How to Get Paid Treating Medical Obesity for Physician Offices
Aug20

How to Get Paid Treating Medical Obesity for Physician Offices

Upcoming Webinar that many Obesity Physicians and Offices are Still Confused on How to Get Paid for their Obesity Services! You Don’t Want to Miss this Webinar on Obesity Services Reimbursement AUG 31, 2017 Thursday 2:00PM (EST) JOIN THE WEBINAR RIGHT FROM YOUR OFFICE. NO TRAVEL OR HOTEL STAY REQUIRED. What’s Inside the Webinar? Getting Paid for Physician Obesity Services – August 31, 2017 at 2:00PM (EST) – 90 Minutes Live “Obesity, a common and costly health issue, affects more than one-third of adults and 17 percent of youth in the United States. “ –  Centers for Disease Control and Prevention By the numbers, 78 million adults and 12 million children are obese—figures many regard as an epidemic. Being obese increases the risk for heart disease, stroke and type 2 diabetes—the first, fourth and seventh leading causes of death, respectively—and contributes to more than one in five cancer-related deaths. Obesity-related health care spending continues to grow, with researchers estimating medical costs at $147 billion annually, including $7 billion for Medicare prescription drugs. The American Medical Association recognized obesity as a disease in 2013 and the American Academy of Pediatrics recommended obesity prevention, assessment and patient counseling in 2007. Medicare first recognized obesity as a medical condition in 2004 and began covering interventions when scientific evidence demonstrated their effectiveness. In 2011, Medicare issued a Coverage Decision memorandum outlining requirements for intensive behavioral counseling and therapy for beneficiaries affected by obesity. As of January 2012, Medicare and most private insurers cover obesity screening and behavioral counseling. In addition, as of Jan.1, 2014, the ACA requires: No consumer cost- sharing. Most insurance plans in all 50 states are required to cover certain services with no cost-sharing, including obesity screening and counseling for all adults and children. This includes no annual deductible amount, no enrollee copayments or coinsurance.Premium surcharges for being obese are prohibited in most insurance policies in all 50 states, including those sold through exchanges. Learning Objectives Apply Proper Billing and Coding for Behavioral Obesity Services Understand Comorbidity E/M with and Time-based Behavioral Counseling Describe Incident-to Physician’s Billing Describe the role of a Dietician or Nutritionist Understand different scenarios in the practice with Obesity Services (Face-to-Face Individual versus Group) Understand how to identify and bill for TeleHealth Medicine Encounter Describe the role of other Non-Physician Services (NP, PA) Understand the Medicare and Commercial Insurance Documentation, Determination and Utilization Guidelines Who Should Attend this Webinar? Primary Care Providers: General Practice Family Practice Internal Medicine Obstetrics/Gynecology Pediatric Medicine Geriatric Medicine Nurse Practitioner Physician Assistant OTHER SPECIALTY: Gastroenterologists Pain Management Physicians PM & R Physicians Opthalmologists Neurologists Psychiatrists Bariatric Surgeons The presenter will be discussing...

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CMS Medicare Require Global Surgery Reporting for Post-Op Visits for 9 States
Aug16

CMS Medicare Require Global Surgery Reporting for Post-Op Visits for 9 States

CMS Require Global Surgery Reporting for Post-Op Visits Effective July 01, 2017 from 9 States  CMS now require providers who are part of a group practice with 10 or more providers; and are practicing in the State of Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island to report CPT Code 99024 to indicate a… Please LOGIN HERE to view this content. Or, REGISTER HERE Find this article useful? Please comment below and share what you just found from this website! Go ahead - please click "SHARE"EmailTweetShare on...

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Physician Provider Going Out of Network with the Insurance Company | Think Again
Aug05

Physician Provider Going Out of Network with the Insurance Company | Think Again

Going Out of Network with the Insurance Company, think again (especially when you are a Primary Care Provider)   How long ago have you revisited your contracts? when was the last time you have reviewed your contracts? – maybe 3, 5 or even 10+ years ago?). Three biggest reasons why provider would pursue going out of network: 1. If you are no longer happy with your payers’ contracted rates or because the contracted rates keep on changing; 2. Timely filing limit policy is also one reason; 3. Reimbursement Policy Guidelines (bundling services into one payment); But Before you go out of network, here are the things you might consider and take a look at: 1. As you know, not all your patients have an out-of-network benefits. You have to understand that because of this, your existing patients must be transferred to another provider or facility that accepts in-network benefits. Otherwise, out of network deductible/coinsurance will apply towards your patients’ responsibility; 2. Your patients population will likely decrease due to patients’ being without an out-of-network benefits. 3. Some insurance company would send the payment check for your rendered services made payable to their member or your patient because you are an out-of-network provider (isn’t this so true?); 4. When you are following-up on claim status, some insurance company will not disclose a more detailed information regarding the claim status (especially denial and rejection) not unless the patient (their member) will call them; (reality! – hold time for out-of-network provider on the phone is probably 20 minutes minimum!) – isn’t this true? Who had experienced this? (please share your thoughts below on the comment box); I do think the best action to do it — before terminating your contract with the insurance company is to try to NEGOTIATE first. Our company can help you with the process in negotiating with the insurance payer. Contact us here. Talk to your provider relations manager in the area. Discuss your intention of going out of network and ending your contract. Tell them your reasons why you want to terminate the contract. I know the insurance company will be willing to negotiate your contracted rate or your entire contract as a whole! Especially if they know it will affect their “members” — your patients! Now, if in the end, you still have decided to terminate the contract. Just make sure you inform your patients ahead of time and bluntly explain to them your reasons why you are terminating the contract with their insurance company. Explain it to the patients what and how this will affect them. The financial responsibility they might incur for being out...

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