All Entries in the "Reimbursement and documentation" Category
Medicare coding changes give hospitalists more to remember
I recently spoke on the phone with Leslie Flores, MHA, partner at Nelson Flores Hospital Medicine Consultants in La Quinta, CA for an article in the upcoming issue of Hospitalist Leadership Advisor, a supplement to Medical Staff Briefing. We discussed CMS’s recent decision to stop reimbursing physicians for consulting codes and requiring that physicians bill an initial or subsequent care code for activities that were previously considered consultations. Admitting physicians will have to add the modifier -AI to the codes they submit to distinguish them from other physicians caring for the same patient. Flores brings up a good point:
“To distinguish the admitting physician from the consulting physicians, the admitting physician has to add a modifier. One of the things that worries me is that the billing office is going to get initial hospital care codes from several physicians, and if the admitting doctor forgets to append the code, the billing office is going to have to go around asking all the physicians who admitted the patient. It is not so hard to do if all the docs are in the same group, but if they are not, it could get tricky.”
Share how your hospitalist program is managing the recent coding changes in the comment box below.
Q&A with Richard Rohr: How Medicare coding changes affect hospitalists
CMS’s recent decision to stop reimbursing physicians for consult codes has hospitalists everywhere wondering how their practices will be affected. I spoke with Richard E. Rohr, MD, MMM, FACP, FHM, director of hospitalist programs at Guthrie Healthcare System in Sayre, PA, to find out what the buzz is about and get some background on the recent changes.
LJ: Why are hospitalists concerned about the new coding changes?
RR: Up until now, there have been a set of codes for services that are provided by physicians who see their own patients, and then there is a set of codes for consultations. Traditionally, those codes have carried a somewhat higher payment than the codes one would use for seeing your own patient, even for the same level of complexity of examination and record keeping.
LJ: Why were consulting codes historically reimbursed at a higher rate?
RR: Back in the 1960s when Medicare was created, consultations were a big deal and they weren’t done very often, [more]
Greeley Medical Staff Institute and bundled payments
I recently had the privilege of speaking at the Greeley Medical Staff Institute Symposium in Naples, Florida, November 8-9, and found the experience to be both very enjoyable and educational. I really enjoyed serving on the opening plenary session panel discussion regarding healthcare reform. I was amazed at the prophetic abilities of the organizers in having the panel speak about reform exactly nine hours after the House of Representatives passed the 1,990-page bill! I had the honor of sharing the podium with Dr. Jon Burroughs of the Greeley Company and Dr. John Maa, one of the nations thought leaders on surgicalists. The session was moderated by Dr. Rick Sheff, executive director of the Greeley Company.
One of the questions posed was regarding the effect of the proposed “bundled payments.” Predictably, this has proven to be a very volatile topic amongst physicians. The Phoenix Group, of which I am a member, published a white paper earlier this year on the topic. The first draft stated that “healthcare reform legislation holds the potential for a cataclysmic uprooting of the traditional fee-for-service payment system.” In final form the word cataclysmic was removed. I suppose “cataclysmic” is in the eye of the beholder, but one thing is clear: The current bill is designed to change how providers get paid, and even how their businesses are structured and aligned and, ultimately, how care is rationed. Consider the following:
[more]
Bundling to hit hospitalists, says new white paper
You may have already heard that the hospitalist think tank Phoenix Group recently released a white paper, “Hospitalists Assess the Impact of Bundled Fees.” The white paper makes a bold statement, calling the proposed payment restructuring in the form of bundling fees the “cataclysmic uprooting of the traditional fee-for-service payment system.”
Although the Society of Medicine at its annual 2009 meeting declared that it has no official stance on bundling, The Phoenix Group has been vocal in assessing the effects of bundling.
Inpatient quality data deadline this week
Hospitals in the Reporting Hospital Quality Data for Annual Payment Update (RHQDAPU) 2010 fiscal year program have until the end of this week to submit their quality data for Medicare’s pay-for-reporting program. RHQDAPU-participating hospitals must report inpatient data regarding the new measure of cardiac surgery by Aug. 15.
All other hospitals that are not participating in the RHQDAPU program can voluntarily submit data but are not required to.
The My Quality Net Web site provides a tool to help with data collection.
Consultation: What code to use?
How familiar are you with the proper use of consultation codes? If your answer is “not very,” you are not alone. But get ready: CMS is proposing to change the way we must document and code for consultations and transfer of care. One of the proposed changes in its 2010 inpatient physician payment rule is to eliminate payment for consultation codes. The rationale includes ongoing confusion about the use of consultation codes. Quite frankly, I believe this is one time they are correct: There IS confusion, or at least a great amount of variability in coding and documentation of consultations.
The CMS proposal will instruct providers to use “initial visit” E&M codes when providing consultations. A hospitalist would bill an admission code for the initial visit and a new modifier will be created for the admitting physician. Since consultation codes have historically been paid at a higher rate than initial visit codes, the proposal could have a negative impact on physician incomes. To counter-balance this, CMS is proposing a modest increase in work RVUs for initial hospital visits.
[more]
Is gainsharing in sight?
The July issue of Today’s Hospitalist includes a very interesting Q&A session with Andrew Knoll, MD, JD, on the topic of gainsharing. The article centers on an opinion issued by the Office of Inspector General (OIG) last fall that perhaps indicates a relaxed future view of gainsharing. I believe this is an idea whose time has come. Many hospitalists have long been frustrated that the financial benefits of their hard work in improving the efficiency and quality of care have largely been enjoyed by the hospitals in which they serve.
The OIG opinion was favorable toward a hospital that shared a pay-for-performance bonus (received from an insurer) with its medical staff members. The bonus was paid for achieving quality improvement goals though the exact goals were was not disclosed. This is potentially good news for hospitalists, but we should remain cautious with our optimism.
[more]
Primary care and healthcare reform: Where do we fit in?
In the healthcare reform discussion, one thing that most people agree on is the need to revamp primary care and primary care reimbursement. One congressional committee has published a Discussion Draft on the House healthcare reform bill.
This bill calls for increasing Medicare reimbursement by 5% (10% if the physician practices in an area defined as a health professional shortage area) for primary care services. These services are defined as evaluation and management services, including new and established patient office visits, and “other physicians services as the Secretary determines are associated with ensuring accessible, continuous, coordinated, and comprehensive care for individuals enrolled under this part.”
[more]
Health reform and the hospitalist
By Richard Rohr, MD, MMM, FACP, FHM
Some sort of health reform is likely to be enacted by Congress before the year is out, and we can be sure that it will change hospital medicine in some manner, but details are still hazy.
We will see some expansion of coverage to the currently uninsured, which would help hospital medicine groups, but I am not sure that universal coverage will be achieved this year. Don’t look for a single payer system–this country is too pluralistic to accept that. Private insurers will continue to play an important role, and you’ll probably keep all or most of your present billing numbers.
[more]
Sen. Baucus talks about healthcare reform
[caption id="" align="alignright" width="125" caption="Photo Sen. Max Baucus (D-Mont.) / Press Office "]
[/caption]
The Hospitalist, a Society of Hospital Medicine publication, interviewed Sen. Max Baucus (D-Mont.) for the May issue Q&A, titled, “Medicine’s Change Agent: Influential senator says HM can help lower costs, improve quality of care.”
The six-term Senator and leader of the Senate Finance Committee, who wrote the white paper, “Call to Action: Health Care Reform 2009,” has been one of the Senate members spearheading healthcare reform.
With the ambitious goal of controlled healthcare spending, Baucus proposes a return to primary care and preventative care through community health centers and rural clinics.
[more]Live from SHM: Understanding practice finances
Scott F. Enderby, DO, MMM, of East Bay Physicians Medical Group in Berkeley, Calif., talks about the importance of understanding practice finances. (Photo/Karen M. Cheung)
All practices should view hospital medicine as a business, said Scott F. Enderby, DO, MMM, of East Bay Physicians Medical Group in Berkeley, Calif. on Friday morning at a session titled, “What Every Hospitalist Should Know About Practice Finances.” Regardless of your status as a for-profit and non-profit organization, you should be concerned about the financial operations of your practice. “Absolutely, without a doubt,” said Enderby about staying financially informed.
Surprisingly, however, only a third of group leaders actually know about their practice finances, according to recent SHM survey data. The younger generation of hospitalists, especially, is further removed from the money paperwork, according to Enderby.
One cause is that the amount of access to these important documents that a practice has can vary by group size. For example, at smaller practices, leaders may not have the same accessibility as larger institutions. Everyone should have access to the financial statements, said Enderby.
Some things to look for in your financial toolbox are the following types of statements:
- Balance sheet
- Statement of operations
- Cash flow
- Notes to financial statements
Here’s a quick tip – “Skip to the end of the novel first,” said Enderby. Flipping to the notes first will how you understand how the financial numbers are derived.
Why should a hospitalist care about any of the money numbers? “No organization wants to go bankrupt,” said Enderby. “We all have a vested interest in our practice surviving.”
