Expert answer:Explore the Need for Accuracy
Expert answer:Please research website for more information:http://www.stfm.org/FamilyMedicine/Vol47Issue3/Eva…www.films.com: Diagnostic Criteria Diagnosing Mental Disorders DSM-5 and ICD-10 & Charting a New Course (Alexander Street a Proquest Company)Week 2 – Assignment: Explore the Need for AccuracyInstructionsAssume the role of a newly appointed financial manager. You must update senior leadership on the important role of your team of billing and coding professionals. The healthcare industry differs from others and maintaining accuracy is critical; assess your team’s performance, and then justify the need of accuracy for senior leadership. Create a PowerPoint presentation that addresses the following points:Explain the importance of capturing all of the charges associated with specific transactions.Summarize the key role of coding for services.Determine the purpose and effect of financial functions within healthcare organizations.Incorporate appropriate animations, transitions, and graphics as well as speaker notes for each slide. The speaker notes may be comprised of brief paragraphs or bulleted lists.Support your presentation with at least three scholarly resources. In addition to these specified resources, other appropriate scholarly resources may be included.Length: 12-15 slides (with a separate reference slide)Notes Length: 100-150 words for each slideGrading RubricCriteriaContent (12 points) Points 1 Captured the importance of capturing charges associated with medical diagnosis and treatment. 3 2 Explored the importance of medical coding. 4 3 Assessed the purpose and effect of financial functions within a healthcare organization. 5 Organization (3 points)1 Included speaker notes for each slide, animations, transitions, and graphics. Included a minimum of three scholarly references, with appropriate APA formatting applied to citations and paraphrasing. Presentation is 12-15 slides long. 3 Total 15
untitled.pdfcourse_7_week_2.pdf
course_7_week_2_assignment.docx
Unformatted Attachment Preview
CME
KENT MOORE AND BARBARA HAYS, CPC, CPMA, CPC-1, CEMC
CODING AND BILLING RULES IN 2016:
OUT WITH THE OLD,
IN WITH THE NEW
Incident-to rules and advance care planning
top the list of changes.
J
an. 1
ushers in
a new Medicare physician fee schedule and
regulations, as well as a new edition of CPT.
The
2016 versions clarify Medicare’s “incident-to” rules and
formalize codes and billing rules for Medicare’s new
advance care planning benefit, among other changes.
Here is a summary of the changes most likely to affect
family physicians.
“Incident-to” services
First, the Centers for Medicare & Medicaid Services
(CMS) has amended its incident-to regulations to clarify
that the physician or other practitioner who bills for
incident-to
services must be the same person who directly supervised
the ancillary personnel who provided the services. The
direct supervision requirement for incident-to services has
not changed – the physician must be present in the office
suite
(but not the exam room) and immediately available
to furnish assistance and direction throughout the
performance of the service.
This does not mean that the billing/supervising
physician also has to be the one who initiated the
original care plan or service upon which the incident-to
service is based. Under the clarified regulations, scenarios
like the following are acceptable: Dr. A treats Mrs. Jones
on Monday, initiating a plan of care and asking her to
return in one week for follow-up with the nurse. Dr. A
is on vacation when the patient returns and his partner,
Dr. B, directly supervises the nurse visit and bills for the
service under his own provider number.
When incident-to services are provided, practices
will need to decide which physician qualifies as the
supervising physician. Although claims don’t identify
that services were provided incident to a physician’s care,
medical record documentation should clearly name the
supervising physician.
Note that services and supplies provided incident to
transitional care management
and chronic care management services remain
About the Authors
Kent Moore is senior strategist for physician payment for the American Academy of Family Physicians (AAFP) and is a contributing
editor to Family Practice Management. Barbara Hays is coding and compliance strategist for the AAFP. Author disclosures: no
relevant financial affiliations disclosed.
Downloaded from the Family Practice Management website at www.aafp.org/fpm. Copyright © 2016
American
Academy of| www.aafp.org/fpm
Family Physicians. |For
the private, noncommercial
use of one individual user of the website.
14 | FAMILY PRACTICE
MANAGEMENT
January/February
2016
All other rights reserved. Contact copyrights@aafp.org for copyright questions and/or permission requests.
THE PHYSICIAN WHO BILLS FOR INCIDENT-TO SERVICES
MUST BE THE SAME PERSON WHO DIRECTLY SUPERVISED THE
ANCILLARY PERSONNEL WHO PROVIDED THE SERVICES.
an exception to the direct supervision
requirement. These can continue to be
provided under the general supervision of the
physician (or other practitioner). General
supervision means the service is furnished
under the
physician’s overall direction and control, but
the physician’s presence in the office suite is
not required.
CMS also amended its regulations to
clarify that ancillary personnel are prohibited
from providing incident-to services if they
have been excluded from Medicare, Medicaid,
or any other federally funded health care programs by the Office of Inspector General or
have had their Medicare enrollment revoked
for any reason. Such individuals are technically prohibited from providing services to
Medicare beneficiaries, but CMS makes it
explicit in this case.
Advance care planning
CPT established two new codes in 2015 to
describe advance care planning services that
are being paid by Medicare beginning in
January 2016:
• 99497, “Advance care planning including
the explanation and discussion of advance
directives such as standard forms (with completion of such forms, when performed), by
the physician or other qualified health professional; first 30 minutes, face-to-face with the
patient, family member(s), and/or surrogate,”
• +99498, “each additional 30 minutes (list
separately in addition to code for primary
procedure).”
You can use these codes to report the
face-to-face service, regardless whether the
visit includes completing the relevant legal
forms. CPT describes an advance directive
as “a document appointing an agent and/or
recording the wishes of a patient pertaining
to his/her medical treatment at a future time
should he/she lack decisional capacity at that
time.” Some examples of these forms are a
health care proxy, durable power of attorney
for health care, living will, and medical orders
for life-sustaining treatment.
CMS has assigned a total of 2.40 relative value units (RVUs) to 99497 and 2.08
RVUs to 99498 in the non-facility setting
(e.g., physician office), which translates to
$85.99 and $74.52, respectively, using the
2016 Medicare conversion factor (unadjusted for geography, sequestration, and any
applicable Medicare payment adjustments).
Payment may still depend on local coverage
determinations.
CMS offers the following example of how
a physician might provide and bill for advance
care planning:
A physician sees a 68-year-old male with
heart failure and diabetes who takes multiple
medications. She provides evaluation and
management (E/M) of these two diseases,
including adjusting medications as appropriate. In addition to discussing the patient’s
short-term treatment options, the physician
learns of the patient’s interest in discussing
long-term treatment options and planning.
The patient inquires about the possibility
of a heart transplant if his congestive heart
failure worsens. The physician and patient
also discuss advance care planning for care
and treatment if he suffers a health event that
adversely affects his decision-making capacity.
In this example, the physician would report
a standard E/M code and one or both of the
advanced care planning codes, depending on
the duration of the service. The physician
would not count the time spent on the E/M
portion of the visit toward the time used to
code 99497 and 99498; per CPT, no active
management of the problem or problems is
undertaken during the time period for which
these two codes are reported.
Note that the advance care planning service described in the example above would not
necessarily have to occur on the same day as
an E/M service. Advance care planning can be
billed as a stand-alone service.
The supervising
physician does not
have to be the one
whose professional
service initiated the
incident-to service.
Ancillary personnel cannot provide
incident-to services if they have
been excluded
from a federally
funded health care
program.
Advanced care
planning can be
provided and billed
as a stand-alone
service.
January/February 2016 | www.aafp.org/fpm | FAMILY PRACTICE MANAGEMENT | 15
Other CPT changes
Two new vaccine
codes have been
added: Cholera,
90625, and DTaPIPV-Hib-HepB,
90697.
Preventive medicine counseling
codes are reportable on the same
day as an E/M service by appending
modifier 25.
New code 69209
can be reported
for removal of
impacted cerumen
without the use of
instrumentation.
Family physicians should also note the following CPT changes for 2016.
Vaccines. The following vaccine codes
have been added:
• 90625, “Cholera vaccine, live, adult dosage, 1 dose schedule, for oral use,”
• 90697, “Diphtheria, tetanus toxoids, acellular pertussis vaccine, inactivated poliovirus
vaccine, Haemophilus influenzae type b
PRP-OMP conjugate vaccine, and hepatitis
B vaccine (DTaP-IPV-Hib-HepB), for intramuscular use.”
Both of these vaccines are pending
approval by the Food and Drug Administration (FDA).
CPT also includes two new codes for
meningococcal vaccines that were introduced
in February 2015:
• 90620, “Meningococcal recombinant
protein and outer membrane vesicle vaccine,
serogroup B (MenB), 2 dose schedule, for
intramuscular use,”
• 90621, “Meningococcal recombinant lipoprotein vaccine, serogroup B (MenB), 3 dose
schedule, for intramuscular use.”
Two codes that were pending FDA
approval when they appeared in the 2015 edition of CPT have now received approval:
• 90630, “Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, for
intradermal use,”
• 90651, “Human Papillomavirus vaccine
types 6, 11, 16, 18, 31, 33, 45, 52, 58,
nonavalent (HPV), 3 dose schedule, for
intramuscular use.”
been added. This panel, code 80081, differs
from the existing obstetric panel, code 80055,
in that it includes “HIV-1 antigen(s), with
HIV-1 and HIV-2 antibodies, single result
(87389)” as a component. Remember that
if a single component of the panel is not
performed, you need to separately report
the codes for the components that were
performed.
Ear irrigation services. To assist practices when reporting services for removal of
impacted cerumen without the use of instrumentation, a new code, 69209, “Removal
impacted cerumen using irrigation/lavage,
unilateral,” was created. This new code
should not be reported on the same day
code 69210, “Removal impacted cerumen
requiring instrumentation, unilateral,” is
used. For bilateral cerumen removal, use
modifier 50.
Going forward
These are just some of the changes to be aware
of in 2016. You should review Appendix B in
the CPT manual and the sections of CPT that
you use most often to identify other changes
that may be relevant to your practice. Also be
sure to periodically review the errata and technical changes posted by the American Medical
Association (http://bit.ly/1Lx0p4k). Using the
correct codes will facilitate payment of your
claims in 2016.
Preventive medicine counseling.
Changes to the CPT descriptions within
the subcategories of counseling risk factor
reduction and behavior change intervention
allow codes 99406-99409 to be reported
for a preventive service on the same day as a
problem-oriented E/M service.
Additionally, preventive medicine
individual and group counseling codes
(99401-99404 and 99411-99412) have been
clarified as being reportable with a distinct
E/M service performed on the same day. In
these cases, use modifier 25 to indicate that
the additional service was significant and
separately identifiable.
Obstetric HIV testing panel. A new
obstetric panel that includes HIV testing has
16 | FAMILY PRACTICE MANAGEMENT | www.aafp.org/fpm | January/February 2016
Send comments to fpmedit@aafp.org, or
add your comments to the article at http://
www.aafp.org/fpm/2016/0100/p16.html.
Copyright of Family Practice Management is the property of American Academy of Family
Physicians and its content may not be copied or emailed to multiple sites or posted to a
listserv without the copyright holder’s express written permission. However, users may print,
download, or email articles for individual use.
Please research website for more information:
http://www.stfm.org/FamilyMedicine/Vol47Issue3/Evans175
www.films.com: Diagnostic Criteria Diagnosing Mental Disorders DSM-5 and ICD-10 & Charting a New
Course (Alexander Street a Proquest Company)
Week 2 – Assignment: Explore the Need for Accuracy
Instructions
Assume the role of a newly appointed financial manager. You must update senior leadership on the
important role of your team of billing and coding professionals. The healthcare industry differs from
others and maintaining accuracy is critical; assess your team’s performance, and then justify the need of
accuracy for senior leadership. Create a PowerPoint presentation that addresses the following points:
Explain the importance of capturing all of the charges associated with specific transactions.
Summarize the key role of coding for services.
Determine the purpose and effect of financial functions within healthcare organizations.
Incorporate appropriate animations, transitions, and graphics as well as speaker notes for each slide.
The speaker notes may be comprised of brief paragraphs or bulleted lists.
Support your presentation with at least three scholarly resources. In addition to these specified
resources, other appropriate scholarly resources may be included.
Length: 12-15 slides (with a separate reference slide)
Notes Length: 100-150 words for each slide
Grading Rubric
Criteria Content (12 points) Points 1 Captured the importance of capturing charges associated with
medical diagnosis and treatment. 3 2 Explored the importance of medical coding. 4 3 Assessed the
purpose and effect of financial functions within a healthcare organization. 5 Organization (3 points) 1
Included speaker notes for each slide, animations, transitions, and graphics. Included a minimum of
three scholarly references, with appropriate APA formatting applied to citations and paraphrasing.
Presentation is 12-15 slides long. 3 Total 15
…
Purchase answer to see full
attachment
How it works
- Paste your instructions in the instructions box. You can also attach an instructions file
- Select the writer category, deadline, education level and review the instructions
- Make a payment for the order to be assignment to a writer
- Download the paper after the writer uploads it
Will the writer plagiarize my essay?
You will get a plagiarism-free paper and you can get an originality report upon request.
Is this service safe?
All the personal information is confidential and we have 100% safe payment methods. We also guarantee good grades