Nearly 200 years ago, the brilliant French historian Alexis de Tocqueville traveled the fledgling United States and observed that in lieu of hereditary wealth and aristocracy, we were building a society on individualism, market capitalism, and honoring the hard-working common man. However, in his 1835 book, he cautioned that laws could never be a substitute for public morality and that such a society was less endangered by “the great profligacy of a few”, but by the “laxity of morals amongst all.” Those words were prophetic. Individualism and market capitalism have enabled us to create the most technologically advanced healthcare system in the world, but Medicare will be bankrupt in less than 10 years. Although there are a lot of reasons for this dire situation, they include “a laxity of morals amongst all and the great profligacy of a few.” … read more
Proposed Medicare cuts create greater barriers to screening and revascularization services
Few medical procedures are as life-altering as an amputation. But statistics show hundreds of thousands of Americans have their limbs surgically removed each year because they don’t have access to adequate vascular screening and care.
In the rural communities of North Carolina that we serve, the nearest “in-hospital” alternative to our office-based treatment locations is at least 2 to 3 hours away, which can result in delays in care that lead to poor clinical outcomes. The patients we serve are living with vascular diseases such as peripheral artery disease (PAD) and critical limb ischemia (CLI) … read more
Upon performing reviews of colleagues’ documentation practices, one consistent deficiency I find is the documentation that accompanies in-office imaging, namely X-ray and ultrasound studies. Each payer may have their own guidelines, but most follow the guidelines promulgated by Medicare in the Medicare Benefit Policy Manual, Chapter 15, Section 80.
These guidelines include the requirement of a written order in the medical record for the imaging study. This order must include … read more
Information regarding coding, coverage, and payment is provided as a service to our readers. Every effort has been made to ensure accuracy. However, HMP and the author do not represent, guarantee, or warranty that coding, coverage, and payment information is error-free and/or that payment will be received.
To our readers: This article is the beginning of a series of articles on proper documentation practices for wound care. In this series, I will discuss different topics in wound care documentation practices that I have seen in my travels and found to be insufficient in light … read more
The CPT codes 99304–99306 cover initial nursing facility care. Yes, podiatrists can absolutely submit initial nursing facility evaluation and management (E/M) codes for Medicare patients.
Medicare does not recognize consultation codes. When Medicare stopped recognizing consultation codes on January 1, 2010, it then instructed specialists, including podiatrists, to use the initial nursing facility codes when seeing a nursing facility patient for the first time during that patient’s admission. Podiatrists should use initial nursing facility codes if that encounter qualified for what the facility would consider a “consult” and even if the specialist was not the admitting/primary doctor. Since there are now multiple doctors using those initial encounter codes, the admitting/primary doctor must use an “AI” modifier on the initial E/M encounter.
This change did not alter the fact that in order to submit any E/M code, one must meet the thresholds of complexity for that code. Complexity refers to the key elements of E/M coding (history, exam, decision making) in what you performed, what you documented and what was medically necessary … read more
WoundRounds on Demand Webinar
Part B billing for wound care supplies is tricky. The facility’s billing department needs accurate wound documentation plus knowledge of eligible wounds and products. Part B Billing consultant Amanda Smithey presents practical advice and tips to optimize wound care billing.
Includes: Overview of Medicare Guidelines for Reimbursement of Eligible Wounds and Documentation Tips Appropriate Product Selection Based on Medicare Reimbursement Guidelines Evaluating Your Current Part B Reimbursement Program for Wound Care Supplies
The Medicare Administrative Contractor (MAC) for Jurisdiction J (Tennessee, Alabama, and Georgia) is transitioning from Cahaba to Palmetto. The Part A transition went into effect January 26, 2018 and Part A providers should already be submitting claims to Palmetto GBA. Cahaba has discontinued the receipt of Part A redetermination, reopening, and ADR submissions via the InSite Web Portal … read more
In an atmosphere of changing reimbursement, it’s important to understand indications and utilization guidelines for healthcare services. Otherwise, facilities won’t receive appropriate reimbursement for provided services. This article focuses on Medicare reimbursement for hyperbaric oxygen therapy (HBOT).
Indications and documentation requirements
The Centers for Medicare & Medicaid Services (CMS) National Coverage Determination for HBOT lists covered conditions for HBOT, as do the individual Medicare Administrative Contractor’s (MAC) Local Coverage Determination policies and/or articles. (See Conditions for which CMS approves use of HBOT.) Providers should thoroughly review the indications and utilization guidelines to ensure coverage criteria are met for each clinical condition … read more
Did you ever wonder how much it really costs to treat and heal various wounds? Patients, family members, and healthcare team members often complain to me that $5/day for nutrition therapy is “too expensive.” Cost is relative, because according to the first comprehensive study of Medicare spending on wound care, it appears that an investment in medical nutrition therapy is a wise investment indeed.
A new study entitled An Economic Evaluation of the Impact, Cost, and Medicare Policy Implications of Chronic Nonhealing Wounds1, demonstrates the economic impact of chronic nonhealing wounds in the Medicare population and highlights the associated need for quality measures and reimbursement models for wound care within the US Centers for Medicare & Medicaid Services (CMS) payment policies. The study analyzed 2014 Medicare data to determine the cost of chronic wound care for Medicare beneficiaries in aggregate, by wound type, and by care setting …. read more