This webinar is a review of how to appropriately assign frequently misapplied CPT and HCPCS modifiers. Older modifiers and newly added modifiers, that were effective January 1, 2023, will be covered. This webinar is focused on modifiers that should be used on the professional side. While some of these modifiers can also be used on the facility side, this presentation does not focus on assigning modifiers on the facility side. Stay tuned for part two of this series which will cover a facility-focused guide to applying modifiers correctly.
Physicians Angels is the first virtual real-time scribe service for medical professionals. Our innovative service offers live data entry and support to busy medical professionals. Physicians Angels helps you focus on patient care, not paper care.
Physicians Angels is the first virtual real-time scribe service for medical professionals. Our innovative service offers live data entry and support to busy medical professionals. Physicians Angels helps you focus on patient care, not paper care.
NCQA’s Accreditation process provides payers with a comprehensive framework to improve quality of care and services. It allows members and employers to compare health plan performance across various plans and against industry benchmarks. NCQA accreditation has 3 parts – HEDIS, Patient experience CAHPS measures and NCQA standards
A seminar made to the Tennessee Department of Health in July 2015. An introduction to HL7 standards with a focus on HL7 v3 messaging and clinical document architecture standards.
Healthcare Management for Change
Lecture By Ravi kumudesh,
President, College of Medical Laboratory Science
for Allied Health Science Graduates
On December 09, 2016
at National Institute of Health Science, Sri Lanka
“Management is the art of “knowing what you want to do” and then seeing that it is done in the best and cheapest way. ……F.W.Taylor
Strategist Management
"The Art and Science of Formulating, Implementing, and Evaluating Cross-Functional Decisions That Enable an Organization to Achieve It’s Objectives"
Management as a process “consisting of planning, organizing, actuating and controlling, performed to determine and accomplish the objective by the use of people and resources.”
……George R. Terry
7 Strategies to Improve HEDIS Scores and Star RatingsHealthx
In recent years, achieving high scores on HEDIS® measures and Medicare Star Ratings has taken on greater importance for health plans. What was once nice-to-have for marketing purposes has become a must-have for operating in certain lines of business. Here’s why: NCQA Health Plan Accreditation, financial bonuses, and even a plan’s ability to enroll members can be affected by their ratings. If HEDIS Scores and Star Ratings are so important, why don’t more plans work to improve them?
Quality and Outcome Framework (QOF) is a voluntary annual incentive programme for GPs in England, detailing practice achievement results. The primary objective of QOF is to drive the quality of primary care and reduce variations in the quality of care amongst GPs
Total Quality Management in HealthcareGunjan Patel
Now days, Healthcare systems are of fundamental interests to all level of Hospitals in our societies. Eventually, increasing importance and reliance are placed on total quality management in healthcare systems. Due to this rising importance that is also reflected in the increasing percentage of national and international resources for both private and public sector to allocated in hospital management systems. Hospitals and other healthcare organization across the globe have been progressively implementing TQM to reduce costs, improve efficiency and provide high quality patient care.
The best of clinical pathway redesign - practical examples of delivering bene...NHS Improvement
The examples here showcase just some of the innovations that have enabled thousands of patients to enjoy better health and well-being thanks to practicalservice improvements implemented on various clinical pathways
Webinar - A Physician-Focused Guide to Applying Modifiers CorrectlyHealth Catalyst
This webinar is a review of how to appropriately assign frequently misapplied CPT and HCPCS modifiers. Older modifiers and newly added modifiers, that were effective January 1, 2023, will be covered. This webinar is focused on modifiers that should be used on the professional side. While some of these modifiers can also be used on the facility side, this presentation does not focus on assigning modifiers on the facility side. Stay tuned for part two of this series which will cover a facility-focused guide to applying modifiers correctly.
A Facility-Focused Guide to Applying Modifiers Corectly.pptxHealth Catalyst
This webinar is a review of how to appropriately assign frequently misapplied CPT and HCPCS modifiers. Older modifiers and newly added modifiers, that were effective January 1, 2023, will be covered. This webinar is focused on modifiers that should be used on the facility side. While some of these modifiers can also be used on the professional side, this presentation does not focus on assigning modifiers on the professional side. For information regarding applying modifiers on the professional side, please see part one of this series--A Physician-Focused Guide to Applying Modifiers Correctly.
NCQA’s Accreditation process provides payers with a comprehensive framework to improve quality of care and services. It allows members and employers to compare health plan performance across various plans and against industry benchmarks. NCQA accreditation has 3 parts – HEDIS, Patient experience CAHPS measures and NCQA standards
A seminar made to the Tennessee Department of Health in July 2015. An introduction to HL7 standards with a focus on HL7 v3 messaging and clinical document architecture standards.
Healthcare Management for Change
Lecture By Ravi kumudesh,
President, College of Medical Laboratory Science
for Allied Health Science Graduates
On December 09, 2016
at National Institute of Health Science, Sri Lanka
“Management is the art of “knowing what you want to do” and then seeing that it is done in the best and cheapest way. ……F.W.Taylor
Strategist Management
"The Art and Science of Formulating, Implementing, and Evaluating Cross-Functional Decisions That Enable an Organization to Achieve It’s Objectives"
Management as a process “consisting of planning, organizing, actuating and controlling, performed to determine and accomplish the objective by the use of people and resources.”
……George R. Terry
7 Strategies to Improve HEDIS Scores and Star RatingsHealthx
In recent years, achieving high scores on HEDIS® measures and Medicare Star Ratings has taken on greater importance for health plans. What was once nice-to-have for marketing purposes has become a must-have for operating in certain lines of business. Here’s why: NCQA Health Plan Accreditation, financial bonuses, and even a plan’s ability to enroll members can be affected by their ratings. If HEDIS Scores and Star Ratings are so important, why don’t more plans work to improve them?
Quality and Outcome Framework (QOF) is a voluntary annual incentive programme for GPs in England, detailing practice achievement results. The primary objective of QOF is to drive the quality of primary care and reduce variations in the quality of care amongst GPs
Total Quality Management in HealthcareGunjan Patel
Now days, Healthcare systems are of fundamental interests to all level of Hospitals in our societies. Eventually, increasing importance and reliance are placed on total quality management in healthcare systems. Due to this rising importance that is also reflected in the increasing percentage of national and international resources for both private and public sector to allocated in hospital management systems. Hospitals and other healthcare organization across the globe have been progressively implementing TQM to reduce costs, improve efficiency and provide high quality patient care.
The best of clinical pathway redesign - practical examples of delivering bene...NHS Improvement
The examples here showcase just some of the innovations that have enabled thousands of patients to enjoy better health and well-being thanks to practicalservice improvements implemented on various clinical pathways
Webinar - A Physician-Focused Guide to Applying Modifiers CorrectlyHealth Catalyst
This webinar is a review of how to appropriately assign frequently misapplied CPT and HCPCS modifiers. Older modifiers and newly added modifiers, that were effective January 1, 2023, will be covered. This webinar is focused on modifiers that should be used on the professional side. While some of these modifiers can also be used on the facility side, this presentation does not focus on assigning modifiers on the facility side. Stay tuned for part two of this series which will cover a facility-focused guide to applying modifiers correctly.
A Facility-Focused Guide to Applying Modifiers Corectly.pptxHealth Catalyst
This webinar is a review of how to appropriately assign frequently misapplied CPT and HCPCS modifiers. Older modifiers and newly added modifiers, that were effective January 1, 2023, will be covered. This webinar is focused on modifiers that should be used on the facility side. While some of these modifiers can also be used on the professional side, this presentation does not focus on assigning modifiers on the professional side. For information regarding applying modifiers on the professional side, please see part one of this series--A Physician-Focused Guide to Applying Modifiers Correctly.
Modifiers List in Medical Billing and CodingNick Johnson
A CPT Modifier is a two-position alpha and alpha-numeric code used to identify certain situations that require the basic value of a procedure to be either enhanced or diminished. A modifier provides the means by which a service or procedure that has been performed can be altered without changing the procedures code. Modifying circumstances include. CPT Modifiers are an important part of the managed care system or medical billing.
A service or procedure that has both a professional and technical component. (26 or TC)
A service or procedure that was performed more than once on the same day by the same physician or by a different physician. (76 or 77)
A bilateral procedure service that was performed. (50)
A distinct procedure service. (59)
Presentation of proper coding and usage of modifiers (Level I and Level II)
Have trouble knowing what modifier to use and how use will impact your claim? Take a look at the presentation "The In's and Out's of Coding with Modifiers", which explain modifiers for you! Hope you enjoy!
2 Best Practices to Improve Emergency Department CodingManish Jain
Emergency Department Coding Best Practices - Read First part of the article published by AAPC Healthcare Business Monthly Magazine - the article has been authored by Gayathri Natarajan, head of Coding for Access Healthcare
2011 CMS Physician Quality Reporting System (PQRS): Teaching Doctors of Chiropractic How to Report on Measures Related to Quality Patient Care by Tony Hamm, American Chiropractic Association
Medical coding best-practices_for_emergency_departments (1)Manish Jain
In this paper, you will learn about the unique medical coding and billing challenges posed by emergency departments and the coding best practices to ensure optimal reimbursements.
The Ultimate Guide to Orthopedic Medical Billing - Best Practices and Strateg...Cosentus
This is truly extraordinary how something as simple can have a hold in such a profound level of specialty. This can contribute to the field of medicine in a very important manner. Orthopedics is the medical level of discipline that
works on the surgery that is connected with the conditions of the musculoskeletal system like bones, tendons, joints, and ligaments. An important process for orthopedic practitioners is to work with orthopedic medical billing.
A Guide for Medical Billing and Coding Audits for Wound Care Providers.pdfSolemanOne
Utilizing evidence-based clinical practice guidelines, wound care practitioners can use this medical billing road map to enhance their clinical documentation and adhere to payer coverage policy and medical necessity requirements.
Empowering ACOs: Leveraging Quality Management Tools for MIPS and BeyondHealth Catalyst
Join us as we delve into the crucial realm of quality reporting for MSSP (Medicare Shared Savings Program) Accountable Care Organizations (ACOs).
In this session, we will explore how a robust quality management solution can empower your organization to meet regulatory requirements and improve processes for MIPS reporting and internal quality programs. Learn how our MeasureAble application enables compliance and fosters continuous improvement.
Unlock the Secrets to Optimizing Ambulatory Operations Efficiency and Change ...Health Catalyst
Today’s healthcare leaders are seeking technology solutions to optimize efficiencies and improve patient care. However, without effective change management and strategies in place, healthcare leaders struggle to strategically improve patient flow, space, to strategically improve patient flow, space, and schedule management, and implement daily huddles. The role of technology in supporting operational efficiency and change management initiatives is inevitable.
During this webinar, attendees will learn how to optimize Ambulatory Operational Efficiencies and Change Management. Attendees will also learn about the importance of visual management boards in enhancing clinic performance and insights into effective change management approaches.
Patient expectations are rising, and organizations are continuously being asked to do more with less.
Additionally, the convergence of several significant emerging market and policy trends, economic uncertainty, labor force shortages, and the end of the COVID-19 public health emergency has created a unique set of challenges for healthcare organizations.
Attend this timely webinar to learn about new trends and their impact on key healthcare issues, such as patient engagement, migration to value-based care, analytics adoption, the use of alternative care sites, and data governance and management challenges.
During this webinar, we will discuss the complexities of AI, trends, and platforms in the industry. Dive deep into understanding the true essence of AI, exploring its potential, real-world use cases, and common misconceptions. Gain valuable insights into the latest technology trends impacting healthcare and discover strategies for maximizing ROI in your technology investments.
Explore the profound impact of data literacy on healthcare organizations and how it shapes the utilization of data and technology for transformative outcomes. Understand the top technology priorities for healthcare organizations and learn how to navigate the digital landscape effectively. Furthermore, simplify industry jargon by defining common data elements, fostering clearer communication and collaboration across stakeholders.
Finally, uncover the transformative potentials of platforms in healthcare and how they can revolutionize scalability, interoperability, and innovation within your organization. Don't miss this opportunity to gain invaluable insights from industry experts and stay ahead in the ever-evolving healthcare landscape. Reserve your spot now for an enlightening journey into the future of healthcare technology!
Three Keys to a Successful Margin: Charges, Costs, and LaborHealth Catalyst
How can cost management and complete charge capture protect and enhance the margin?
In this webinar, we will look at 2024 margin pressures likely to impact your organization’s financial resiliency. This presentation will also share how organizations can move from Fee-for-Service to Value; bringing Cost to the forefront.
2024 CPT® Updates (Professional Services Focused) - Part 3Health Catalyst
Each year the CPT code set undergoes significant changes. Physicians and their office staff need to be aware of the changes in order to ensure a smooth transition into 2024. Join us for a discussion of the new, deleted and revised CPT codes and associated guidelines for 2024. This presentation will focus on the changes to the CPT dataset and the associated work RVU value changes that impact professional service reporting.
During this complimentary webinar, we will empower you to correctly apply the new and revised codes and discuss the rationale behind this year’s changes. You will leave with an understanding of the financial implications of the changes on your practice.
2024 CPT® Code Updates (HIM Focused) - Part 2Health Catalyst
Each year the CPT code set and the HCPCS code set undergo significant changes, and your coding staff needs to be aware of the changes in order to ensure a smooth transition into 2024. Join us for a discussion of the new, deleted and revised CPT codes and associated guidelines for 2024. This is part two in a three-part series.
During these complimentary webinars, we will empower you to correctly apply the new and revised codes and discuss the rationale behind this year’s changes. This presentation will be geared towards hospital staff with a focus on the surgical section of the CPT book in addition to surgical Category III codes.
2024 CPT® Code Updates (CDM Focused) - Part 1Health Catalyst
Each year the CPT and the HCPCS code sets undergo significant changes, and your staff needs to be aware of the changes in order to ensure a smooth transition into 2024. Join us for a discussion of the new, deleted, and revised CPT codes and associated guidelines for 2024. This is part one in a three-part series, with a CDM focus.
During these complimentary webinars, we will empower you to correctly apply the new and revised codes and discuss the rationale behind this year’s changes. This presentation will be geared towards hospital staff with a focus on the non-surgical sections of the CPT book.
What’s Next for Hospital Price Transparency in 2024 and BeyondHealth Catalyst
The Centers for Medicare & Medicaid Services (CMS) published updates to the hospital price transparency requirements in the CY 2024 Outpatient Prospective Payment System (OPPS) Final Rule. The updates will be phased in over the next 14 months and include several significant changes including the use of a CMS-mandated template, a requirement for an affirmation statement from the hospital, and several new data elements. Join us to discover what changes are scheduled for implementation in 2024 and 2025 and how they’ll impact your facility.
During this complimentary 60-minute webinar, we’ll analyze the key provisions of the Price Transparency regulations and provide insights to help you prepare for the upcoming changes.
Automated Patient Reported Outcomes (PROs) for Hip & Knee ReplacementHealth Catalyst
What was once voluntary reporting will soon be made mandatory with penalties.
On July 1, 2024, all health systems will be required to collect Patient Reported Outcome Measures (PROM) as part of the Centers for Medicare & Medicaid Services (CMS) regulation for the following measures:
Hospital-Level, Risk Standardized Patient-Reported Outcomes Performance Measure (PRO-PM) Following Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA)
Hospital-Level Risk-Standardized Complication Rate (RSCR) Following Elective Primary THA/TKA
Are you equipped to handle these new requirements?
Mandatory data collection begins April 1, 2024, and failure to submit timely data can result in a 25 percent reduction in payments by Medicare.
Attend this webinar to learn how mobile engagement can empower your organization to meet this requirement.
2024 Medicare Physician Fee Schedule (MPFS) Final Rule UpdatesHealth Catalyst
According to the Centers for Medicare & Medicaid Services (CMS), the calendar year (CY) 2024 MPFS final rule was created to advance health equity and improve access to affordable healthcare. This webinar will cover the major policy updates of the MPFS final rule including updates to the telehealth services policy and remote monitoring services and enrollment of MFTs and MHCs as Medicare providers. The conversation will also cover policy changes on split (or shared) evaluation and management (E/M) visits, and the Appropriate Use Criteria (AUC) for Advanced Diagnostic Imaging.
What's Next for OPPS: A Look at the 2024 Final RuleHealth Catalyst
During this webinar, we’ll analyze the key provisions of the OPPS final rule and identify the significant changes for the coming year to help prepare your staff for compliance with the 2024 Medicare outpatient billing guidelines.
Insight into the 2024 ICD-10 PCS Updates - Part 2Health Catalyst
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Prepare for mandatory ICD-10 CM diagnosis code updates, which take effect on October 1, 2023. By attending this 60-minute educational session, medical coders and healthcare professionals will gain a comprehensive understanding of the changes to the 2024 ICD-10 diagnosis codes and their guidelines, along with major complication or comorbidity (MCC), complication or comorbidity (CC), and Medicare Severity Diagnosis Related Groups (MS-DRGs) classification changes. With this information, professionals can ensure accurate and compliant diagnosis coding for optimal billing and reimbursement.
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Many hospitals today face a perfect storm of operational and financial challenges. With increasing competition from outpatient facilities and rising care costs negatively impacting budgets, now is the time to boost your clinical registry’s value. However, collecting and analyzing data can be time-consuming and costly without the right tools. During this webinar, we will share insights and best practices for increasing the value of registry participation and how it’s possible to reduce costs while improving outcomes using the ARMUS Product Suite.
Tech-Enabled Managed Services: Not Your Average OutsourcingHealth Catalyst
During this webinar you'll learn the following:
The importance of optimizing performance, reducing labor costs and sourcing talent given current market challenges.
Highlighting the need for a balanced approach to cost reduction.
How to reap the benefits of outsourcing (cost cutting, expertise, etc) while protecting yourself from the collateral damage that often comes with them.
This webinar will provide an in-depth review of the CPT/HCPCS code set changes that will be effective on July 1, 2023. The review will include additions and deletions to the CPT/HCPCS code set, revisions of code descriptors, payment changes, and rationale behind the changes.
How Managing Chronic Conditions Is Streamlined with Digital TechnologyHealth Catalyst
Chronic conditions across the United States are prevalent and continue to rise. Managing one or more chronic diseases can be very challenging for patients who may be overwhelmed or confused about their care plan and may not have access to the resources they need. At the same time, care teams are overburdened, making it difficult to provide the support these patients require to stay as healthy as possible. A new approach to chronic condition management leverages technology to enable organizations to scale high-quality care, identify gaps in care, provide personalized support, and monitor patients on an ongoing basis. Such streamlined management will result in better outcomes, reduced costs, and more satisfied patients.
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In this fast-paced webinar, we will discuss the impact of the end of the public health emergency (PHE), including upcoming changes to the different flexibilities allowed during the PHE and the timeline for when these flexibilities will end. We’ll also cover coding changes and reimbursement updates.
Automated Medication Compliance Tools for the Provider and PatientHealth Catalyst
When it comes to sustaining patient health outcomes, compliance and adherence to medication regimens are critically important, especially as providers manage patients with complex care needs and multiple medications. But, with provider burnout and staffing shortages at an all-time high, an efficient solution is critical. The use of automated medication management workflows to decrease provider burnout, while improving both medication compliance and patient engagement, is the way forward.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
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Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
NCCI and PTP edits indicate that two codes generally can’t be reported together. Certain modifiers help to bypass these edits which I’ll show in the next slide.
modifiers that may be used under apropriate clinical circumstances to bypass an NCCI PTP edit include…
It’s very important that NCCI PTP-associated modifiers only be used when appropriate. In general, these circumstances relate to separate patient encounters, separate anatomic sites, or separate specimens.
We’re not going to cover all of these today- a couple of these are only for facility use- we will cover most. I just wanted to give you the full list.
The physician may need to indicate that an E&M service was performed during a postoperative period for reasons unrelated to the original procedure. This modifier is attached to that specific E&M service code. Not going to use this if patient is coming in for a complication of surgery or infection related to the surgery, removal of sutures, or other wound treatment… that’s all part of your surgical package.
Diagnosis code is critical since it should be unrelated, but there is the event where you may have the same dx code if the same problem occurs at a different anatomical site. That should be specified in the documentation.
Post operative period- This is the global period or global days. For major surgeries (90 day global period), global days start the day prior to the surgery, count the day of surgery, then count 90 days after surgery. For minor surgeries, count the day of the procedure then the appropriate number of days following surgery. (ex. Global days of 10. Surgery is day zero, then ten days) For information about global days: CMS’s Resource Based relative value scale, also published yearly in AMA’s Medicare RBRVS: The physician’s guide. So if you’re no longer in the surgical period then this modifier is not needed.
Diagnosis code selection is critical when indicating the reason for the E&M service. Must be unrelated. If the dx code for the E/M service doesn’t clearly support that the visit was unrelated to the initial surgery, it may be necessary to submit additional documentation. Doctor notes more details about visit and why it’s not related.
For information about global days: CMS’s Resource Based relative value scale, also published yearly in AMA’s Medicare RBRVS: The physician’s guide
Without the modifier, the payer may consider this visit as part of the surgical global package which would lead to it being denied.
Used to indicate that on the day a procedure or service identified by a CPT code was performed, the patient’s condition required a significant, separately identifiable E/M service above and beyond the other service provided or beyond the usual preoperative and postoperative care associated with the procedure that was performed.
Second bullet- a different diagnosis as the original diagnosis may not be required to report the E/M service on the same date with the modifier 25. So the procedure and the E/M may have the same diagnosis code associated to it. This was clarified by the AMA because there are cases where you are only reporting modifier 25 because you are going above and beyond the usual work for the procedure, not because you are tending to a different issue, so in that case the diagnosis would be the same. An example of going above and beyond the usual work would be if a patient comes in for a scalp laceration and before suturing the laceration the physician performs a neurological examination and a comprehensive history/exam. So for this instance the physician could report the code for the procedure as well as an E/M with mod. 25
Third bullet- So the main thing you want to ask is why is this patient being seen? Are there signs, symptoms, conditions that must be addressed before deciding to perform a procedure or service? If yes, then that E/M might be medically necessary with modifier 25. And again, this can be related to the procedure or not.
What happens if you do not append modifier 25 to an E/M service and you report a procedure/service with the E/M service? It would be likely that it would either be denied (even if you have a different diagnosis for each service), or the insurance would pay for the lesser of the two services and bundle the services.
Services that do not meet appropriate guidelines for reporting an E/M service. (Ex. To report code 99203 three of the key components (history, examination, and MDM) of the CPT description must be met and supported in the documentation. So do not use automatically if two different diagnoses are present. The E/M key components must be met.
Be careful when dealing with commercial payers… this is one modifier where we tend to see differences between payers and medicare policies. Many payers believe that modifier 25 is over used and abused. This modifier has been on the Office of Inspector General (OIG) watch list and has triggered many provider audits for high use and mis use. So just use caution when reporting this esp. when reporting minor procedures. The documentation must show that the E/M service goes above and beyond usual care for this type of procedure.
So if the E/M service is related to the renal failure (hypertension, fluid overload, uremia, electrolyte imbalance) or any E/M service related to the dialysis procedure performed on the same date of service as the dialysis procedure should NOT be reported separately, even if performed on a separate patient encounter that day. So if you report a modifier 25 on this day make sure that the documentation explicitly states that it was not related to the renal failure or dialysis.
When pre operative critical care codes are reported on the date of the procedure, the diagnosis must support that the service is unrelated to the performance of the procedure. If the diagnosis for the critical care services is unrelated to the specific anatomic injury or general surgical procedure performed, this is sufficient
Again, this is something payers are scrutinizing.. They may see that one physician in a group uses it more than others and that may raise a red flag, or they may see that there’s a higher percentage than they deem “normal” use
For preventative medicine services you really need to make sure that a separate issue is being addressed that requires significant additional work to perform the key components of an E/M service. So let’s look at an preventative medicine example where modifier 25 would be appropriate.
B/c there was extra work for the physician and he spent more time obtaining history of the problem and examining the problem focused area and providing straightforward MDM for the knee problem, it is appropriate to provide preventative care and problem oriented care in the same visit.
we see a difference in coding guidance and payers here. Coding guidance says not to use modifier since it’s stated in the code definition but some payers want the modifier regardless. So check with your payer. You can push back here and say coding guidance does not support modifier usage in these circumstances but ultimately it will be on the payer to decide.
These are informational only but were added to streamline claims processing so that there wouldn’t be a need to request additional documentation to avoid duplicate or other inappropriate billing.
Some third party payers require these modifiers.
Unlisted codes do not report specific procedures; therefore modifiers should not be appended
Most S&I codes are already separated into unilateral and bilateral where appropriate
Multiple payers do not use these modifiers as intended – Don’t be afraid to push back on payers that are asking for modifiers that violate correct coding principles
This should not be appended to procedures for midline organs like the bladder, uterus, esophagus, or nasal septum.
Breaking up procedures that state bilateral in the code description and coding them as two unilateral procedures is against the NICCI guidelines and incorrect coding from a CPT perspective.
Medicare Physician Fee Schedule bilateral indicator – This is a PAYMENT indicator and not necessarily an indicator of where modifier -50 is appropriate but sometimes it can be. For example, unlisted hysteroscopy procedure, uterus (58579) has a bilateral indicator of 1 which means that “ modifier 50 can be appropriate” although modifier -50 is clearly not appropriate in this case. You won’t use modifier 50 with your bilateral surgery indicators that indicate that 50 is not appropriate such indicator 9 which indicates that the bilateral concept doesn’t apply (used for an office visit).
Another thing to note about mod 50. If more than one bilateral procedure is performed, make sure to adjust the number of units to reflect the number of procedures and it’s also recommended to add an anatomical modifier with the 50 to show that the additional services are not duplicates.
For modifier 50- medicare and most payers will pay at 150%
Provides a way to report the report that the procedure was reduced without disturbing the identification of the actual service performed.
Second bullet- ankle example.. If only one view was completed.
If a key component is missing from an E/M service, or if the service cannot be supported with another E/M level or code, the service is reported with the unlisted E/M code 99499
Third bullet- time based procedure codes.. Look into this to explain
Unilateral or bilateral- descriptor says it covers either so you do not need to reduce the services.
If the code describes a panel of tests such as code 80076 which is the hepatic function panel and one of the tests are not done.. Like the albumin test.. Then code all the tests done separately rather than adding the modifier 52
Another note about this modifier- CMS is not going to recognize this on PLA codes or add on codes.
First bullet- So modifier 53 would not be used in cases where the procedure does not require any type of anesthesia, like some radiology procedures or EKGs or device programming.
First bullet- So if the plan was for the patient to have multiple procedures while under anesthesia, you only want to report the first procedure that was planned with the modifier. Do not report the other procedures.
Second- Same as modifier 52, not to be used with E/M
Third- You just code the open procedure
Fourth- you just code the more extensive procedure.
Fifth- an op report explaining what extent the procedure go ot.
First bullet- Used to indicate that the procedure being coded is not considered a component of another procedure. It’s used for services that are not normally reported together, but are appropriate under the circumstances.
Second bullet- so for example if a patient has two separate operations on the same day. Or if they have one surgery session but on two different anatomic sites through two different incisions (that is not typically reported together). Example: Patient has destruction of actinic keratosis of the back and a skin biopsy of the cheek. The skin biopsy may be separately coded with modifier 59 since the sites are different.
2nd bullet- Example: 34833 and 34820 describe different procedures; however the instructions found in the CPT book state these procedures should not be reported together for the same side of the body. If performed on separate sides, modifiers RT and LT may be reported
3rd bullet – example for anatomic sites would be to use the finger modifiers (like F1, F2, etc.) to indicate that the procedure was done on separate digits rather than assigning a 59 to the second procedure code.
These four modifiers were created by CMS in Jan. 2015 due to the widespread misuse and abuse of modifier 59. They give more specificity than modifier 59. No more information was posted about these modifiers for years and then In March 2022 more information regarding the use of these modifiers was released and I’ve included the link here. (long time after they initially came out)
Basically these modifiers should be used in place of 59 whenever possible. Should only be used when a more specific anatomic modifier can’t be used such as RT, LT, etc.
Separate encounter- if patient has two services during two different encounters on the same day you would use this. In the MLN article they talk about using this with timed codes performed during the same encounter and that it can be used if the procedures unit of service is time (like codes that state per 15 minutes)… if you provide 2 timed services that are separate and distinct and aren’t mingled with each other like you complete one service before starting the next, you can use this modifier in that situation.
Separate structure- used for different anatomic sites during the same encounter only when the procedure is performed on different organs, different anatomic regions, or in limited situations on different, non contiguous lesions in different anatomic regions of the same organ. So lesions that are not touching. Also, if this can be described more accurately with the actual anatomic modifier you need to use that one instead of this.
Separate practitioner- different practitioner.
Unusual non-overlapping service- 2 instances they go into detail about with using modifier XU is:
Using modifier XU properly for a diagnostic procedure which is performed before a
therapeutic procedure only when the diagnostic procedure is the basis for performing the
therapeutic procedure. When you perform a diagnostic procedure before a surgical procedure or
non-surgical therapeutic procedure and it’s the basis on which you decide to perform the surgical
procedure or non-surgical therapeutic procedure, you may consider that diagnostic procedure to be a
separate and distinct procedure if it:
a. Occurs before the therapeutic procedure and isn’t mingled with services the therapeutic
intervention requires
b. Provides clearly the information needed to decide whether to proceed with the therapeutic
procedure; and
c. Doesn’t If the diagnostic procedure is constitute a service that would have otherwise been required during the therapeutic
intervention (See example 10 below.)
an inherent component of the surgical procedure, don’t report it separately
Another example for the use of modifier XU would be for a
diagnostic procedure which occurs after a completed therapeutic procedure only when the diagnostic procedure isn’t a common,
expected, or necessary follow-up to the therapeutic procedure. When a diagnostic procedure
follows the surgical procedure or non-surgical therapeutic procedure, you may consider that
diagnostic procedure to be a separate and distinct procedure if it:
a. Occurs after the completion of the therapeutic procedure and isn’t mingled with or otherwise
mixed with services that the therapeutic intervention requires
b. Doesn’t constitute a service that would have otherwise been required during the therapeutic
intervention. If the post-procedure diagnostic procedure is an inherent component or
otherwise included (or not separately payable) post-procedure service of the surgical
procedure or non-surgical therapeutic procedure, don’t report it separately
Recommend checking out the MLN I put here… many examples
First bullet ECG example: So the modifier is only appended to the subsequent services/procedures, not the first one. Medicare will allow multiple ECG interpretations on the same day when necessary but to prevent billing denials the time that each service was performed must be submitted on the claim.
Obviously this shouldn’t be used with procedures that would not reasonably be done twice in once day like the removal of a device. If they removed it once then it’s out already so it would be questioned.
Bullet 2- So if different doctors run the same test on the same date of service just to confirm results. It would not be appropriate to use modifier 91 in this case. Or if best practices were not followed when drawing the specimen and the specimen was compromised, it would not be appropriate to run the test twice and use modifier 91 on the second.
So when you’re reporting this you will report each service on a separate line with 91 only appended to the repeat procedure.
The word Procedure was added to this description to clarify that this modifier does not only apply to major inpatient surgeries.. This is any procedure.
Modifier 58 is Staged or related procedure or service by the same physician or QHP during the post op period.
Modifier 79 is an unrelated procedure that is performed by the same physician in the post op period. It is something completely different from the first procedure that has nothing to do with the first procedure.. Example if the patient got in a wreck and needed surgery for an injury due to the wreck.
Modifier 76 we covered previously but as a reminder this is when the exact same procedure or service is repeated again. Reasons may include:
It was performed for comparative purposes
The two services were performed at different times (indicate actual times)
It was for follow-up after treatment or intervention
It was to repeat a test at different intervals
Again global days of 10 ,or 90
This is for procedures with global days of 0, 10, or 90.
Second bullet: CMS says that the usual reimbursement amount accounts for the possibility that sometimes the procedure or service will be easier and other times more difficult so the documentation must really support the substantial additional work that was done and the reason for that additional work.
Substantial additional work= Many coding specialists say that unless 25% more work was performed mod. 22 shouldn’t be appended. For CMS and many other payers, they require that the operative time increase by 50% for modifier 22 to be appended.
CMS will require you to submit documentation if you use this modifier. (an operative report)
Remember- don’t just say “took extra time”.. Need to explain why it took extra time. … also generalized statements like “the surgery was difficult” will not hold up.
For obesity.. Extra time due to obesity won’t hold up… why did the obesity make the surgery more difficult or take extra time
If extra time is due to an average amount of division of adhesions between organs this won’t hold up… routine division of adhesions is a normal part of surgery. Would have to be more than average. Maybe they have scar tissue that’s making it difficult to get to procedure site.
The MACs have their own guidelines about what counts as increased procedural services. … some require a separate statement along with the op report.
Third party payers sometimes want to review the entire record before granting this modifier… could delay payment. Some third payers do not recognize this modifier anymore and won’t pay extra.
CMS added 3 new modifiers for home oxygen use. These would replace the KX modifier that indicates the presence of qualifying medical information. They are effective Jan. 1, but not available until the April 2023 HCPCS code release. Not much information has been provided on these modifiers. CMS sent out a brief announcement introducing these three modifiers, but there was no detail included. They said that the MACs would provide more detail. I have not seen additional detail published yet. Just wanted to make you aware of them to watch out for additional info from your MAC.
CMS will allow Medicare beneficiaries access to select audiology services without a physician order once every 12 months through use of a new “AB” modifier, reported with one or more of 36 CPT codes delivered on the same date of service when provided by audiologists. In the proposed rule, CMS planned to create a new G-code to replace CPT codes when a service is provided by an audiologist without a physician order. However, in the final rule CMS reversed course on the G-code proposal and selected the CPT code/modifier option based on the specific and detailed rationale offered by ASHA in its comments. While the use of the code/modifier improves the accuracy of audiology claims data and payments, as well as eliminates coding confusion, ASHA finds the restrictions placed on accessing audiology services without a physician order to be arbitrary and lacking any clinical justification. ASHA will continue to advocate for passage of the bipartisan and bicameral Medicare Audiologist Access and Services Act (H.R. 1587/S. 1731), which removes the physician referral requirement completely while appropriately expanding Medicare coverage to include both diagnostic and treatment services provided by audiologists.
From phys. Fee schedule final rule fact sheet.
CMS finalized a policy to allow beneficiaries direct access to an audiologist without an order from a physician or NPP for non-acute hearing conditions. The finalized policy will use a new modifier ─ instead of using a new HCPCS G-code as we proposed ─ because we were persuaded by the commenters that a modifier would allow for better accuracy of reporting and reduce burden for audiologist. The service(s) can be billed using the codes audiologists already use with the new modifier, and include only those personally furnished by the audiologist. The finalized direct access policy will allow beneficiaries to receive care for non-acute hearing assessments that are unrelated to disequilibrium, hearing aids, or examinations for the purpose of prescribing, fitting, or changing hearing aids. This modification in our finalized policy necessitates multiple changes to our claims processing systems, which will take some time to fully operationalize, but audiologists may use modifier AB, along with the finalized list of 36 CPT codes, for dates of service on and after January 1, 2023.
CMS finalized the proposal to permit audiologists to bill for this direct access (without a physician or practitioner order) once every 12 months per beneficiary. Medically reasonable and necessary tests ordered by a physician or other practitioner and personally provided by audiologists will not be affected by the direct access policy, including the modifier and frequency limitation.
Did not see any additional information from the MACS on this modifier
You may start reporting on Jan. 1, 2023 that’s when modifier was effective, but it’s not mandatory until 7/1
Append this modifier to the supply code for the drug or biological to show that there is no discarded amount to report after administration to the patient.
Use of this modifier ties in with modifier JW, which is not a new modifier.. Its been around since 2003. JW is appended to drugs or biologicals codes to show that the provider administered the necessary or prescribed amount of the drug supplied in a single dose vial and discarded the remaining amount of the drug.
We have an article on the health catalyst website under “insights” with more detail on the use of this modifier and CMS also has a good FAQ document that I have linked in the references at the end.
This is not a new modifier, just want to talk about this one real quick since I just mentioned it and it’s the counterpart of JZ
CMS has no specific requirements regarding the method, format, or where the discarded amount of the drug is documented within the EHR. However, the organization expects providers to maintain accurate medical records regarding drug waste for every beneficiary.
Just a note about this modifier- it shouldn’t be assigned to drugs that are oral, inhaled, or implanted.
Link takes you to the CMS website and you need to click on “List of Telehealth Services for Calendar Year 2023” to see which codes qualify for these modifiers. It’s a downloadable document. The document lists out all codes applicable for telehealth services so modifier 95 can be placed on all of them, but only the ones with a Yes in the column that says “can audio-only interaction meet the requirements?” can have modifier 93.
These are specific to mental health services- Can still use CMS’s telehealth list, but make sure that if it’s a mental health service you are using FQ or FR rather than 93 or 95