Readers Write: What Physicians Need to Know About Getting Paid for CPT 99490

What Physicians Need to Know About Getting Paid for CPT 99490
By Nat Findlay

Right now it seems like Medicare’s Chronic Care Management Program is the best kept secret in healthcare. After all, receiving money for a service that physicians traditionally perform for free appears to be a win/win for all involved.

However, there are certain provisions you should be aware of to make sure you are paid fully and on time for chronic care management (CCM), with minimal difficulties. To help you navigate this sometimes complicated process, here are five things you should know about getting paid for CPT 99490.

1) Money is already being made. The CMS has established a baseline payment rate of $42.60 for CCM that can be billed up to once per month per qualified patient. Physicians are already taking advantage, and so can you. Multiply that above figure by the number of your patients with chronic conditions, and it’s apparent why recent estimates indicate that a typical practice could see up to $77,000 in increased annual revenue by participating.

2) Certain codes cannot overlap. One tricky aspect of CCM is that 99490 cannot be billed in the same service period alongside other codes that are sometimes used for elderly patients or end-of-life care. This includes CPT 99495–99496 (transitional care management), HCPCS codes G0181/G0182 (home health care supervision/hospice care supervision), or CPT codes 90951–90970 (certain End-Stage Renal Disease services). Awareness of these restrictions at your practice will help you avoid unpleasant billing errors and devise better care plans.

3) You must prove compliance. Since the end goal of CCM is improving care, a major goal of the program is to ensure that providers are designing better patient-centered care plans and accurately capturing the patient’s health over an extended period of time. As such, making sure that this information is accurately captured in a certified EHR is of the utmost importance; without it, you cannot be paid on time or prove value. This worksheet explains what is needed to make sure you’re not stepping outside any of the CMS guidelines.

4) There may be a co-pay. To enroll a patient in a CCM program, he or she may need to agree to a monthly co-pay of $8. About 90 percent of patients will pay nothing out of pocket, but some 10 percent of beneficiaries who rely solely on the Medicare program for healthcare coverage will be liable for that small co-pay for each virtual visit. Convincing patients to sign up for CCM might be not be the most fun job you’ll have, but carefully explaining that they will never have to wait for a medication to be refilled, or someone to fix their wheelchair — and that the service is available on a 24×7 basis — is mighty compelling.

5) Both physicians and non-physician practitioners may bill the code, but only once per month. One of the more appealing parts of participating in CCM is that it does not require the PCP to complete the patient call, as various licensed providers may do so, including physician assistants, advanced practice registered nurses, clinical nurse specialists, and certified medical assistants. However, only one practitioner may be paid for the CCM service for a given calendar month; dedicating multiple personnel towards the program might improve patient outcomes, but it won’t get you paid any extra.

(Bonus) Check out this CMS tool. If you’re still feeling unsure, this Physician Fee Schedule Search Tool from CMS should helpful relieve your anxieties. It allows you to search by location, facility price, and other variables to see how much you’ll be getting paid for attesting to 99490.

Nat Findlay is CEO of Hello Health in New York City.

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Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 10/20/15

Top News

Teladoc conducts its 1 millionth visit, making it the first telemedicine vendor to reach that particular milestone. The 13 year-old company also touts other milestones, including being the first and so far only telemedicine company to be certified by the National Committee for Quality Assurance for its physician credentialing process. The news comes just a few weeks after news broke that Highmark will not renew its contract with the company for fully insured members, causing Teladoc shares to take a sizeable tumble. Experts haven’t yet weighed in on whether or not the company will realize its hoped-for Q3 revenue of between $19 million and $19.5 million – a nudge up from Q2’s $18.2 million.

Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Announcements and Implementations

San Jose, CA-based Bizmatics retools customer support for its Prognocis EHR via adoption of a cloud-based phone system from 8×8.

MedSafe launches an ICD-10 education and compliance program for physician practices.

Less than a week ahead of the Genomics pre-conference scheduled at its annual conference, WEDI creates a Genomic Data Exchange Workgroup to develop a plan for incorporating genomic data into the healthcare system. AMA Personalized Medicine Program Director Katherine Taber, Aetna Vice President of Consumer Clinical Strategy Adam Scott, and Intermountain Healthcare Clinical Genetics Institute Senior IT Strategist Grant Wood will lead the new group.

Mental health startup Lantern adds stress to its line of Web-based cognitive behavioral therapy programs. The new stress track includes podcasts, exercises, interactive techniques, and secure messaging with a health coach.

San Francisco-based startup Amino launches a platform to connect consumers to physicians with experience in treating certain conditions. The tool, which also lets consumers filter physicians based on location and accepted insurance plans, is based on the claims data of 188 million patients that the company has been gathering since 2013. Co-founder and CEO David Vivero, who spent a year as an executive at Zillow, penned a personal post explaining why his healthcare experiences prompted him to truly put “consumer” into the “consumerization of healthcare.”

Acquisitions, Funding, Business, and Stock

Venture capital company ISelect invites over 200 physicians to Evidence-Based Innovation 1.0, a November 3rd event in St. Louis that aims to connect MDs with local healthcare startups. “St. Louis’ innovative early-stage healthcare companies need doctors as customers,” explains ISelect CEO Carter Williams. “We’re bringing the doctors and the early-stage companies together. Sort of an obvious thing, but it’s never been done before.”

People

Jodi Daniel (ONC) joins Crowell & Moring as a partner in its Health Care Group.

Kyle Duke (TennCare) joins PatientFocus as EVP of operations.

Research and Innovation

Rock Health publishes findings from its first survey on consumer adoption of digital health technologies, finding that less than 20 percent of the general public engages with any digital health tools beyond online searches for medical conditions and online doctor review sites. HIStalk Connect’s Lt. Dan digs into the details here.

A KLAS interoperability brief puts Athenahealth ahead of Epic and Cerner in the category of “Easiest to Connect To,” citing high marks from Athena customers relating to integrating outside patient data into their workflows, and the hassle-free experiences non-customers have reported in interfacing with the company’s technology.

Government and Politics

American College of Cardiology members converge in Washington, DC as part of the organization’s yearly legislative conference. Talking points include EHR usability and the promotion of transparency in EHR vendor contracts by making gag clauses illegal.

Other

Medscape takes a look at the worst healthcare predictions over the last 20 years, showing special love to EHRs: “Policy-makers, including but not limited to President Obama, predicted that we could use the savings from digitizing medical records to pay for extending insurance coverage. It’s the worst prediction because what resulted — the current-day EHR — is an unmitigated disaster. EHRs not only remove the humanity from the patient/doctor interaction, they distract caregivers from what is most important. Distraction … is our number-one patient safety issue. EHRs make it worse.”

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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News 10/19/15

Top News

Athenahealth launches Let Doctors Be Doctors, a website and hashtag that physicians can use to complain about their EHRs. It’s a fairly brilliant marketing move, given that the company’s product development team will benefit from the feedback. Plus, ZDoggMD seems to be a campaign spokesperson, ratcheting up the cool factor considerably.

Webinars

None in the next few days. Contact Lorre for webinar services. Past webinars are on our HIStalk webinars YouTube channel.

Acquisitions, Funding, Business, and Stock

Executives attending the KLAS Keystone Summit in Utah agree to objective interoperability metrics and ongoing reporting, though no details are released as to what the measures are; how they were agreed upon; and how executives from Epic, Cerner, Greenway Health, Athenahealth, and EClinicalWorks, among seven other vendors, will go about reporting them. KLAS naturally plans to serve as the organization that will assist the vendors in creating a plan to launch and monitor the collaboration. Though the announcement is vague, I would be interested to learn what a dozen leading EHR vendors, particularly Epic, agree upon, and how ambulatory might figure into the equation.

Relay Health announces the successful processing of $25 billion in ICD-codes stemming from 13 million claims made using the company’s RCM technologies.

Announcements and Implementations

Talksoft offers a mobile survey tool to benchmark patient experience and practice performance.

EClinicalWorks launches 10e, a cloud services platform incorporating EHR functionality with population health and patient engagement tools

X-Ray Associates of New Mexico, the state’s largest outpatient provider of medical imaging services, selects the RIS V7.6 software suite from MedInformatix.

Reliance Medical Group (NJ) implements MD Revolution’s RevUp for CCM solution, offering its 40 physicians clinical decision support, enhanced patient engagement services, and care-plan access in between patient visits.

Government and Politics

The American Osteopathic Association makes clear its disappointment with the Meaningful Use program, stressing that additional though unspecified changes are needed beyond those announced with much fanfare last week. “When only 10 percent of providers are in compliance, it’s clear that a substantial overhaul is needed in order for EHRs to achieve their stated purpose,” says John Becher, DO, president of the American Osteopathic Association. “At this juncture, the meaningful use program as it stands is not strengthening the critical physician-patient relationship that osteopathic physicians hold sacred, which is exactly the opposite of the law’s intent.”

Healthcare.gov bashing ramps up, with the New York Times pointing out that the federal health insurance exchange’s “window shopping” feature is behind schedule due to unanticipated bugs and a lack of payer-submitted data. Due to the delay, users shopping for policies ahead of open enrollment are not able to view health plan benefits, prices, and details. HHS now plans to launch the new search tool closer to November 1.

ONC’s Office of Standards and Technology Director, Steven Posnack, lays out how the agency plans to move forward with implementing the final rule’s regulatory requirements, including certification companion guides and draft test procedures for each EHR certification criterion. NIST will also make available “alpha” versions of 2015 Edition testing tools for early feedback and pilot testing.

Telemedicine

An Accenture report suggests that utilization of virtual tools in the areas of self-care, patient management, and annual visits could potentially save PCPs $10 billion annually. The report makes an interesting comparison to the amount of time PCPs could save if certain tools are used in certain care settings: For example, using virtual solutions in diabetes care could free up 11 percent of the PCP workforce, which the company equates to $2 billion in savings each year.

The American Academy of Sleep Medicine publishes a 12-page position paper with recommendations of technical specifications and best practices for specialists to consider when incorporating sleep telemedicine into their practice. Though comprehensive, the AASM makes sure to point out that specialists should be prepared to adjust their practices based on the anticipated rapid expansion of telemedicine technologies. The academy anticipates that potential areas of expansion will include high-risk population management, wearable device technology, bundled payment schemes, integrative care models of delivery, wellness programs, and home health.

Other

Researchers in London determine that physically fit office workers won’t benefit from working at a standing desk as opposed to a seated one, no doubt leaving millions of standing desk owners wondering about their return policies. The researchers found that “extended butt parking” didn’t result in a higher risk of premature death for employees already active, proving that a gym membership is far more valuable to your health than the latest ErgoDepot desk.

Sponsor Updates

• PerfectServe will exhibit at the Western Section AUA Annual Meeting October 25-29 in Indian Wells, CA.

Blog Posts

• Top 10 Hospitals Where Patients Prosper (Billian’s HealthData)
• RTLS – The ‘Chocolate’ that Energizes Your EMR (Versus)

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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Readers Write: What Med Students Really Think About Healthcare IT

What Med Students Really Think About Healthcare IT
By Kenneth Iwuji, RN

Results from the annual Future Physicians of America Survey are in, presenting me with a well-timed opportunity to weigh in on some of the survey’s most interesting findings. This year, 1,026 respondents (75 percent of whom were third and fourth-year medical students) shared their opinions on medical training, preparation for practice, state of patient care, interoperability and how they plan to use digital medicine. Here is my take on what I consider to be the most interesting highlights:

Timely access to patient records needs improvement. Almost all students believe that easily sharing patient records among care teams is critical to improving patient care, yet 44 percent are concerned about the ability to do so within a hospital or practice; 73 percent worry about the ability to share patient information across unaffiliated practices. Other findings show that 96 percent believe improving the ability of EHR systems to access patient data from other systems is important to providing better patient care.

This point especially resonated with me. I’ve been a registered nurse for seven years and still practice while in medical school. I’ve worked for various health systems that use numerous vendors and it’s always been nearly impossible to synchronize patient information; the systems can’t talk to each other. In order to gain critical information about my patients, I still find myself making telephone calls and faxing request for release of medical records, which just doesn’t cut it in emergency situations. It also leads to a lot of waste in the system — we have no choice but to repeat tests and procedures because we cannot gain access to the results when needed. It baffles me that these systems can’t find a way to sync up — every other electronic device in our lives does.

Students are lukewarm on telemedicine, preferring face-to-face visits. When it comes to leveraging digital tools to enhance delivery of care, 41 percent of students turn to a medical app first for clinical answers while only 29 percent would seek advice from a peer first. Almost all would encourage patients to use monitoring devices (97 percent) or email them for treatment advice via a patient portal (74 percent). Yet 98 percent of medical students would prefer to see their future patients face-to-face for the initial visit as opposed to virtually. Even for follow-ups, 89 percent of students favor the traditional face-to-face exam. This may strike some folks as strange, given the surge in telemedicine in the past few years. There are benefits to telemedicine, of course, especially when care isn’t readily accessible to patients, but there is no better substitution for face-to-face visits that allow a physician to perform a thorough examination and form a relationship with the patient. Great physicians do not rely only on technology or laboratory tests and procedures to make diagnoses and formulate treatment plans. Coming up with the most accurate diagnosis or even differential diagnosis involves spending time with the patient and obtaining a detailed history; the best way to do that is face-to-face.

Burdensome documentation is overwhelming. (I can personally attest to this.) Seventy-one percent of third- and fourth-year students report they spend more time documenting encounters than seeing the patients themselves; 80 percent expect they will continue to document more than interact with patients when they become physicians. Again, this feels to be a shortcoming of the technology — instead of being able to spend my time taking care of the patient, I have to stay glued to the screen. EHRs should be more user friendly — simple changes could make a big difference. For example, sometimes I find myself double charting the same information in different screens. After I chart information once, it should carry over to the next needed screen.

Finally, dissatisfaction with practice management training continues. For the fifth year in a row, medical students said they have been inadequately prepared to run a successful healthcare practice: Only eight percent feel equipped to manage a practice and only 4 percent to bill and code. I personally am not especially frustrated by this, though it seems some of my peers are. I view school as the place where we learn; we shouldn’t be expected to become experts until we are in practice.

Despite my frustrations with healthcare technology, I still have faith that it will continue to evolve and will eventually work seamlessly for all providers; the barriers just need to be broken down. There is no reason why information shouldn’t flow freely and securely, providing benefits to patients and allowing doctors to do their work.

Kenneth Iwuji, RN is a fourth-year medical student at Texas Tech University Health Sciences Center School of Medicine.

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

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Population Health Management Weekly Wrap Up 10/18/15

IT solutions provider UST Global makes a $5 million stock investment in Sandlot Solutions.

Apollo Medical Holdings completes a $10 million investment from physician-led managed services organization Network Medical Management, which is slated to soon nominate a representative to Apollo’s BoD.

Verisk Analytics is rumored to have retained Morgan Stanley to sell its Verisk Health business in what should be a billion-dollar deal.

Geisinger Health System (PA) makes Cerner’s HealtheIntent population health management platform a vital component of its Unified Data Architecture platform after a successful proof-of-concept project in which Geisinger used the tool to aggregate clinical and financial data from its Epic EHR and insurance company. The two organizations, along with XG Health Solutions, are also working to develop SMART on FHIR applications to manage specific patient populations and improve outcomes.

Seattle Children’s Hospital signs a three-year contract with Wellcentive to implement its population health management and value-based care solutions. The hospital will use the tools within its Seattle Children’s Care Network and Pediatric Partners in Care program.

EClinicalWorks launches 10e, a cloud services platform incorporating EHR functionality with population health and patient engagement tools. The new product also integrates telehealth visits, as well as wearables data.

Dātu Health enters into an accelerator-style partnership with St. Joseph Health that will see the company move it development operations from Boulder, CO to Orange County, CA to more easily collaborate on developing its Digital Encounter and Persuasion Engine technologies with healthcare companies within SJH’s investment portfolio. SJH announced a $10 million investment into the St. Louis-based startup earlier this month.

Sponsor Updates

• Intelligent Medical Objects will exhibit at the EClinicalWorks 2015 National Conference October 16-19 in Nashville.
• Leidos Health will exhibit at the Georgia HIMSS annual conference and tradeshow October 23 in Atlanta.

Blog Posts

• Epic MyChart patient engagement strategies: Buy-in, special challenges and Meaningful Use (Nordic)

Contacts

Jennifer,  Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan

More news: HIStalk, HIStalk Connect.

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