Enos Medical Coding
  • Home
  • Chart Audits
  • Consulting
  • About Us
  • Contact Us

Medicare Telehealth Extension: Crucial Lifeline or Short-Sighted Stopgap?

12/24/2024

0 Comments

 
In a recent move, Congress has passed the American Relief Act of 2025, which was signed into law by President Biden on December 21. Included in this legislation is a three-month extension of Medicare telehealth flexibilities, providing a crucial lifeline to patients and providers alike. However, this extension raises questions about the future of telehealth services and the broader implications for healthcare.
The Details of the Extension
The new telehealth provisions extend many of the flexibilities introduced during the COVID-19 pandemic through March 31, 2025. Key aspects include:
  • Originating Site Flexibility: Patients can continue to receive telehealth services from their homes.
  • Geographic Restrictions Waived: There are no limitations based on patient location.
  • Audio-Only Communication: Services can be provided via audio-only communication when necessary.
  • Expanded Provider Types: A wider range of healthcare providers, including physical therapists and speech-language pathologists, can offer telehealth services.
  • Hospice and Hospital Care at Home: Telehealth remains an option for face-to-face encounters required for hospice care recertifications and for acute hospital care at home programs.
Concerns and Criticisms
Despite these positive strides, several flexibilities are set to expire at the end of 2024, including first-dollar coverage of telehealth services under high-deductible health plans (HDHPs) and health savings accounts (HSAs). This expiration will likely increase out-of-pocket costs for patients who have been relying on pre-deductible telehealth coverage.
Critics argue that the short duration of this extension creates ongoing uncertainty for both patients and providers. The American Telemedicine Association called the legislation "far from an ideal outcome." Stakeholders are pushing for a more permanent solution that can provide stability and continued access to telehealth services.
The Path Forward
The American Relief Act of 2025 offers a temporary solution, but the healthcare community is urging Congress to take further action before the March deadline. A more permanent extension of telehealth flexibilities is essential to ensure that patients, especially those in rural or underserved areas, continue to have access to critical healthcare services.
In the words of Kyle Zebley, Senior Vice President of Public Policy at the American Telemedicine Association, "Together, with future actions to come, we are on the brink of achieving landmark victories for patients, the healthcare system, and the future of care delivery."
As we look ahead, it's clear that the conversation around telehealth is far from over. The evolving landscape of healthcare delivery demands proactive measures to secure long-term solutions that benefit all stakeholders.
0 Comments

Key 2025 CPT Updates: What You Need to Know

11/25/2024

0 Comments

 
Picture
As we head into 2025, medical professionals and billing teams need to stay ahead of the game with the latest changes in CPT coding. The American Medical Association (AMA) has announced several significant updates for 2025 that could impact documentation, billing, and reimbursement. Here’s a quick overview of the most noteworthy changes:
1. New and Revised Telehealth CodesTelehealth continues to evolve as a mainstay of healthcare delivery, and 2025 brings expansions to the CPT code set for virtual care. Look for new codes designed to better capture remote patient monitoring and virtual evaluations for chronic conditions. These changes reflect ongoing efforts to make telehealth services more accessible and adequately reimbursed.
2. Evaluation and Management (E/M) AdjustmentsE/M coding sees further refinement, particularly in hospital-based and prolonged services. The revisions aim to simplify coding decisions and align with the principles introduced in the 2021 overhaul. Prolonged service codes will also include clearer guidance on time thresholds and documentation requirements.
3. Expanded Procedure Codes for Advanced TechnologyEmerging technologies like artificial intelligence (AI) in diagnostics and minimally invasive surgical techniques are seeing new procedure codes. These additions pave the way for innovation while providing clear reimbursement pathways for cutting-edge treatments.
4. Behavioral Health and Social Determinants of Health (SDoH)Recognizing the growing importance of mental health and social factors in care, 2025 includes new codes for comprehensive behavioral health evaluations and SDoH screenings. These updates support a holistic approach to patient care and incentivize providers to address these critical areas.
5. Clarifications and DeletionsSeveral underutilized or redundant codes are being deleted, with clarifications added to others for improved consistency. Be sure to review these updates to avoid denials or miscoding.
Key Takeaways for Billing Compliance ProfessionalsWith these changes, providers and billing teams must prioritize education and update their systems accordingly. Start by:
  • Training staff on the new and revised codes.
  • Reviewing documentation requirements to ensure compliance.
  • Updating billing software and templates to reflect the changes.
Stay tuned for more detailed breakdowns of specific updates and how they might affect your specialty. As always, compliance remains key to ensuring smooth operations and optimal reimbursement.

Schedule an educational webinar for your billing and/or clinical staff as part of your compliance program!

0 Comments

Boost Your Practice Revenue: The Power of Billing Audits and Training

9/6/2023

0 Comments

 
Picture
Imagine your practice as a thriving garden. Just like a garden needs proper care, attention, and nourishment to flourish, your practice's revenue also requires careful cultivation. Let's delve into how billing audits and training can be the essential tools to help your garden of revenue bloom:

Uncovering Hidden Revenue Streams:
Think of your revenue as fertile soil with untapped potential. Billing audits are like a gardener's meticulous inspection of the soil, looking for hidden treasures. They unearth errors, missed opportunities, and discrepancies in your billing and coding processes. With each audit, you uncover new revenue streams that have been there all along, waiting to be harvested.

Maximizing Reimbursements:
Just as a gardener knows how to nurture each plant for optimal growth, your practice needs skilled professionals who understand how to code and document services correctly. Comprehensive training ensures that your team is well-equipped to plant the seeds of accurate billing. When your team knows how to navigate the coding landscape effectively, you can expect better reimbursements for the services you provide.

Reducing Costly Errors:
In the garden of revenue, errors are like invasive weeds. They can choke the life out of your financial landscape. Billing audits help identify and eradicate these errors. Paired with training, they prevent future weeds from taking root. This dual approach reduces costly mistakes and ensures that your revenue garden remains healthy and thriving.

Navigating the Regulatory Maze:
The healthcare industry is like a garden with constantly changing weather patterns. Staying compliant with regulations and guidelines is crucial. Billing audits act as your weather vane, detecting compliance issues before they become storms. With proper training, your team learns to adapt and stay ahead of the regulatory curve, ensuring that your practice is always in alignment with industry standards.


​By embracing the power of billing audits and training, you're not just managing a practice – you're cultivating a flourishing garden of revenue. These tools are your gardening gloves, helping you nurture your financial landscape with care and precision.


0 Comments

Maximizing Revenue and Minimizing Risk: The Benefits of Yearly Medical Billing Audits

6/20/2023

0 Comments

 
In today's complex healthcare landscape, accurate and compliant medical billing practices are paramount. Conducting yearly billing audits is essential for medical groups of all sizes to ensure financial health and reputation.  Here are just a few benefits of regular audits, and how they can save money and provide you with peace of mind: 

  1. Importance of Billing Audits: Accurate billing is critical, as overbilling or under-documenting can result in adverse audit outcomes, financial penalties, and damaged relationships with insurers. Conversely, underbilling means lost revenue for medical groups. Regular billing audits mitigate these risks and ensure accurate reimbursement.
  2. Optimizing Revenue: Comprehensive billing audits go beyond compliance and uncover opportunities for revenue optimization. By analyzing billing reports and reviewing medical records, auditors identify missed reimbursement opportunities, boosting overall revenue and financial stability.
  3. Enhancing Compliance and Training: Yearly billing audits demonstrate a medical group's commitment to compliance with regulations and insurance policies. They reassure physicians that the group prioritizes their financial success. Robust compliance policies, supported by audits, also serve as a mitigating factor in adverse audit situations.
  4. Peace of Mind: Billing uncertainties create anxiety for medical groups. Yearly audits provide peace of mind by thoroughly reviewing financial processes, identifying areas for improvement, and ensuring accurate and compliant practices. Confidence in billing practices leads to a stress-free environment.
  5. Choosing a Trusted Audit Service Provider: Partnering with a reliable audit service provider is crucial. Look for expertise in medical billing audits, compliance regulations, and medical coding. A knowledgeable partner will guide the audit process, provide detailed reports, and offer tailored recommendations for improvement.
In today's complex healthcare landscape, yearly medical billing audits are essential for both small and large medical groups. Audits protect against adverse outcomes, optimize revenue, strengthen compliance efforts, and provide peace of mind. Embrace the proactive approach of billing audits to ensure the financial success of your medical group.

0 Comments

Telehealth Changes After the COVID-19 Public Health Emergency: What You Need to Know

4/6/2023

0 Comments

 
The COVID-19 pandemic has made telehealth more popular and accessible than ever before. But not all telehealth changes that were implemented during the public health emergency (PHE) will last forever. Some will expire when the PHE ends on May 11, 2023, while others will continue until December 31, 2024 or beyond.

Behavioral Health Services
During the PHE, Medicare expanded coverage of behavioral health services via telehealth. For example, Medicare allowed Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to provide behavioral health services via telehealth as distant site providers, waived geographic and location restrictions for originating sites for behavioral health services, and permitted audio-only communication platforms for behavioral health services.
​
Some of these changes are permanent or extended until December 31, 2024. However, some changes will expire when the PHE ends. For example, Medicare will revert to its pre-PHE list of telehealth services, which means that some behavioral health codes that were added during the PHE will no longer be covered by Medicare via telehealth. Also, Medicare will reinstate the requirement for an in-person visit within six months of an initial behavioral health telehealth service, and annually thereafter, with any provider of the same group and specialty.

Place of Service Codes
During the PHE, Medicare instructed providers to use place of service (POS) code 11 (office) for telehealth services provided to patients in their homes or other locations, instead of POS code 02 (telehealth), which would normally apply for telehealth services. This was done to ensure that providers would receive the same payment rate for telehealth services as they would for in-person services.
Medicare also created a new POS code 10 (temporary lodging) for telehealth services provided to patients who are temporarily located outside their home state or county due to a federally declared emergency or public health emergency.
These changes will remain in effect until December 31, 2024. After that date, Medicare will resume using POS code 02 for telehealth services and discontinue using POS code 10.

Audio-Only Services
During the PHE, Medicare allowed certain telehealth services to be delivered using audio-only communication platforms when the patient does not have the ability for audio and video. This was especially helpful for patients who had limited access to technology or internet connectivity.
This allowance will also expire when the PHE ends, except for behavioral health services, which can continue to be delivered using audio-only platforms until December 31, 2024.
Teaching Physician Supervision
During the PHE, Medicare allowed teaching physicians to virtually supervise residents using real-time audiovisual communication when they provide telehealth services to Medicare beneficiaries until the end of the PHE.
This change will also expire when the PHE ends, except for telehealth services provided by residents in rural areas, which can continue to be virtually supervised by teaching physicians after the end of the PHE.

Billing Rules
During the PHE, Medicare allowed nurse practitioners (NPs) and physician assistants (PAs) to provide and bill for telehealth services under the direct supervision of a physician who is virtually present using real-time audiovisual communication until the end of the PHE.
​
This change will also expire when the PHE ends. After May 11, 2023, NPs and PAs will need to bill for telehealth services under their own enrollment or under the general supervision of a physician who is not required to be virtually present.

Conclusion
Telehealth has been a lifeline for many patients and providers during the COVID-19 pandemic. But not all telehealth changes that were implemented during the PHE will last forever. Some will expire when the PHE ends on May 11, 2023, while others will continue until December 31, 2024 or beyond. To stay updated on telehealth policy changes, please visit https://telehealth.hhs.gov/ and https://www.cms.gov/.



0 Comments
<<Previous

    Author

    Mike and Nancy are independent consultants and coding educators.  They are a mother/son team who are active in local and regional professional organizations.

    Archives

    November 2024
    September 2023
    June 2023
    April 2023
    July 2022
    July 2021
    January 2021
    March 2020
    January 2020
    April 2019
    January 2018
    September 2017
    May 2013
    April 2013
    January 2013
    December 2012
    November 2012
    October 2012
    September 2012
    May 2012
    March 2012
    January 2012
    November 2011
    October 2011
    September 2011
    July 2011
    June 2011

    Categories

    All
    Auditing
    Awv
    Certification
    Certified Coding Exam
    Coding
    Coding And Billing
    Coding Certification
    Coding Course
    Coding Education
    Coding Seminars
    Cpc
    Cpc Course
    Cpc Exam
    Cpt
    Health Information Technology
    ICD-10
    ICD-10 Education
    ICD-9
    Implementation
    Medical Billing
    Medical Coding
    Medicare
    Mgma
    Nancy Enos Coding
    News
    Oig
    Preventative
    Primary Care
    Spotlight
    Today.
    Work Plan

    RSS Feed