HCC Blog by Caridad

COVID-19: Correctly Billing Telehealth, Telecommunication and Telephone-only Services During the Emergency This page from Noridian has tips for billing. Topics covered: Telehealth services - POS 11 for office Virtual check-ins - G2010 and G2012, no modifier is needed Telephone-only services -            98966-98968 (Non-face-to-face non-physician telephone services)           99441-99443 (Non-face-to-face physician telephone services)           Bill the appropriate code with the POS where the service would normally take place.           No modifier is required. If these services are submitted with modifier 95, the claim may deny. https://med.noridianmedicare.com/web/jea/article-detail/-/view/10521/covid-19-correctly-billing-telehealth-telecommunication-and-telephone-only-services-during-the-emergency CMS Resources: Medicare Telemedicine Health Care Provid...

This is the detailed information on Risk Adjustment in Medicare Advantage Plans, a 201 page document.  Section 2 is a "PRIMER ON RISK ADJUSTMENT AND THE CMS-HCC MODEL" https://www.cms.gov/Medicare/Health-Plans/MedicareAdvtgSpecRateStats/Downloads/RTC-Dec2018.pdf DECEMBER 2018 Accessed April 17 2020 Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations.  The information presented herein is for general informational purposes only and is accurate as of the date of publication.

This is excellent news for risk adjustment from our friends at INDUSTRY COLLABORATION FFORT,  www.iceforhealth.org Memo from CMS regarding the submittal of diagnosis for risk adjustment that are from telehealth visits. When the visits meets all risk adjustment eligibility, then diagnoses from telehealth services can meet the risk adjustment face-to-face requirement when the services are provided using an interactive audio and video telecommunications system that permits real-time interactive communication. Simply, patient and provider need to be able to see each other for the telehealth visit. Use place of service code “02” for telehealth or use the CPT telehealth modifier “95” with any place of service. http://www.iceforhealth.org/library/documents/Applicability_of_Diagnoses_from_Telehealth_Services_for_Risk_Adjustment_4.10.2020.pdf https://www.cms.gov/files/document/applicability-diagnoses-telehealth-services-risk-adjustment-4102020.pdf

MEDICARE TELEMEDICINE HEALTH CARE PROVIDER FACT SHEET In this fact sheet there is information on the following: EXPANSION OF TELEHEALTH WITH 1135 WAIVER: TYPES OF VIRTUAL SERVICES:      MEDICARE TELEHEALTH VISITS      VIRTUAL CHECK-INS      E-VISITS      HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) and Summary of Medicare Telemedicine Services https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet published: 3/17/2020 last accessed: 4/18/2020 Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulation...

I found this in-depth article on the management of the clinical side of treating Pulmonary Embolism. Posting the link below. http://www.onlinejacc.org/content/67/8/976 Journal of the American College of Cardiology Volume 67, Issue 8, March 2016 DOI: 10.1016/j.jacc.2015.11.061 Authors:   Stavros V. Konstantinides, Stefano Barco, Mareike Lankeit and Guy Meyer MANAGEMENT OF PULMONARY EMBOLISM Another Interesting Point Is Figure 1 PE: RISK-ADJUSTED MANAGEMENT IN THE ACUTE PHASE AND OVER THE LONG TERM. Covers the clinical aspects of the disease process.  Happy Learning!

The annual event we look forward to is the CMS Call Letter release. They have let us know it will not be published for 2021.  Refer to the fact sheet below: https://www.cms.gov/newsroom/fact-sheets/2021-medicare-advantage-and-part-d-advance-notice-part-ii-fact-sheet-0