Understanding Social Determinants of Health

The article starts by laying the foundation for understanding SDOH. It defines SDOH as the conditions in which people are born, grow, live, work, and age. These conditions are influenced by a variety of factors, including economic status, education, neighborhood, and social support systems. The article emphasizes that addressing SDOH is critical for improving patient outcomes and reducing healthcare disparities.

The Importance of SDOH Reporting

One of the key takeaways from the article is the importance of reporting SDOH data in healthcare settings. It explains how capturing SDOH data can help healthcare providers identify patients at risk and tailor their care plans accordingly. Moreover, the article highlights how SDOH data can be used to allocate resources more effectively and reduce healthcare costs in the long run.

Coding and Documentation

The article also delves into the coding and documentation aspects of SDOH reporting. It provides valuable insights into the specific codes and guidelines that healthcare professionals should follow when documenting SDOH-related information. Proper coding and documentation are crucial for ensuring that SDOH data is accurately recorded and can be used for improving patient care.

Compliance and Ethical Considerations

In addition to the technical aspects, the article touches upon compliance and ethical considerations related to SDOH reporting. It discusses the need for safeguarding patient privacy and ensuring that SDOH data is used responsibly. This section of the article is essential for healthcare professionals to navigate the legal and ethical aspects of SDOH reporting.

Conclusion

In conclusion, the article “Reporting Social Determinants of Health” on AAPC’s blog is a comprehensive resource for healthcare professionals looking to enhance their understanding of SDOH and how it impacts patient care. It provides valuable information on the importance of SDOH reporting, coding and documentation guidelines, as well as compliance and ethical considerations. By reading this article and implementing the insights it offers, healthcare providers can take significant steps towards improving patient outcomes and addressing healthcare disparities.

To access the full article and dive deeper into this important topic, click here. We highly recommend it as essential reading for anyone involved in healthcare delivery and management. Stay informed, stay compassionate, and together, let’s unlock better healthcare for all.

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1. Conversion Factor Reduction:

CMS is proposing a Conversion Factor (CF) of $32.75 for 2024, which represents a $1.14 reduction compared to the CF of $33.89 in 2023. This translates to a substantial 3.34 percent decrease. While many had hoped for stability in the CF, the proposed reduction is a significant concern for radiologists.

Specialty Impact:

• Radiology: A 3 percent decrease
• Interventional radiology: A 4 percent decrease
• Nuclear medicine: A 3 percent decrease
• Radiation oncology: A 2 percent decrease
• Radiation therapy centers: A 2 percent decrease

When adjusted for inflation, Medicare physician payment to radiologists has effectively declined by 26 percent from 2001 to 2023, before factoring in these additional cuts.

3. Calls for Congressional Intervention:

Radiology societies, including the American College of Radiology (ACR) and the American Society for Radiation Oncology (ASTRO), are actively advocating for congressional action to address these reimbursement challenges. There is a growing consensus that Congress must play a pivotal role in ensuring fair and sustainable reimbursement for radiologists.

For more detailed insights into the proposed changes and their potential impact on radiologists, you can refer to this source from the AAPC.

As the healthcare landscape continues to evolve, staying informed and actively participating in discussions surrounding reimbursement is crucial for radiology professionals. We will keep you updated on any developments regarding the 2024 MPFS.

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Changes to the vaccine include:

• These updated vaccines now include a monovalent (single) component tailored to the Omicron variant XBB.1.5.
• The CDC strongly recommends these updated COVID-19 vaccines for individuals aged 6 months and older.

In addition to the vaccine updates, there have been some changes to the CPT codes for COVID-19-related services:

New CPT Codes Effective September 11, 2023:

• 90480 – COVID-19 Vaccine Administration
• 91318 – COVID-19 Vaccine, 3 mcg/0.2 mL
• 91319 – COVID-19 Vaccine, 10 mcg
• 91320 – COVID-19 Vaccine, 30 mcg
• 91321 – COVID-19 Vaccine, 25 mcg
• 91322 – COVID-19 Vaccine, 50 mcg

It’s important to note that the federal government is not purchasing these products; instead, Medicare Part B covers the drug and its administration under the applicable Medicare Part B payment policy. For the most up-to-date billing codes and related information, please visit the provided link.

Changes to Medicare Coverage:

As of September 12, 2023, Medicare will no longer cover the following CPT Codes:

91312, 91313, 91314, 91315, 91316, 91317, 0121A, 0124A, 0134A, 0141A, 0142A, 0144A, 0151A, 0154A, 0164A, 0171A, 0172A, 0173A, and 0174A.

For further details and additional resources, you can explore the COVID-19 Vaccine Provider Toolkit on the CMS.gov website.

Stay informed about the latest updates in the fight against COVID-19 by following our blog for regular updates.

The post FDA Approves Updated mRNA Vaccines for Enhanced COVID-19 Protection appeared first on Custom Data Services, Inc..

That’s why we’re excited to share an insightful article by expert Caroline Fife, MD.  In her post, she sheds light on the essential documentation required for debridement, providing valuable insights for healthcare professionals. Caroline is a highly respected authority in the field of wound care. So join us as we explore the expertise of Caroline Fife and discover why her post is a must-read for anyone involved in wound care.

Our in office expert coders have highlighted a couple of key takeaways from Caroline’s post:

• From her section on “Documentation among EACH physician visits”: “The patient’s medical record must contain clearly documented evidence of the progress on the wound’s response to treatment at each physicians visit.”
• From her section on the “Big 15” parts of your document note: “When debridements are reported, the debridement operating notes must demonstrate tissue removal (i.e., skin, full press partial thickness; subcutaneous tissue; muscle and/or bone), the methodology applied go debride (i.e., hydrostatic, sharp, abrasion, etc.) and the character of the wound (including dimensions, description of necrotic material presentation, description of tissue removed, degree of epithelialization, etc.) before and after debridement. Pressure Ulcers: Prevention, Evaluation, and Executive”

To view the full article from Caroline follow the link below.

https://www.intellicure.com/blog/debridement-audits-what-documentation-is-required/

The post Debridement Audits: Expert Insights and Required Documentation appeared first on Custom Data Services, Inc..

Application of the JZ Modifier:

The JZ modifier is used to identify instances when a drug is injected into a patient from a single-use container and no waste was discarded.

As specified by CMS:

To submit claims for a non-discarded claim, submit one complete claim line.

• HCPCS code for drug given
• JZ modifier to indicate no waste
• Number of units given to the patient
• Calculate submitted price for the amount given

Documentation Requirements:

Accurate and detailed documentation is vital for compliant billing and reimbursement. When using the JZ modifier, healthcare providers must include the following information in their documentation:

• Name of the drug being administered
• Dosage and quantity of the drug
• Route of administration (IV, IM, or SQ)
• Date and time of administration
• Patient’s medical record number
• The NDC (National Drug Code) for the drug product

Including these details ensures transparency and supports proper claims processing and auditing procedures.

Training and Compliance:

To successfully implement the JZ modifier guidelines, healthcare providers should invest in ongoing training and education for their coding and billing staff. This will help them stay up-to-date with the latest CMS guidelines and ensure accurate and compliant documentation, coding, and billing practices.

For more information please review the Billing and Coding: JW and JZ Modifier Billing Guidelines on the CMS website.

The post Demystifying the JZ Modifier: A Guide to CMS Guidelines appeared first on Custom Data Services, Inc..

According to a recent survey by Merritt Hawkins, a Dallas medical consulting and recruiting firm, it now takes an average of 29 days to get an appointment with a family care physician.

This is a significant jump from 2014, when the average wait time was 19.5 days. This figure is exemplary of the overcrowding and lack of one-on-one attention that plagues the American medical system, a source of frustration for doctors and patients alike.
One possible solution to these problems, at least for high-earning Americans, is the concierge system. This approach to medicine is also referred to as “direct patient contracting,” “cash-only,” “retainer,” or “boutique.” The characteristics of these practices include administrative service fees, paid monthly or annually, same-day cash payment for medical services, and smaller patient panels.
From the patient’s perspective, the main selling point of the concierge model of medicine is a more personalized level of care. Concierge practices provide amenities like all-hours access to physicians and the ability to make same-day appointments. In exchange for these amenities, patients pay an annual or monthly fee in lieu of, or in some cases in addition to, a traditional insurance policy.
Michael Friedlander of SpecialDocs Consultants, a concierge medical practice, estimates that these fees average between $1,200-$5,000 per year. The amount of the fee tends to correlate with the affluence of the area. Doctors in expensive communities can charge more per patient, and as a result are often able to limit their practices to fewer patients. Because of these smaller patient panels, patients at concierge practices are able to build closer relationships with their physicians and have access to a wider range of preventative procedures.
For those in the medical community looking to transition their practices to the concierge model may mean a different approach to medicine as a business. According to some physicians, the greatest barrier to success within the framework of this model is a lack of formal business training. Dike Drummond, a concierge practitioner and the founder of The Happy MD, describes this model as “inherently entrepreneurial,” and posits that it “will always involve a fairly sophisticated marketing program to be successful.”
However, not all concierge physicians approach the model in the same way as Dr. Drummond. Dr. Jordan Shlain, for one, seems to disagree with the necessity of Drummond’s marketing-heavy approach. Dr. Shlain’s private medical group in San Francisco doesn’t engage in advertising or have any significant web presence. All of their clients are word-of-mouth. They also charge $40,000 to $80,000 annually per family, a rate that stands out even in the relatively affluent context of concierge medicine. In accordance with their high fees, physicians in Shlain’s practice earn an annual salary between $500,000 to $700,000. This is approximately double the expected salary range for a successful internist in the Bay Area. Shlain’s group is an example of how a concierge medical practice can maintain a significantly smaller patient panel and still experience financial success.
When converting to direct patient care practices (DPCPs), medical groups often downsize their patient panels. A 2005 study from the U.S. Government Accountability Office found that retainer physicians serve an average of 491 patients. The year before starting their retainer-based practices, this same pool of physicians saw an average of 2,716 patients. This radical change raises the question of what happens to less-affluent patients when their physicians convert to a concierge model.
A major ethical issue surrounding the adoption of the concierge model is patient abandonment. There are some legal guidelines: local and state patient abandonment laws dictate how physicians should proceed when terminating relationships with patients during the downsizing process that inevitably comes with a concierge transition.
Furthermore, retainer practices could exacerbate preexisting racial and economic disparities in medical coverage. In a study for the Medical Practice and Quality Committee of the American College of Physicians, Robert Doherty found that the patient panels of concierge medical practices are less likely to include African American and Hispanic patients, as well as patients from lower income brackets.
Some DPCPs use their high retainer fees for wealthy clients to subsidize healthcare for lower-income patients. Some have even managed to make their services more accessible to economically vulnerable patients than traditional insurance-accepting practices.
Beyond the ethical consideration that goes into transitioning to the concierge model, physicians must also consider how their participation in this model might affect the larger medical landscape. The Association of American Medical Colleges estimates that by 2020, there will be a shortage of 91,500 doctors. Factor in the radical downsizing that is almost invariably a feature of a switch to the concierge model, and it seems that a large-scale shift to concierge medicine could result in a severe patient bottleneck in the traditional medical community
Sources:

1. Doherty, Robert. “Assessing the Patient Care Implications Of.”
2. Drummond, Dike. “Concierge Medicine Will Get Massive Boost from Obamacare.”
3. Gerstner, Lisa. “6 Things to Know About Concierge Medicine.”
4. Schwartz, Nelson D. “The Doctor Is In. Co-Pay? $40,000.”

About the Author:
Madeline Woods is a freelance writer and researcher. She achieved a bachelor’s of art from Depaul University in writing, rhetoric, and discourse. Madeline can found on LinkedIn.

The post How concierge healthcare will affect doctors, patients, and health insurance. appeared first on Custom Data Services, Inc..

•  ABC – Achievable Benchmark of Care
• ACA – The Patient Protection and Affordable Care Act
• ACO – Accountable Care Organization
• APM – Alternative Payment Model
• BCPI – Bundled Payments for Care Improvement
• CAH – Critical Access Hospital
• CAHPS – Consumer Assessment of Healthcare Providers and Systems
• CEHRT – Certified EHR Technology
• CERT – Comprehensive Error Rate Testing
• CFR – Code of Federal Regulations
• CHIP – Children’s Health Insurance Program
• CJR – Comprehensive Care for Joint Replacement
• CMMI – Centers for Medicare and Medicaid Innovation
• CPIA – Clinical Practice Improvement Activity
• CPI – Clinical Practice Improvement
• CPR – Customary Prevailing and Reasonable
• CPS – Composite Performance Score
• CPT – Current Procedural Technology
• CQM – Clinical Quality Measure
• DMEPOS – Durable Medical Equipment, Prosthetics/Orthotics, and Supplies Fee Schedule
• DSH – Disproportionate Share Hospital
• EHR – Electronic Health Records
• EP – Eligible Professional
• ESRD – End Stage Renal Disease
• FFS – Fee For Service
• FQHC – Federally Qualified Health Center
• GAO – Government Accountability Office
• GPCI – Geographic Pricing Cost Index
• HHA – Home Health Agency
• HHS – Health and Human Services
• HIE – Health Information Exchange
• HIPAA – Health Insurance Portability ad Accountability Act of 1996
• HITECH – Health Information Technology for Economic and Clinical Health
• HPSA – Health Professional Shortage Area
• HRSA – Health Resources and Services Administration
• IT – Information Technology
• IRF – Inpatient Rehabilitation Facility
• LTCH – Long Term Care Hospital
• MA – Medicare Advantage
• MA-PD – Medicare Advantage Prescription Drug
• MAC – Medicare Administrative Contractor
• MACRA – The Medicare Access and CHIP Reauthorization Act of 2015
• MDH – Medicare Dependent Hospital
• MEI – Medicare Economics Index
• MedPAC – Medicare Payment Advisory Commission
• MIPAA – Medicare Improvements for Patients and Providers Act of 2008
• MIPS – Merit-based Incentive Payment Programs
• MLR – Minimum Loss Rate
• MSPB – Medicare Spending per Beneficiary
• MSR – Minimum Savings Rate
• MUA – Medically Underserved Area
• MU – Meaningful Use
• NPI – National Provider Identifier
• NQF – National Quality Forum
• NRDR – National Radiology Data Registry
• OCM  – Oncology Care Model
• ONC – Office of the National Coordinator for Health Information Technology
• PAMA – Protecting Access to Medicare Act of 2014
• PAYGO – Pay As You Go
• PCPI – Physician Consortium for Performance Improvement
• PECOS – Medicare Provider Enrollment, Chain, and Ownership System
• PFPMs – Physician Focused Payment Models
• PFS – Physician Fee Schedule
• PHS – Public Health System
• PQRS – Physician Quality Reporting System
• PREP – Personal Responsibility Education Program
• QDCR – Qualified Clinical Data Registry
• QE – Qualified Entities
• QI – Qualifying Individual
• QP – Qualified APM Professional
• QRDA – Quality Reporting Document Architecture
• QRUR – Quality and Resource Use Reports
• RBRVS – Resource-Based Relative Value Scale
• RAC – Recovery Audit Contractor
• RHC – Rural Health Clinic
• RVU – Relative Value Unit
• SGR – Sustainable Growth Rate
• SNF – Skilled Nursing Facility
• TCPI – Transforming Clinical Practice Initiative
• TIN – Tax Identification Number
• TMA – Transitional Medical Assistance Program
• USC  – United States Code
• VM – Value-based Payment Modifier
• VPS – Volume Performance Standard

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“Amounts which are never expected to be collected, by virtue of laws regulations, contracts or internal policies applicable to the services provided by the entity.””

In most cases your physician has signed a contract with an insurance company to apply discounted rates for services provided. This discounted rate is the disallowance, or the difference between the actual amount of the procedure and the amount agreed upon by the insurance company and the physician.
Completing this type of contract will give the physician “in network” status. If you visit a physician that is “in network”, the amount you will be responsible for paying will generally be less than if you go to an out-of-network physician. In some case the insurance company will either pay less or not pay anything for services you receive from non-network physicians.

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