employers when delayed, denied or abandoned care harms the health of employees and results in missed work days, lost productivity and other costs.”

A vast majority of respondents, 93 percent, say that they’ve had to delay care while awaiting health insurer authorization of necessary procedures. A further 82 percent of respondents say they’ve had patients abandon treatment because of struggles getting authorization from health insurers, the release says.

When asked how often prior authorization criteria is based on evidence-based science or guidelines national medical societies, 30 percent of respondents say that the criteria is rarely or never based on these things. Only 1 percent of respondents say that prior authorizations have had a somewhat or significantly positive impact patient clinical outcomes, according to the release.

“Now is the time for employers to demand transparency from health plans on the growing impact of prior authorization programs on the health of their workforce,” Harmon says.

 to limit the impact of prior authorizations on their practice:

Assign a staff member to each payer. This person can become an expert on the payers for which they are responsible, learning their specific expectations and what to avoid. They can also build relationships with their counterparts at the payer, which may help expedite claims and appeals. This person should also create a basic guidebook for each payer that others can follow if needed.

Maximize the use of technology. Most payers offer online forms for the prior authorization process and some EHRs integrate directly with payer formularies. The more a practice can use these online forms, the more quickly an authorization can be obtained. In many cases, any missing information will be flagged before submission.

Document all treatment decisions and back them up with evidence-based practices. Payer justification for prior authorizations is that physicians are not always following the latest evidence-based practices, so ensure all treatment decisions are based on the latest guidelines. If a prescription is not following the formulary, make sure all information as to why it is not is included in the prior authorization form.

This article was published by our sister publication 

Prior authorizations are an obvious obstacle for physicians, but it also negatively impacts employers.

AMA: Prior authorizations hurt productivity

The Department of Health and Human Services (HHS) will release more than $2 billion in Provider Relief Fund payments through the Health Resources and Services Administration (HRSA).

According to a news release,1 these Phase 4 General Distribution payments will go to more than 7,600 providers across the country this week, This brings the total of distributed payments from the Provider Relief Funds and the American Rescue Plan in the last three months.

“Provider Relief Fund payments have served as a lifeline for our nation’s heroic health care providers throughout the pandemic, helping them to continue to recruit and retain staff and deliver care to their communities,” HHS Secretary Xavier Becerra says in the release. “This funding is just the latest example of the Biden-Harris administration’s dedication to ensuring that providers continue to have the resources they need to meet the evolving challenges presented by COVID-19 and keep providing critical services to the American people.”

The Phase 4 payments are focused on equity and include reimbursing a higher percentage for smaller providers and incorporating bonuses for those which serve Medicaid, Children’s Health Insurance Program, and Medicare beneficiaries, the release says.

“The COVID-19 pandemic is an unprecedented challenge for health care providers and the communities they serve,” HRSA Administrator Carole Johnson says in the release. “The Provider Relief Fund remains an important tool in helping to sustain the critical health care services communities need and support the health care workforce that is delivering on the frontlines every day.”

As previously reported, HHS awarded $103 million in payments from the Provider Relief Fund aimed at improving retention by funding evidence-informed programs, practices, and training with a specific focus on practices in underserved and rural areas. The money will be given to 45 different grantees.

The rates of depression and anxiety among healthcare workers have only been compounded by the COVID-19 pandemic as staff member suffering the physical and emotional demands of treating patients during a public health emergency. The ARP money will fund the creation of partnerships and utilization of local resources to support healthcare professionals’ response to workplace stressors.

This article was originally published on Medical Economics®. 

HHS distributing $2 billion more in provider relief fund payments to health care providers impacted by the COVID-19 pandemic. News release. Department of Health and Human Services. January 25, 2022. Accessed January 28, 2022. 

https://www.hhs.gov/about/news/2022/01/25/hhs-distributing-2-billion-more-provider-relief-fund-payments-health-care-providers-impacted-covid-19-pandemic.html

Payments are meant to assist providers who have been impacted by the COVID-19 pandemic.

HHS: $2 billion provider relief fund payments to be released

The Food and Drug Administration (FDA) has authorized a pair of COVID-19 antiviral pills that could change the dynamic of the ongoing pandemic.

, the agency issued emergency use authorization for both the Pfizer Paxlovid antiviral pills and the 

 for treatment of patients who test positive for COVID-19 and who are at high risk for progression to severe forms of the disease as soon as possible after diagnosis and within five days of the onset of symptoms. Paxlovid is authorized in adult patients and in pediatric patients 12 years of age or older and weighing more than 88 pounds, while molnupiravir is only authorized for patients over the age of 18 as use in younger patients can affect bone and cartilage growth.

 was authorized Dec. 22 with Patrizia Cavazzoni, MD, director of the FDA’s Center for Drug Evaluation and Research, touting the pill’s approval in the release.

“Today’s authorization introduces the first treatment for COVID-19 that is in the form of a pill that is taken orally — a major step forward in the fight against this global pandemic,” said Cavazzoni at the time. “This authorization provides a new tool to combat COVID-19 at a crucial time in the pandemic as new variants emerge and promises to make antiviral treatment more accessible to patients who are at high risk for progression to severe COVID-19.”

“Today’s authorization provides an additional treatment option against the COVID-19 virus in the form of a pill that can be taken orally. Molnupiravir is limited to situations where other FDA-authorized treatments for COVID-19 are inaccessible or are not clinically appropriate and will be a useful treatment option for some patients with COVID-19 at high risk of hospitalization or death,” Cavazzoni says in the Merck release. “As new variants of the virus continue to emerge, it is crucial to expand the country’s arsenal of COVID-19 therapies using emergency use authorization, while continuing to generate additional data on their safety and effectiveness.”

 article was originally published on Medical Economics®.

The moves bring two new weapons to the toolbox for physicians fighting the pandemic.

FDA authorizes Pfizer, Merck COVID-19 antiviral pills

The Food and Drug Administration (FDA) has approved the first injectable pre-exposure prevention treatment for HAV.

 for use in at-risk adults and children weighing at least 77 pounds as a preventative measure reducing the risk of sexually acquired 

. It is given first as a two-shot regimen administered a month apart and then one shot every two months after.

Patients are able to either start their treatment with Apretude or take oral cabotegracir for four week and see how their body tolerates the drug, the release says.

“Today’s approval adds an important tool in the effort to end the HIV epidemic by providing the first option to prevent HIV that does not involve taking a daily pill,” Debra Birnkrant, MD, director of the Division of Antivirals in the FDA’s Center for Drug Evaluation and Research, says in the release. “This injection, given every two months, will be critical to addressing the HIV epidemic in the U.S., including helping high-risk individuals and certain groups where adherence to daily medication has been a major challenge or not a realistic option.”

Centers for Disease Control and Prevention

 (CDC) to note that in 2020 about 25 percent of the 1.2 million for whom PrEP is recommended were prescribed it, compared to 3 percent in 2015.There is still room for improvement, as the groups most at-risk are also less likely to adhere to a daily medication regimen. The agency hopes that long-acting injectable PrEP options being brought to market will increase uptake and adherence in these groups.

In a pair of randomized, double-blind trials comparing Apretude to Truvada, Apretude was shown to be more effective than Truvada at lowering risk. In a trial of cisgender men and transgender women who have sex with men, participants who took Apretude were shown to have 69 percent less risk of getting infected with HIV. In the other trial of cisgender women, those who took Apretude were shown to have 90 percent less risk of getting infected with HIV, according to the release.

Side effects seen more in participants who received Apretude compare to those who received Truvada in either trial include injection site reactions, headache, pyrexia, fatigue, back pain, myalgia, and rash.

This article was originally published by our sister publication Medical Economics.

Apretude is approved for use in at-risk adults and adolescents to reduce the risk of sexually acquired HIV.

