Keith A. Reynolds

The following coding advice is intended to help medical practices efficiently bill each session to ensure they receive the full revenue they are owed.

Bill Dacey, MHA/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 the site 

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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.

Practice Management: Expert coding tips

The telehealth revolution triggered by the COVID-19 pandemic has led insurance companies to embrace a virtual-first model when creating new healthcare plans.

, some of the biggest names in health insurance are getting in on the action offering plans which see beneficiaries encouraged to choose an online doctor which acts as their first point of contact for most primary care and can make referrals for in-person care.

Many insurers offering these plans have hired outside firms to provide physicians who may hold licenses in several states and not located near the patients. Patient information is passed to the physicians through either the insurers internal EHR system or that of the third-party provider leading to questions of how health information could be passed from out of network hospitals or physicians, the report says.

Kaiser Health News likens the new programs to “HMO 2.0,” noting that skeptics have raised concerns about the need for primary care visits to be held in person due to the need to collect vital health information. Some insurers have provided patient with personal health devices to collect this information.

The latest insurer to step into the space is UnitedHealthcare. According to a news release, the company is launching a new virtual first plan called NavigateNOW. The plan is touted as offering beneficiaries 24/7 access to care through Optum for a premium 15% cheaper than traditional benefit plans.

“Patients want more options for getting care that is convenient for them and their lives,” said Kristi Henderson, Optum senior vice president for virtual transformation, and CEO of Optum Virtual Care, which includes Optum’s national virtual-first medical group. “Our work with UnitedHealthcare is designed to help make it simpler for patients and members to interact with their care providers by bringing together our virtual resources and national clinical footprint to provide a more seamless, connected experience.”

None of these programs would be possible without the seismic shift in healthcare toward telehealth, necessitated by the COVID-19 pandemic.

As previously reported, 36% of patients have accessed telehealth services during the past year, up from just 9% in 2020 and 7% in 2019. Usage is consistent across all generational groups, with the highest usage among members of Generation Y and Pre-Boomers. The top reasons for telehealth utilization are convenience (57%), ability to receive care quickly (47%), and safety (36%).

While it has seen a boom, patients’ patience with telehealth seems to be waning as overall satisfaction with both direct-to-consumer and payer-sponsored telehealth services declined in 2021 from 2020. The most frequently cited barriers encountered by patients are limited services (24%), lack of awareness of costs (15%), confusing technology requirements (15%), and lack of information about providers (15%).

Overall satisfaction is 85 points lower (on a 1000-point scale) among patients with the lowest self-reported health status than among patients who consider themselves to be in excellent health. Similarly, healthier patients are more likely than less healthy patients to understand the information provided during the visit, say they receive clear explanations, perceive that their visits are highly personalized, and obtain high-quality diagnoses.

Beneficiaries are encouraged to choose an online doctor who acts as their first point of contact for most primary care.

Telehealth boom has insurers launching virtual-first health plans

The US Federal Trade Commission (FTC) has issued a statement on the Health Breach Notification Rule, providing clarification on which parties bear responsibility when there is a data breach in health apps and other connected devices.

 from the agency, the rule ensures that entities not covered by the Health insurance Portability and Accountability Act (HIPAA) still face consequences when health data is compromised. It requires vendors of personal health records (PHR) and PHR-related entities must notify consumers and the FTC, and possibly the media, if unsecured identifiable health information is breached or face civil penalties. It also covers these entities’ service providers.

Simply put, the statement says those entities covered by the rule which have experienced breaches cannot hide this from the consumers who have trusted them with sensitive health information.

Issued more than a decade ago, the rule’s requirements with respect to health apps and connected devices are more important than ever with the explosion in their use. While the FTC has advised mobile health app to examine their obligations under the rule, the agency has never enforced it and many entities appear to misunderstand its requirements, according to the statement.

The statement goes on to explain that the rule is triggered when a vendor of PHR with individually identifiable health information created or received by a healthcare provider experiences a breach of security. These breaches are not limited to cybersecurity intrusions or nefarious actions. Incidents of unauthorized access, including sharing of covered information without the individual’s consent, triggers the notification obligation of the rule.

The COVID-19 pandemic has exposed the cybersecurity gaps of many healthcare organizations and saw an increase in attacks from bad actors.

Some tips to keep your practice safe include:

The Federal Trade Commission issued a statement on the  Health Breach Notification Rule.

Keith A. Reynolds

Articles

Practice Management: Expert coding tips

Telehealth boom has insurers launching virtual-first health plans

Cybersecurity: US government offers clarity on culpability in health app breaches