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where we cover interesting and relevant news, insights, events, and more related to the health care industry and pMD. Most importantly, this blog is a fun, engaging way to learn about developments in an ever-changing field that is heavily influenced by technology.

POSTS BY TAG | Health Care


Here's The Latest in Health Care:


According to a new survey, nearly three-quarters of hospitals and health systems in the US have been actively engaging with revenue cycle management optimization during the pandemic through RCM technology. RCM was one of the areas in health care that largely moved to remote work once the pandemic hit, which many hospitals and health systems are considering making more permanent.  Read More

CMS is proposing a series of changes to their Promoting Interoperability Program, the successor to meaningful use, designed to bolster the response to public health emergencies such as COVID-19. The agency plans to amend program stipulations for eligible hospitals and critical access hospitals, broadening requirements focused on public health and clinical data exchange.  Read More

New research shows that critical care nurses' overall health is linked to the number of medical errors they reported. 67 percent of nurses with higher stress scores reported making medical errors in the last five years, more than 10 percent more than the nurses with lower stress scores.  Read More

For the first time, the majority of physicians worked outside of physician-owned practices in 2020, as doctors continue to gravitate toward employment by hospitals and other organizations, according to the American Medical Association (AMA). A number of factors, including the growing complexity of health care, new Medicare regulations around value-based purchasing, and insurer prior authorizations have contributed to making these employment arrangements increasingly more desirable.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, medical billing revenue cycle management, telehealthsecure messaging, clinical communication, and care navigation software.


In part one of this series, we talked about the health care technology landscape that has contributed to a state where rarely does one system hold a patient’s entire, or current, health record. Rather, in many cases, pieces of information are scattered across a variety of different systems operated by the various providers involved in a patient’s care. Fortunately, health care providers are required by law to give patients access to their health data. We previously walked through the process one might follow to obtain copies of their health records, now it’s time to determine how and where to store that information.


Why go through the trouble of compiling all of your health care records? The short answer is so that you can have them easily accessible when you need them most. In today’s world, the vast majority of people own a smartphone, which they take with them wherever they go. Because of that, we’d argue that organizing and storing your health records in a secure app, on your phone, is by far the best way to manage your health care data.  As of Q4 of 2020, there were 51,476 iOS apps listed under the “medical” category in the Apple App Store, and 49,890 Android apps in the Google Play Store.


So what should you look for when choosing an app with which to entrust your sensitive information?  First and foremost - it should be HIPAA-compliant. But what does that mean from a technical perspective?  Look for references to encryption, emergency access, secure backup, and biometric, or “two-factor” authentication. It’s important that if you leave your smartphone sitting out, someone can’t just pick it up and look at your lab results, or a recent communication with your doctor without first scanning their face, or finger, or entering a password.


Similarly, if you were to lose the phone, you’d want to make sure anyone trying to pull data off of it would be prevented from accessing the health care app’s database due to the use of strong encryption. On the other hand, when you got a replacement phone, you wouldn’t want to rebuild your centralized health record database from scratch. Look for an app that makes reference to securely backing up your data and try to understand upfront what the process of recovering your information involves.


Finally, and arguably the most important item to consider is data transmission and control. A driving factor behind curating your own health records is the ability to grant access to relevant parts of it to providers involved in your health care. Consider choosing an app that has convenient tools for sending and receiving health information between you and your doctor easily and securely. The app should let you choose the means by which you transmit your data and should provide an avenue that’s encrypted end-to-end.


And finally, do some homework on who built the app. Pick a company that is oriented around improving patient health outcomes by providing better continuity in health care data, not one that’s out to make a quick buck by monetizing your health records. At pMD, we care deeply about empowering both patients and providers to have a higher quality, delightful health care experience.




 

To find out more about pMD's suite of products, which includes our charge capture and MIPS registry, billing services, telehealthsecure messagingclinical communication, and care navigation software and services, please contact pMD.

Here's The Latest in Health Care:


After years of holdout, health care organizations are coming around to treating individuals less like patients and more like consumers. On the provider side, that’s meant expanding beyond traditional services and into new primary, specialty, and acute care delivery approaches enabled by new virtual care technologies.  Read More

The COVID-19 pandemic created a host of challenges for revenue cycle management leaders, from widespread service line shutdowns to shifting staff to work at home and increasing self-pay balances. Gaining a clear picture of A/R productivity is crucial to managing denials and increasing collections for revenue cycle management success.  Read More

Aligned with their physician counterparts, nurses graded EHR usability an “F,” and respondents also revealed a high level of burnout, according to a new study. In fact, almost half of the nurses experienced burnout, which health care professionals connect to low EHR usability. Improved EHR usability can lead to higher EHR adoption rates, fewer clinical errors, less clinician burnout, financial benefits, and improved patient safety.  Read More

The pandemic accelerated "hospital at home" programs, which use remote monitoring and telehealth technologies to provide patients with hospital-level care without the risks and costs associated with hospital stays. Health system innovation executives are particularly excited about the emergence of hospitals at home and how technology can shape the future of the care model.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, medical billing revenue cycle management, telehealthsecure messaging, clinical communication, and care navigation software.


Most of us see a variety of health care providers for everything from routine primary care, to specialty treatment for chronic conditions, to lab tests and x-rays, to procedures for injuries. In the United States, it’s likely that each individual practice and facility will have their own system(s) for storing the health records associated with the portion of your care that they rendered. However, those databases often don’t communicate or share information with the other providers’ systems. U.S. law requires that each health care provider store your electronic health records securely, but it does not mandate that it all be centralized in any one place.

As a result, as we move through the healthcare system we often leave a trail of comprehensive, but very siloed information behind us. A recent study estimated that a single hospital, on average, has 16 different electronic medical record vendors actively in use across all of its affiliated practices. This makes putting together a complete picture of one’s health history, or even current status, potentially a very daunting challenge. Your lab results, imaging tests, vaccination records, current medications, notes from that recent cardiologist visit, and even data from your fitness tracker device might all live in separate places.

Not only is this inconvenient and inefficient, but it can also be potentially dangerous.  Imagine being treated at an emergency room and not remembering, or not being capable of communicating your blood type or known drug allergies. What if your gastroenterologist unknowingly prescribes a medication that has an adverse interaction with your blood pressure drug? Because these disparate providers don’t necessarily share or have access to all of your health records, the burden is on the patient to build and maintain a centralized repository of their data and self-report this information to all of their various providers.

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) gives individuals the right to request copies of their medical records from each of their providers. Health care entities are required to provide this information within a reasonable timeframe and for no or low cost. Unfortunately, most state laws don’t stipulate that patients actually own their data, and the process for requesting and obtaining it can be cumbersome - sometimes requiring a written request. But, the federal law is at least clear about the patient’s right to access the data.  

Furthermore, HIPAA mandates that individuals can request their health information be delivered to them in digital format, which is helpful when approaching building a centralized, patient-controlled repository of one’s healthcare records. Once you’ve got the data in hand, the question becomes how, and where to store it in a way that’s both secure, yet easily accessible for you and any family member or health care provider with whom you choose to share it.  

In part two of this series, we’ll look at why it makes sense to carry your health information with you on your smartphone and discuss what to look for in an app to help make it easy and safe.

To find out more about pMD's suite of products, which includes our charge capture and MIPS registry, billing services, telehealthsecure messagingclinical communication, and care navigation software and services, please contact pMD.

Here's The Latest in Health Care:


Telehealth investment hit an all-time high of $4.2 billion in the first quarter of 2021, almost doubling the $2.2 billion raised in the same quarter a year ago. That's the highest global funding for telehealth during one quarter on record, which also represents an increase of 18% from the $3.6 billion raised in the fourth quarter of 2020. Clearly, investors are betting on telehealth to continue to play a large role in care delivery moving forward.  Read More

Landmark data-sharing regulations from HHS' Office of the National Coordinator for Health Information Technology and CMS seek to tie healthcare providers and patients across the care continuum closer together—but historical disparities in technology adoption between health care sectors could pose challenges for providers in post-acute and long-term care settings.  Read More

Round two of the COVID-19 telehealth program, which is a $249.95 million federal initiative that builds on the $200 million program established as part of the CARES Act, will open the application portal on April 29th. This round contains a number of tweaks, including a system for rating applicants that prioritizes hard-hit and low-income areas, tribal communities, and those in provider shortage areas.  Read More

CMS has announced the suspension of the Medicare sequester cuts, which was set to expire April 1st, will now last through the end of the year, and that it will release all claims held since the start of April. In addition to the extension, the new law also contains other health care measures, including technical corrections related to rural health clinics and disproportionate share hospitals.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, medical billing revenue cycle management, telehealthsecure messaging, clinical communication, and care navigation software.

Here's The Latest in Health Care:


The goal of hospitals should be to always provide patients with a positive experience. New research by Press Ganey found that while common themes run through the experiences of happy patients, there is much more variation when it comes to the experiences of unhappy patients. The findings demonstrate that preventing negative experiences requires the same kind of vigilance needed to prevent the vast range of potential safety problems.  Read More

Over the last few years, there has been an estimated 20 percent increase in hospitals and health systems considering physicians as candidates in their CEO searches. It’s become apparent that physicians with the right training and experience could learn a lot about hospital operations and bring with them the much-needed clinical and front-line experience.  Read More

Before the COVID-19 pandemic, telehealth was more of a novelty than a necessity. The concept of touching base with a doctor remotely was promising, but there were hurdles. Now, almost 90 percent of Americans want to continue using telehealth for non-urgent consultations after COVID-19 has passed.  Read More

• The Mayo Clinic has launched a new initiative to collect and analyze patient data from remote monitoring devices and diagnostic tools to accelerate diagnoses and disease prediction using artificial intelligence (AI). The platform will deliver clinical decision support tools, diagnostic insights, and care recommendations to help clinicians make faster and more accurate diagnoses.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, medical billing revenue cycle management, telehealthsecure messaging, clinical communication, and care navigation software.


Here's The Latest in Health Care:


• As telehealth continues to play an important role in meeting the demands of patients and a strained health care workforce, it’s critical that providers get patients on board with using the technology for the long term. Its future adoption, however, heavily depends on the ability to support a trusting relationship between patients and physicians.  Read More

According to a new survey, slow prior authorization protocols directly contributed to care delivery delays and poor treatment outcomes for some patients during the surge in COVID-19 cases last winter. Nearly all physicians surveyed said they spent 16 hours on average seeking prior authorization for patient care, which delayed treatment.  Read More

CMS has begun recouping the accelerated and advance Medicare payments from providers who borrowed the emergency funds to battle COVID-19. During the recoupment period, CMS will hold back a portion of new Medicare claims from providers until the payments advanced last year are recouped. Providers are required to have paid back the advanced payments in full 20 months after they received the first payment. If they fail to do so, CMS will charge an interest of four percent on the remaining balance.  Read More

The pandemic has accelerated a growing desire among providers and even some medical technology manufacturers to acquire or get into the surgery center business, experts say. One of the biggest drivers of this shift has been eroding patient volumes at hospitals due to fears of contracting COVID-19.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, medical billing revenue cycle management, telehealthsecure messaging, clinical communication, and care navigation software.


Here's The Latest in Health Care:


Telehealth proved its mettle this past year. Now more hospitals and health systems are looking to expand their efforts beyond video visit-based virtual care, and push for expanded remote patient monitoring programs such as acute care at home. But some big questions still need ironing out, as regulations and reimbursement mechanisms are in major flux.  Read More

The industry-wide conversation around prior authorizations is both complicated and contentious. They are considered useful for preventing adverse health events but a headache for providers. In order to soothe the controversies around prior authorizations, payers and providers may turn to electronic prior authorizations for faster care delivery, lowered provider burden, and an overall better patient experience.  Read More

Telehealth use among surgeons for patient visits soared in the early months of the coronavirus pandemic in 2020. While rates of telehealth use have declined as in-person care has resumed, telehealth use remains substantially higher across all surgical specialties than it was prior to the pandemic according to a new study.  Read More

2020 offered a perfect storm for cybercriminals, with the number of ransomware attempts against the health care industry rising by 123%. Ransomware attacks cost the healthcare industry $20.8 billion in downtime last year, which is double the number from 2019. In addition, more than 18 million patient records were impacted by these ransomware attacks, a 470% increase from 2019.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, medical billing revenue cycle management, telehealthsecure messaging, clinical communication, and care navigation software.


Here's The Latest in Health Care:


One year ago, when the COVID-19 pandemic upended life as we know it, some revenue cycles were better positioned than others to deal with the demands of the emergency. Organizations that had revenue cycle analytics, denial management tools, employees working remotely, and automated check-in processes in place at the beginning of 2020 were perhaps better positioned than other organizations to manage the operational demands of the pandemic.  Read More

People on dialysis who contract COVID-19 are at far greater risk for serious illness and death, so now, dialysis centers will be getting thousands of COVID-19 vaccine doses to vaccinate their patients and employees. The doses will be provided directly to dialysis centers for patients who receive treatment at least three times a week.  Read More

According to a new Kaufman Hall analysis, nearly 40% of hospitals could operate in the red this year even if the vaccine rollout is smooth and COVID-19 hospitalizations decline. The analysis, conducted on behalf of the American Hospital Association (AHA), gives a glimpse of the lingering financial impact of the pandemic on hospitals.  Read More

CMS has opened applications for the second cohort of the Primary Care First (PCF) value-based payment model which seeks to drive down costs and increase the quality of care. the PCF model will explore if switching from fee-for-service to Medicare performance-based payments could increase the quality of care and reduce overall Medicare costs.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, medical billing revenue cycle management, telehealthsecure messaging, clinical communication, and care navigation software.


Welcome to the "Biller’s Corner" of the pMD blog, your trusted source for updates, tips, and tricks provided by seasoned medical billing and coding experts!

Medical coding is often a moving target, especially during a pandemic. But have no fear, we’re here to provide guidance on some recent coding updates you need to know about!

NEW COVID-19 VACCINATION CODE ALERT

Speaking of the pandemic, the AMA recently released the CPT® code 91303 for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative-free, 5×1010 viral particles/0.5mL dosage, for intramuscular use.

Here’s what you need to know:


* This is the code used for the one-dose COVID-19 vaccine developed by Janssen Pharmaceutica, a division of Johnson & Johnson.


* It should be used in conjunction with the CPT code 0031A, Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative-free, 5×1010 viral particles/0.5mL dosage, single dose.


AMA PROVIDES ADDITIONAL CLARITY ON THE UPDATED E/M CODE SET

Another hot topic this year has been the significant updates to E/M office codes (99201-99215). The primary intention behind the changes is to reduce the administrative burden of unnecessary documentation, in turn, allowing for more time to interact with patients. While the intention is great, there has been a lot of confusion surrounding the revisions made to this code set, and many physicians have reported that the ambiguity of the new revisions is actually leading to additional time spent on documenting. This is obviously the opposite of what they were going for, so the AMA is acting on that feedback and has released the following revisions, retroactive to January 1, 2021.

TIME-BASED BILLING

For time-based billing, you should not account the following:


* Performance of other services when reported separately


* Travel time


* Teaching that is not required for the management of the specific patients' care


Also, remember Medicare and private payers’ policies can differ when it comes to reporting prolonged services for time-based billing. Although the AMA has established the CPT 99417,  Medicare has assigned a status indicator of “I” for this code which denotes the code as invalid. Instead, Medicare will accept HCPCS code G2212 when reporting 15 minutes of prolonged care, performed on the same encounter as E/M codes 99205 and 99215. When billing for either code, be sure that it is listed separately in addition to a level 5 office/outpatient E/M service.

MEDICAL DECISION MAKING

When it comes to medical decision making (MDM), you should account for tests that are analyzed as part of MDM and are not reported separately when interpreting the study. These may be counted as ordered or reviewed when selecting an MDM level.  When determining the complexity of problems and the number of problems addressed, also consider the following:


* If the presenting symptoms are likely to represent a highly morbid condition, this may “drive” MDM even when the ultimate diagnosis is not highly morbid. Multiple low severity conditions may equate to a higher risk level due to interaction.


* When determining data reviewed and analyzed, pulse oximetry is not considered a test.


* When considering data elements reviewed, a combination of three data elements can be counted by reporting a unique test ordered, plus a note reviewed and an independent historian. However, it does not require each item type or category to be represented.


* Ordering a test may include those considered, but not selected after shared decision making due to patient health risk or a discussion to forego further testing due to lack of medical necessity.


UNDERSTANDING THE KEY TERMINOLOGY

The AMA has also provided clearer instructions to interpret the definitions that make up the elements of MDM. Understanding the following terms as they are laid out by the AMA is crucial:


* Analyzed: Tests ordered are presumed to be analyzed when the results are reported. Therefore, when they are ordered during an encounter, they are counted in that encounter. Tests that are ordered outside of an encounter may be counted in the encounter in which they are analyzed.


* Discussion:  Discussion requires an interactive exchange. The exchange must be direct and not through intermediaries (eg, clinical staff or trainees). The discussion can be asynchronous and occur on a later date following the encounter but must be completed within a short time period (eg, within a day or two).


* Independent Historian: When collecting the history, it does not need to be obtained in person but does need to be obtained directly from the historian providing the information.


* Risk: The term “risk” as used in these definitions relates to risk from the condition. While condition risk and management risk may often correlate, the risk from the condition is distinct from the risk of the management.


* Surgery (minor or major): The classification of surgery into minor or major is based on the common meaning of such terms when used by trained clinicians, similar to the use of the term “risk.” These terms are not defined by a surgical package classification. Be advised that CPT guidelines indicate that it is the provider's clinical determination whether surgery is considered major or minor and is not dictated by global days. However, if the surgery occurs in an office setting, you will have a hard time justifying it as a major surgery. Major surgeries will most often require the use of an operating room.


* Surgery (elective or emergency): Elective procedures and emergent or urgent procedures describe the timing of a procedure as it relates to the patient’s condition. An elective procedure is typically planned in advance and scheduled, while an emergent procedure is typically performed immediately or with minimal delay to allow for patient stabilization. Both elective and emergent procedures may be minor or major procedures. 


* Surgery (risk factors): Risk factors are those that are relevant to the patient and procedure. Evidence-based risk calculators may be used, but are not required, in assessing patient and procedure risk.


A full list of revisions can be found on the AMA website. Plus, be on the lookout for even more revisions that will become effective in 2023. 

Make sure to check back in soon for more billing and coding updates! And if you are interested in learning more about pMD’s billing and revenue cycle management services, please contact us here or give us a call at 800-587-4989 x2. We’d love to hear from you! 


To find out more about pMD's suite of products, which includes our charge capture and MIPS registry, billing services, telehealthsecure messagingclinical communication, and care navigation software and services, please contact pMD.