[ad_1]
The QSEHRA has been a demonstrably effective health benefits tool for businesses throughout the United States for several years now. However, nonprofit organizations have not received the same attention as regular businesses, despite their distinct needs, and dramatic influence on the American economy.
[ad_1]
Now that Open Enrollment is over, you can enroll in or change Marketplace coverage only if you have a life event, like getting married, having a baby, or losing health coverage, that qualifies you for a Special Enrollment Period.
[ad_1]
Time’s running out for 2020 Marketplace insurance! Open Enrollment for 2020 Marketplace insurance ends Sunday, December 15. This means you have only 3 days to enroll in, re-enroll in, or change a 2020 Marketplace plan.
[ad_1]
Open Enrollment for 2020 Marketplace coverage starts November 1, 2019. There are things you can do now to get ready, whether you’re applying for the first time or planning to re-enroll.
[ad_1]
Patient loyalty factors into a lot of decisions that healthcare leaders are making, but are those investments misplaced? It’s common knowledge in business that it is much more cost-efficient and easier to retain a current customer than go get new ones.
[ad_1]
CMS Administrator Seema Verma recently announced the proposed the calendar year 2020 Physician Fee Schedule. This plan has overhauled the way the physician is paid to help address the growing number of patients who have multiple chronic diseases.
[ad_1]
Imagine if your patients were armed with all the tools and resources they needed to make informed decisions on their healthcare choices and billing options. The focus on surprise medical bills and patient loyalty has been in the news recently, along with how high-deductible health policies are linked to delayed diagnosis and treatment.
[ad_1]
The infusion can be defined as “Administration of fluids or medications into the blood through the veins”. When the drug delivery exceeds 15 minutes, it falls into infusion. Each hour of infusion is deemed a separately billable unit. Infusions can be categorized as below:
• Initial
• Sequential
• Additional
• Concurrent
• Prolonged
Initial Infusion
“Initial” service is narrated as “the service that best describes the key or primary reason for the encounter”. If a drug is delivered to a patient for more than 30 minutes and less than 1 hour and 20 minutes, then that type of infusion is considered as an initial infusion. Only one initial code can be billed per patient encounter. Some of the basic principles are being described below:
• The initial code that best describes the “Key Service” (service being performed that day) should be reported.
• If chemotherapy and the non-chemotherapy infusion are performed on the same day then chemotherapy infusion is the key service, the initial code for chemotherapy (96413) should be billed.
• If non-chemotherapy and hydration are performed on the same day, the non-chemotherapy infusion is the key service; the initial code for non-chemotherapy (96365) should be billed.
Sequential Infusion
“Sequential” is when multiple drugs are getting infused “back to back” or one after the other. If a drug has already been administered to a patient through Infusion, Push, and/or Injection and another drug is required to be administered for approximately another hour, then the infusion of the second drug will be considered as Sequential Infusion.
• The “additional sequential drug” codes are used to report the second and subsequent drugs administered during a patient encounter.
• Code 96367 is used to report additionally infused therapeutic diagnostic drug and code 96417 is used to report an additionally infused drug which is to be categorized as chemotherapy administration.
Additional Infusion
If a drug is infused to the patient for more than one hour and twenty minutes then further infusion shall be termed as an additional infusion for billing purposes. Let’s say that if a drug is infused for two hours twenty min continuously then the second hour of infusion will be considered as an additional hour and this infusion will be termed as “additional infusion” of that drug. In this scenario, we should bill an additional infusion code along with the initial infusion code.
Code 96415 is used for initial chemotherapy infusion and code 96366 shall be used for non-chemo (therapeutic and diagnostic) infusion. Following has been established in this regard that:
• This code is used to report the additional hour of infusion, after the first hour of an individual drug.
• To report an additional hour of infusion of a particular drug, the infusion time must last more than 30 minutes beyond the first hour. Infusion lasting less than 30 minutes should be rounded down and not be reported.
• The additional hour code can be used to report infusion up to 8 hours. The first hour of the infusion would be captured using either the “additional sequential drug” or “initial” codes along with remaining hours are reported under each additional.
Concurrent Infusion
“Concurrent” term is used when multiple therapeutic or diagnostic medications (not hydration fluids) are infused simultaneously through separate bags through the same IV line. If a drug is scheduled to be delivered to a Patient for an hour but after twenty minutes depending on the condition of the patient the physician plans to infuse another drug using a separate IV infusion bag during the same time span of the first drug then we have to bill concurrent hour along with the initial hour of infusion.
In order to report a concurrent administration, the drugs cannot simply be mixed in one bag; there must be more than one bags each containing a single or more drug. It is not appropriate to bill an infusion administration code for each drug that is contained within an IV bag. If more than one drug is administered in a single IV infusion bag then it should be billed as one infusion service.”
Prolonged Infusion
If a drug has to be infused for more than 8 continuous hours, then that category of infusion is known as a prolonged infusion. For prolonged infusion, generally, a special medical device is known as “Infusion Pump” is being used and likewise, we can name this infusion as “Pump Infusion”. Infusion Pumps are used to deliver very small quantities of drugs over long periods of time.
Conclusion
The above-mentioned categorization of Infusions can simplify the medical billing during the patient encounters and maximally benefit the treating physicians. The laid down criteria can go a long way in gaining patient and physician’s confidence in billing services through simplification of the processes in advance.
Learn more Coding & Billing For Duplex Scan Of Extremity Veins
[ad_2]
Billing of chemotherapy:
There are three most common modalities of cancer treatment such as Chemotherapy (antineoplastics), Radiation (Radiotherapy) and Surgery.
We will discuss billing of Chemotherapy (Antineoplastics)
AMA’s Current Procedural Terminology (CPT) provides three categories of chemotherapy administration and non-chemotherapy injections and infusions like;
1. Hydration
2. Therapeutic(healing)/Prophylactic (preventative) and diagnostic Injections and infusion (excluding chemotherapy)
3. Chemotherapy administration
Chemotherapy administration codes apply to parenteral administration of non-radionuclide anti-neoplastic drugs. And it can also apply to anti-neoplastic agents provided for treatment of non-cancer diagnoses like “cyclophosphamide for auto-immune conditions”.Or to substances such as some specific monoclonal antibody agents, and certain biologic response modifiers.
Hierarchy of administration:
Keep in mind these two facts;
• Infusions are primary to pushes.
• Pushes are primary to injections.
Facilities should follow the administration and initial code hierarchies. And should supersede parenthetical instructions for add-on codes that suggest an add-on of a higher hierarchical position may be reported in conjunction with a base code of a lower position. For example, the hierarchy will not allow reporting CPT 96374 with 96360, as 96374 is a higher order code; the IV push is primary to hydration.
What is Push?
For chemotherapy administration and Therapeutic/Prophylactic/Diagnostic infusions and injections a push is defined as;
• Injection in which the healthcare professional is continuously present to administer the substance/drug and observe the patient
• Infusion of 15 minutes or less
Here we go for understanding the billing hierarchy in full length;
Billing initial code:
When administering multiple infusions, injections or combinations, only one “initial” service code should be reported, unless protocol requires that two separate IV sites must be used. The initial code is the code that best describes the key or primary reason for the encounter and should always be reported irrespective of the order in which the infusions or injections occur. If an injection or infusion is of a subsequent or concurrent nature, even if it is the first such service within that group of services, then a subsequent or concurrent code should be reported. For example, the first IV push given subsequent to an initial one-hour infusion is reported using a subsequent IV push code.
Sequential Injection or Infusion:
CPTs 96366, 96367, 96375 should be reported to identify a therapeutic, prophylactic, or diagnostic drug infusion or injection, if administered as secondary, or a subsequent service, in association with CPT 96413 when through the same IV access. All sequential services require that there be a new substance or drug, except that facilities may report a sequential intravenous push of the same drug using CPT 96376.
Same day Evaluation and management (E/M):
If a significant separately identifiable E/M service is performed, the appropriate E/M code should be reported using modifier 25 in addition to the chemotherapy code. For an E/M service provided on the same day, a different diagnosis is not required.
For Chemo infusion table, push table and allergy injections and heparin coding table click here;
Tables
[ad_1]
Revenue cycle management improvement is a constant in the healthcare industry. Whether you’re looking to improve outcomes, protect and increase revenue, lower costs, leverage technologies, improve analytics or even dip your toes is a broader pond of talent—it all boils down to continuous improvement in the face of change.
