Is it time
to renegotiate your managed care
contracts?
One of the most
frequently asked questions I receive
from anesthesiologists is whether
or not Medi-Bill handles managed
care contract negotiations. Medi-Bill
no longer handles direct managed
care negotiations for our clients
because this exceedingly difficult
task has a much higher rate of
success when handled by a competent
health care attorney. Because
of our volume however and long-standing
relationships with various healthcare
attorneys, we are able to provide
your practice with skilled health
care attorneys who specializes
in managed-care renegotiations
at highly discounted rates.
It is crucial that
your practice periodically renegotiate
managed-care contracts or reimbursement
will suffer dramatically. Medi-Bill
can help streamline and simplify
this important task. We also provide
Medicare provider enrollment and
general physician credentialing
as a free part of our service.
If you are preparing
to start a new practice Medi-Bill
can help. Call 1-800-811-1882
ext. 2201.
CMS
Eliminates Consult Codes
In the July 13,
Federal Register, CMS announced
its plan to eliminate payment
for consultation codes effective
January 1, 2010. The proposal
includes non-cash payment for
all inpatient (99251 - 99255,
inpatient consultation for a new
or established patient) and outpatient
(99241 - 99245, office consultation
for new or established patient)
and consultation codes.
Even though CMS
stopped payment for the -- office
consultation codes (99241 -- 99245,
office consultation for a new
or established patient) and inpatient
consultation codes (99251 -- 99255,
inpatient consultation for a new
established patient) in 2010,
the American Medical Association
chose not to delete the listed
codes from the 2010 CPT Manual.
Please understand:
just because the consult codes
appear in 2010 CPT is not an indication
of whether or not payer will actually
cover the services this year.
Medicare published a final rule
and opted to discontinue payment
on the listed consultation codes.
Private insurance may or may not
follow suit.
This Catch-22 is
only a CMS issue and not a private
payer elimination. The American
Medical Association has Consultations
in the CPT manual and WE,
will have to
manage which entities pay and
which do not. Generally, over
time, institutions typically follow
Medicare guidelines. Further confusing
the issue is the fact that many
Medicare recipients who opt out
into HMO plans will also follow
Medicare guidelines.
Instead of reporting
consult codes, you will need to
report inital hospital or new/established
patient office visit (E/M) for
these services.
Historically, only
the admitting physician reported
initial hospital codes (99221
-- 99223, Initial hospital care.)
And specialists who subsequently
treated the patient billed inpatient
consultation codes.
Because of the CMS
policy regarding consultation
codes you should bill initial
hospital care for the initial
inpatient visit. If you perform
a consultation in the hospital,
you should use the initial hospital
visit code (99221 -- 99223) or
the subsequent hospital visit
code (99231 -- 99233), according
to Medicare's new fee guidelines
in 2010.
Dr. Peter A. Holliman
who is the American Medical Association
CPT editorial Vice President recently
advised physicians at the RBRVS
2010 symposium in Chicago to"
stop thinking about 99221 -- 99223
as admit codes." 99221 --
99223 are for the initial hospital
care that a physician provides.
A physician could see an inpatient
who has been in the hospital for
several days. If the physician
is providing initial hospital
care, he can use 99221 -- 99223
even if he provides the care on
the same date subsequent to the
admission day. Additionally, more
than one physician can now use
the initial hospital code for
the same patient. If two physicians
from different specialties are
both consulting on a patient for
the first time, both physicians
will use the initial hospital
care code.
Each physician will
be allowed to utilize the 99221
-- 99223 code range only once,
after which he will report subsequent
hospital care codes (99231 --
99233, Subsequent hospital care,
per day, for the evaluation of
management) for follow-up visits.
Primary care physicians
should use the AI (Principal physician
of record) as CPT modifier. This
indicates they are the initial
admitting physician and all other
claims submitted for the initial
hospital care will be presumed
consultations.
Correct ICD-9 coding
is always important. However,
now that more than one physician
can report initial hospital care,
your diagnosis codes prove why
two or more physicians might be
necessary for the same care.
Separate diagnosis
codes will help substantiate the
medical necessity for providing
consult services. If an auditor
reviews your hospital code (99221
-- 99223) documentation, different
diagnosis will show why more than
one physician's evaluation and
management was necessary for the
same patient. If two patients
from different specialties are
treating the same problem, there
needs to be a clear reason for
the service.
Providers should
include the reason he/s. needed
to see the patient. Separate diagnosis
codes will make a big difference
in the initial claim processing
phase because they help support
medical necessity. Additionally,
different diagnosis will be especially
important for the follow-up care
(99231 -- 99233).
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