Tag Archives | Hhs Secretary

HHS Deems Health Insurance Rate Hikes Unreasonable

Insurers in nine states, that is Arizona, Idaho, Louisiana, Missouri, Montana, Nebraska, Virginia, Wisconsin, and Wyoming have asked for rate increases as high as 24 percent.

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Medicare Covers 99406, 99407

If you’ve been writing off tobacco cessation counseling as non-payable, it’s time to change your tune.

The change: In the past, you could collect for tobacco cessation counseling for a patient with a tobacco-related disease or with signs or symptoms of one. But on Aug. 25, CMS announced that “under new coverage, any smoker covered by Medicare will be able to receive tobacco cessation counseling from a qualified physician or other Medicare recognized practitioner who can work with them to help them stop using tobacco.”

“For too long, many tobacco users with Medicare coverage were denied access to evidencebased tobacco cessation counseling,” said Kathleen Sebelius, HHS secretary, in an Aug. 25 statement. “Most Medicare beneficiaries want to quit their tobacco use. Now, older adults and other Medicare beneficiaries can get the help they need to successfully overcome tobacco dependence.”

Count Attempts and Minutes

The new tobacco cessation counseling coverage expansion will apply to services under Medicare Part B and Part A. That means your physicians and coders should know how to correctly document and report the sessions.

“Medicare allows billing for two counseling attempts in a year, but each attempt can occur over multiple sessions, with four sessions per attempt,” explains Jennifer Swindle, CPC, CPC-E/M, CPC-FP, RHIT, CCP-P, director of coding and compliance for PivotHealth LLC in Brentwood, Tenn.

According to section 12 of chapter 32 of the Medicare Claims Processing Manual, “Claims for smoking and tobacco use cessation counseling services shall be submitted with an appropriate diagnosis code. Diagnosis codes should reflect: the condition the patient has that is adversely affected by tobacco use or the condition the patient is being treated for with a therapeutic agent whose metabolism or dosing is affected by tobacco use.”

Swindle says 305.1 (Tobacco use disorder) is one diagnosis supporting…

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CPT 99406, 99407 Coverage Extended to All Smokers

CMS announcement is triumph for physicians who haven’t collected in the past.
If you’ve been writing off tobacco cessation counseling as non-payable, it’s time to change your tune.
In the past, CMS only covered 99406-99407 (Smoking and tobacco us…

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Proposed 2011 Fee Schedule Offers Vast Benefits for Primary Care Practices

CMS adds Obama recs into next year’s fee schedule.

The President signed the Patient Protection and Affordable Care Act (PPACA) into law on March 23, but many practices haven’t yet noticed significant impacts from the legislation. In 2011, however, you could see huge boosts from it, because CMS has proposed incorporating many of the law’s features into next year’s Physician Fee Schedule.

On June 25, CMS released its proposed Physician Fee Schedule for 2011. The 1,250-page document, which will be published in the July 13 Federal Register, offers several advantages to medical practices, including bonuses for primary care physicians. “Improving access to preventive services and primary care is a top priority for HHS,” said HHS Secretary Kathleen Sebelius in a June 25 statement. “The proposed rule is just one part of a broader effort we are making to improve the health status of Medicare beneficiaries.”

According to the proposal, primary care practitioners will benefit from a 10 percent bonus starting on January 1, as prescribed in the PPACA.

Practitioners who qualify will be doctors, nurse practitioners, clinical nurse specialists, or physician assistants with the primary specialty designation of family medicine, internal medicine, geriatric medicine, or pediatrics.

To qualify for the 10 percent bonus, the law stipulates that the primary care practitioners will have to bill at least 60 percent of their allowed charges as ‘primary care services,’ which are defined by E/M codes 99201-99215, nursing facility or rest home care codes 99304-99340, or home services codes 99341-99350.

“The rule we are proposing today is just one part of the Administration’s efforts to improve the health status of Medicare beneficiaries by expanding access to preventive services, and promoting early detection and prompt treatment of medical conditions,” said Jonathan Blum, deputy administrator and director of CMS’s Center for Medicare, in a…

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CMS Will Cover HIV Screening As Preventive Care Service

Bonus: Effective immediately!
You’re probably accustomed to CMS taking away coverage for certain services, but in an early holiday gift to practices, CMS has actually added a preventive care service to its roster of covered screenings, effective immediately.
CMS issued a final decision on Dec. 8 declaring that HIV testing will now be covered for Medicare beneficiaries [...]

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