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Professional Coding Corner

Cases of COVID-19 are on the rise again in many states, and with this news comes uncertainty for medical practices and rural health systems nationwide. Will providers be prepared for an influx of patients? Will they have enough personal protective equipment to be safe? This is in addition to the everyday stressors of running a profitable business. This month, we’ve compiled four news stories to help providers stay abreast of industry changes. As we head into additional waves of COVID-19, what are your concerns, and how can Physician Practice Resources help? Email us at info@ppr-corp.com. Most importantly, stay safe out there.  

Rural hospitals continue to struggle during COVID-19 

One mustn’t look far to find news coverage of rural hospitals struggling nationwide to care for patients with COVID-19. Shortage of ICU beds is a challenge. This article published on pewtrusts.org sums it up succinctly: “Rural hospitals don’t have access to the same supply chains that larger hospitals have and staffing shortages can quickly become critical when one health care worker in a department of two falls ill.”  

The National Rural Health Associates predicts that rural hospitals with less than 90 days’ cash on hand may not survive another six months without proactive strategies to help strengthen their bottom lines. This article published by the American Hospital Association says today’s rural hospitals need financial flexibility, connectedness through telehealth and other technologies, and regulatory flexibility.  

Access is also a challenge in rural communities. Recent research indicates that one in four rural households (24%) couldn’t get medical care for a serious problem when they needed it during the coronavirus outbreak. A majority of those individuals who were unable to get care reported negative health consequences as a result. The research was conducted by NPR, The Robert Wood Johnson Foundation, and Harvard T.H. Chan School of Public Health as part of a five-part polling series July–August 2020.  

What is your organization doing to improve access and ensure revenue integrity?   

CMS adds 11 new services to the Medicare telehealth services list 

On October 14, 2020, the Centers for Medicare & Medicaid Services (CMS) expanded the list of telehealth services covered by Medicare during the COVID-19 Public Health Emergency. In particular, it added the following codes and short descriptions:  

  • 93797Cardiac rehabilitation 
  • 93798Cardiac rehabilitation/monitoring 
  • 93750Interrogation of ventricular assist device in person 
  • 95970Electronic analysis of implanted neurostimulator pulse generator/transmitter without programming  
  • 95971Electronic analysis of implanted neurostimulator pulse generator/transmitter with simple spinal cord or peripheral nerve neurostimulator pulse generator/transmitter programming  
  • 95972Electronic analysis of implanted neurostimulator pulse generator/transmitter with complex spinal cord or peripheral nerve neurostimulator pulse generator/transmitter programming  
  • 95983Electronic analysis of implanted neurostimulator pulse generator/transmitter with brain neurostimulator pulse generator/transmitter programming, first 15 minutes 
  • 95984Electronic analysis of implanted neurostimulator pulse generator/transmitter with brain neurostimulator pulse generator/transmitter programming, additional 15 minutes 
  • G0422 Intensive cardiac rehabilitation with exercise
  • G0423Intensive cardiac rehabilitation without exercise 
  • G0424Pulmonary rehabilitation with exercise 

Be sure to review Medicare requirements for billing telehealth, and contact private payers to obtain their specific policies as well.  

Telehealth waivers require frequent monitoring 

This recent article in The New York Times highlights the ever-changing landscape of telehealth waivers that impact patient cost-sharing responsibilities. As the article points out, payers may also no longer waive copayments and deductibles related to telehealth. Providers must track these changes and effective dates carefully across all payers. Appointing someone to oversee this process can be extremely advantageous in terms billing patients correctly.  

Providers need to educate patients about their medical bills 

Only 52% of patients fully understand their financial responsibility for their recent medical bill, according to a recent patient survey conducted by TransUnion. What can help? Clear cost information as well as upfront cost estimates offered in advance or at the time of serviceIt’s also important to create customized patient payment models and provide financing options that fit patients’ individual needs. What is your practice doing to move the needle on these initiatives?  

About us 

Physician Practice Resources, Inc., founded in 2002, headquartered in Matteson, IL is a full service company that partners with small and large organizations to build solutions that enhance operational effectiveness, improve clinical documentation and decrease overall compliance related risks. Our core competencies include: Consulting Services, Medical Coding, Temporary Help Services, Professional Management and Development Training, Continuing Education Webinars/Workshops and Coding Exam Preparation and Tutoring. Contact us at https://www.ppr-corp.com/about-ppr-corp/ for more information. 

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