By David Doyle from Physicians Practice
According to a recent study released by Software Advice, 97 percent of patients are frustrated by wait times at the doctor’s office. Fortunately there are some low-cost and even cost-free ways for physicians to reduce overall patient dissatisfaction with wait times.
1. Keep Patients Occupied
Idle time tends to feel longer; so one way to make a long wait more bearable is to keep your patients occupied. Many practices accomplish this by having patients fill out paperwork, but too much busy work creates additional frustrations. The recent widespread implementation of electronic health records (EHRs) makes this a short-term solution at best.
One tried-and-true method for keeping patients occupied is to stock the waiting room with a wide selection of current magazines, newspapers, and other reading materials. For a more modern approach, consider adding complimentary Wi-Fi service so patients can use their smartphones, tablets, or laptops while they wait. Software Advice reported that 60 percent of their study respondents believed that access to free Wi-Fi would minimize their level of frustration in the waiting room.
2. Set Expectations
Unclear wait times have also been shown to contribute to patient frustration, and the same holds true outside of your practice. Thus, wait times are now provided for everything from pizza delivery to standing in line for a theme park ride. Yet some practices still fail to provide an estimated wait time for their patients. Offering a rough estimate lets patients know they have time to open a magazine or load a website on their smart phones instead of anxiously eyeing the clock and wondering what’s taking the doctor so long.
3. Explain the Wait Time and Provide Updates
One reason why long waits are so agitating is because patients feel as though their time isn’t being respected by the practice. Instead of letting patients assume the worst, whenever possible your staff should provide an explanation for the wait and ease patients’ concerns. Patients will often flip from feeling frustrated to forgiving upon learning that the physician was called into an emergency surgery or that the office’s EHR system is temporarily down. After informing patients about the reason for a delay or long wait, provide periodic updates so they don’t feel forgotten.
4. Break Up the Wait
Breaking up the wait by moving patients to different locations in the office will help patients feel like their appointments are starting on time. Have an assistant or nurse begin the appointment at the scheduled start time by bringing the patient into an exam room. Even if a patient has to wait to be seen by the doctor, the delay feels shorter in the exam room than out in the waiting room. Software Advice found that females are more likely than males (40 percent versus 33 percent) to prefer waiting in a private exam room.
5. Ask for Patient Feedback
Everyone likes to feel heard. So in many instances, simply asking patients for feedback after their appointments will minimize dissatisfaction. Strauss & Seidel found that dissatisfied customers whose complaints are taken care of are more likely to recommend the business to others than are satisfied customers. Consider administering a brief survey to gauge patient attitudes about your practice’s wait time. Your patients will appreciate the opportunity to voice any frustrations and that you care enough about their waiting room experience to look for ways to improve it.
Sometimes you cannot avoid long wait times, but taking these five steps to ensure a positive experience for your patients will keep them from negatively affecting your practice’s reputation.
Wednesday, January 29, 2014
Medicare eRx HCPCS G8553 Deleted 12/31/2013
eRx HCPCS G8553 Deleted
Effective for claims billed with dates of service 01/01/2014, HCPCS G8553 is no longer valid. Because Electronic Prescribing (eRx) reporting is not being monitored during 2014, no new code will be created. The eRx incentive program finalized on 12/31/13; however, providers are encouraged to continue to electronically prescribe as it is a measure under Electronic Health Records (EHR) and should be reported as such.
Individual eligible professionals and group practices who participated in the eRx Group Practice Reporting Option (GPRO) who were not successful electronic prescribers will be subject to a 2.0% payment adjustment on their Medicare Part B services provided January 1, 2014 through December 31, 2014.
To avoid the 2014 eRx payment adjustment, individual eligible professionals and group practices must have been successful 2013 electronic prescribers, reporting HCPCS G8553 on at least 10 billable Medicare Part B Physician Fee Schedule (PFS) services provided from January 1, 2013 through June 30, 2013.
Review the CMS 2014 eRx Payment Adjustment Information Fact Sheet
for more detailed information, including how an eligible professional or group practice can request a hardship exemption to the 2014 eRx payment adjustment or to request an informal application review. The deadline to request an informal review is February 28, 2014. See instructions in the above mentioned fact sheet.
Individual eligible professionals and group practices who participated in the eRx Group Practice Reporting Option (GPRO) who were not successful electronic prescribers will be subject to a 2.0% payment adjustment on their Medicare Part B services provided January 1, 2014 through December 31, 2014.
To avoid the 2014 eRx payment adjustment, individual eligible professionals and group practices must have been successful 2013 electronic prescribers, reporting HCPCS G8553 on at least 10 billable Medicare Part B Physician Fee Schedule (PFS) services provided from January 1, 2013 through June 30, 2013.
Review the CMS 2014 eRx Payment Adjustment Information Fact Sheet
Last Updated Jan 15, 2014
2013 PQRS - Medicare EHR Incentive Pilot: Submit Quality Data by February 28, 2014
2013 PQRS - Medicare EHR Incentive Pilot: Submit Quality Data by February 28, 2014
The Physician Quality Reporting System (PQRS) Medicare EHR Incentive Pilot allows eligible professionals to meet the clinical quality measure (CQM) reporting requirement for the Medicare EHR Incentive Program through electronic submission while also reporting for the PQRS program.
Are you an eligible professional who is participating or wishes to participate in the 2013 PQRS-Medicare EHR Incentive Pilot ? You can now submit your 2013 quality data.
If you would like to participate in the pilot you must submit 12 months of CQM data by February 28, 2014 at 11:59 pm ET.
Steps to Successfully Participate
To successfully participate in the pilot, you must do the following by February 28, 2014:
For More Information
For further guidance on the 2013 PQRS-Medicare EHR Incentive Pilot, please read the Participation Guide and Quick-Reference Guide .
If you have additional questions, please contact QualityNet Help Desk at 866-288-8912 (TTY 877-715-6222) or via qnetsupport@sdps.org. The Held Desk is available Monday through Friday from 7 a.m.-7 p.m. CST.
Source: CMSLISTS Email Update dated January 15, 2014
Are you an eligible professional
If you would like to participate in the pilot you must submit 12 months of CQM data by February 28, 2014 at 11:59 pm ET.
Steps to Successfully Participate
To successfully participate in the pilot, you must do the following by February 28, 2014:
- Register for an IACS account (for EHR submission only)
- Indicate intent to report CQMs using pilot in EHR Registration & Attestation System
- Generate required reporting files
- Test data submission
- Submit quality data
For More Information
For further guidance on the 2013 PQRS-Medicare EHR Incentive Pilot, please read the Participation Guide
If you have additional questions, please contact QualityNet Help Desk at 866-288-8912 (TTY 877-715-6222) or via qnetsupport@sdps.org. The Held Desk is available Monday through Friday from 7 a.m.-7 p.m. CST.
Source: CMSLISTS Email Update dated January 15, 2014
Last Updated Jan 16, 2014
Obamacare's Big Changes Change Little for Physicians
By James Doulgeris and Nicholas Bonvicino, MD taken from Physicians Practice
"It starts with complete command of the fundamentals," Jesse Owens explained about his dominance in the Olympics. Athletes know that. Engineers know that. Plumbers and tradesmen know that.
Congress and the Obama administration could learn a lot from these working folk. Their single-minded conviction that mandating massive changes to healthcare's banking system will somehow fix a fundamentally broken healthcare-delivery system is like trying to fix government bureaucracy by changing the tax code.
With one-sixth of the U.S. economy in the balance, politics and egos have to move aside in both parties to face reality instead of reelection.
American medicine, with all of its technological, training, and fiscal prowess, has lost its way. This is the place to be if you have a complex trauma or disease. We invent and have an overabundance of the most sophisticated diagnostics, pharmacology, and facilities in the world.
But if you have a chronic condition like diabetes, COPD, or CHF, where 80 percent of our overall healthcare dollars go and 96 percent of Medicare dollars go, you are better off in 45 other countries, many of which are in what we consider the “third world.”
As our costs have gone up, our relative standing in many key metrics of population health have fallen far behind. An argument for socialized medicine and more primitive technology? Hardly.
An argument for more attention to prevention, personalized care, and integration of medical care with social institutions, you bet!
Our system has come to treat symptoms instead of people, and Obamacare reinforces the problem fiscally and philosophically. Case in point: Providing a diabetic with insurance that doesn’t pay to motivate, teach, or provide the support for what needs to be done between doctor visits is worse than wasteful. Further, applying high individual deductibles that discourage frequent and regular office and home care visits that can improve compliance and health status are a drop in the bucket compared to the costs of an amputation or blindness.
Since we are talking policy, what are the fundamentals on a policy basis?
1. Technology reform. Obamacare’s $16 billion program encouraging and funding stand-alone electronic medical records systems back fired. They boost compensation instead of collaboration, increasing costs while doing nothing to increase efficiency or effectiveness. EHR systems were created to maximize reimbursement by exploiting the inherent flaws in fee-for-service reimbursement by boosting up-coding and high-cost service production. Supporting common, interoperable platforms that transform EHR data into actionable information to manage population health and cost, removing regulatory stonewalls, and requiring EHR providers to allow access to their data platforms to make common platforms work fixes the problem.
2. Reimbursement reform. Get serious about paying for results instead of tasks. Encourage physician-owned and -led networks financially and with regulatory and tort relief, and eliminate the Rube Goldberg gain-sharing schemes. Make it simple: premium less actual cost = savings. Then split them. Value versus volume. Reimbursement for results. Pay for performance. They all mean savings, and not the few percent from tweaking the status quo, but hundreds of billions from allowing the free market to perform.
3. Reform reform. Get hospitals out of the accountable care business. Savings come from keeping patients OUT of the hospital, and successful accountable care organizations are a fiscal disaster for them. Instead of enabling regional hospital monopolies that eliminate competition, particularly lower-cost community hospitals, enable primary-care physicians to become "purchasing agents" for their patients. This will foster competition on price, quality, and safety through price transparency in the marketplace. Remove the shackles and allow them to do what is right instead of complying with what is regulated.Managing safety, fair play, and honest competition and preventing and dealing with abuses quickly and firmly are the government's job. Central management is not.
4. Tort reform. Instead of holding physicians liable for not using the best technology, indemnify them when they use best practices.These things are not liberal or conservative, political or progressive — they are practical. And, way overdue.
Courtesy of Physicians Practice
"It starts with complete command of the fundamentals," Jesse Owens explained about his dominance in the Olympics. Athletes know that. Engineers know that. Plumbers and tradesmen know that.
Congress and the Obama administration could learn a lot from these working folk. Their single-minded conviction that mandating massive changes to healthcare's banking system will somehow fix a fundamentally broken healthcare-delivery system is like trying to fix government bureaucracy by changing the tax code.
With one-sixth of the U.S. economy in the balance, politics and egos have to move aside in both parties to face reality instead of reelection.
American medicine, with all of its technological, training, and fiscal prowess, has lost its way. This is the place to be if you have a complex trauma or disease. We invent and have an overabundance of the most sophisticated diagnostics, pharmacology, and facilities in the world.
But if you have a chronic condition like diabetes, COPD, or CHF, where 80 percent of our overall healthcare dollars go and 96 percent of Medicare dollars go, you are better off in 45 other countries, many of which are in what we consider the “third world.”
As our costs have gone up, our relative standing in many key metrics of population health have fallen far behind. An argument for socialized medicine and more primitive technology? Hardly.
An argument for more attention to prevention, personalized care, and integration of medical care with social institutions, you bet!
Our system has come to treat symptoms instead of people, and Obamacare reinforces the problem fiscally and philosophically. Case in point: Providing a diabetic with insurance that doesn’t pay to motivate, teach, or provide the support for what needs to be done between doctor visits is worse than wasteful. Further, applying high individual deductibles that discourage frequent and regular office and home care visits that can improve compliance and health status are a drop in the bucket compared to the costs of an amputation or blindness.
Since we are talking policy, what are the fundamentals on a policy basis?
1. Technology reform. Obamacare’s $16 billion program encouraging and funding stand-alone electronic medical records systems back fired. They boost compensation instead of collaboration, increasing costs while doing nothing to increase efficiency or effectiveness. EHR systems were created to maximize reimbursement by exploiting the inherent flaws in fee-for-service reimbursement by boosting up-coding and high-cost service production. Supporting common, interoperable platforms that transform EHR data into actionable information to manage population health and cost, removing regulatory stonewalls, and requiring EHR providers to allow access to their data platforms to make common platforms work fixes the problem.
2. Reimbursement reform. Get serious about paying for results instead of tasks. Encourage physician-owned and -led networks financially and with regulatory and tort relief, and eliminate the Rube Goldberg gain-sharing schemes. Make it simple: premium less actual cost = savings. Then split them. Value versus volume. Reimbursement for results. Pay for performance. They all mean savings, and not the few percent from tweaking the status quo, but hundreds of billions from allowing the free market to perform.
3. Reform reform. Get hospitals out of the accountable care business. Savings come from keeping patients OUT of the hospital, and successful accountable care organizations are a fiscal disaster for them. Instead of enabling regional hospital monopolies that eliminate competition, particularly lower-cost community hospitals, enable primary-care physicians to become "purchasing agents" for their patients. This will foster competition on price, quality, and safety through price transparency in the marketplace. Remove the shackles and allow them to do what is right instead of complying with what is regulated.Managing safety, fair play, and honest competition and preventing and dealing with abuses quickly and firmly are the government's job. Central management is not.
4. Tort reform. Instead of holding physicians liable for not using the best technology, indemnify them when they use best practices.These things are not liberal or conservative, political or progressive — they are practical. And, way overdue.
Courtesy of Physicians Practice
HCPCS Codes Subject to and Excluded from CLIA Edits: NOridian/Medicare
HCPCS Codes Subject to and Excluded from CLIA Edits
MLN Matters®Number: MM8567
Related Change Request (CR) #: CR 8567
Related CR Release Date: January 17, 2014
Effective Date: January 1, 2014
Related CR Transmittal #: R2857CP
Implementation Date: April 7, 2014
Provider Types Affected
This MLN Matters® Article is intended for physicians, other providers, and suppliers submitting claims to Medicare Administrative Contractors (MACs), including Durable Medical Equipment Medicare Administrative Contractors (DME/MACs), for services to Medicare beneficiaries.
Provider Action Needed
This article is based on Change Request (CR) 8567 which informs MACs about changes to HCPCS codes that are new for 2014 and are subject to Clinical Laboratory Improvement Amendments (CLIA) edits. The CLIA regulations require a facility to be appropriately certified for each test performed. Make sure your billing staffs are aware of these changes.
Background
The Clinical Laboratory Improvement Amendments (CLIA) regulations require a facility to be appropriately certified for each test performed. To ensure that Medicare and Medicaid only pay for laboratory tests performed in certified facilities, each claim for a HCPCS code that is considered a CLIA laboratory test is currently edited at the CLIA certificate level.
The HCPCS codes are considered a laboratory test under CLIA change each year. Contractors need to be informed about the new HCPCS codes that are both subject to CLIA edits and excluded from CLIA edits.
The HCPCS codes listed below are new for 2014 and are subject to CLIA edits. The list does not include new HCPCS codes for waived tests or provider-performed procedures. The HCPCS codes listed below require a facility to have either a CLIA certificate of registration (certificate type code 9), a CLIA certificate of compliance (certificate type code 1), or a CLIA certificate of accreditation (certificate type code 3). A facility without a valid, current, CLIA certificate, with a current CLIA certificate of waiver (certificate type code 2) or with a current CLIA certificate for provider-performed microscopy procedures (certificate type code 4) must not be permitted to be paid for these tests.
- G0461 - Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain;
- G0462 - Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (list separately in addition to code for primary procedure);
- 80155 - Caffeine level;
- 80159 - Clozapine level;
- 80169 - Everolimus level;
- 80171 - Gabapentin level;
- 80175 - Lamotrigine level;
- 80177 - Levetiracetam level;
- 80180 - Mycophenolate (mycophenolic acid) level;
- 80183 - Oxcarbazepine level;
- 80199 - Tiagabine level;
- 80203 - Zonisamide level;
- 81287 - MGMT (O-6-methylguanine-DNA methyltransferase) gene analysis;
- 81504 - Genetic profiling on oncology biopsy lesions;
- 81507 - DNA analysis using maternal plasma; and
- 87661 - Infectious agent detection by nucleic acid (dna or rna); trichomonas vaginalis, amplified probe technique.
Additional Information
The official instruction, CR 8567 issued to your MAC regarding this change may be viewed at http://www.cms.hhs.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads /R2857CP.pdf
Last Updated Jan 23, 2014
CMS 1500 Claim Form Instructions: Revised for Form Version 02/12
CMS 1500 Claim Form Instructions: Revised for Form Version 02/12
MLN Matters® Number: MM8509
Related Change Request (CR) #: CR 8509
Related CR Release Date: December 27, 2013
Effective Date: January 6, 2014
Related CR Transmittal #: R2842CP
Implementation Date: January 6, 2014
Provider Types Affected
This MLN Matters® Article is intended for physicians and other providers submitting claims to Medicare contractors (carriers, A/B Medicare Administrative Contractors (A/B MACs), and Durable Medical Equipment Medicare Administrative Contractors (DME/MACs)) for services provided to Medicare beneficiaries.
Provider Action Needed
This change request (CR) 8509 revises the current CMS 1500 claim form instructions to reflect the revised CMS 1500 claim form, version 02/12.
Form Version 02/12 will replace the current CMS 1500 claim form, 08/05, effective with claims received on and after April 1, 2014:
Background
The National Uniform Claim Committee (NUCC) recently revised the CMS 1500 claim form. On June 10, 2013, the White House Office of Management and Budget (OMB) approved the revised form, 02/12. The revised form has a number of changes. Those most notable for Medicare are new indicators to differentiate between ICD-9 and ICD-10 codes on a claim, and qualifiers to identify whether certain providers are being identified as having performed an ordering, referring, or supervising role in the furnishing of the service. In addition, the revised form uses letters, instead of numbers, as diagnosis code pointers, and expands the number of possible diagnosis codes on a claim to 12.
The qualifiers that are appropriate for identifying an ordering, referring, or supervising role are as follows:
The Administrative Simplification Compliance Act (ASCA) requires Medicare claims to be sent electronically unless certain exceptions are met. Those providers meeting these exceptions are permitted to submit their claims to Medicare on paper. Medicare requires that the paper format for professional and supplier paper claims be the CMS 1500 claim form. Medicare therefore supports the implementation of the CMS 1500 claim form and its revisions for use by its professional providers and suppliers meeting an ASCA exception. More information about ASCA exceptions can be found in Chapter 24 of the "Medicare Claims Processing Manual" which is available at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c24.pdf on the Centers for Medicare & Medicaid Services (CMS) website.
Additional Information
The official instruction, CR 8509 issued to your MAC regarding this change may be viewed at
http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2842CP.pdf on the CMS website. CR 8509 contains the instructions for completing the revised CMS 1500 claim form (02/12), which will become part of Chapter 26 in the "Medicare Claims Processing Manual" (Pub. 100-04).
Related Change Request (CR) #: CR 8509
Related CR Release Date: December 27, 2013
Effective Date: January 6, 2014
Related CR Transmittal #: R2842CP
Implementation Date: January 6, 2014
Provider Types Affected
This MLN Matters® Article is intended for physicians and other providers submitting claims to Medicare contractors (carriers, A/B Medicare Administrative Contractors (A/B MACs), and Durable Medical Equipment Medicare Administrative Contractors (DME/MACs)) for services provided to Medicare beneficiaries.
Provider Action Needed
This change request (CR) 8509 revises the current CMS 1500 claim form instructions to reflect the revised CMS 1500 claim form, version 02/12.
Form Version 02/12 will replace the current CMS 1500 claim form, 08/05, effective with claims received on and after April 1, 2014:
- Medicare will begin accepting claims on the revised form, 02/12, on January 6, 2014;
- Medicare will continue to accept claims on the old form, 08/05, through March 31, 2014;
- On April 1, 2014, Medicare will accept paper claims on only the revised CMS 1500 claim form, 02/12; and
- On and after April 1, 2014, Medicare will no longer accept claims on the old CMS 1500 claim form, 08/05.
Background
The National Uniform Claim Committee (NUCC) recently revised the CMS 1500 claim form. On June 10, 2013, the White House Office of Management and Budget (OMB) approved the revised form, 02/12. The revised form has a number of changes. Those most notable for Medicare are new indicators to differentiate between ICD-9 and ICD-10 codes on a claim, and qualifiers to identify whether certain providers are being identified as having performed an ordering, referring, or supervising role in the furnishing of the service. In addition, the revised form uses letters, instead of numbers, as diagnosis code pointers, and expands the number of possible diagnosis codes on a claim to 12.
The qualifiers that are appropriate for identifying an ordering, referring, or supervising role are as follows:
- DN - Referring Provider
- DK - Ordering Provider
- DQ - Supervising Provider
The Administrative Simplification Compliance Act (ASCA) requires Medicare claims to be sent electronically unless certain exceptions are met. Those providers meeting these exceptions are permitted to submit their claims to Medicare on paper. Medicare requires that the paper format for professional and supplier paper claims be the CMS 1500 claim form. Medicare therefore supports the implementation of the CMS 1500 claim form and its revisions for use by its professional providers and suppliers meeting an ASCA exception. More information about ASCA exceptions can be found in Chapter 24 of the "Medicare Claims Processing Manual" which is available at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c24.pdf
Additional Information
The official instruction, CR 8509 issued to your MAC regarding this change may be viewed at
http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2842CP.pdf
Last Updated Jan 29, 2014
Monday, January 20, 2014
Sample HIPAA Confidentiality Agreement for Medical Practice Vendors
With the HIPAA Omnibus Rule requiring greater identification, documentation, and management between medical practices and vendors, some new formalities may come into play.
Here's a link for a sample confidentiality agreement, drafted by attorney Amy Fehn of HealthLawOffices.com, to help put your vendors on notice and demonstrate to the federal government your good faith efforts to achieve HIPAA compliance.
Follow this link and click the download button: http://www.physicianspractice.com/hipaa/sample-hipaa-confidentiality-agreement-medical-practice-vendors?cid=fbP2011614
From Physicians Practice
Here's a link for a sample confidentiality agreement, drafted by attorney Amy Fehn of HealthLawOffices.com, to help put your vendors on notice and demonstrate to the federal government your good faith efforts to achieve HIPAA compliance.
Follow this link and click the download button: http://www.physicianspractice.com/hipaa/sample-hipaa-confidentiality-agreement-medical-practice-vendors?cid=fbP2011614
From Physicians Practice
Thursday, January 16, 2014
Wednesday, January 15, 2014
Top Ten Tech Tools for Your Medical Practice
By Rosemarie Nelson taken from Physicians Practice
It doesn't matter how busy the other guy tells you he is; you know you are even busier. While you can fit more in a day than the average person and usually accomplish this before they even wake up, that doesn't mean you can't use a little help. Here are 10 time-saving apps and technology tips that can make your personal and professional life easier.
1. Epocrates. It's likely that you know about this mobile drug-reference resource. It's free and as many as 50 percent of U.S. physicians rely on Epocrates to help improve patient safety and increase practice efficiency. For an annual subscription fee, you can also have access to ICD-9 and CPT billing codes, lab tests and panels with reference ranges, and more.
2. Quick response codes. By scanning a QR code (similar to a bar code) using a smartphone camera, you can access data that links your phone directly to a webpage. For example, if you add QR codes to patient statements, patients can easily link to your payment page online. There are multiple, free QR code generation websites: Qrstuff.com, Zxing.appspot.com/generator, Quikqr.com. Create the code, print it, and you're ready to go.
3. Patient education apps. There are plenty of apps to help patients keep track of and understand their health, but two that are particularly useful are:
• DrawMD (free in Apple app store) — physicians can sketch, stamp, or type on detailed anatomic images and then save them to the EHR and/or share images with patients.
• NumeraNET (free in Apple app store) — patients can share information such as weight, blood pressure, and pedometer results with physicians, who can then send the information to their EHR.
4. Telecommuting. Telecommuting is not just for your transcriptionist — think coding and billing staff and even phone operations. www.telecommute.org
5. Back up data. Not just your practice management system, but your entire PC network so that all those documents and forms and accounts payable records are all safely stored and retrievable if a problem occurs. Investigate Internet-based services for data backup such as HP Live Vault or OffSite Backup.
6. Doximity. This app provides access to a social network for physicians and healthcare professionals across the United States — similar to "LinkedIn." Features include a free digital fax, ability to upload your CV, and earn honoraria. Free.
7. Password management. Passwords, while they can be troublesome, are a necessity. Be sure that you force a password change for all users on your network at least once per quarter. Do not allow staff to post their passwords anywhere. Change all passwords for all staff and providers whenever an employee resigns or is terminated. Check out RoboForm. It provides a master password and inserts a toolbar into your browser to auto-logon for up to 10 applications for free ($29.95 for more).
8. Patient surveys. Survey on the Spot, a free app in Apple's online store, allows you to gather instant feedback on your practice with custom surveys; see compiled survey results in your account and get software alerts when a patient rates your service as poor.
9. Kiosks. Let your patients check-in and make their copayment at a kiosk in your reception area. Some kiosks will even verify insurance eligibility! A few of the vendors you might consider are: OTech Group, ClearWave, SeePoint, and Phreesia.
10. Get in shape. Feeling great can help you be even more productive. Try these two apps for your smartphone:
• Crossfit Daily. Get your daily workout with how-to details, including video. Each workout will provide the benchmark for you and feedback from others attempting these serious exercises. Free.
• LoseIt. Enter your daily calorie budget and throughout the day you can add the food you take in and the exercise you complete. Voila! Are you under (weight loss) or over (weight gain) your budget? The app is easy to use, allowing you to create "My Foods" lists, custom recipes, and brand name food lists. Free.
The approach to effective use of technology tools is incremental. If you wait until the next version comes out, or the next upgrade, or the complete interface, or … you will miss many opportunities to reap incremental benefits. "All or nothing" is a losing proposition. Take small steps down the path of technology and you will gain big returns for yourself and for your practice.
Courtesy of: http://www.physicianspractice.com/technology/top-ten-tech-tools-your-medical-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=19122013
It doesn't matter how busy the other guy tells you he is; you know you are even busier. While you can fit more in a day than the average person and usually accomplish this before they even wake up, that doesn't mean you can't use a little help. Here are 10 time-saving apps and technology tips that can make your personal and professional life easier.
1. Epocrates. It's likely that you know about this mobile drug-reference resource. It's free and as many as 50 percent of U.S. physicians rely on Epocrates to help improve patient safety and increase practice efficiency. For an annual subscription fee, you can also have access to ICD-9 and CPT billing codes, lab tests and panels with reference ranges, and more.
2. Quick response codes. By scanning a QR code (similar to a bar code) using a smartphone camera, you can access data that links your phone directly to a webpage. For example, if you add QR codes to patient statements, patients can easily link to your payment page online. There are multiple, free QR code generation websites: Qrstuff.com, Zxing.appspot.com/generator, Quikqr.com. Create the code, print it, and you're ready to go.
3. Patient education apps. There are plenty of apps to help patients keep track of and understand their health, but two that are particularly useful are:
• DrawMD (free in Apple app store) — physicians can sketch, stamp, or type on detailed anatomic images and then save them to the EHR and/or share images with patients.
• NumeraNET (free in Apple app store) — patients can share information such as weight, blood pressure, and pedometer results with physicians, who can then send the information to their EHR.
4. Telecommuting. Telecommuting is not just for your transcriptionist — think coding and billing staff and even phone operations. www.telecommute.org
5. Back up data. Not just your practice management system, but your entire PC network so that all those documents and forms and accounts payable records are all safely stored and retrievable if a problem occurs. Investigate Internet-based services for data backup such as HP Live Vault or OffSite Backup.
6. Doximity. This app provides access to a social network for physicians and healthcare professionals across the United States — similar to "LinkedIn." Features include a free digital fax, ability to upload your CV, and earn honoraria. Free.
7. Password management. Passwords, while they can be troublesome, are a necessity. Be sure that you force a password change for all users on your network at least once per quarter. Do not allow staff to post their passwords anywhere. Change all passwords for all staff and providers whenever an employee resigns or is terminated. Check out RoboForm. It provides a master password and inserts a toolbar into your browser to auto-logon for up to 10 applications for free ($29.95 for more).
8. Patient surveys. Survey on the Spot, a free app in Apple's online store, allows you to gather instant feedback on your practice with custom surveys; see compiled survey results in your account and get software alerts when a patient rates your service as poor.
9. Kiosks. Let your patients check-in and make their copayment at a kiosk in your reception area. Some kiosks will even verify insurance eligibility! A few of the vendors you might consider are: OTech Group, ClearWave, SeePoint, and Phreesia.
10. Get in shape. Feeling great can help you be even more productive. Try these two apps for your smartphone:
• Crossfit Daily. Get your daily workout with how-to details, including video. Each workout will provide the benchmark for you and feedback from others attempting these serious exercises. Free.
• LoseIt. Enter your daily calorie budget and throughout the day you can add the food you take in and the exercise you complete. Voila! Are you under (weight loss) or over (weight gain) your budget? The app is easy to use, allowing you to create "My Foods" lists, custom recipes, and brand name food lists. Free.
The approach to effective use of technology tools is incremental. If you wait until the next version comes out, or the next upgrade, or the complete interface, or … you will miss many opportunities to reap incremental benefits. "All or nothing" is a losing proposition. Take small steps down the path of technology and you will gain big returns for yourself and for your practice.
Courtesy of: http://www.physicianspractice.com/technology/top-ten-tech-tools-your-medical-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=19122013
Monday, January 13, 2014
Seven Simple Strategies to Market Your Medical Practice
Getting in the habit of actively marketing your practice shouldn't have to wait until your New Year's Resolutions. Get started today with these seven simple strategies to market your medical practice:
1. Have a blog connected to your practice website. Blog often and about a variety of topics. And make sure people can subscribe to your blog by e-mail (which is more beneficial for your marketing efforts than RSS feeds). 2. Turn your existing patients into raving fans. It is easier to maintain an existing patient base then it is to find new prospective patients and convert them into patients. Make sure you and your staff over deliver and takes excellent care of the patients who love you already. Those patients will become raving fans and carry the load of some of your marketing for you. 3. Gather testimonials. If you have ancillary products or services and they have worked for you personally or for your staff and your services, save them and use them on your website, for social media, or for other marketing efforts. This builds credibility and social proof that you are amazing. 4. Stay in touch. Take those e-mail addresses that you gathered in the first strategy and stay in touch with your patients, at least monthly. Make sure you include a note from a provider or staff member, a recommendation of a product/service/event, and a short article of helpful content. 5. Be open. Make sure your marketing message conveys what patients, disease processes, or diagnoses you are passionate about (market to your ideal patients). By showing up and showing who you are and what you have, you will invite the type of patients that will make your practice both successful and joyful for you. 6. Participate in the media. Seek out and take opportunities to be featured in the media as an expert and share those appearances in your marketing efforts. You could be featured nationally or locally, in print or online, or even on television or the radio. It is often as simple as sending an e-mail or making a call. 7. Get offline too. It would make all of our lives easier if we could only use online or offline-marketing strategies to market practices. The fact of the matter is that with a "brick-and-mortar" business (which is what a medical practice is), you must be involved and present in your local community. Both online and offline marketing works together in synergy to get the desired effect of bringing in more patients to grow your practice.
Pick a few of the strategies that you can begin immediately with the goal being to implement all of them by the end of January 2014. Once you get in the marketing groove, you will find that marketing is fun and even a joyful experience. Rome wasn't built in a day; it takes 21 days to form a habit and in the case of marketing, six to 12 months to be great at it, but stick with it … it will pay off.
From Physicians Practice, By Audrey "Christie" Mclaughlin, RN: http://www.physicianspractice.com/blog/seven-simple-strategies-market-your-medical-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=17122013
1. Have a blog connected to your practice website. Blog often and about a variety of topics. And make sure people can subscribe to your blog by e-mail (which is more beneficial for your marketing efforts than RSS feeds). 2. Turn your existing patients into raving fans. It is easier to maintain an existing patient base then it is to find new prospective patients and convert them into patients. Make sure you and your staff over deliver and takes excellent care of the patients who love you already. Those patients will become raving fans and carry the load of some of your marketing for you. 3. Gather testimonials. If you have ancillary products or services and they have worked for you personally or for your staff and your services, save them and use them on your website, for social media, or for other marketing efforts. This builds credibility and social proof that you are amazing. 4. Stay in touch. Take those e-mail addresses that you gathered in the first strategy and stay in touch with your patients, at least monthly. Make sure you include a note from a provider or staff member, a recommendation of a product/service/event, and a short article of helpful content. 5. Be open. Make sure your marketing message conveys what patients, disease processes, or diagnoses you are passionate about (market to your ideal patients). By showing up and showing who you are and what you have, you will invite the type of patients that will make your practice both successful and joyful for you. 6. Participate in the media. Seek out and take opportunities to be featured in the media as an expert and share those appearances in your marketing efforts. You could be featured nationally or locally, in print or online, or even on television or the radio. It is often as simple as sending an e-mail or making a call. 7. Get offline too. It would make all of our lives easier if we could only use online or offline-marketing strategies to market practices. The fact of the matter is that with a "brick-and-mortar" business (which is what a medical practice is), you must be involved and present in your local community. Both online and offline marketing works together in synergy to get the desired effect of bringing in more patients to grow your practice.
Pick a few of the strategies that you can begin immediately with the goal being to implement all of them by the end of January 2014. Once you get in the marketing groove, you will find that marketing is fun and even a joyful experience. Rome wasn't built in a day; it takes 21 days to form a habit and in the case of marketing, six to 12 months to be great at it, but stick with it … it will pay off.
From Physicians Practice, By Audrey "Christie" Mclaughlin, RN: http://www.physicianspractice.com/blog/seven-simple-strategies-market-your-medical-practice?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=17122013
Complying With New Business Associate HIPAA Rules: 4 Changes to Know
When the HIPAA Omnibus Final Rule went into effect in March 2013, one of the most significant changes to HIPAA Privacy and Security Rules involved "business associate" (BA) agreements, and the rules that govern the relationship practices have with BAs.
Failure to properly follow these new rules governing agreements with BAs can lead to substantial penalties that have the potential to ruin a medical practice's reputation and cripple it financially.
Here are four changes practices should know about, and what they need to do to reduce their risk of exposure to penalties.
1. BAs can now be held directly liable for HIPAA breaches — but this doesn't protect covered entities.
Under the revised rules, a BA can now be held directly liable and subject to civil and criminal penalties for committing HIPAA violations. Individuals or companies considered BAs (which can include IT service providers such as my company and many others; see below to learn how the definition of BA has expanded) should be taking a number of steps to become compliant with the Omnibus Final Rule — steps practices need to know about, as is discussed in #4.
These steps include:
"Some covered entities [CE] may now have a false sense of security that because HIPAA reaches directly to the BA, they are not as culpable as they once were," he says. "In fact, a BA that's negligent or worse in handling PHI can cause significant liability to the CE. This makes it incredibly important to have a well-drafted BA agreement."
Not only is a practice statutorily required to have a BA agreement with any organization or individual PHI is disclosed to, the BA agreement should serve other purposes. It should clearly delineate the reporting obligations of the BA, in the event of a HIPAA violation, to the practice so the practice can comply with its reporting requirements to the government and affected patients.
"Another important element we put into all of our BA agreements is an indemnification provision that should the BA be responsible for causing a data breach, it is financially obligated to compensate the CE for the costs of responding to a breach," Morrone says. "These amounts can be fairly significant. It can cost hundreds of thousands of dollars just to do the reporting that's required under federal law."
2. The definition of BA has changed.
Under the revised rules, the definition of BA has been completely reworded. A BA now includes any vendor that creates, receives, maintains, or transmits PHI on behalf of a CE, even those that do not access PHI. BAs can now include organizations involved in patient safety activities, health information organizations and PHI data storage companies.
With this expanded definition, practices should determine whether any existing contracts should be replaced with BA agreements. In addition, practices should also review existing BA agreements. It is a common practice for BAs to request inclusion of a clause that removes themselves and their subcontractors from liability under HIPAA. A practice should now strongly object to its inclusion since BAs are now liable under the new rules.
3. The definition of BA has expanded to include subcontractors.
Subcontractors are now considered a BA of a practice if it has access to the practice's PHI. Practices would be wise to request information on these subcontractors, and research them as if the practice were contracting directly with the subcontractor.
Practices should require its BAs to ensure any subcontractors it may engage on its behalf that will have access to the practice's PHI agree to the same restrictions, conditions and requirements that apply to the BA with respect to such information.
Practices should also include in its BA agreement a stipulation that requires BAs to receive approval from the practice prior to engaging any new subcontractors that will have access to the PHI.
4. Practices must take steps to confirm its BAs follow HIPAA.
If a practice delegates duties to a BA, the practice now has a responsibility to confirm — to the best of its ability — the BA is handling those duties in conformity with HIPAA rules. There are a few steps practices should take.
Practices should request and review copies of the BAs risk assessment, and the policies and procedures developed to ensure the BA maintains HIPAA compliance. This should include the policy and procedure that states the practice will be notified if a breach occurs.
Practices should request information about a BA's HIPAA training program. Practices should also request a copy of a BAs cybersecurity insurance, which is designed to mitigate losses from a variety of cyber incidents, including data breaches.
While it is critical to take these steps to confirm a BA's services are HIPAA compliant, it is perhaps even more important for practices to perform careful due diligence on the companies it is considering as partners.
"The fines for not complying with HIPAA are as high as $1.5 million," Morrone says. "Having a well-drafted BA agreement can go a long way, but with so much at stake, CEs must carefully choose those companies they are engaging with to handle PHI."
By Nelson Gomes from Physician Practice: http://www.physicianspractice.com/blog/complying-new-business-associate-hipaa-rules-4-changes-know?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=17122013
Failure to properly follow these new rules governing agreements with BAs can lead to substantial penalties that have the potential to ruin a medical practice's reputation and cripple it financially.
Here are four changes practices should know about, and what they need to do to reduce their risk of exposure to penalties.
1. BAs can now be held directly liable for HIPAA breaches — but this doesn't protect covered entities.
Under the revised rules, a BA can now be held directly liable and subject to civil and criminal penalties for committing HIPAA violations. Individuals or companies considered BAs (which can include IT service providers such as my company and many others; see below to learn how the definition of BA has expanded) should be taking a number of steps to become compliant with the Omnibus Final Rule — steps practices need to know about, as is discussed in #4.
These steps include:
- Conducting a risk assessment of the methods used to protect patient health information (PHI);
- Developing and/or revising policies and procedures based upon that analysis to ensure HIPAA compliance is maintained;
- Training staff members on HIPAA rules and the BAs responsibility to protect PHI; and
- Entering into BA agreements with applicable subcontractors (see #3 to learn more about the changing responsibility of subcontractors)
"Some covered entities [CE] may now have a false sense of security that because HIPAA reaches directly to the BA, they are not as culpable as they once were," he says. "In fact, a BA that's negligent or worse in handling PHI can cause significant liability to the CE. This makes it incredibly important to have a well-drafted BA agreement."
Not only is a practice statutorily required to have a BA agreement with any organization or individual PHI is disclosed to, the BA agreement should serve other purposes. It should clearly delineate the reporting obligations of the BA, in the event of a HIPAA violation, to the practice so the practice can comply with its reporting requirements to the government and affected patients.
"Another important element we put into all of our BA agreements is an indemnification provision that should the BA be responsible for causing a data breach, it is financially obligated to compensate the CE for the costs of responding to a breach," Morrone says. "These amounts can be fairly significant. It can cost hundreds of thousands of dollars just to do the reporting that's required under federal law."
2. The definition of BA has changed.
Under the revised rules, the definition of BA has been completely reworded. A BA now includes any vendor that creates, receives, maintains, or transmits PHI on behalf of a CE, even those that do not access PHI. BAs can now include organizations involved in patient safety activities, health information organizations and PHI data storage companies.
With this expanded definition, practices should determine whether any existing contracts should be replaced with BA agreements. In addition, practices should also review existing BA agreements. It is a common practice for BAs to request inclusion of a clause that removes themselves and their subcontractors from liability under HIPAA. A practice should now strongly object to its inclusion since BAs are now liable under the new rules.
3. The definition of BA has expanded to include subcontractors.
Subcontractors are now considered a BA of a practice if it has access to the practice's PHI. Practices would be wise to request information on these subcontractors, and research them as if the practice were contracting directly with the subcontractor.
Practices should require its BAs to ensure any subcontractors it may engage on its behalf that will have access to the practice's PHI agree to the same restrictions, conditions and requirements that apply to the BA with respect to such information.
Practices should also include in its BA agreement a stipulation that requires BAs to receive approval from the practice prior to engaging any new subcontractors that will have access to the PHI.
4. Practices must take steps to confirm its BAs follow HIPAA.
If a practice delegates duties to a BA, the practice now has a responsibility to confirm — to the best of its ability — the BA is handling those duties in conformity with HIPAA rules. There are a few steps practices should take.
Practices should request and review copies of the BAs risk assessment, and the policies and procedures developed to ensure the BA maintains HIPAA compliance. This should include the policy and procedure that states the practice will be notified if a breach occurs.
Practices should request information about a BA's HIPAA training program. Practices should also request a copy of a BAs cybersecurity insurance, which is designed to mitigate losses from a variety of cyber incidents, including data breaches.
While it is critical to take these steps to confirm a BA's services are HIPAA compliant, it is perhaps even more important for practices to perform careful due diligence on the companies it is considering as partners.
"The fines for not complying with HIPAA are as high as $1.5 million," Morrone says. "Having a well-drafted BA agreement can go a long way, but with so much at stake, CEs must carefully choose those companies they are engaging with to handle PHI."
By Nelson Gomes from Physician Practice: http://www.physicianspractice.com/blog/complying-new-business-associate-hipaa-rules-4-changes-know?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=17122013
Forgiving Patient Copays Can Lead to Unforgiving Consequences
At one time in America, there was no such thing as "health insurance." Patients negotiated directly with hospitals and doctors, and paid what they could, often on a sliding scale, according to ability. Eventually, health insurance entered the market, easing the burden of healthcare costs.
It didn't take long to realize the ordinary rules of supply and demand would not apply, if the insurance company, not the patient, was responsible for the bill. Copayments, deductibles, and coinsurance developed as a check against overutilization. If the patient had some "skin" in the game, this would provide some disincentive, though not absolute, but some hedge against over-use. This protective requirement, though necessary, is at times at odds with AMA Code of Ethics Opinion 8.03, which holds: "The primary objective of the medical profession is to render service to humanity; reward or financial gain is a subordinate consideration.
"In the current economy, as available dollars are becoming scarce, insurance carriers have begun checking up on the collection of copayments, deductibles, and coinsurance. With greater regularity, physicians and hospitals are receiving letters requesting proof, in perhaps five randomly selected cases, that the provider has collected, or sufficiently attempted to collect the portion of fees which is the patient's responsibility. This comes as a shock to many providers, who in keeping with Opinion 8.03, and the historical tradition of sliding scales, based upon ability to pay, have subordinated financial ability to pay in favor of the higher duty to care for the patient's need.
It is important to understand, however, forgiveness of copayments could land you in hot water. Therefore, doctors must understand the rules regarding waiver of copayments. AMA Opinion 6.12 addresses the ethical considerations:
Opinion 6.12 - Forgiveness or Waiver of Insurance Copayments
Under the terms of many health insurance policies or programs, patients are made more conscious of the cost of their medical care through copayments. By imposing copayments for office visits and other medical services, insurers hope to discourage unnecessary healthcare. In some cases, financial hardship may deter patients from seeking necessary care if they would be responsible for a copayment for the care. Physicians commonly forgive or waive copayments to facilitate patient access to needed medical care. When a copayment is a barrier to needed care because of financial hardship, physicians should forgive or waive the copayment.
A number of clinics have advertised their willingness to provide detailed medical evaluations and accept the insurer's payment but waive the copayment for all patients.
Physicians should be aware that forgiveness or waiver of copayments may violate the policies of some insurers, both public and private; other insurers may permit forgiveness or waiver if they are aware of the reasons for the forgiveness or waiver. Routine forgiveness or waiver of copayments may constitute fraud under state and federal law. Physicians should ensure that their policies on copayments are consistent with applicable law and with the requirements of their agreements with insurers.
Where the insurance contract requires a doctor to make reasonable attempts to collect the patient's portion, an open question surrounds the definition of "reasonable attempts to collect the debt." Historically, doctors could satisfy the requirement by sending at least three letters attempting to collect the debt. However, the Office of Inspector General (OIG) has taken the position that the routine waiver of copayments could constitute a criminal kickback in Medicare cases.
This has emboldened private insurers, who are relying upon this contractual provision as a basis for a post-payment recoupment audit. If a provider cannot demonstrate efforts to collect from the patient, the carrier may demand a refund for any benefits paid across a large patient population.
Providers should be aware of this new emphasis upon patient responsibility. My advice would be to proactively get ahead of the problem. Contact your insurance representative to find out what is expected of you and document the response. By all means, if you are a physician and you receive a letter from an insurance carrier requesting proof of attempts to collect, do not ignore it. A failure to cooperate could constitute grounds for termination of the contract with the payer.
Because this emphasis upon collection of copayments is a fairly recent phenomenon, even if you have been deficient in the past, you may be able to satisfy the carrier by demonstrating a corrective plan of action going forward.
Courtesy of Physicians Practice, By Martin Merritt http://www.physicianspractice.com/blog/forgiving-patient-copays-can-lead-unforgiving-consequences?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=17122013
It didn't take long to realize the ordinary rules of supply and demand would not apply, if the insurance company, not the patient, was responsible for the bill. Copayments, deductibles, and coinsurance developed as a check against overutilization. If the patient had some "skin" in the game, this would provide some disincentive, though not absolute, but some hedge against over-use. This protective requirement, though necessary, is at times at odds with AMA Code of Ethics Opinion 8.03, which holds: "The primary objective of the medical profession is to render service to humanity; reward or financial gain is a subordinate consideration.
"In the current economy, as available dollars are becoming scarce, insurance carriers have begun checking up on the collection of copayments, deductibles, and coinsurance. With greater regularity, physicians and hospitals are receiving letters requesting proof, in perhaps five randomly selected cases, that the provider has collected, or sufficiently attempted to collect the portion of fees which is the patient's responsibility. This comes as a shock to many providers, who in keeping with Opinion 8.03, and the historical tradition of sliding scales, based upon ability to pay, have subordinated financial ability to pay in favor of the higher duty to care for the patient's need.
It is important to understand, however, forgiveness of copayments could land you in hot water. Therefore, doctors must understand the rules regarding waiver of copayments. AMA Opinion 6.12 addresses the ethical considerations:
Opinion 6.12 - Forgiveness or Waiver of Insurance Copayments
Under the terms of many health insurance policies or programs, patients are made more conscious of the cost of their medical care through copayments. By imposing copayments for office visits and other medical services, insurers hope to discourage unnecessary healthcare. In some cases, financial hardship may deter patients from seeking necessary care if they would be responsible for a copayment for the care. Physicians commonly forgive or waive copayments to facilitate patient access to needed medical care. When a copayment is a barrier to needed care because of financial hardship, physicians should forgive or waive the copayment.
A number of clinics have advertised their willingness to provide detailed medical evaluations and accept the insurer's payment but waive the copayment for all patients.
Physicians should be aware that forgiveness or waiver of copayments may violate the policies of some insurers, both public and private; other insurers may permit forgiveness or waiver if they are aware of the reasons for the forgiveness or waiver. Routine forgiveness or waiver of copayments may constitute fraud under state and federal law. Physicians should ensure that their policies on copayments are consistent with applicable law and with the requirements of their agreements with insurers.
Where the insurance contract requires a doctor to make reasonable attempts to collect the patient's portion, an open question surrounds the definition of "reasonable attempts to collect the debt." Historically, doctors could satisfy the requirement by sending at least three letters attempting to collect the debt. However, the Office of Inspector General (OIG) has taken the position that the routine waiver of copayments could constitute a criminal kickback in Medicare cases.
This has emboldened private insurers, who are relying upon this contractual provision as a basis for a post-payment recoupment audit. If a provider cannot demonstrate efforts to collect from the patient, the carrier may demand a refund for any benefits paid across a large patient population.
Providers should be aware of this new emphasis upon patient responsibility. My advice would be to proactively get ahead of the problem. Contact your insurance representative to find out what is expected of you and document the response. By all means, if you are a physician and you receive a letter from an insurance carrier requesting proof of attempts to collect, do not ignore it. A failure to cooperate could constitute grounds for termination of the contract with the payer.
Because this emphasis upon collection of copayments is a fairly recent phenomenon, even if you have been deficient in the past, you may be able to satisfy the carrier by demonstrating a corrective plan of action going forward.
Courtesy of Physicians Practice, By Martin Merritt http://www.physicianspractice.com/blog/forgiving-patient-copays-can-lead-unforgiving-consequences?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=17122013
Why Cloud Services are Ready for Prime Time in Healthcare
Chances are, you've heard about cloud computing but may not know much about it and how it relates to HIPAA. Here, we answer a few key questions about cloud services.
Cloud hosting — what is it?Cloud hosting has many variants and goes by many names, but it generally refers to the IT model where a medical practice uses computer servers and data-storage systems located in a service provider's data center rather than onsite at the practice. Some people think that since the word "cloud" is used, there is somehow magically no more hardware issues to worry about. On the contrary, a typical cloud-hosting facility has massive amounts of hardware and software systems. Cloud is so new, is it right for healthcare?Cloud hosting is actually not a new concept. In fact, versions of cloud hosting under different names have been around for nearly 30 years. In the early days of massive mainframes, such companies as Boeing Computer Services and Computer Science Corporation offered these services under the terms "timeshare" and "service bureau." Over the years many other labels have been used, including application service provider (ASP), software-as-a-service (SaaS),infrastructure as a service (IaaS), utility computing, and hosting. Finally about five years ago, the label "cloud" finally took hold, and although some of the terms above are still relevant in specialized circumstances, cloud hosting covers the overall concept.
What has made it an attractive solution for healthcare? Recent advances in several areas, including server and storage virtualization, and increased bandwidth of broadband services, have made cloud hosting much more attractive. In addition, server architecture — including both processing horsepower and processing (CPUs) — have become massively scalable. And improvements in management software have significantly added to both performance and reliability. These advances in technology have prompted significant changes in the way cloud services can be configured and delivered. What about the cloud and HIPAA?Cloud services are not automatically HPAA compliant. In fact,not only are many cloud providers not HIPAA compliant, they are wholly ignorant of HIPAA principles. The new HIPAA Omnibus rule released earlier in 2013 required all service providers to undergo a HIPAA compliance and remediation program by September 23, 2013.
(If you are using a cloud provider, you should contact them and request a copy of their HIPAA compliance program documents, and also request that they sign a Business Associate Agreement. If they cannot produce them, or they are reluctant to execute a BAA, you have a major problem.)
Cloud-hosting services can be made HIPAA compliant, provided proper HIPAA security is built into the platform, along with HIPAA-compliant processes and procedures for its operation. Note: There are some common "cloud services" that you may be familiar with or are already using that are definitely not HIPAA compliant. These include common web mail services from many Internet Service Providers (ISPs) such as AOL, Gmail, Hotmail, etc. These are not — nor can they be made to be — HIPAA compliant. In addition, most of them specifically prohibit any kind of business use, so in using them in conjunction with a medical practice typically violates their "Terms of Use" policies.
What are the big advantages of cloud over onsite servers, storage, etc.? Perhaps the biggest advantages are in the ability to grow as the practice’s needs grow, and to avoid the costly and disruptive effects of repeated computer upgrades every few years. Most people understand that new computer systems are obsolete within a few months after they are installed. So system designers have to anticipate future needs and buy more capacity than they really need, based on anticipated requirements of a few years down the road. Eventually the needs increase and even the "new" equipment becomes underpowered. So in a computer system "lifecycle," for the first few years there is too much capacity, and for the last few years there is too little capacity. Therefore for most of the time, the system is either too big or too small. Cloud services allow the computing horsepower — CPU, memory and hard drive space — to be "dialed-up" as needs increase, so it can keep pace with the needs of the practice. And generally that upgrade can be done without the downtime typically associated with a computer system "forklift upgrade."
And a good cloud provider is generally able to offer access to hardware and software tools that would be unaffordable to a typical practice.
What about support?This is critical, and it is important to make sure you understand what is being provided to the practice by a cloud provider. With onsite servers and other infrastructure, you have to have staff (or contract with an IT provider) to maintain your servers and take care of things like data backups, operating system patches, etc. With cloud hosting, those services are still necessary, and in most cases they can be provided more efficiently than with an onsite model. However not all cloud providers deliver those services automatically, so you need to check and make sure. Are cloud services foolproof?No, since there is still hardware, software — and people — involved, there is still the potential for outages and downtime, so you need to do your homework and make sure you understand the risks as well as the advantages
My EHR is hosted —does that mean I’m good to go as far as HIPAA is concerned?
Not at all. There has never been a reported HIPAA breach from an EHR — either hosted or onsite. The main culprits have been e-mail, files stored locally, and the theft of portable devices like laptops and USB drives. So you need to consider your non-EHR applications, and make sure they are properly secured. This is true whether those applications are running locally or with a cloud provider. One advantage of properly designed cloud services is that they tend to not allow healthcare data to be stored on local devices.
Courtesy of Physicians Practice http://www.physicianspractice.com/blog/why-cloud-services-are-ready-prime-time-healthcare?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=12122013
Friday, January 10, 2014
Modifier and HCPCS Changes for 2014 for Medicare
The following new and deleted National Level II modifiers and HCPCS are effective for dates of service on/after January 1, 2014.
In compliance with the Health Insurance Portability and Accountability Act (HIPAA), CMS eliminated the 3-month grace period for discontinued codes in Change Request (CR) 3093 dated February 6, 2004. Effective for dates of services on/after January 1, 2010, there is no grace period for billing discontinued HCPCS codes.
NOTE: The inclusions of modifiers or codes in this article do not necessarily indicate coverage. New modifiers and HCPCS identified as Durable Medical Equipment (DME) are not included in this listing.
This taken from Noridian website, CMS update: https://med.noridianmedicare.com/web/jeb/article-detail/-/view/10525/modifier-and-hcpcs-changes-for-2014 Also follow this link to see deleted codes for 2014.
New Modifiers for 2014
New 2014 HCPCS
In compliance with the Health Insurance Portability and Accountability Act (HIPAA), CMS eliminated the 3-month grace period for discontinued codes in Change Request (CR) 3093 dated February 6, 2004. Effective for dates of services on/after January 1, 2010, there is no grace period for billing discontinued HCPCS codes.
NOTE: The inclusions of modifiers or codes in this article do not necessarily indicate coverage. New modifiers and HCPCS identified as Durable Medical Equipment (DME) are not included in this listing.
This taken from Noridian website, CMS update: https://med.noridianmedicare.com/web/jeb/article-detail/-/view/10525/modifier-and-hcpcs-changes-for-2014 Also follow this link to see deleted codes for 2014.
New Modifiers for 2014
| Modifier | Description |
|---|---|
| AO | Alternate payment method declined by provider of service |
| JE | Administered via dialysate |
| PM | Post mortem |
New 2014 HCPCS
| HCPCS | Description |
|---|---|
| A4555 | Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement only |
| A9520 | Technetium tc-99m, tilmanocept, diagnostic, up to 0.5 millicuries |
| A9575 | Injection, gadoterate meglumine, 0.1 ml |
| A9599 | Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography (pet) imaging, per study dose |
| C1841 | Retinal prosthesis, includes all internal and external components |
| C5271 | Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area |
| C5272 | Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure) |
| C5273 | Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children |
| C5274 | Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure) |
| C5275 | Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area |
| C5276 | Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure) |
| C5277 | Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children |
| C5278 | Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure) |
| C9132 | Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity |
| C9133 | Factor ix (antihemophilic factor, recombinant), rixibus, per i.u. |
| C9441 | Injection, ferric carboxymaltose, 1 mg |
| C9497 | Loxapine, inhalation powder, 10 mg |
| C9735 | Anoscopy; with directed submucosal injection(s), any substance |
| C9737 | Laparoscopy, surgical, esophageal sphincter augmentation with device (eg, magnetic band) |
| D0393 | Treatment simulation using 3d image volume |
| D0394 | Digital subtraction of two or more images or image volumes of the same modality |
| D0395 | Fusion of two or more 3d image volumes of one or more modalities |
| D0601 | Caries risk assessment and documentation, with a finding of low risk |
| D0602 | Caries risk assessment and documentation, with a finding of moderate risk |
| D0603 | Caries risk assessment and documentation, with a finding of high risk |
| D1999 | Unspecified preventive procedure, by report |
| D2921 | Reattachment of tooth fragment, incisal edge or cusp |
| D2941 | Interim therapeutic restoration - primary dentition |
| D2949 | Restorative foundation for an indirect restoration |
| D3355 | Pulpal regeneration - initial visit |
| D3356 | Pulpal regeneration - interim medication replacement |
| D3357 | Pulpal regeneration - completion of treatment |
| D3427 | Periradicular surgery without apicoectomy |
| D3428 | Bone graft in conjunction with periradicular surgery - per tooth, single site |
| D3429 | Bone graft in conjunction with periradicular surgery - each additional contiguous tooth in the same surgical site |
| D3431 | Biologic materials to aid in soft and osseous tissue regeneration in conjunction with periradicular surgery |
| D3432 | Guided tissue regeneration, resorbable barrier, per site, in conjunction with periradicular surgery |
| D4921 | Gingival irrigation - per quadrant |
| D5863 | Overdenture - complete maxillary |
| D5864 | Overdenture - partial maxillary |
| D5865 | Overdenture - complete mandibular |
| D5866 | Overdenture - partial mandibular |
| D5994 | Peridontal medicament carrier with peripheral seal - laboratory processed |
| D6011 | Second stage implant surgery |
| D6013 | Surgical placement of mini implant |
| D6052 | Semi-precision attachment abutment |
| D8694 | Repair of fixed retainers, includes reattachment |
| D9985 | Sales tax |
| G0461 | Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain |
| G0462 | Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (list separately in addition to code for primary procedure) |
| G0463 | Hospital outpatient clinic visit for assessment and management of a patient |
| G9187 | Bundled payments for care improvement initiative home visit for patient assessment performed by a qualified health care professional for individuals not considered homebound including, but not limited to, assessment of safety, falls, clinical status, fluid status, medication reconciliation/management, patient compliance with orders/plan of care, performance of activities of daily living, appropriateness of care setting; (for use only in the meidcare-approved bundled payments for care improvement initiative); may not be billed for a 30-day period covered by a transitional care management code |
| G9188 | Beta-blocker therapy not prescribed, reason not given |
| G9189 | Beta-blocker therapy prescribed or currently being taken |
| G9190 | Documentation of medical reason(s) for not prescribing beta-blocker therapy (eg, allergy, intolerance, other medical reasons) |
| G9191 | Documentation of patient reason(s) for not prescribing beta-blocker therapy (eg, patient declined, other patient reasons) |
| G9192 | Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, other reasons attributable to the health care system) |
| G9193 | Clinician documented that patient with a diagnosis of major depression was not an eligible candidate for antidepressant medication treatment or patient did not have a diagnosis of major depression |
| G9194 | Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 180 day (6 month) continuation treatment phase |
| G9195 | Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 180 day (6 months) continuation treatment phase |
| G9196 | Documentation of medical reason(s) for not ordering first or second generation cephalosporin for antimicrobial prophylaxis |
| G9197 | Documentation of order for first or second generation cephalosporin for antimicrobial prophylaxis |
| G9198 | Order for first or second generation cephalosporin for antimicrobial prophylaxis was not documented, reason not given |
| G9199 | Venous thromboembolism (vte) prophylaxis not administered the day of or the day after hospital admission for documented reasons (eg, patient is ambulatory, patient expired during inpatient stay, patient already on warfarin or another anticoagulant, other medical reason(s) or eg, patient left against medical advice, other patient reason(s)) |
| G9200 | Venous thromboembolism (vte) prophylaxis was not administered the day of or the day after hospital admission, reason not given |
| G9201 | Venous thromboembolism (vte) prophylaxis administered the day of or the day after hospital admission |
| G9202 | Patients with a positive hepatitis c antibody test |
| G9203 | Rna testing for hepatitis c documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c |
| G9204 | Rna testing for hepatitis c was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given |
| G9205 | Patient starting antiviral treatmentfor hepatitis c during the measurement period |
| G9206 | Patient starting antiviral treatment for hepatitis c during the measurement period |
| G9207 | Hepatitis c genotype testing documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c |
| G9208 | Hepatitis c genotype testing was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given |
| G9209 | Hepatitis c quantitative rna testing documented as performed between 4-12 weeks after the initiation of antiviral treatment |
| G9210 | Hepatitis c quantitative rna testing not performed between 4-12 weeks after the initiation of antiviral treatment for reasons documented by clinician (eg, patients whose treatment was discontinued during the testing period prior to testing, other medical reasons, patient declined, other patient reasons) |
| G9211 | Hepatitis c quantitative rna testing was not documented as performed between 4-12 weeks after the initiation of antiviral treatment, reason not given |
| G9212 | Dsm-ivtm criteria for major depressive disorder documented at the initial evaluation |
| G9213 | Dsm-iv-tr criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specified |
| G9214 | Cd4+ cell count or cd4+ cell percentage results documented |
| G9215 | Cd4+ cell count or percentage not documented as performed, reason not given |
| G9216 | Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given |
| G9217 | Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below 00 cells/mm3, reason not given |
| G9218 | Pcp prophylaxis was not prescribed within 3 months oflow cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15%, reason not given |
| G9219 | Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3 for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis) |
| G9220 | Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% for medical reason (i.e., patient's cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient's cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis) |
| G9221 | Pneumocystis jiroveci pneumonia prophlaxis prescribed |
| G9222 | Pneumocystis jiroveci pneumonia prophylaxis prescribed wthin 3 months of low cd4+ cell count below 200 cells/mm3 |
| G9223 | Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% |
| G9224 | Documentation of medical reason for not performing foot exam (e.g., patient with bilateral foot/leg amputation) |
| G9225 | Foot exam was not performed, reason not given |
| G9226 | Foot examination performed (includes examination through visual inspection, sensory exam with monofilament, and pulse exam - report when all of the 3 components are completed) |
| G9227 | Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan |
| G9228 | Chlamydia, gonorrhea and syphilis screening results documented (report when results are present for all of the 3 screenings) |
| G9229 | Chlamydia, gonorrhea, and syphilis not screened, due to documented reason (patient refusal is the only allowed exclusion) |
| G9230 | Chlamydia, gonorrhea, and syphilis not screened, reason not given |
| G9231 | Documentation of end stage renal disease (esrd), dialysis, renal transplant or pregnancy |
| G9232 | Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition for specified patient reason |
| G9233 | All quality actions for the applicable measures in the total knee replacement measures group have been performed for this patient |
| G9234 | I intend to report the total knee replacement measures group |
| G9235 | All quality actions for the applicable measures in the general surgery measures group have been performed for this patient |
| G9236 | All quality actions for the applicable measures in the optimizing patient exposure to ionizing radiation measures group have been performed for this patient |
| G9237 | I intend to report the general surgery measures group |
| G9238 | I intend to report the optimizing patient exposure to ionizing radiation measures group |
| G9239 | Documentation of reasons for patient initiaiting maintenance hemodialysis with a catheter as the mode of vascular access (eg, patient has a maturing avf/avg, time-limited trial of hemodialysis, patients undergoing palliative dialysis, other medical reasons, patient declined avf/avg, other patient reasons, patient followed by reporting nephrologist for fewer than 90 days, other system reasons) |
| G9240 | Patient whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiated |
| G9241 | Patient whose mode of vascular access is not a catheter at the time maintenance hemodialysis is initiated |
| G9242 | Documentation of viral load equal to or greater than 200 copies/ml |
| G9243 | Documentation of viral load less than 200 copies/ml |
| G9244 | Antiretroviral thereapy not prescribed |
| G9245 | Antiretroviral therapy prescribed |
| G9246 | Patient did not have at least one medical visit in each 6 month period of the 24 month measurement period, with a minimum of 60 days between medical visits |
| G9247 | Patient had at least one medical visit in each 6 month period of the 24 month measurement period, with a minimum of 60 days between medical visits |
| G9248 | Patient did not have a medical visit in the last 6 months |
| G9249 | Patient had a medical visit in the last 6 months |
| G9250 | Documentation of patient pain brought to a comfortable level within 48 hours from initial assessment |
| G9251 | Documentation of patient with pain not brought to a comfortable level within 48 hours from initial assessment |
| G9252 | Adenoma(s) or other neoplasm detected during screening colonoscopy |
| G9253 | Adenoma(s) or other neoplasm not detected during screening colonoscopy |
| G9254 | Documentation of patient discharged to home later than post-operative day 2 following cas |
| G9255 | Documentation of patient discharged to home no later than post operative day 2 following cas |
| G9256 | Documentation of patient death following cas |
| G9257 | Documentation of patient stroke following cas |
| G9258 | Documentation of patient stroke following cea |
| G9259 | Documentation of patient survival and absence of stroke following cas |
| G9260 | Documentation of patient death following cea |
| G9261 | Documentation of patient survival and absence of stroke following cea |
| G9262 | Documentation of patient death in the hospital following endovascular aaa repair |
| G9263 | Documentation of patient survival in the hospital following endovascular aaa repair |
| G9264 | Documentation of patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter for documented reasons (eg, patient is undergoing palliative dialysis with a catheter, patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant, other medical reasons, patient declined avf/avg, other patient reasons) |
| G9265 | Patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter as the mode of vascular access |
| G9266 | Patient receiving maintenance hemodialysis for greater than or equal to 90 days without a catheter as the mode of vascular access |
| G9267 | Documentation of patient with one or more complications or mortality within 30 days |
| G9268 | Documentation of patient with one or more complications within 90 days |
| G9269 | Documentation of patient without one or more complications and without mortality within 30 days |
| G9270 | Documentation of patient without one or more complications within 90 days |
| G9271 | Ldl value < 100 |
| G9272 | Ldl value >= 100 |
| G9273 | Blood pressure has a systolic value of < 140 and a diastolic value of < 90 |
| G9274 | Blood pressure has a systolic value of =140 and a diastolic value of = 90 or systolic value < 140 and diastolic value = 90 or systolic value = 140 and diastolic value < 90 |
| G9275 | Documentation that patient is a current non-tobacco user |
| G9276 | Documentation that patient is a current tobacco user |
| G9277 | Documentation that the patient is on daily aspirin or has documentation of a valid contraindication to aspirin automatic contraindications include anti-coagulant use, allergy, and history of gastrointestinal bleed; additionally, any reason documented by the physician as a reason for not taking daily aspirin is acceptable (examples include non-steroidal anti-inflammatory agents, risk for drug interaction, or uncontrolled hypertension defined as > 180 systolic or > 110 diastolic) |
| G9278 | Documentation that the patient is not on daily aspirin regimen |
| G9279 | Pneumococcal screening performed and documentation of vaccination received prior to discharge |
| G9280 | Pneumococcal vaccination not administered prior to discharge, reason not specified |
| G9281 | Screening performed and documentation that vaccination not indicated/patient refusal |
| G9282 | Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., biopsy taken for other purposes in a patient with a history of non-small cell lung cancer or other documented medical reasons) |
| G9283 | Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation |
| G9284 | Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation |
| G9285 | Specimen site other than anatomic location of lung or is not classified as non small cell lung cancer |
| G9286 | Documentation of antibiotic regimen prescribed within 7 days of diagnosis or within 10 days after onset of symptoms |
| G9287 | No antibiotic regimen prescribed within 7 days of diagnosis or within 10 days after onset of symptoms |
| G9288 | Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., a solitary fibrous tumor in a person with a history of non-small cell carcinoma or other documented medical reasons ) |
| G9289 | Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation |
| G9290 | Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation |
| G9291 | Specimen site other than anatomic location of lung, is not classified as non small cell lung cancer or classified as nsclc-nos |
| G9292 | Documentation of medical reason(s) for not reporting pt category and a statement on thickness and ulceration and for pt1, mitotic rate (e.g., negative skin biopsies in a patient with a history of melanoma or other documented medical reasons) |
| G9293 | Pathology report does not include the pt category and a statement on thickness and ulceration and for pt1, mitotic rate |
| G9294 | Pathology report includes the pt category and a statement on thickness and ulceration and for pt1, mitotic rate |
| G9295 | Specimen site other than anatomic cutaneous location |
| G9296 | Patients with documented shared decision-making including discussion of conservative (non-surgical) therapy prior to the procedure |
| G9297 | Shared decision-making including discussion of conservative (non-surgical) therapy prior to the procedure not documented, reason not given |
| G9298 | Patients who are evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure including history of dvt, pe, mi, arrhythmia and stroke |
| G9299 | Patients who are not evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure including history of dvt, pe, mi, arrhythmia and stroke, reason not given |
| G9300 | Documentation of medical reason(s) for not completely infusing the prophylactic antibiotic prior to the inflation of the proximal tourniquet (e.g., a tourniquet was not used) |
| G9301 | Patients who had the prophylactic antibiotic completely infused prior to the inflation of the proximal tourniquet |
| G9302 | Prophylactic antibiotic not completely infused prior to the inflation of the proximal tourniquet, reason not given |
| G9303 | Operative report does not identify the prosthetic implant specifications including the prosthetic implant manufacturer, the brand name of the prosthetic implant and the size of the prosthetic implant, reason not given |
| G9304 | Operative report identifies the prosthetic implant specifications including the prosthetic implant manufacturer, the brand name of the prosthetic implant and the size of the prosthetic implant |
| G9305 | Intervention for presence of leak of endoluminal contents through an anastomosis not required |
| G9306 | Intervention for presence of leak of endoluminal contents through an anastomosis required |
| G9307 | No return to the operating room for a surgical procedure, for any reason, within 30 days of the principal operative procedure |
| G9308 | Unplanned return to the operating room for a surgical procedure, for any reason, within 30 days of the principal operative procedure |
| G9309 | No unplanned hospital readmission within 30 days of principal procedure |
| G9310 | Unplanned hospital readmission within 30 days of principal procedure |
| G9311 | No surgical site infection |
| G9312 | Surgical site infection |
| G9313 | Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis for documented reason (eg, cystic fibrosis, immotile cilia disorders, ciliary dyskinesia, immune deficiency, prior history of sinus surgery within the past 12 months, and anatomic abnormalities, such as deviated nasal septum, resistant organisms, allergy to medication, recurrent sinusitis, chronic sinusitis, or other reasons) |
| G9314 | Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis, reason not given |
| G9315 | Documentation amoxicillin, with or without clavulanate, prescribed as a first line antibiotic at the time of diagnosis |
| G9316 | Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family |
| G9317 | Documentation of patient-specific risk assessment with a risk calculator based on multi-institutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family not completed |
| G9318 | Imaging study named according to standardized nomenclature |
| G9319 | Imaging study not named according to standardized nomenclature, reason not given |
| G9320 | Documentation of medical reason(s) for not naming ct studies according to a standardized nomenclature provided (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery) |
| G9321 | Count of previous ct (any type of ct) and cardiac nuclear medicine (myocardial perfusion) studies documented in the 12-month period prior to the current study |
| G9322 | Count of previous ct and cardiac nuclear medicine (myocardial perfusion) studies not documented in the 12-month period prior to the current study, reason not given |
| G9323 | Documentation of medical reason(s) for not counting previous ct and cardiac nuclear medicine (myocardial perfusion) studies (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery) |
| G9324 | All necessary data elements not included, reason not given |
| G9325 | Ct studies not reported to a radiation dose index registry due to medical reasons (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery) |
| G9326 | Ct studies performed not reported to a radiation dose index registry, reason not given |
| G9327 | Ct studies performed reported to a radiation dose index registry with all necessary data elements |
| G9328 | Dicom format image data availability not documented in final report due to medical reasons (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery) |
| G9329 | Dicom format image data available to non-affiliated external entities on a secure, media free, reciprocally searchable basis with patient authorization for at least a 12-month period after the study not documented in final report, reason not given |
| G9340 | Final report documented that dicom format image data available to non-affiliated external entities on a secure, media free, reciprocally searchable basis with patient authorization for at least a 12-month period after the study |
| G9341 | Search conducted for prior patient ct imaging studies completed at non-affiliated external entities within the past 12-months and are available through a secure, authorized, media-free, shared archive prior to an imaging study being performed |
| G9342 | Search conducted for prior patient imaging studies completed at non-affiliated external entities within the past 12-months and are available through a secure, authorized, media-free, shared archive prior to an imaging study being performed not completed, reason not given |
| G9343 | Search for prior patient completed dicom format images not completed due to medical reasons (eg, ct studies performed for radiation treatment planning or image-guided radiation treatment delivery) |
| G9344 | Search for prior patient completed dicom format images not completed due to system reasons (ie, facility does not have archival abilities through a shared archival system) |
| G9345 | Follow-up recommendations according to recommended guidelines for incidentally detected pulmonary nodules (eg, follow-up ct imaging studies needed or that no follow-up is needed) based at a minimum on nodule size and patient risk factors documented |
| G9346 | Follow-up recommendations according to recommended guidelines for incidentally detected pulmonary nodules not documented due to medical reasons (eg, patients with known malignant disease, patients with unexplained fever, ct studied performed for radiation treatment planning or image-guided radiation treatment delivery) |
| G9347 | Follow-up recommendations according to recommended guidelines for incidentally detected pulmonary nodules not documented, reason not given |
| G9348 | Ct scan of the paranasal sinuses ordered at the time of diagnosis for documented reasons (eg, persons with sinusitis symptoms lasting at least 7 to 10 days, antibiotic resistance, immunocompromised, recurrent sinusitis, acute frontal sinusitis, acute sphenoid sinusitis, periorbital cellulitis, or other medical) |
| G9349 | Documentation of a ct scan of the paranasal sinuses ordered at the time of diagnosis or received within 28 days after date of diagnosis |
| G9350 | Ct scan of the paranasal sinuses not ordered at the time of diagnosis or received within 28 days after date of diagnosis |
| G9351 | More than one ct scan of the paranasal sinuses ordered or received within 90 days after diagnosis |
| G9352 | More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis, reason not given |
| G9353 | More than one ct scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis for documented reasons (eg, patients with complications, second ct obtained prior to surgery, other medical reasons) |
| G9354 | More than one ct scan of the paranasal sinuses not ordered within 90 days after the date of diagnosis |
| G9355 | Elective delivery or early induction not performed |
| G9356 | Elective delivery or early induction performed |
| G9357 | Post-partum screenings, evaluations and education performed |
| G9358 | Post-partum screenings, evaluations and education not performed |
| G9359 | Documentation of negative or managed positive tb screen with further evidence that tb is not active |
| G9360 | No documentation of negative or managed positive tb screen |
| J0401 | Injection, aripiprazole, extended release, 1 mg |
| J0717 | Injection, certolizumab pegol, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) |
| J1442 | Injection, filgrastim (g-csf), 1 microgram |
| J1446 | Injection, tbo-filgrastim, 5 micrograms |
| J1556 | Injection, immune globulin (bivigam), 500 mg |
| J1602 | Injection, golimumab, 1 mg, for intravenous use |
| J3060 | Injection, taliglucerace alfa, 10 units |
| J3489 | Injection, zoledronic acid, 1 mg |
| J7301 | Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg |
| J9047 | Injection, carfilzomib, 1 mg |
| J9262 | Injection, omacetaxine mepesuccinate, 0.01 mg |
| J9306 | Injection, pertuzumab, 1 mg |
| J9354 | Injection, ado-trastuzumab emtansine, 1 mg |
| J9371 | Injection, vincristine sulfate liposome, 1 mg |
| J9400 | Injection, ziv-aflibercept, 1 mg |
| L8679 | Implantable neurostimulator, pulse generator, any type |
| Q0507 | Miscellaneous supply or accessory for use with an external ventricular assist device |
| Q0508 | Miscellaneous supply or accessory for use with an implanted ventricular assist device |
| Q0509 | Miscellaneous supply or accessory for use with any implanted ventricular assist device for which payment was not made under medicare part a |
| Q2028 | Injection, sculptra, 0.5 mg |
| Q2050 | Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10mg |
| Q2052 | Services, supplies and accessories used in the home under the medicare intravenous immune globulin (ivig) demonstration |
| Q3027 | Injection, interferon beta-1a, 1 mcg for intramuscular use |
| Q3028 | Injection, interferon beta-1a, 1 mcg for subcutaneous use |
| Q4137 | Amnioexcel or biodexcel, per square centimeter |
| Q4138 | Biodfence dryflex, per square centimeter |
| Q4139 | Amniomatrix or biodmatrix, injectable, 1 cc |
| Q4140 | Biodfence, per square centimeter |
| Q4141 | Alloskin ac, per square centimeter |
| Q4142 | Xcm biologic tissue matrix, per square centimeter |
| Q4143 | Repriza, per square centimeter |
| Q4145 | Epifix, injectable, 1 mg |
| Q4146 | Tensix, per square centimeter |
| Q4147 | Architect extracellular matrix, per square centimeter |
| Q4148 | Neox 1k, per square centimeter |
| Q4149 | Excellagen, 0.1 cc |
| S9960 | Ambulance service, conventional air services, nonemergency transport, one way (fixed wing) |
| S9961 | Ambulance service, conventional air service, nonemergency transport, one way (rotary wing) |
| T4544 | Adult sized disposable incontinence product, protective underwear/pull-on, above extra large, each |
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