HIPAA and Protected Health Information – What It Means to You and Your Practice

Kathy McCoy, MBA May 9th, 2012

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While HIPAA changed healthcare in many ways, it’s the Privacy Rule and its regulations regarding Protected Health Information (PHI) that affect so many healthcare occupations today.

You know that in your practice, you require arriving patients to sign in on a removable label sign-in sheet from which the previous names have been removed. You also ask them to sign a release form stating that they’ve read the Notice of Privacy Practices. But do you know why?

Welcome to the world of HIPAA — the Health Insurance Portability and Accountability Act.

The Birth of HIPAA

HIPAA was enacted in August of 1996, and included two parts. Title I protected health insurance coverage for workers and their families when changing or losing their jobs. Title II, also known as the Administrative Simplification (AS) provisions, required the establishment of national standards for electronic health records, a privacy rule for protected health information (PRI), security requirements and more.

The Privacy Rule and PHI

While HIPAA changed healthcare in many ways, it’s the Privacy Rule and its regulations regarding Protected Health Information (PHI) that affect so many healthcare occupations today. PHI is any information held by a covered entity — a medical or insurance office, for example – which concerns health status, provision of health care or payment for healthcare for an individual. There are strict regulations regarding the management of PHI, and by default, PHI is presumed private and the property of the individual. Failing to manage PHI securely can result in investigations, lawsuits and even civil and criminal penalties.

Title II of HIPAA

Under Title II of HIPAA, PHI must be protected. But Title II is not law alone; it also provides standardizations for electronic data interchange (EDI) that enable entities to exchange patient electronic health records (EHR) effectively and securely. These standards are called transaction standards code sets, and they define communications of patient information between doctors, labs, insurance companies and other healthcare entities.

Protections in Medical Billing

Electronic health records are used in both clinical and administrative occupations, such as medical billing. Software used to operate medical billing or EHR systems can utilize a database local to the operation, or it can be web-based and utilize a remote database. Third party, web-based systems with remote databases are considered by many to be safer and more secure. They are safe because patient data is maintained off-site and is not subject to accidents, fires or other threats. Off-site data is backed up regularly and is “mirrored” with database copies maintained on identically configured servers in secondary locations. With web-based medical billing software, patient records cannot be carried away on a laptop or other portable computer, so theft is less of a problem.

For healthcare professionals, it’s essential that HIPAA protections are understood and followed. Today companies that manage patient information operate thorough compliance programs to ensure that their employees have the information they need to protect their patients’ and their companies’ interests. If your company doesn’t have such a plan in place, suggest that they implement one. Consult the links below for more information.

A Few Important Things to Remember:

  • Develop a Policy – Every practice should have a written policy regarding PHI and make it available to the staff.
  • Train Your Staff – Training should occur regularly and include both instruction and testing. This is especially important for employees who have never worked in healthcare or with PHI.
  • Inform Your Patients — All patients must sign HIPAA release forms stating that they understand how their protected health information may be used and the signed forms must be kept on file with the practice.
  • Know What is and What is Not OK — PHI can only be reported to authorities for specific purposes as defined by The US Department of Health and Human Services. These include threats of communicable disease, suspicions of abuse and/or domestic violence, OSHA requirements, reporting disease, injury or significant events (birth/death).
  • Do You Need To Know? — If you don’t need protected health information to do your job, you are not authorized to see it.

Note: Kareo has a number of security features that help make it HIPAA compliant. As a web-based system, Kareo is accessed via logins and passwords, so the information does not reside on your computer. There are automatic log-outs that you can set up if you often need to leave your computer. There are also permission levels that allow you to set up user accounts and limit access as appropriate. You can view Kareo’s HIPAA agreement now.

Resources:

HIPAA Basics and Privacy Rights

Protecting Patients

Steps to Take to Ensure Compliance

HIPAA Enforcement through DHHS

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RVUs: The Key to Improving Your Reimbursement and Profitability

Sara M. Larch, MSHA, FACMPE May 7th, 2012

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RVUs are very helpful in analyzing reimbursement performance.

Medical practices have been using Relative Value Units (RVUs) since they were adopted by Medicare in 1992.  The Resource Based Relative Value System (RBRVS) was created at Harvard University in a national RBRVS study by a multi-disciplinary team of researchers.  In 1988, the results were submitted to the Health Care Financing Administration (today CMS) to be used in the Medicare system as a payment methodology.  The RBRVS system took effect on January 1, 1992.

In the early years, medical practices only utilized RVUs to understand the Medicare fee schedule.  Now the role of RVUs has expanded.  RVUs have become the standard measurement in analysis of reimbursement and payer contracts, physician compensation and productivity, and practice staffing and operating costs.  RVUs are not impacted by how you set your fees, by how much money you have collected or which payor the patient has or where the service was provided. Using RVUs to analyze your practice removes other variables that can make results confusing.

The calculation of RVUs seems complicated but really is just a sum of three measures that are then multiplied by a conversion factor to create a fee schedule (allowable reimbursement).  Total RVUs (TRVU) are calculated for each CPT by adding:

Physician Work RVU (wRVU)

+ Practice Expense RVU (peRVU)

+ Malpractice Expense RVU (mpRVU)

Total RVU (TRVU)

X Conversion Factor (CF)

Fee Schedule (allowable reimbursement)

The Geographic Practice Cost Index (GPCI) is then applied to the allowed reimbursement to adjust for geographic differences in wages, malpractice and practice overhead expenses.  In the chart below, you will see how an established patient visit (99213) will be calculated in New York, Arkansas and Ohio.  Within the chart you see the TRVUs for 99213 (2.11) and then as you move right in the chart, you can see how the GPCI alters the work, practice expense and malpractice expense RVUs for each of the three locations.  These new TRVU calculations are multiplied by the Conversion Factor (CF) resulting in different allowed amounts paid across the United States.

Example:

Within the chart you see the TRVUs for 99213 (2.11) and then as you move right in the chart, you can see how the GPCI alters the work, practice expense and malpractice expense RVUs for each of the three locations.

Now that you are comfortable with how the RVUs are calculated and adjusted, we also need to mention the role of modifiers.  As you know already, the Medicare fee schedule includes information about modifiers that affect payment (for example, assistant surgeon, 26/TC, bilateral, etc.).  These modifiers also impact the RVUs calculated.  Often practices forget to adjust RVUs due to modifiers resulting in overstated RVUs.  For example, if a surgeon is operating as an Assistant Surgeon and you credit that individual with the CPT’s full RVU value without considering the modifier, then you have overstated the RVUs.  Better performing practices analyze RVUs for each CPT code and for each modifier associated with that CPT code, and this does require more work.  To understand this more, go to the CMS web page mentioned at the end of this article, look up a couple CPT codes and see how the modifiers change the value of the RVU.

Reimbursement Analysis

RVUs are very helpful in analyzing reimbursement performance.  You can certainly analyze your Medicare reimbursement using RVUs.  You can also use RVUs to evaluate reimbursement for all of your other payers.  If this is the first time you are using RVUs to analyze reimbursement, I would suggest that you start with a small subset of data – look at RVUs for your top 10 most frequent CPT codes for your top two payers.  Once you are clear on what you want to look at and have become more comfortable with the data, you will be ready to analyze a larger dataset.  Hopefully you already have an RVU report that is set up within your practice management system.

If you are using Kareo, as you build your standard fee schedule, you can load in the RVU for each procedure code as set by Medicare. This includes the three components of RVU (Work, Practice Expense, and Malpractice). Once RVUs are loaded into your standard fee schedule, you can use advanced productivity reporting to compare the relative productivity of providers within your practice in a manner that is independent of the insurance company that was billed.  This report can be customized by service location, by CPT code and can differentiate wRVUs vs. TRVUs.  Additional analysis can be done by downloading data to Excel.

To analyze your reimbursement by payer, you want to divide total collectionsby TRVUs generated for each payer that you are analyzing.  You want to include collections from the payer and from the patient on those payer’s claims.  Your analysis will be improved if you can exclude CPT codes that do not have an RVU assigned.

There are many more examples of ways to utilize RVUs to analyze your reimbursement, evaluate physician productivity and cost of practice per RVU.  To learn more about how to effectively use RVUs to improve your profitability, please join us for the webinar being held later this month, Using RVUs to Improve Your Bottom Line. Register now!

Additional Resources:

Medicare Physician Fee Schedule (MPFS) at http://www.cms.gov/apps/physician-fee-schedule/overview.aspx

The MPFS website provides more than 10,000 physician services, the associated relative value units, a fee schedule status indicator and various payment policy indicators needed for payment adjustment (i.e., payment of assistant at surgery, team surgery, bilateral surgery, etc.).

Note to Kareo users: The Kareo Fee Schedule Import Wizard enables you to easily import a Medicare fee schedule for your specific state/region.

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Immunizations and Administration: Coding and Billing Them Correctly

Betsy Nicoletti, M.S., CPC May 7th, 2012

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Medical practices can be paid for immunizations with a little preventive medicine of their own, insuring correct coding and billing

A journalist called me recently and asked, “Why do you think there is such a high denial rate for Medicare for code 90471, immunization administration?  90471 is an active code in the Medicare Fee Schedule; why should there be so many denials?”

Experienced coders and billers could answer this journalist’s question in a heartbeat: Because Medicare pays for limited immunizations, and they have developed HCPCS codes to use for most of the covered immunizations.  This means practices need to use two sets of vaccine administration codes, and select the correct code based on the patient’s insurance.  Before we answer the question, let’s review immunization billing.

Medical practices use three sets of codes to report immunizations: the vaccines, the administration and Medicare-developed HCPCS codes for administration and some vaccines.

CPT vaccine codes: The first are CPT codes for the vaccines themselves, used if the practice has purchased the vaccines.   These vaccines or toxoids are in the code range of 90476 through 90749.   In addition, at the start of the CPT section on vaccines, the AMA notes that new vaccines are posted on their website twice a year.  Vaccine formulations change so frequently that the AMA does not wait for the publication of a new book.  Medical practices should use these vaccine codes to report the vaccine that is administered, when the vaccine was a cost to the practice.

States provide some vaccines for children, and in that case, report only the administration.  Some medical practices use the CPT vaccine codes with a one-cent charge in order to record in their practice management system what vaccine was administered.  In 2012, there was one new vaccine/toxoid code and two with revised descriptions.  All medical practices should review their charge slips at the start of each year to be sure that the vaccines listed on the slip match exactly the vaccines being administered. The sheer number of vaccines and combinations has increased significantly.

CPT administration codes:  In 2011, CPT changed the definition of vaccine administration codes.  There are two sets of administration codes with different definitions.  The first is 90460 and 90461 for administration to children up to age 18 by any route of administration with counseling by a physician or other qualified health care professional.  90460 is used for the first or only component of each vaccine or toxoid administered, and 90461 is an add-on code used for each additional vaccine or toxoid component.  CPT instructs us to use 90461 for each additional component in a given vaccine.  That means there could be two or three administration codes for a single multi-component vaccine.

The next set of vaccine administration codes are without counseling (9047190474), used for any age group, and do differentiate between method of administration.  90471 and 90472 are used for an intradermal, subcutaneous or IM injections.  90471 is for the initial vaccine, single or combination and 90472 for each additional vaccine.  90473 is immunization administration by intranasal or oral route; 1 vaccine (single or combination vaccine/toxoid.)  90474, and add-on code, is used for each additional vaccine/toxoid.

HCPCS vaccine and administration codes:  As if the CPT codes for administration and vaccines weren’t complicated enough, Medicare developed its own codes for vaccines and their administration.   When Medicare was authorized by Congress in the 1960s, it was for the care of sickness and injury, not for preventive services.  Over the years, Congress has added coverage for some preventive services such as flu vaccines.  In response, CMS developed its own codes for the vaccines it covers, to differentiate the services.  Medicare covers the seasonal flu vaccine, pneumococcal vaccine (or a combination of the two), and the hepatitis B vaccine under Part B Medicare.  Medicare covers herpes zoster vaccine under Part D Medicare—that is, not in a physician office billed to the Part B Contractor.

In order to get the flu, pneumoccal and hep B vaccines paid by Medicare, the medical practice must use HCPCS administration codes. (G0008 for influenza with diagnosis code V04.81; G0009 for pneumoccal with diagnosis code V03.82 and G0010 for hep B, with diagnosis code V05.3).   Use CPT codes for the vaccine/toxoid, except for Afluria, Flulaval, Fluvirin and Fluzone which have HCPCS codes.  These are listed on CMS’ quick reference information for Medicare Immunization Billing.

But, we’ve left our journalist without an answer.  Why might there be so many Medicare denials for 90471, vaccine administration?  Perhaps the group was using 90471 for a flu or pneumoccal vaccine administration, in which case Medicare would deny it.  Medicare requires the HCPCS codes for administration of those two toxoids.  Perhaps Medicare was denying 90471 when used to submit a herpes zoster vaccine.  Since that vaccine is a Part D benefit, both the vaccine and the administration will be denied in the office.  Or perhaps the practice was giving a patient a tetanus shot.  Medicare doesn’t cover a tetanus shot routinely (only after an injury) so the service could have been denied for that reason.

Medical practices can be paid for these services with a little preventive medicine of their own, insuring correct coding and billing:

  • Review the code descriptions for administration;
  • Review and update the vaccine/toxoid codes to reflect the ones currently in use in the practice; and
  • Use HCPCS codes for Medicare patients.

Betsy_Nicoletti_discusses correct billing and coding for immunizationsBetsy Nicoletti, M.S., CPC, is the founder of Codapedia.com, a wiki for physician reimbursement. She is a nationally known speaker and consultant, and can be reached at www.mpconsulting.org.

You can watch an informational video by Betsy Nicoletti on Medical Billing Update: Three Tips to Improve Reimbursements now. She has also written recently on Compare and Contrast: Modifier 33 and Modifier PT and Preventive Services: How Practices Can Benefit from the Mandate

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Hidden Ways Medical Billing Shortcomings Hurt Your Practice

Laurie Morgan May 7th, 2012

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When a practice’s medical billing staff or service fails to accurately claim all the revenue the practice has earned – for example, by under-coding to ‘save time’ or neglecting to use important modifiers – this naturally represents an immediate loss of revenue.  But when the team begins to cut service corners or fall behind in coding knowledge, it also means the door is opened for much bigger problems to impact the practice.

Redoing work means repeat costs.  Consider sloppy claims documentation, which leads to increased denials and associated lost revenue.  Besides the missed revenue, there is an added cost for researching, re-documenting and appealing claims.  That means wasted staff time – and, if physicians have to help out with the documenting, their precious time is wasted, too.  Other tasks will suffer in order to accommodate this extra processing: newer claims submitted a bit later, patient statements somewhat delayed.  And this, in turn, has costs: when claims go out later, the money comes in later – and when patient statements go out later, it can mean they won’t get paid at all.  This, in turn, means higher collection costs over time – another hidden, but significant, cost.

Patient inconveniences are costly.  Incorrect coding also creates multiple layers of problems.  If a claim is denied and never appealed, will your patient automatically be sent a statement for the full amount? How much time will be spent responding to the patient’s inquiries about the unexpected bill?

Like incorrect coding, overly aggressive coding can also cause patients to end up with unexpected balances due.  When incorrect or overly aggressive coding leads to unexpected charges for patients, this almost always creates additional costs.  Besides additional customer service time to help patients understand (or rectify) ‘surprise’ bills, the hassle patients experience tarnishes the practice’s image. A negative experience with a practice’s billing staff or service can make the difference between a patient referring your practice or not.  Even worse, some patients will be motivated to complain about billing problems online – tarnishing your physicians’ reputation.  (A quick scan of negative physician reviews on Yelp.com, for example, will reveal just how closely tied bad billing experiences are to overall views of physicians.)

Inaccurate patient billing wastes time and aggravates patients – and also creates the impression that the practice is disorganized, which in turn rubs off on your physician(s).  If patients become so annoyed they move on to other doctors, that lost revenue must be replaced with a new patient – and, of course, it’s much more expensive to attract and establish a new patient than it would be to retain an existing one.

When patients are inadvertently seen out-of-network – e.g., when a payer directory incorrectly lists your practice as in-network, and no one on staff catches the error before the visit – the ‘surprise’ amount billed can be significant, as can the degree of dissatisfaction!

Under-coding is anything but ‘conservative.’  In an effort to reduce denials and speed payments, some practices have resorted to habitual under-coding – thinking that lower codes will pass through payer systems quickly and require less documentation.  But, even if this works for a while, over time any repetitive short-cut that’s used in lieu of accurate coding can set off alarm bells.  Payers compare practice billing patterns, and any significant, repeated deviation will catch attention – and could lead to an audit.  The disruption and additional workload required by an audit can be very costly to your practice.

Not all payers are created equal.  It’s not uncommon for practices to have the majority of their claims-related problems stemming from a single payer – the old 80/20 rule in action.  But, few practices take steps to compare the “hassle factor” of their contracted payers – or to try to address ongoing problems.  For example, if you’re finding you get little assistance from your contact at a payer, or that it takes forever to receive a call back, you might be able to work with that payer to be assigned a new rep – and help to minimize costly delays and repeat contacts.

The bottom line:  in billing, as in so many aspects of managing a medical practice today, little things make a huge difference over time.  Keeping up with coding changes, being diligent about documentation up front (and urging your physicians to do the same), and insisting on accurate (versus “safe”) coding may not seem like huge steps forward for your practice – but, you’ll avoid problems that can multiply over thousands of annual transactions and create significant costs for your practice.

Laurie Morgan is a management consultant with Capko & Company. She specializes in marketing, management and technology for medical practices and blogs about practice management issues at www.capko.com/blog. Laurie has a BA in Economics from Brown University and an MBA from Stanford. Laurie recently wrote for Getting Paid on Keeping Tabs on Payer Contracts – Good for Your Practice and Your Patients, Too.

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Medical Billing Tip of the Month – May

Kareo May 7th, 2012

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The results are in! Thank you to everyone who voted on our blog and Facebook for the May Medical Billing Tip of the Month. The winner of our Medical Billing Tip of the Month contest this month is…

Making the Best Use of the Hot Keys in Kareo

We all know that when we can speed up our processes, we accomplish more. The results of better productivity mean a healthier medical practice or billing company.

If you take time to learn your Hot Keys in Kareo (Those F keys with numbers), and use them, you can speed up your processes. This is really helpful when you are using the keyboard and want to save time and hand movements by not having to reach for the mouse.

Here is a Hot Key guide for you:

F1 This is the Help Key. This takes you right to the Kareo help guide. Here you can access the knowledge you need for those issues you are struggling with. You do not need to leave what you are doing, as this guide pops up as a small window. Once you have opened the guide, you will need your mouse to access the information and close the window.

These next keys are for all things new:

F2 Entering a new Patient? Use this key first.

F3 Here you can create a new appointment.

F4 Doing Charge Entry? This is your New Encounter screen.

F5 Make a new payment with this key.

F6 Go right to the Scan Document Screen with this hot key.

Our next group of Hot Keys is for existing Information. You will notice they are the next five keys up from the “new” keys:

F7 Find a patient. (See, F2 is five keys up from here.)

F8 Already created your appointment at F3? Now you can use this key to find it.

F9 This is five up from the new encounter screen, now go find an encounter.

F10 Find a payment. You might use this key a lot.

F11 You can find the already scanned documents using this key.

The next Hot Key is special and does not fit the “five keys up” rule.

F12 This is the Find Task key. If you have tasks for certain days and times, this is where you can find them.

Well, we have used up the “F” Hot Keys, so how do we go to the Find Claim Screen? Check this out:

Ctrl+ Shift + C Push all three keys at the same time. You can find the claim you need here.

Now for the Hot Key that streamlines your Kareo processes:

Esc After being in Kareo for a while, you may find yourself with screens that just get in the way. If you are through with a screen, you can simply hit the Esc key and remove the unwanted screen.

Dan Young  
Co-Owner, Vice President/Operations  
Resolutions Billing & Consulting

Fellow Kareo user Brent Adams of Physicians Advantage Services notes that you can alter some of the hot keys by opening the hotkeys.xml file under the Kareo/Client folder in Program Files.

Thank you to all who entered; please be sure to submit your Medical Billing Tip of the Month to Marketing@Kareo.com by Tuesday, May 22, for inclusion in the next round of judging. We’ll post the top three tips on our Facebook page and on the Kareo blog for your vote! You will win a $250 American Express gift card if your tip is chosen. Good luck!

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Let’s Collect Deductibles in 2012: Tips for Improving Self Pay Collections #4

Kathy McCoy, MBA May 3rd, 2012

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Practice management guru and author Sara M. Larch, MSHA, FACMPE quantifying why and how patient self pay collections could make or break your practice in 2012

It’s 2012 – Do you know where your cash flow is coming from? If you haven’t heard by now that high deductible health plans are putting medical practices more at risk than ever before, we have a must-view webinar for you. Called Let’s Collect Deductibles in 2012: Tips for Improving Self Pay Collections, it features noted practice management guru and author Sara M. Larch, MSHA, FACMPE quantifying why and how patient self-pay collections could make or break your practice in 2012. And she offers a comprehensive plan of action to make sure you collect all the monies due you from patients.  Industry experts project that patient self-pay payments will make up 30 percent of a practice’s total annual revenue in 2012. That puts medical practices at risk of losing one third of their cash flow if they don’t start working hard to collect self-pay dollars directly from patients.

You can glean valuable information by checking our prior posts: Part I on the need for improving your self pay collections, Part II on motivating patients to pay at the time of service and Part III on “Best Practices” in self-pay collections. This blog post will underscore the case for avoiding sending accounts to collection agencies and ways to support your staff in improving their payment at the time of service (PATOS) skills.

During the webinar, Sara presented a compelling case for making PATOS collections a priority. According to Sara, co-pays that are uncollected at the time of service spend an average of 16 days in Accounts Receivables. Deductibles take four times longer than co-pays to collect.  For balances due, most practices sent statements at 30, 60 and 90 days. Many send a letter accompanying the statement at 90, 120 and—if goes that long–150 days. The average cost for all this follow-up is $17.68 per account. If the balance is still unpaid, it typically goes to a collection agency at 180 days–at a cost of 25-50% of the recovered amounts. There’s no question that most practices would prefer to avoid the use a collection agency in chasing dollars owed by patients. In addition to creating an unpleasant touchpoint with patients, it’s expensive. Consistent and effective follow-up can be challenging and the older an account gets, the harder it is to collect. But the bottom line is this: on average, 50% of overall patients’ financial responsibility goes uncollected once they leave the office. 

The average cost for all the usual follow-up in self pay collections is $17.80 per account

The statistics above are ones you should share with your office staff when you initiate intensified efforts to collect PATOS. Sara suggests that you ensure they also understand and be able to explain the practice’s patient collection policies, and to identify each patient’s expected co-pay, deductible and/or prior balance. They need to follow the practice’s cash collection policies and ask patients for payment in a firm, tactful manner.

Kareo regularly sponsors videos and webinars featuring leading medical billing experts discussing a variety of practice management issues. You can sign up for our notification list for upcoming informative webinars such as this one. And be sure to check out our webinar archive for other topics that may be of interest to you. 

You can also hear Sara speak in our next webinar, Using RVUs to Improve Your Bottom Line. Register now!

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Optimizing Office Visits for Preventive Services #3: The Annual Wellness Visit

Kathy McCoy, MBA May 2nd, 2012

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Betsy Nicoletti explains key points related to Medicare's Annual Wellness Visit, including who's eligible

The Initial Annual Wellness Visit (code G0438) is available to either those Medicare enrollees who have already had their Welcome to Medicare visit or those who never had that visit and have been enrolled for more than one year. During a recent webinar sponsored by Kareo entitled Optimizing Office Visits for Preventive Services, respected coding guru and author Betsy Nicoletti, M.S., CPC, explained the differences between the timing and staging of the wellness visits that Medicare will fund for its enrollees.

Betsy explained that the Initial Annual Wellness Visit can only be performed once per patient. Those who had their welcome visit become eligible for their Initial Annual Wellness Visit 366 days after that welcome appointment. It is important to note that the patient may be new to the practice or a current patient who has never enjoyed this benefit. What are the components of the Initial Annual Wellness Visit?

  • A Physical Exam, including height, weight, BMI calculation (or waist circumference), BP and “other routine measurements as deemed appropriate”
  • Taking or updating the  individual’s medical and family history
  • Establishing a list of current providers and suppliers of medical care
  • Detection of any cognitive impairment that the individual may have by direct observation, from medical records, patient reports, or concerns raised by family members
  • Review potential for depression based on use of appropriate screening instrument
  • Review of individual’s functional ability and level of safety  based on direct observation, or use of a screening questionnaire
  • Written screening schedule, such as a checklist, for the next 5-10 years
  • A list of risk factors and conditions for which primary, secondary or tertiary interventions are recommended or are underway, including mental health conditions or risk factors or conditions identified through this visit or the IPPE AND
  • A list of treatment options and their associated risks and benefits
  • Furnishing of personalized health advice and referral, as appropriate to health education or preventive counseling programs aimed at reducing identified risk and improving self management including weight loss, smoking cessation, fall prevention and nutrition
  • And, any other element determined as appropriate by the Secretary of Health and Human Services  through the National Coverage Determination process
  • Effective January 1, 2012 a health risk assessment must also be part of the Initial Annual Wellness Visit. Clinicians need to use an evaluation tool designed to provide a systematic approach to obtaining accurate information about the patient’s health status, injury risk, modifiable risk factors and urgent health needs. Guidelines state that it can be completed prior to, or as part of, an annual wellness visit. The information from the HRA is reflected in the personalized prevention plan that is created for the individual.

The Initial Annual Wellness Visit can only be performed once per patient.

Subsequent Annual Wellness Visits (code G0439) can occur annually once the Initial Wellness Visit has taken place. They are updates to the Initial Annual Wellness Visit and include:

  • Update the written screening schedule established at initial visit
  • Update the list of risk factors and conditions for which treatment was recommended
  • Furnish personalized health advice and referral, as appropriate to health education or preventive counseling programs aimed at reducing identified risk and improving self management including weight loss, smoking cessation, fall prevention and nutrition.

Our last blog on this webinar will cover those preventive services for which you can bill Medicare or commercial providers. Bookmark our blog to make it easy to check back on that discussion.  If you would like to explore any other practice management or medical billing topics of interest, feel free to check our webinar archive. You can also join our notification list for upcoming informative webinars such as this one.

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Welcome to Getting Paid, a weblog by Kareo offering ideas, news and opinions about medical billing and practice management with the goal of making medical billing easier and yes, getting you paid. Visit the Product Blog for more information on our products.

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