A Consumer's Guide To The Health Law

Kaiser Health News published a consumer guide to the health law. According to the article, here is what is to come by 2014:

• In 2014, if you don't have health insurance you will have to have it or you will have to pay a fine.
• Individual penalty will be $95/year or 1% of their income (whichever is greater) it will rise to 2.5% (or $695) by 2016
• Family penalty will be $2,085/year or 2.5% of their income whichever is greater.
• Requirement may be able to be waived for reasons for example: financial reasons or religious beliefs
• Federal law will override state laws on blocking requirements to have health insurance.
  
• Insurance at work is likely to stay the same
• Plan may change
• May change premiums, deductibles, co-pays and network coverage.
  
• Some parts of the law that are in place now:
• Eligible for preventative services with no out-of-pocket costs
• Health plans can't cancel your coverage if you get sick
• Children with pre-existing conditions cannot be denied coverage
  
• Government will pay for anyone with an income at or lower than 133% of the poverty level
• $14,856 for an individual and $30,656 for a family of 4
  
• If you don't qualify for Medicaid:
• Subsidies will be available for individuals and families between 133% and 400%
• $14,856-$44,680 for individuals $30,656-$92,200 for families
• 
  
• Information on small businesses providing insurance
• No employer is required to provide health insurance
• In 2014, if your business has more than 50 employees the business will have to pay a fee.
  
• If you're over 65, there are changes listed in the article too.

For the full article, please click the following link: After the Election: A  Consumer's Guide To The Health Law

For additional billing, coding, and reimbursement resources, please click the following link: Medical Reimbursement Resources Page.

Predictive Modeling Analysis of Medicare Claims

Since June 30, 2011, Medicare has implemented a predictive analysis system. The following bullets explains the predictive modeling anaylysis in more detail.

Predictive Modeling Analysis of Medicare Claims

• Predictive Analytics System analyzes Medicare FFS (Fee-for-service) claims in order to detect fraudulent activity.

The modeling technology goes as follows:

• Builds profiles of providers, networks, billing patterns, and beneficiary utilization
• These profiles create risk scores estimating the likelihood of fraud.
• The profiles are automatically prioritized by which has the most alerts and risk score.
• The analysts at CMS then review the cases which were those of high risk score/ high alert.
• Depending on what the analysts find, they take the appropriate action.

What the risk score does to the claims payment:

• Only alert CMS to review the claims activity
• CMS does not deny claims because of predictive model results
• Enables automated cross-checks

To read the full article, please click the following link: Predictive Modeling Analysis of Medicare Claims

For additional billing, coding, and reimbursement resources, please click the following link: Medical Reimbursement Resources Page

Affordable Care Act & Grandfathered Health Plans

Healthreform.gov published an article on Affordable Care Act and "Grandfathered" Health Plans. The purpose of the Affordable Care Act is to give families and businesses more control over their health care

Protecting Patients' Rights in All Plans

• Must provide certain benefits to their customers for plan years starting on or after September 23, 2010.

Additional Consumer Protections Apply to Non-Grandfathered Plans

• They can make routine changes
• Grandfathered plans for policies in effect on March 23, 2010
• Cannot:
• cut or reduce benefits
• raise co-insurances
• significantly raise co-payment charges
• significantly raise deductibles
• significantly lower employee contributions
• add or tighten on annual limit on what insurer pays
• change insurance companies

Projected Impact on Consumers and Plans

• Large Employer Plans
• Small Business Plans
• Individual Health Market
• People in Special Types of Health Plans

Projections of Employer Plans Remaining Grandfathered, 2011-2013

• See chart in article
• Choices in 2014 and subsequent years

For the full article, please click the following link: Keeping the Health Plan You Have: The Affordable Care Act and Grandfathered Health Plans

For additional billing, coding and reimbursement resources, please click the following link: Medical Reimbursement Resources Page

What Employers Should Know About Healthcare Changes Ahead

Insurance Journal published an article on "What Employees Should Know About Healthcare Changes Ahead" The article discussed what would happen after Obamacare.  5% of companies are using the approach in which they give their employees a set amount of money to buy their own health insurance.

The article suggested the follow as to what you can do currently:

• This year's tax season matters
• Look at your tax return you may qualify for subsidies
• Income levels will determine premium costs and what is covered by tax credits
• If you and your spouse file separately consider filing jointly
  
• Educate yourself
• Public Exchanges are going to start October 1, 2013 open-enrollment for health insurance begins.
  
• Save money
• If you have a HSA (Health Savings Account) they are unsure if these will carry-on after 2013 so the article suggested to max these out & you will have money later.
• Insurance costs could rise in 2014

For the full article, please click the following link: What Employers Should Know About Healthcare Changes Ahead

For additional billing, coding, and reimbursement resources please click the following link: Medical Reimbursement Resources Page

Coding Changes for 2013

ACP Internist published an article with updates on coding changes for 2013. In the article they discussed the revised ICD-9 update schedule as follows:

• Oct 1, 2011 - ICD-9 & ICD-10 code sets
• Oct 1, 2012 - limited code updates for ICD-10 (no updates to ICD-9)
• Oct 1, 2014 - limited code updates to ICD-10 code set (no updates to ICD-9 since it no longer will be used)
• Oct 1, 2015 - regular updates to ICD-10 will begin.

New Care Management Codes

• Will be introduced in 2013
• Reporting and reimbursement of non-face-to-face care for complex, chronic illnesses & have been discharged from a hospital or facility not described in CPT or HCPCS codes.

Complex Chronic Care Codes - allows physicians & qualified health professionals to report the work & time they spend on a patient's care (including non-face-to-face elements)

• 99487
• 99488
• 99489

Transitional Care Management Codes - codes for follow-up care after the patient has been discharged from a facility setting.

• CPT 99495
• communication with the patient or caregiver within two business days of discharge
• MDM of at least moderate complexity during the service period
• face-to-face visit within 14 calendar days 
• CPT 99496
• communication with the patient or caregiver within two business days of discharge
• MDM of at least moderate complexity during the service period
• face-to-face visit within 7 calendar days

For the full article, please click the following link: Variety of Coding Changes Loom For 2013.

For additional billing, coding. and reimbursement resources, please click the following link: Medical Reimbursement Resources Page.

2013 Radiology CPT Code Update

An article published by the American College of Radiology discusses the following codes that have changed in 2013. Below is how the article broke down the Radiology Codes by specialty.

Diagnostic Radiology

• Revised - Cervical Spine Codes
• 72040, 72050, 72052
• Deleted - Bronchography
• 71040, 71060

Interventional Radiology 

• New - Thoracentesis & Pleural Drainage Codes 
• 32554, 32555, 32556, 32557
• Deleted - Pneumocentesis & Thoracentesis
• 32420, 32421, 32422
• New - Cerviccocerebral Artery Studies
• 36221, 36222, 36223, 36224, 36225, 36226, 36227, 36228
• Deleted - Cerviocerebral Angiography Codes
• 75650, 75660, 75662, 75665, 75671, 75676, 75680, 75685
• New - Retrieval of Foreign Body
• 37197
• Deleted - Foreign Body Retrieval Codes
• 37203
• New - Thrombolysis Codes
• 37211, 37212, 37214
• Deleted - Thrombolysis Codes
• 37201, 37209, 75900

Nuclear Medicine

• New - Endocrine and Parathyroid
• 78012, 78013, 78014, 78071, 78072
• Revised - Parathyroid Codes
• 78070
• Deleted - Endocrine Codes
• 78000, 78001, 78003, 78006, 78007, 78010, 78011

Radiation Oncology 

• New - Stereotactic Body Radiation Therapy Code
• 32701

Category III Code Changes

• New - Focused Microwave Ablation Code
• 0301T
• Extended - CAD and HDR Brachytheraphy Codes
• 0174T, 0175T, 0182T

For the full article, please click the following link: 2013 CPT Code Update - Radiology.

For additional billing, coding, and reimbursement resources, please click the following link: Medical Reimbursement Resources Page.

More Health-Law Changes Coming in 2013

The Wall Street Journal published an article titled: "More Health-Law Changes Coming in 2013". The article listed the following 5 changes that will come about in the year 2013. They are as follows:

1. Higher Premiums
• 13% of companies planning to raise their employees contributions by 5% or more.
• Insurers give rebates to consumers if the insurers spend less that 80% of premiums on medical care.
• In 2012, 13 million consumers got rebates worth $1.1 billion dollars
  
2. Straightforward Summaries
• Easy-to-read descriptions of how the plan works.
• What it covers and doesn't cover - no fine print.
• New glossary of insurance words that you may not understand
  
3. FSA Limits
• $2,500 is the maximum you can put in a flexible spending account.
• FSA are tax free money that you can use to pay qualified out-of-pocket expenses for 
• Examples: copayments for doctor visits or prescriptions
• If you don't use the full amount that you put aside, you will lose that money.
  
4. Dependent Coverage
• Children up to age 26 can stay on their parents' policies
  
5. Higher Spending Cap
• This year (2013), the spending cap is $2 million
• In 2012, the spending cap was $1.25
• In 2014 the spending cap will go away entirely.

To view the full article, please click the following link: More Health-Law Changes Coming in 2013

For additional billing, coding, and reimbursement resources please click the following link: Medical Reimbursement Resources Page.