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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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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Inpatient Consult Codes | How to Bill for Medicare Billing for Inpatient Consult Admitted Patient in the Hospital
Mar17

Inpatient Consult Codes | How to Bill for Medicare Billing for Inpatient Consult Admitted Patient in the Hospital

Inpatient Consult Codes – How to Bill for Medicare Billing for Inpatient Consult Admitted Patient in the Hospital Codes Your choice of code are based on the 3 Key Components of the Evaluation and Management E/M Services which are the: 1. History, 2. Examination, and 3. Medical decision-making. When billing initial hospital care, all three key… 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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CPT Code for Urine Drug Screen | Pain Management Clinic Drug Testing
Oct14

CPT Code for Urine Drug Screen | Pain Management Clinic Drug Testing

  *** 2017 NEW CPT CODES FOR URINE DRUG SCREENING – READ AND CLICK HERE! CPT Code for Urine Drug Screen | Pain Management Clinic Drug Testing G0431 (DELETED December 2015) G0434 (DELETED December 2015) New Codes: January 2016 CPT Code for Urine Drug Screen Presumptive CPT Code for Drug Screen Testing G0477 QW Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures, (eg, immunoassay) capable of being read by direct optical observation only (eg, dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service. G0478 Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures, (eg, immunoassay) read by instrument-assisted direct optical observation (eg, dipsticks, cups, cards, cartridges), includes sample validation when performed, per date of service. G0479 Drug tests(s), presumptive, any number of drug classes; any number of devices or procedures by instrumented chemistry analyzers (eg, immunoassay, enzyme assay, TOF, MALDI, LDTD, DESI, DART, GHPC, GC mass spectrometry), includes sample validation when performed, per date of service. Definitive CPT Code for Drug Screen Testing G0480 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 1-7 drug class(es), including metabolite(s) if performed. G0481 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 8-14 drug class(es), including metabolite(s) if performed. G0482 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding immunoassays (eg, IA, EIA, ELISA, EMIT, FPIA) and enzymatic methods (eg, alcohol dehydrogenase)); qualitative or quantitative, all sources, includes specimen validity testing, per day, 15-21 drug class(es), including metabolite(s) if performed.) G0483 Drug test(s), definitive, utilizing drug identification methods able to identify individual drugs and distinguish between structural isomers (but not necessarily stereoisomers), including, but not limited to GC/MS (any type, single or tandem) and LC/MS (any type, single or tandem and excluding...

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How to Bill for BCA Body Composition Analysis for Obesity Services | CPT Code for Body Composition Analysis
Aug19

How to Bill for BCA Body Composition Analysis for Obesity Services | CPT Code for Body Composition Analysis

  “The American Medical Association’s (AMA) recent revision of Current Procedural Technology (CPT) Category III Code 0358T, the code that insurance companies use to recognize Whole Body Composition Analysis tests whose results are generated through a scale called the bioelectric impedance analysis (BIA). Previously, code 0358T had only covered body composition tests that were conducted while a subject tested in the supine position.  A testing period for the revised code will now follow the CPT editorial board’s decision.  The code is scheduled for early release onJuly 1st, 2015, and patients and practitioners can begin contacting their insurance companies for billing options from this date.  Implementation will follow on January 1st, 2016.” So here’s what we need to know, the BCA or the Body Composition code that we can utilize is from the revised Category III code 0358T which will take effect January 1st, 2016 but the providers has to start calling their insurance payors since this code is a CAT III (Contains Temporary Set of Codes) and may not be reimbursable. Source: http://www.inbodyusa.com/blogs/inbodyblog/29243713-inbody-announces-important-revision-to-body-composition-analysis-cpt-code     GOT Question? Connect with me! 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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Billing Obesity Screening, Treatment and Counseling for Medicare and Commercial Payers
Jul12

Billing Obesity Screening, Treatment and Counseling for Medicare and Commercial Payers

If you are doing Obesity Screening and Counseling Services in your practice, here are the codes and guidelines I want to share with you: Keyword Tag: Billing Obesity Billing Obesity Screening, Treatment and Counseling for Medicare Keyword Tag: Billing Obesity HCPCS/CPT Codes G0447 – Face-to-face behavioral counseling for obesity, 15 minutes G0473 – Face-to-face behavioral counseling for obesity, group (2–10), 30 minutes Keyword Tag: Billing Obesity ICD-9-CM Codes for Obesity Screening, Treatment and Counseling for Medicare Keyword Tag: Billing Obesity Cross-over Diagnosis Codes (Choose 1)    –  V85.30–V85.39, V85.41–V85.45  V85.30 Body Mass Index 30.0-30.9, adult (Use ICD-10 Code Z68.30 – Effective October 1, 2015) V85.31 Body Mass Index 31.0-31.9, adult (Use ICD-10 Code Z68.31 – Effective October 1, 2015) V85.32 Body Mass Index 32.0-32.9, adult (Use ICD-10 Code Z68.32- Effective October 1, 2015) V85.33 Body Mass Index 33.0-33.9, adult (Use ICD-10 Code Z68.33 – Effective October 1, 2015) V85.34 Body Mass Index 34.0-34.9, adult (Use ICD-10 Code Z68.34 – Effective October 1, 2015) V85.35 Body Mass Index 35.0-35.9, adult (Use ICD-10 Code Z68.35 – Effective October 1, 2015) V85.36 Body Mass Index 36.0-36.9, adult (Use ICD-10 Code Z68.36 – Effective October 1, 2015) V85.37 Body Mass Index 37.0-37.9, adult (Use ICD-10 Code Z68.37 – Effective October 1, 2015) V85.38 Body Mass Index 38.0-38.9, adult (Use ICD-10 Code Z68.38 – Effective October 1, 2015) V85.39 Body Mass Index 39.0-39.9, adult (Use ICD-10 Code Z68.39 – Effective October 1, 2015) Keyword Tag: Billing Obesity V85.41 Body Mass Index 40.0-44.9, adult (Use ICD-10 Code Z68.41 – Effective October 1, 2015) V85.42 Body Mass Index 45.0-49.9, adult (Use ICD-10 Code Z68.42 – Effective October 1, 2015) V85.43 Body Mass Index 50.0-59.9, adult (Use ICD-10 Code Z68.43 – Effective October 1, 2015) V85.44 Body Mass Index 60.0-69.9, adult (Use ICD-10 Code Z68.44 – Effective October 1, 2015) V85.45 Body Mass Index 70 and over, adult (Use ICD-10 Code Z68.45 – Effective October 1, 2015)     Keyword Tag: Billing Obesity Who Is Covered for Billing Obesity Screening, Treatment and Counseling for Medicare? Keyword Tag: Billing Obesity Medicare beneficiaries: • With obesity (Body Mass Index [BMI] ≥ 30 kilos) • Who are competent and alert at the time counseling is provided; and • Whose counseling is furnished by a qualified primary care physician or other primary care practitioner in a primary care setting 01 – General Practice 08 – Family Practice 11 – Internal Medicine 16 – Obstetrics/Gynecology 37 – Pediatric Medicine 38 – Geriatric Medicine 50 – Nurse Practitioner 89 – Certified Clinical Nurse Specialist 97 – Physician Assistant Keyword Tag: Billing Obesity Frequency for Billing Obesity Screening, Treatment and Counseling for Medicare • First month: one visit every week; • Months 2 – 6: one visit...

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