Most awaited Regulatory update of July 2016 by Mr Steven Lash.You can leave your comment and ask as many as questions for any further regulatory update.
A peak into the future healthcare systems and hospitals by Steven LashSteven Lash
Steven Lash shared PPT on how a Peak Into the Future Healthcare Systems & Hospitals. He shows different-2 health plans for your coming years. Watch and share the info if you think this help for you and others as well.
THE INTELLIGENCE OF MACHINES AND BRANCH OF COMPUTER SCIENCE THAT AIMS TO CREATE IT- “The study and design of intelligent agents”.
An area of computer science that deals with giving m/c ability to seem like they have human intelligence.
Skroutz V. Dimos on "Designing Design @ Digitized 2016 ConferenceSkroutz S.A.
Vasilis Dimos ,Co-Founder & Head UX/Design at Skroutz S.A. talks about the basic principles about "Designing Design Systems" in an engineering company such as www.skroutz.gr. Style guides, patterns and design systems are essential for any designer to achieve visual, functional and logical consistency.
Dear Sir/ Madam,
I am writing this email for showing my interest to join with your company as IT support. Currently I am working as IT support at Royal safari garden resort and convention.
I attached CV, Photograph, and other documents for your consideration.
Looking forward to hear a goodnews from you,
Best Regards,
Kemal Virlanda
Dear Sir/ Madam,
I am writing this email for showing my interest to join with your company as IT support. Currently I am working as IT support at Royal safari garden resort and convention.
I attached CV, Photograph, and other documents for your consideration.
Looking forward to hear a goodnews from you,
Best Regards,
Kemal Virlanda
A peak into the future healthcare systems and hospitals by Steven LashSteven Lash
Steven Lash shared PPT on how a Peak Into the Future Healthcare Systems & Hospitals. He shows different-2 health plans for your coming years. Watch and share the info if you think this help for you and others as well.
THE INTELLIGENCE OF MACHINES AND BRANCH OF COMPUTER SCIENCE THAT AIMS TO CREATE IT- “The study and design of intelligent agents”.
An area of computer science that deals with giving m/c ability to seem like they have human intelligence.
Skroutz V. Dimos on "Designing Design @ Digitized 2016 ConferenceSkroutz S.A.
Vasilis Dimos ,Co-Founder & Head UX/Design at Skroutz S.A. talks about the basic principles about "Designing Design Systems" in an engineering company such as www.skroutz.gr. Style guides, patterns and design systems are essential for any designer to achieve visual, functional and logical consistency.
Dear Sir/ Madam,
I am writing this email for showing my interest to join with your company as IT support. Currently I am working as IT support at Royal safari garden resort and convention.
I attached CV, Photograph, and other documents for your consideration.
Looking forward to hear a goodnews from you,
Best Regards,
Kemal Virlanda
Dear Sir/ Madam,
I am writing this email for showing my interest to join with your company as IT support. Currently I am working as IT support at Royal safari garden resort and convention.
I attached CV, Photograph, and other documents for your consideration.
Looking forward to hear a goodnews from you,
Best Regards,
Kemal Virlanda
Replacing HHGM, the Patient-Driven Groupings Model (PDGM) is sure to be a continued hot topic for home care agencies through the proposed implementation in 2020.
Chronic Care Management - Implemented By TimeDoc - May 2018Dan Wellisch
This is May's presentation of the Chicago Technology For Value-Based Healthcare Meetup - https://www.meetup.com/Chicago-Technology-For-Value-Based-Healthcare-Meetup/
The Medicare Access and CHIP Reauthorization Act of 2015 is fundamentally transitioning the U.S. Healthcare System from a Fee-For-Service model to a Fee-For-Value reimbursement model. MACRA encourages healthcare providers to utilize HIT, population health management, and care coordination in pursuit of The Triple Aim (Improving individual healthcare quality, improving population health , and reducing cost).
The Medicare Aaccess and CHIP Reauthorization Act of 2015 establishes two Quality Payment Programs to transition the U.S. Healthcare System from a Fee-For-Service reimbursement methodology to a Fee-For-Value model. MACRA fundamentally adjusts the Medicare Fee Schedule, forcing healthcare providers to utilize HIT, population health management, and care coordination to receive financial rewards.
Slideshow presentation from the NC Association of County Commissioners' update at the 2016 City-County Management Association Winter Seminar on Feb. 5.
Telehealth Services: Part B Provider Outreach and EducationVSee
Telehealth Failures & Secrets to Success Conference 2017 by VSee Speaker Series
Speaker: Carynne Godfrey
Title: Part B Provider Outreach and Education Representative
Organization: NORIDIAN HEALTHCARE SOLUTIONS LLC
More info at: vsee.com/conference
Prepping for CCJR: Lessons Learned in Physician Alignment and Bundled PaymentsWellbe
With CMS’ recent announcement of its Comprehensive Care for Joint Replacement (CCJR) payment model and its plan to implement in seventy-five geographic areas, hospitals must be prepared to manage the entire episode of care from the time of surgery through ninety days after discharge. CCJR presents both opportunities and challenges for hospitals. In order to achieve success, organizations must manage their system of care delivery, ensure they are aligned with their physicians and post acute providers, and master the analytics necessary for driving high quality, low cost care.
MedAssets has worked with numerous providers to implement alignment models that bring hospitals and their physicians together, evaluate, identify, and implement changes to the care delivery system to improve quality and decrease cost across the continuum, and employ meaningful analytics for managing an episode of care.
Kevin Lieb, Senior Director for MedAssets’ Physician Alignment Solutions division, will share examples demonstrating how organizations have successfully implemented Episodes of Care. Mr. Lieb will also share examples from both hospital led and specialist led programs and provide lessons learned from these experiences.
This webinar will enable attendees to do the following:
• Identify alignment models within bundled payments and understand their applicability to your organization
• Understand the analytic capabilities necessary for success in a bundled payment environment
• Identify opportunities and strategies for cost reduction and quality improvement
About the Speaker:
Mr. Lieb has more than 20 years of healthcare-related experience focusing on quality improvement, market development and cost reduction initiatives for the hospital provider market. Mr. Lieb has worked for a number of well-known healthcare companies including GE Medical Systems, HCIA and LBA in Denver, Colorado. His responsibilities included healthcare consulting with a focus on process improvement and quality initiatives.
Independent healthcare in house lawyers' forum - September 2017Browne Jacobson LLP
Our independent healthcare in house lawyers' forum covered the following topics:
• healthcare procurement law update – a review of the Light Touch Regime (LTR) and recent trends; and
• regulatory law update.
MACRA Proposed Rule: Issues & OpportunitiesPolsinelli PC
A proposed rule implementing the 2015 Medicare Access and CHIP Reauthorization Act (MACRA) outlines changes to the Medicare program to migrate from payment for volume to arrangements linked to quality and value. This webinar will review key provisions of the proposed rule and their impact on existing and future payment structures, including key issues, opportunities, and potential areas for comment and modification before the rule is finalized.
On our agenda:
-MACRA background and policy objectives expressed in proposed rule
-Changes to existing Medicare reimbursement programs
-Merit-Based Payment Incentive System (MIPS) program proposals
-Alternative Payment Models (AMP) proposals
-Implications, opportunities, and issues under the proposed rule
New Long Term Care Survey Process (LTCSP) PowerPoint and Speaker Notes from CMSMaritza Martinez
This is a PowerPoint put together by CMS for Long Term Care Providers to get them ready for the new LTCSP, which will be starting on November 27, 2018 - one week from today. CMS also provided speaker notes in order to explain some of the slides. It is very helpful in providing an overview for the upcoming new survey process.
The PPS [Prospective Payment System] to PDPM Pendulum: An Analysis of PDPM Co...PYA, P.C.
The Skilled Nursing Facility (SNF) industry has faced disruption with Medicare Part A’s transition to the Patient Driven Payment Model (PDPM) in the fall of 2019. Providers seeking additional guidance to further develop and shape their compliance programs are encouraged to view the presentation given by join PYA at the AHLA Long Term Care and the Law program in March of 2020.
PYA Post-Acute Service Line Manager Amy Dalton co-presented with Liz Steffen, MJ CHC CPHRM MBA HCM MA CCC-SLP, Senior Divisional Corporate Compliance Officer of Promedica Health System. “The PPS [Prospective Payment System] to PDPM Pendulum: An Analysis of PDPM Compliance Matters Post Go-Live” covers the following topics:
• Trends in care provision related to value-based outcomes and quality of care.
• Relevant compliance updates from the Department of Health and Human Services, Department of Justice, and Office of Inspector General.
• Clinical operational and compliance-related hurdles for SNFs post-PDPM go-live.
• How PDPM fits into the larger context of a SNF compliance program.
• PDPM recommendations and best practices going forward.
For more information visit https://www.thesaurus.ie or https://www.brightpay.ie
The way in which we communicate and send payroll information to Revenue is changing. The objective of PAYE Modernisation allows for Revenue, employers and employees to access the most accurate, up-to-date information relating to pay and statutory payroll deductions. The new real time reporting / PAYE Modernisation system will be effective from the 1st of January 2019 and will apply to all employers. Payroll bureaus and accountants will need to be ready to implement all employee payments correctly from the start of 2019.
Thesaurus Software recently hosted a free, CPD accredited webinar to discuss what PAYE Modernisation is, how it will impact your clients and how you can prepare for the January deadline.
Speakers include:
Main Speaker: Paul Byrne - Managing Director at Thesaurus Software and former Accountant in Practice
Guest Speaker: Sinead Sweeney - PAYE Modernisation Change Manager at Revenue Commissioners
This webinar was hosted by McKonly & Asbury Partner, Michael Hoffner and Senior Managers, Josh Bantz and Samuel BowerCraft.
The webinar reviewed he new Trust Services Criteria that will be effective for SOC 2 and SOC 3 reports issued after December 15, 2018. The emphasis of this webinar was on evaluating the changes to the criteria, impacts on the report, and processes and procedures for transitioning from the 2016 Criteria to the 2017 Criteria. The presenters looked in-depth at how clients should map their controls from the 2016 Trust Services Criteria to the 2017 Trust Services Criteria including challenges with the new criteria.
As we all know the asia cup is playing between six nations,The hot favorite team who can Won world cup is India and 2nd one is Pakistan by Steven lash San Diego.
Steven Lash San Diego Pay Tribute to Sidhu Moose Wala.pptxSteven Lash
One of the finest singer of Punjabi industry has lost his life,while attacked by a group of men in mansa district near moose village.Steven Lash San Diego pay tribute to Sidhu Moose wala for his legendary songs.
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Replacing HHGM, the Patient-Driven Groupings Model (PDGM) is sure to be a continued hot topic for home care agencies through the proposed implementation in 2020.
Chronic Care Management - Implemented By TimeDoc - May 2018Dan Wellisch
This is May's presentation of the Chicago Technology For Value-Based Healthcare Meetup - https://www.meetup.com/Chicago-Technology-For-Value-Based-Healthcare-Meetup/
The Medicare Access and CHIP Reauthorization Act of 2015 is fundamentally transitioning the U.S. Healthcare System from a Fee-For-Service model to a Fee-For-Value reimbursement model. MACRA encourages healthcare providers to utilize HIT, population health management, and care coordination in pursuit of The Triple Aim (Improving individual healthcare quality, improving population health , and reducing cost).
The Medicare Aaccess and CHIP Reauthorization Act of 2015 establishes two Quality Payment Programs to transition the U.S. Healthcare System from a Fee-For-Service reimbursement methodology to a Fee-For-Value model. MACRA fundamentally adjusts the Medicare Fee Schedule, forcing healthcare providers to utilize HIT, population health management, and care coordination to receive financial rewards.
Slideshow presentation from the NC Association of County Commissioners' update at the 2016 City-County Management Association Winter Seminar on Feb. 5.
Telehealth Services: Part B Provider Outreach and EducationVSee
Telehealth Failures & Secrets to Success Conference 2017 by VSee Speaker Series
Speaker: Carynne Godfrey
Title: Part B Provider Outreach and Education Representative
Organization: NORIDIAN HEALTHCARE SOLUTIONS LLC
More info at: vsee.com/conference
Prepping for CCJR: Lessons Learned in Physician Alignment and Bundled PaymentsWellbe
With CMS’ recent announcement of its Comprehensive Care for Joint Replacement (CCJR) payment model and its plan to implement in seventy-five geographic areas, hospitals must be prepared to manage the entire episode of care from the time of surgery through ninety days after discharge. CCJR presents both opportunities and challenges for hospitals. In order to achieve success, organizations must manage their system of care delivery, ensure they are aligned with their physicians and post acute providers, and master the analytics necessary for driving high quality, low cost care.
MedAssets has worked with numerous providers to implement alignment models that bring hospitals and their physicians together, evaluate, identify, and implement changes to the care delivery system to improve quality and decrease cost across the continuum, and employ meaningful analytics for managing an episode of care.
Kevin Lieb, Senior Director for MedAssets’ Physician Alignment Solutions division, will share examples demonstrating how organizations have successfully implemented Episodes of Care. Mr. Lieb will also share examples from both hospital led and specialist led programs and provide lessons learned from these experiences.
This webinar will enable attendees to do the following:
• Identify alignment models within bundled payments and understand their applicability to your organization
• Understand the analytic capabilities necessary for success in a bundled payment environment
• Identify opportunities and strategies for cost reduction and quality improvement
About the Speaker:
Mr. Lieb has more than 20 years of healthcare-related experience focusing on quality improvement, market development and cost reduction initiatives for the hospital provider market. Mr. Lieb has worked for a number of well-known healthcare companies including GE Medical Systems, HCIA and LBA in Denver, Colorado. His responsibilities included healthcare consulting with a focus on process improvement and quality initiatives.
Independent healthcare in house lawyers' forum - September 2017Browne Jacobson LLP
Our independent healthcare in house lawyers' forum covered the following topics:
• healthcare procurement law update – a review of the Light Touch Regime (LTR) and recent trends; and
• regulatory law update.
MACRA Proposed Rule: Issues & OpportunitiesPolsinelli PC
A proposed rule implementing the 2015 Medicare Access and CHIP Reauthorization Act (MACRA) outlines changes to the Medicare program to migrate from payment for volume to arrangements linked to quality and value. This webinar will review key provisions of the proposed rule and their impact on existing and future payment structures, including key issues, opportunities, and potential areas for comment and modification before the rule is finalized.
On our agenda:
-MACRA background and policy objectives expressed in proposed rule
-Changes to existing Medicare reimbursement programs
-Merit-Based Payment Incentive System (MIPS) program proposals
-Alternative Payment Models (AMP) proposals
-Implications, opportunities, and issues under the proposed rule
New Long Term Care Survey Process (LTCSP) PowerPoint and Speaker Notes from CMSMaritza Martinez
This is a PowerPoint put together by CMS for Long Term Care Providers to get them ready for the new LTCSP, which will be starting on November 27, 2018 - one week from today. CMS also provided speaker notes in order to explain some of the slides. It is very helpful in providing an overview for the upcoming new survey process.
The PPS [Prospective Payment System] to PDPM Pendulum: An Analysis of PDPM Co...PYA, P.C.
The Skilled Nursing Facility (SNF) industry has faced disruption with Medicare Part A’s transition to the Patient Driven Payment Model (PDPM) in the fall of 2019. Providers seeking additional guidance to further develop and shape their compliance programs are encouraged to view the presentation given by join PYA at the AHLA Long Term Care and the Law program in March of 2020.
PYA Post-Acute Service Line Manager Amy Dalton co-presented with Liz Steffen, MJ CHC CPHRM MBA HCM MA CCC-SLP, Senior Divisional Corporate Compliance Officer of Promedica Health System. “The PPS [Prospective Payment System] to PDPM Pendulum: An Analysis of PDPM Compliance Matters Post Go-Live” covers the following topics:
• Trends in care provision related to value-based outcomes and quality of care.
• Relevant compliance updates from the Department of Health and Human Services, Department of Justice, and Office of Inspector General.
• Clinical operational and compliance-related hurdles for SNFs post-PDPM go-live.
• How PDPM fits into the larger context of a SNF compliance program.
• PDPM recommendations and best practices going forward.
For more information visit https://www.thesaurus.ie or https://www.brightpay.ie
The way in which we communicate and send payroll information to Revenue is changing. The objective of PAYE Modernisation allows for Revenue, employers and employees to access the most accurate, up-to-date information relating to pay and statutory payroll deductions. The new real time reporting / PAYE Modernisation system will be effective from the 1st of January 2019 and will apply to all employers. Payroll bureaus and accountants will need to be ready to implement all employee payments correctly from the start of 2019.
Thesaurus Software recently hosted a free, CPD accredited webinar to discuss what PAYE Modernisation is, how it will impact your clients and how you can prepare for the January deadline.
Speakers include:
Main Speaker: Paul Byrne - Managing Director at Thesaurus Software and former Accountant in Practice
Guest Speaker: Sinead Sweeney - PAYE Modernisation Change Manager at Revenue Commissioners
This webinar was hosted by McKonly & Asbury Partner, Michael Hoffner and Senior Managers, Josh Bantz and Samuel BowerCraft.
The webinar reviewed he new Trust Services Criteria that will be effective for SOC 2 and SOC 3 reports issued after December 15, 2018. The emphasis of this webinar was on evaluating the changes to the criteria, impacts on the report, and processes and procedures for transitioning from the 2016 Criteria to the 2017 Criteria. The presenters looked in-depth at how clients should map their controls from the 2016 Trust Services Criteria to the 2017 Trust Services Criteria including challenges with the new criteria.
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One of the finest singer of Punjabi industry has lost his life,while attacked by a group of men in mansa district near moose village.Steven Lash San Diego pay tribute to Sidhu Moose wala for his legendary songs.
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How Covid19 2nd wave effect through out India by Steven lash San Diego, How people had lost their near and dear one, Go and register yourself for vaccination and get your first jab of corona.
How covid 19 vaccine works by steven lash San DiegoSteven Lash
In this video we have shared some information on Covid19 vaccine, how the vaccination work exactly. There is priority of vaccination for Front line essential workers such as fire fighters, police officers, corrections officers, food and agricultural workers, United States Postal Service workers, manufacturing workers, grocery store workers, public transit workers, and those who work in the educational sector etc.
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How Covid19 Spread across the world ,it's spreading due to social distancing is ignored. Lock-down protocol is also ignored by people, Lots of people not wearing masks by Steven lash San Diego.
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Steven lash San Diego recommend you to wear a mask and save your lives as well others.To prevent the spread of virus clean your hands on regular basis and maintain a safe distance
from anyone who is coughing or sneezing.
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Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
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Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
2. Regulatory Update
• MACRA aka Quality Payment Program (QPP)
– MACRA Rules have been analyzed
– A QPP team has been established to create a strategy
and business plan including items for road map
• Waiting on publication of CPC+ Healthcare
Information Technology
• Discussion that QPP will be delayed until July 2017
• CMS reported that only 275,000 Medicare patients
were participating in CCM in 2015
3. 2017 Preliminary Rulemaking for
Physician Fee Schedule (PFS)
• Published July 7, 2017; Final Rules published late October/early
November
• Proposed conversion factor drops very slightly for 2017
– In 2016 it was $35.8043
– It 2017 it will be 35.7751
– $42 becomes $41.94 PMPM.
• CMS proposes to add two new CCM codes
• 99487 – Complex chronic care management services
– Same criteria as 99490
– 60 minutes of clinical staff time
– RVU reimbursement is 60% higher than 99490
• 99489 – Each additional 30 minutes of clinical staff time
– In addition to the CPT code for primary procedure
– Slightly less reimbursement than the base code
4. 2017 Rulemaking- continued
• Waive the face-to-face visit requirement
– Mentioned to CMS in April that it should eliminated as this hinders growth
– If physician does enroll patient during a complex visit then the physician will receive
additional reimbursement
• Clarifying and narrowing the 24/7 access standard
– eliminated the necessity for this beyond current practice
• Clarifying the transitions of care standard
– Loosening the standard so no longer required electronically
• Removing the written consent form requirement
– Will make enrolling quicker and easier
• Eliminated the direct supervision requirement for Rural Health Centers (RHC) and
Federally Qualified Health Centers (FQHC)