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Do not lose out on revenue in telehealth billing services. Employ latest technology to boost profits for your practice. Call Info Hub now!
When you talk of technology, we all are aware of how much it has changed our lives, largely for the better, with technology enhancing every part of our lives, bringing the world closer. Now, it is the same technology that has also greatly improved health services, offering medical assistance through telehealth
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Opening Opportunities: Top Medical Billing Jobs You Can Do from Home
Unlocking Opportunities: Top Medical Billing Jobs You Can Do from Home
The world of medical billing offers a multitude of opportunities for those seeking to work from home. As the healthcare industry continues to expand, the demand for skilled medical billers remains high. This guide will unveil the top medical billing jobs you can do remotely and provide you with valuable insights to succeed in this field.
What is Medical Billing?
Medical billing is the process of submitting claims to insurance companies and ensuring providers receive payment for their services. It involves coding diagnoses, processing insurance claims, and managing patient balances. With the rise of telehealth and remote work, many healthcare facilities are outsourcing their billing services, creating lucrative opportunities for remote workers.
Why Choose a Career in Medical Billing?
Flexibility: Many medical billing jobs allow you to set your own hours, making it ideal for individuals seeking a work-life balance.
Growing Demand: With an aging population and evolving healthcare regulations, the need for certified medical billers is projected to grow.
Job Security: The healthcare industry typically offers stable employment opportunities, reducing the risk of job loss.
Types of Medical Billing Jobs You Can Do from Home
Job Title
Job Description
Average Salary (Annual)
Medical Billing Specialist
Responsible for coding, submitting, and following up on claims.
$45,000 – $60,000
Medical Coder
Uses specific coding systems to identify diagnoses and procedures.
$50,000 – $70,000
Claims Processor
Acts as a liaison between healthcare providers and insurance companies.
$40,000 – $55,000
Revenue Cycle Specialist
Manages all aspects of patient billing and collections.
$55,000 – $75,000
Billing Analyst
Analyzes financial data and assists in the revenue management process.
$60,000 – $80,000
Benefits of Working in Medical Billing from Home
Cost Savings: Work-from-home arrangements save on commuting and work attire costs.
Comfort: Home environments can lead to increased productivity without the distractions of an office.
Competitive Salaries: Many remote medical billing jobs offer salaries comparable to on-site positions.
Practical Tips for Getting Started in Medical Billing
If you’re considering a career in medical billing, here are some essential steps to take:
Education: Obtain a high school diploma, and consider pursuing a certification in medical billing or coding.
Gain Experience: Look for internships or entry-level positions to gain hands-on experience.
Network: Join professional organizations such as the American Academy of Professional Coders (AAPC) to connect with others in your field.
Stay Updated: The medical billing field is constantly evolving; stay informed about the latest coding changes and healthcare laws.
First-Hand Experience: A Day in the Life of a Remote Medical Biller
Jessica, a certified medical billing specialist, shared her daily routine working from home. “I usually start my day by checking emails and reviewing claims that need immediate attention. I spend a couple of hours coding and submitting claims before hitting my lunch break. The flexibility allows me to manage my personal responsibilities without compromising my professional duties.”
Case Study: Success with Remote Medical Billing
A recent case study highlighted Jane, who transitioned from an administrative role to a medical billing specialist. After completing an online certification program, she began working for a healthcare provider remotely. Within two years, she experienced a salary increase of 20% due to her expertise.
Conclusion
medical billing jobs provide promising opportunities for those looking to work from home. With flexible schedules, a growing job market, and the potential for competitive salaries, it’s no wonder many are making the transition to this field. By acquiring the right education, gaining relevant experience, and staying updated, you can unlock your potential in the medical billing industry. Start your journey today and explore the rewarding path of remote medical billing jobs!
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Open Your Future: Top Work From Home Medical Billing Jobs in 2021
**Title: Unlock Your Future: Top Work From Home Medical Billing Jobs in 2021**
**Introduction:** In today’s fast-paced world, more and more people are looking for ways to work from home to achieve a better work-life balance. Medical billing is a popular field that offers remote opportunities for individuals looking to kickstart their career in the healthcare industry. If you’re considering a work-from-home medical billing job in 2021, you’re in the right place. In this article, we’ll explore the top opportunities available in this field, along with essential tips to help you succeed.
**Benefits of Work From Home Medical Billing Jobs:** Before diving into the top work-from-home medical billing jobs in 2021, let’s explore some of the key benefits of pursuing a career in this field:
1. Flexibility: Working from home allows you to have better control over your schedule and work at your own pace. 2. Work-Life Balance: Eliminating commute time and office distractions can lead to a better work-life balance. 3. Cost Savings: Working from home can help you save money on transportation, work attire, and dining out. 4. Career Growth: Medical billing is a growing field with ample opportunities for advancement and specialization. 5. Remote Opportunities: With the rise of telemedicine, the demand for remote medical billing professionals is on the rise.
**Top Work From Home Medical Billing Jobs in 2021:**
1. **Medical Billing Specialist:** As a medical billing specialist, your primary responsibilities include submitting claims to insurance companies, following up on unpaid claims, and resolving billing issues. This role requires attention to detail, excellent communication skills, and knowledge of medical coding.
2. **Medical Billing and Coding Auditor:** Medical billing and coding auditors review medical records to ensure accuracy and compliance with coding guidelines. This position requires strong analytical skills, knowledge of billing regulations, and experience in medical coding.
3. **Remote Medical Billing Trainer:** Remote medical billing trainers are responsible for educating and training medical billing professionals on coding guidelines, billing processes, and software usage. This role requires excellent presentation skills, industry knowledge, and the ability to work remotely with trainees.
4. **Telemedicine Billing Specialist:** With the increasing popularity of telemedicine, there is a growing need for telemedicine billing specialists. These professionals are responsible for submitting claims for virtual consultations, verifying insurance coverage, and ensuring timely reimbursement. This role requires familiarity with telehealth regulations and billing practices.
**Practical Tips for Success:**
– Invest in�� a reliable computer and high-speed internet connection to ensure a smooth workflow. – Stay updated on the latest coding guidelines and regulations to avoid billing errors. – Network with other medical billing professionals to stay informed about job opportunities and industry trends. – Consider obtaining industry certifications, such as Certified Professional Biller (CPB) or Certified Professional Coder (CPC), to enhance your qualifications.
**Conclusion:** work-from-home medical billing jobs offer a rewarding career path with numerous opportunities for growth and flexibility. By exploring the top job options in this field and following practical tips for success, you can unlock your future and build a successful career from the comfort of your own home. Remember to stay informed, stay motivated, and stay connected with industry professionals to make the most of your work-from-home journey in medical billing. Good luck!
By following the tips outlined in this article, you can kickstart your career in work-from-home medical billing and achieve your professional goals in 2021 and beyond.
Remember, the key to success in any remote job is dedication, continuous learning, and adaptability to the evolving healthcare landscape. With the right skills and mindset, you can thrive in the work-from-home medical billing industry and unlock your full potential.
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UNLOCK A REWARDING CAREER WITH MEDICAL CODING TRAINING IN WAYANAD.
Unlock a Rewarding Career with Medical Coding Training at Transorze Solutions in Wayanad
In an era where the healthcare sector is constantly growing, the demand for skilled professionals in medical coding has surged, presenting a plethora of opportunities for those looking to make a mark in the industry. If you have an eye for detail, enjoy working with numbers, and seek a stable and rewarding career, consider enrolling in the Medical Coding Training program at Transorze Solutions in the scenic town of Wayanad.
What is Medical Coding?
Medical coding is the process of translating healthcare diagnoses, procedures, and services into universal codes that are used for billing and insurance purposes. These codes ensure that healthcare providers are reimbursed accurately for the services they offer. This crucial function not only streamlines operations within medical facilities but also plays a significant role in maintaining the integrity of patient records.
Why Choose Transorze Solutions?
1. Expert Guidance and Comprehensive Curriculum
Transorze Solutions offers a robust Medical Coding Training program designed to equip students with the necessary skills and knowledge to excel in the coding field. The curriculum is crafted by industry professionals with extensive experience, ensuring that students are up-to-date with the latest coding standards, such as ICD-10, CPT, and HCPCS.
2. Hands-On Experience
The program emphasizes practical training, allowing students to work on real-world scenarios and case studies. This hands-on experience enables learners to apply their theoretical knowledge in practical situations, preparing them for the challenges they will face in their careers.
3. Career Opportunities
Upon completing the program, graduates can explore a variety of career paths in the healthcare sector. Job roles can vary from medical coders and billing specialists to compliance officers and health information technicians. The rise of telehealth and increased regulatory requirements also mean a growing need for coding professionals, making this an opportune time to enter the field.
4. Certification Preparation
Transorze Solutions helps students prepare for various certification exams, such as the Certified Professional Coder (CPC) and Certified Coding Specialist (CCS). These certifications enhance a candidate's employability and potential earnings, making them highly sought after by employers.
Why Wayanad?
Wayanad, known for its lush greenery and serene environment, offers a tranquil setting that is conducive to learning. The region's growing healthcare industry adds to the career prospects for graduates, as local hospitals and clinics increasingly seek out trained medical coders. Students at Transorze Solutions not only receive quality education but also enjoy the benefits of studying in a picturesque location that promotes a healthy work-life balance.
Conclusion
Investing in medical coding training at Transorze Solutions in Wayanad is a step towards securing a promising future in the healthcare industry. With expert training, hands-on experience, and ample career opportunities, students are well-equipped to embark on a successful career path. As the healthcare landscape evolves, so does the need for skilled medical coders, making this the perfect time to unlock your potential and embark on a fulfilling career journey. Take the first step today—your future in medical coding awaits!
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California Medical Coding and Billing: Reimagine Your Revenue Cycle
Managing a healthcare practice in California is complex. We Care Health Pro understands. Our comprehensive medical coding and billing services can streamline your revenue cycle, maximize reimbursements, and free you to focus on what matters most – patient care.
California's Unique Challenges
California's healthcare system is a mix of public and private payers, each with specific coding and billing requirements. Keeping compliant and maximizing reimbursements requires expertise. We Care Health Pro's team of California-based specialists tackles these challenges head-on, ensuring your claims are submitted accurately and efficiently.
Benefits of Our Services
Increased Revenue: Our certified coders and experienced billers work together to maximize claim reimbursements and minimize denials.
Reduced Costs: Eliminate the need for in-house staff and associated overhead.
Improved Efficiency: Focus on patient care while we handle the complexities of medical coding and billing.
Peace of Mind: Knowledgeable professionals ensure your coding and billing are compliant and in good hands.
Transparent Communication: We provide regular reports and updates on your coding and billing performance.
Your California Medical Coding and Billing Partner
We Care Health Pro is a California-based company with a deep understanding of the state's healthcare system. We offer customized solutions to meet the unique needs of your practice, whether you're a small independent practice or a large medical group.
California-Specific Services
Medi-Cal Expertise: We have extensive experience processing Medi-Cal claims efficiently and accurately.
Telehealth Billing and Coding: Ensure proper reimbursement for your telehealth services with our expert team.
In-Network and Out-of-Network Billing: We handle billing for all types of insurance plans.
Denial Management: Our specialists fight denied claims aggressively to recover lost revenue.
Take Control of Your Revenue Cycle
Partnering with We Care Health Pro allows you to focus on what matters most – providing excellent patient care. Contact us today for a free consultation and learn how we can streamline your medical coding and billing processes, boost your revenue, and improve your bottom line.
We Care Health Pro – Because We Care About Your Practice's Success.
#medical billing services#medical billing and coding#medical billing company#medical billing agency#medical billing outsourcing
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Exploring the Latest Trends in Medical Billing and Coding
In today's rapidly evolving healthcare landscape, staying up-to-date with the latest trends in medical billing and coding is crucial for healthcare providers to maintain financial stability and compliance. In this blog, we will delve into the ever-evolving world of medical billing and coding, with a special focus on the services offered by Gables Medical Billing. As a trusted medical billing specialist in Tampa, Gables Medical Billing is at the forefront of these trends, helping healthcare providers streamline their revenue cycles and optimize their financial processes.
Understanding the Role of Medical Billing and Coding Specialists
Before we delve into the latest trends, let's briefly revisit the role of medical billing and coding specialists. These professionals play a pivotal role in the healthcare industry by ensuring that healthcare providers are accurately reimbursed for their services. Here's a simplified breakdown of their roles:
1. Medical Coders: These professionals translate patient diagnoses, treatments, and procedures into universal medical codes, such as ICD-10 and CPT codes. Accurate coding is essential for proper billing and insurance claims.
2. **Medical Billers:** Once the coding is complete, medical billers take over. They prepare and submit claims to insurance companies, government healthcare programs, and patients. Their job is to ensure timely and accurate reimbursement.
Now, let's explore the latest trends in this dynamic field.
**1. **AI and Automation**: One of the most significant trends in medical billing and coding is the integration of artificial intelligence (AI) and automation. Gables Medical Billing has embraced this trend, utilizing AI-driven software to streamline coding processes. AI can help identify coding errors, reduce denials, and enhance accuracy, ultimately improving revenue cycle management.
**2. Telemedicine Billing**: With the rise of telehealth services, billing and coding for virtual visits have become increasingly important. Medical billing specialists in Tampa, like Gables Medical Billing, are well-versed in the specific codes and regulations governing telemedicine billing. They ensure that healthcare providers receive proper reimbursement for remote consultations.
**3. ICD-10 Updates**: The International Classification of Diseases, 10th Edition (ICD-10), is regularly updated to reflect changes in medical terminology and technology. Staying current with these updates is essential to avoid claim denials. Gables Medical Billing employs certified coders who are proficient in the latest ICD-10 revisions.
**4. Value-Based Care Models**: The shift from fee-for-service to value-based care models places greater emphasis on patient outcomes and quality of care. Medical billing specialists must adapt to these changes by focusing on performance metrics, quality reporting, and alternative payment models.
**5. Data Security and Compliance**: As healthcare data breaches become more prevalent, ensuring data security and HIPAA compliance is paramount. Gables Medical Billing employs robust security measures to protect sensitive patient information and adhere to all regulatory requirements.
**6. Revenue Cycle Management**: Effective revenue cycle management is a top priority for healthcare providers. Gables Medical Billing offers comprehensive solutions to optimize revenue cycles, reduce claim denials, and expedite payments, thus improving cash flow.
**7. Patient Financial Responsibility**: With the rise in high-deductible health plans, patients are assuming more financial responsibility. Medical billing specialists must communicate transparently with patients regarding their financial obligations, providing clarity on bills and payment options.
**8. Denial Management**: Minimizing claim denials is critical for revenue optimization. Gables Medical Billing employs proactive denial management strategies to identify and address issues that could lead to claim rejections.
**9. Outsourcing Benefits**: Many healthcare providers are realizing the benefits of outsourcing medical billing and coding to specialists like Gables Medical Billing. Outsourcing allows them to focus on patient care while experts handle the intricate billing and coding tasks.
**10. Compliance with Local Regulations**: As a Tampa-based medical billing specialist, Gables Medical Billing understands the unique regulations and payer requirements in the region. Their localized expertise ensures that clients receive maximum reimbursement while adhering to all Tampa-specific regulations.
In conclusion, the world of medical billing and coding is continually evolving, with new trends and challenges emerging regularly. Healthcare providers in Tampa and beyond can benefit from partnering with Gables Medical Billing, a trusted medical billing specialist in Tampa, to navigate these trends and ensure their financial success. By embracing AI, staying compliant with regulations, and offering specialized expertise, Gables Medical Billing is at the forefront of these trends, making them the ideal partner for healthcare providers looking to optimize their revenue cycles and streamline their financial processes.
#Gables Medical Billing#medical billing services#physician billing services in florida#medical billing florida
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Telehealth Billing – What You Should Know Exactly?
Tele-health billing has been the talk of the trend on national media during the past few months of the increase of the COVID-19 pandemic. Even before the new coronavirus hit the people in the USA, 76% of the US hospitals were offering telehealth medicine to patients from distant locations.
Telehealth refers to telemedicine encompasses patient and physician’s communication through tele tools such as phone calls, emails, and text messages. On the other way around, telemedicine even caters remote clinical services through using technologies for remote patient monitoring and live video conferencing as well.
Though telemedicine is in practice, there are certain guidelines imposed by the CMS pertained to telehealth, along with some variations in reimbursement of claims as well, from payer to payer. To avoid the risk of the increase in the COVID-19 due to the current condition, extension has been provided to Medicare enrolees to get in touch with physicians on emergency and no other option cases only.
What procedure does telehealth billing follow according to new rules imposed by CMS?
For initiating reimbursement of telehealth services, an interactive audio and video telecommunications system that enables communication between the service provider and the beneficiary should be in real-time.
There is a change in the category of services due to the pandemic outbreak, which needs to be followed properly before claims submission/reimbursements. It may not completely change to the existing telehealth billing rules, yet there are notable changes as well.
Earlier to COVID-19, telehealth was considered as a benefit of coverage only if the originating site was outside the country of a Metropolitan Statistical Area, but now there is more liberalness to many medical practices, health centres, individual practitioners, etc.
Prior to COVID-19, all doctors, nurse practitioners, nurse-midwives, clinical nurse specialists, certified and registered nurse anesthetists, etc. were eligible to receive telehealth reimbursements, but now telehealth billing is all about distant site, where the provider who delivers the service is located.
Some of frequently used telehealth billing codes for your knowledge
New patient visits: 99201–99205
Consultations: 99241–99245
Codes for behavioural change interventions: 99406– 99408
Established patient visits: 99212–99215
Changes in telehealth coding due to COVID-19:
In case you are an individual telehealth service provider, then according to CMS, these are the codes you should follow for evaluation and management visits, to Medicare:
99421: If the patient is an established one and opting for online digital evaluation and management service for up to 7days, and the consultation lasts for 5–10 minutes during the 7days, then the provided code should be used.
99422: In the same pattern, if the patient’s consultation lasts for 11–20 minutes, then apply this code.
99423: In case the duration of tele-consultation exceeds 21 or more minutes, then this code has to be considered.
If you are a commercial player, then you might be required to use Modifier 95 on a need basis for tele-health billing with Medicare. However, providers will make use of the same POS code like how they use it for in-person services, as long as the rules remain imposed and the COVID-19 outbreak continues.
Conclusion
Changes in telehealth billing and coding are common anytime no matter whatever the situation we are. But keeping those changes in tele-health coding updated regularly is highly critical for medical practices, due to the increase in the number of patients who opt for telemedicine during this pandemic.
Therefore, to control such complex situations and streamline to telehealth billing process, thinking of outsourcing will be a great choice. 24/7 Medical Billing Services offer a wide range of medical billing and coding services at high quality. The company is especially good at staying in line to the changing rules and trends in medical billing and coding, to provide a great service to medical practices.
Read More :
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Telehealth Billing – What You Should Know Exactly?
Tele-health billing has been the talk of the trend on national media during the past few months of the increase of the COVID-19 pandemic. Even before the new coronavirus hit the people in the USA, 76% of the US hospitals were offering telehealth medicine to patients from distant locations.
Telehealth refers to telemedicine encompasses patient and physician’s communication through tele tools such as phone calls, emails, and text messages. On the other way around, telemedicine even caters remote clinical services through using technologies for remote patient monitoring and live video conferencing as well.
Though telemedicine is in practice, there are certain guidelines imposed by the CMS pertained to telehealth, along with some variations in reimbursement of claims as well, from payer to payer. To avoid the risk of the increase in the COVID-19 due to the current condition, extension has been provided to Medicare enrolees to get in touch with physicians on emergency and no other option cases only.
What procedure does telehealth billing follow according to new rules imposed by CMS?
For initiating reimbursement of telehealth services, an interactive audio and video telecommunications system that enables communication between the service provider and the beneficiary should be in real-time.
There is a change in the category of services due to the pandemic outbreak, which needs to be followed properly before claims submission/reimbursements. It may not completely change to the existing telehealth billing rules, yet there are notable changes as well.
Earlier to COVID-19, telehealth was considered as a benefit of coverage only if the originating site was outside the country of a Metropolitan Statistical Area, but now there is more liberalness to many medical practices, health centres, individual practitioners, etc.
Prior to COVID-19, all doctors, nurse practitioners, nurse-midwives, clinical nurse specialists, certified and registered nurse anesthetists, etc. were eligible to receive telehealth reimbursements, but now telehealth billing is all about distant site, where the provider who delivers the service is located.
Some of frequently used telehealth billing codes for your knowledge
New patient visits: 99201–99205
Consultations: 99241–99245
Codes for behavioural change interventions: 99406– 99408
Established patient visits: 99212–99215
Changes in telehealth coding due to COVID-19:
In case you are an individual telehealth service provider, then according to CMS, these are the codes you should follow for evaluation and management visits, to Medicare:
99421: If the patient is an established one and opting for online digital evaluation and management service for up to 7days, and the consultation lasts for 5–10 minutes during the 7days, then the provided code should be used.
99422: In the same pattern, if the patient’s consultation lasts for 11–20 minutes, then apply this code.
99423: In case the duration of tele-consultation exceeds 21 or more minutes, then this code has to be considered.
If you are a commercial player, then you might be required to use Modifier 95 on a need basis for tele-health billing with Medicare. However, providers will make use of the same POS code like how they use it for in-person services, as long as the rules remain imposed and the COVID-19 outbreak continues.
Conclusion
Changes in telehealth billing and coding are common anytime no matter whatever the situation we are. But keeping those changes in tele-health coding updated regularly is highly critical for medical practices, due to the increase in the number of patients who opt for telemedicine during this pandemic.
Therefore, to control such complex situations and streamline to telehealth billing process, thinking of outsourcing will be a great choice. 24/7 Medical Billing Services offer a wide range of medical billing and coding services at high quality. The company is especially good at staying in line to the changing rules and trends in medical billing and coding, to provide a great service to medical practices.
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In 2019, more than 25 million Americans lacked health insurance coverage. The majority of uninsured people cannot afford health insurance and cannot obtain coverage through an employer. Without health insurance, medical care is often unaffordable. People who must undergo treatment due to a severe condition or emergency can end up with significantly high medical bills and risk facing debt or bankruptcy.
Most health care providers use the fee-for-service payment model. In this arrangement, patients and insurers pay separately for every visit or procedure. This model comes under criticism because it incentivizes health care providers to focus on patient volume rather than the outcome. Fee-for-service is also expensive for insurers, who pass this cost down to policyholders.
In response to the gaps left by health insurance and the fee-for-service model, new payment strategies have emerged in recent years. Advances in videoconferencing technologies have improved the quality and access of telemedicine, which connects patients to doctors and specialists through a secure, HIPAA-compliant web-based platform. Patients can use these portals to set appointments, refill prescriptions, and consult with their primary care physicians. Some telemedicine platforms specialize in areas such as dermatology, mental health, and urgent care.
Telemedicine often is used by brick-and-mortar health clinics to reach remote clients or track patients with chronic illnesses. Patients typically pay for these services through their insurance or government-provided coverage such as Medicaid or Medicare. However, telemedicine companies have started to roll out subscription models as a stream of revenue.
In the subscription model, patients pay a flat monthly or annual fee to access the telemedicine service. Most platforms offer a messaging or video call service that connects members directly to a board-certified physician. Other platforms provide more comprehensive services, including diagnoses and prescriptions.
Subscribers frequently receive medical attention in hours or minutes. For minor and common ailments, some services use sophisticated chatbots to identify symptoms and provide treatment options. These services also may be combined with other Internet-enhanced health technologies, such as wearable devices that measure heart rate, blood pressure, and temperature.
Telemedicine providers also may ask patients to perform at-home diagnostic tests. After medical providers or a third party analyzes the samples, the telemedicine physician makes a treatment plan or refers the patient to a specialist.
The subscription model has several advantages over the fee-for-service model. First, the price is affordable for many uninsured patients. Second, telemedicine services may be available around the clock, unlike health systems that follow regular business hours. Third, since subscription services charge a flat fee to access medical care, health care providers do not charge per procedure, meaning there is more incentive for them to provide preventive care.
However, there are limits to telehealth subscription services. Patients experiencing a medical emergency still require in-person care. Likewise, health experts advise using telemedicine as a supplement, not a replacement, for in-person checkups. Further, while many telemedicine providers target underserved groups, such as people who do not speak English as a first language, these people are less likely to use telemedicine services.
Other factors, such as unequal access to broadband Internet and cultural distrust of health technology, have created barriers to telemedicine. To increase membership among those demographics, marketing strategies must consider the beliefs and values of each population segment.
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Highlights of the American Diabetes Association's 2021 Annual Meeting
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Highlights of the American Diabetes Association's 2021 Annual Meeting
The American Diabetes Association’s annual conference, known as the ADA Scientific Sessions, is always the biggest diabetes event of the year, and 2021 marked the second time this 5-day congress was held completely online because of the lingering COVID-19 pandemic.
When held in person, the conference normally convenes roughly 16,000 physicians, researchers, and diabetes industry experts from across the globe. This 81st annual event drew 11,600 people from 119 countries between June 25 and 29 — slightly lower than the 12,527 registered attendees for the 2020 virtual event. For both, the event organizers expected more people to tune in afterward, thanks to the recorded online sessions being made available for up to 3 months following the conference.
Despite its virtual nature, this year’s conference included nearly 200 presentations with more than 900 presenters on any range of topics. And to top it off, there were roughly 1,100 research posters delving into the latest science in diabetes. You can catch up on some of the action by searching hashtag #ADA2021.
Many of the big themes this year were extensions of what we saw in 2020 with the first-ever virtual SciSessions, but with even deeper focus. Below is our team’s summary of conference highlights.
Of course, the novel coronavirus that took the world to its knees was a main focal point and recurring theme in a large majority of research presented at this year’s Scientific Sessions.
Whether the topic officially had to do with COVID-19 or not, this was on everyone’s mind — from telehealth to research delays because of shutdowns, hospitalizations, etc. New research highlighted how people with underlying health conditions are six times more likely to die of COVID-19, and diabetes is the second most reported condition tied to those deaths in the U.S.
“Seeing the devastating impact of the pandemic on people with diabetes, the ADA is emboldened to work even harder to lead the fight against diabetes,” said the ADA’s chief scientific and medical officer, Dr. Robert Gabbay. “Our mission is reinforced by researchers from around the globe committed to closely studying specific impacts and interventions to help people living with diabetes during this COVID-19 era.”
Research from the T1D Exchange presented at ADA showed that among people with type 1 diabetes (T1D), use of diabetes technology lowered the risk of adverse outcomes with COVID-19. That point was emphasized throughout the conference, though it was offset by the common barriers of access and affordability issues — as well as racial and ethnic disparities in diabetes technology use.
One disturbing research presentation illustrated how type 2 diabetes (T2D) in children had skyrocketed during the COVID-19 pandemic. More pediatric patients were hospitalized between March and December 2020 than in the previous year. It also shows that stay-at-home orders resulting from COVID-19 exacerbated T2D risk for children overall, largely because of limited physical activity, more screen time and sedentary behaviors, disrupted sleep, and higher intake of processed foods and differing eating patterns during the day. A notable stat presented in one session showed that 1 in 4 PWDs in America reported the pandemic had interfered with their ability to obtain healthy food.
“While our study examined hospital admissions for type 2 diabetes in children at one center, the results may be a microcosm of what is happening at other children’s hospitals across the country,” said Dr. Daniel S. Hsia of the Pennington Biomedical Research Center in Baton Rouge, LA. “Unfortunately, COVID-19 disrupted our lives in more ways than we realize. Our study reinforces the importance of maintaining a healthy lifestyle for children even under such difficult circumstances.”
Another study conducted in October 2020 showed that 1 in 5 adults with diabetes reported anxiety or depression. Nearly half of adults (or 47 percent) with T1D reported moderate to severe distress compared with only 11 percent of adults with T2D. That research came from Dr. Sarah C. Westen at the University of Florida, and she told attendees that it meant PWDs with these pandemic-related psychosocial concerns needed follow-up diabetes care aimed at mental health.
Overall, the most common themes were that COVID-19 led to increased health anxiety, limited social interaction, and routine disruption. Many presenters also emphasized the need for more longitudinal research to better understand how these psychosocial factors specifically impacted diabetes management during the pandemic.
“While we are beyond eager to return to ‘normal’ and are well aware of the devastation that continues to occur because of COVID, we hope to take these silver linings, learn from them, and continue to implement things that we found particularly helpful that resulted out of necessity because of the pandemic,” said Catlin Dennis, MPH, of the Oregon-based Novel Interventions in Children’s Healthcare (NICH) at Doernbecher Children’s Hospital. She presented in a session titled “When COVID-19 Clashes with Diabetes.”
Not surprisingly, racial disparities and inequities within diabetes care were a focal point at the ADA conference as well. Many presenters noted that existing disparities were brought to light quite glaringly during the height of COVID-19.
In August 2020, the ADA published a “Health Equity Bill of Rights” that included statements on access to insulin and other diabetes meds, affordable healthcare, and ensuring that PWDs are able to be free from stigma and discrimination. As of April 2021, the ADA is encouraging scientists to apply for grants to conduct research touching on the impact of disparities in diabetes care.
“We can’t improve the health of all Americans without first addressing health inequities in our healthcare system. It’s crucial that we take a groundwater approach to solving these problems so that the solutions are both sustainable and effective. We have an obligation to dismantle these inequities and eliminate the devastating impact they have on families and communities,” ADA CEO Tracey D. Brown said.
One of the few really eye-popping developments this year was the announcement of a consensus statement between American and European diabetes experts, recognizing for the first time ever that there is, in fact, such thing as adult type 1 diabetes (T1D).
Yes, nearly a quarter century after T1D was officially classified and renamed from “juvenile diabetes,” medical experts have now finally issued official guidance on standards of care for adults with T1D.
The “Management of Type 1 Diabetes in Adults—2021 Draft ADA/EASD Consensus Report” is a multiyear effort between the ADA and European Association for the Study of Diabetes (EASD). It includes a new diagnostic algorithm for T1D that begins with measuring islet autoantibodies.
“We know we have guidance for the management of people with type 1 diabetes, but this gets mixed into broader guidelines and many of those broader guidelines are mostly derived from data in people with type 2 diabetes,” said Dr. Anne Peters, a well-known endocrinologist at the University of Southern California (USC) and director of the USC Clinical Diabetes Programs. “The EASD and the ADA recognized that there was a need to develop a comparable consensus report that specifically addresses the needs of people with type 1 diabetes.”
The report lays out that to achieve individualized care, patients should undergo an initial needs assessment. It also addresses behavior considerations such as alcohol and tobacco use, sleep, sick day management, driving, employment, physical activity, and nutrition.
“There is no one eating pattern recommended,” said Amy Hess-Fischl, a registered dietician and nutritionist and certified diabetes care and education specialist (CDCES) at the University of Chicago. “It is all based on the individual sitting in front of us.”
The report notes that there are four critical times for ongoing diabetes management support and education: at diagnosis, annually or when the patient is not meeting treatment targets, when complicating factors develop, and when transitions in life and care occur.
Dr. Jeremy Pettus, endocrinologist at the University of California, San Diego, worked in the consensus group that evaluated an array of medications that might be useful for T1D — some of them more commonly used for type 2 diabetes currently.
“There are other things wrong in type 1 diabetes physiology that we could potentially address with medications to help the vast majority of T1Ds get their blood sugars down to where they need them to be, help lose weight, improve cardiovascular outcomes,” he said. “Type 1s, even with good glycemic control, are still at high risk for cardiovascular disease.”
A hope is that these newer guidelines can help better diagnose T1D in varying age ranges, to help quell common misdiagnosis. But also, to further emphasize that individualized care is necessary when treating someone with the condition.
Another big theme for this Scientific Sessions — and 2021 overall — was the 100th anniversary of insulin’s discovery.
While so much progress has happened in diabetes and with insulin specifically since that game-changing discovery in 1921 by Drs. Frederick G. Banting and Charles Best in Toronto, the conference also highlighted how there is much left to be done for PWDs.
Affordability is at crisis levels in the U.S. and too many can’t get the life-sustaining insulin they need. Yet ironically, many people with type 2 diabetes continue to live in fear of being prescribed this medication.
Sessions delved into the policy sides of insulin accessibility as well as research on new types of insulin and other islet and beta cell transplants, which fall under the “cure” umbrella.
Dr. Ruth S. Weinstock at State University of New York (SUNY) Upstate Medical University, who currently serves as the ADA’s Science and Medicine division president, highlighted in her Sunday morning address that cutting-edge research is driving new therapies and technologies as well as hope for a diabetes cure. But there’s a lot to be concerned about, too.
“As wonderful as the discovery of insulin was, there was a need for purer and more physiological preparations and better insulin delivery systems,” she said. “We have better insulins now, but their administration is still burdensome and associated with challenges. And importantly, hypoglycemia and hypoglycemia unawareness remain problems, increasing in prevalence with longer diabetes duration.”
She pointed to the price of insulin in the U.S. being higher than anywhere else in the world, and encouraged ADA attendees to work toward a goal of more affordable insulin by January 2022 — the century-mark since a 14-year-old received the first-ever dose of insulin.
Meanwhile, developments in pancreatic beta cells garnered attention at the SciSessions as a possible path toward a T1D cure.
Dr. Esther Latres of the JDRF presented updates on manufacturing insulin-producing cells from stem cells, protecting the beta cells (without immunosuppressive drugs) from being destroyed during the immune system attack on a person’s body that leads to T1D.
Dr. Quinn Peterson of the Mayo Clinic presented his latest research on growing pancreatic islets from stem cells, showing findings that scientifically significant insulin production can be prompted using his technique.
As these researchers encouraged more advances in this type of diabetes research, it coincided with the recent news of President Joe Biden’s proposal for a Moonshot Initiative. This would provide $6.5 billion in the federal budget for the National Institutes of Health (NIH) to fund cure-focused research on cancer and other conditions like diabetes. If that proposal gets approved and implemented, it could lead to even more T1D research on advanced treatments and a potential cure.
Another hot topic at the ADA conference this year was the growing emphasis on Time in Range (TIR), which provides more information about glucose control than the traditional 3-month average known as the A1C.
Multiple diabetes experts in a variety of presentations highlighted the importance of TIR as they discussed latest research findings and management, complications that can materialize despite one’s A1C result, and even policy implications from looking at TIR rather than just A1C.
Generated mainly from the use of continuous glucose monitors (CGM), TIR was highlighted for how it helps people stay within the ideal 70-180 mg/dL range as often as possible in order to improve their diabetes management. This was mentioned in countless presentations and research posters.
In one of the sessions posing the question “Is CGM use an effective tool in primary care?” medical professionals and diabetes experts debated whether this tech can be useful for health consumers beyond diabetes care.
Short answer: It depends on the level of engagement a patient may have, but for those with diabetes who are dependent on insulin, the benefits of CGM are no longer in question. Presenters noted that CGM use allows a move away from focusing solely on A1C, with TIR data instead allowing healthcare providers to make better adjustments to insulin or diabetes meds, as well as determine how eating patterns or other aspects of a person’s life might be tweaked to achieve better outcomes.
The eagerly anticipated full results of the phase 3 SURPASS trials were shared at ADA 2021, generating a lot of buzz.
The study followed up on results from early 2021 focused on tirzepatide, a new once-weekly injectable glucose-lowering combo drug (dual GIP and GLP-1 receptor agonist) from Eli Lilly. It’s still in development, but like the exciting initial results, this latest research shows the new drug leads to a sizable A1C reduction as well as weight loss and fewer hypoglycemic episodes for people with type 2 diabetes.
The ADA conference also traditionally features many different research talks focused on diabetes complications. This year, there were multiple sessions aimed at kidney and cardiovascular risk for PWDs, including how various medications — especially for those with T2D — can reduce the risk of these possible complications.
There were sessions focused on spinal cord stimulation to treat painful neuropathy in the feet and toes, as well as how retinopathy is being treated more effectively now than even just a few years back.
One topic that caught our eye was “diabetes foot selfies.” Although some medical appointments to diagnosis, assess, or treat D-complications must happen in person, during the COVID-19 crisis there was a larger trend of people snapping photos of their feet and toes to have their clinicians look at those virtually to help guide decision-making.
“The COVID-19 pandemic required a rapid shift in best care practices,” said Brian M. Schmidt from the University of Michigan Medical School. “This had a huge impact on patients with diabetic foot ulcers and other complications because most of the time those patients were seen exclusively in face-to-face interactions.”
In California, Dr. Laura Shin discussed how her clinic had also used telemedicine and other methods to provide virtual care for patients with diabetes foot issues. They sent info packets to patients, families, and caregivers on conducting “three-minute foot exams,” and how to take selfies in helping clinicians prescribe care and identify high risk instances.
“A large part of us being able to treat these patients as best we could, especially with using different telemedicine technologies, was the ‘foot selfie.’ If they were flexible or agile enough, they could take the pictures themselves using their cell phones, or have a family member or caregiver take the pictures,” she said.
“With COVID-19, we have learned a lot about accessing patients,” Shin added. “Utilizing different tools and avenues for telemedicine was extremely helpful for us and for our patients with diabetes and diabetic foot care needs. And although it’s not a replacement for inpatient visits, I think we were still able to manage to keep a lot of these patients safe, keep them out of the hospital, and keep them moving in the world.”
An anticipated highlight of the ADA SciSessions each year has traditionally been the sprawling exhibit hall, where scores of diabetes companies go all out with elaborate displays. Sales reps try to woo physicians with the latest and greatest new gadgets and tools, and many companies coordinate timing of announcements and new products with this large conference — particularly since it falls in the final month before the fiscal quarter ends and they’re eager to wow investors.
Of course it’s just not the same with the event being online. The virtual exhibit hall is more of a rudimentary marketing tool where you can click on materials and videos but without the fanfare and opportunity to ask questions face-to-face. But there were still some topics of interest here.
Afrezza inhaled insulin
New research was presented on MannKind’s Afrezza inhaled insulin. This ultra rapid-acting inhalable drug has been available in the U.S. for adults with T1D since 2015, but it’s still being studied for possible use in children and adolescents as well as for those with T2D.
In two smaller studies, MannKind showed data that Afrezza is safe in children and adults with T2D.
Researchers tested Afrezza in 30 children between 8-17 and found the inhaled insulin was safe and saw its peak action about 10-15 minutes after inhalation. Within 2 hours, it was out of their systems. For post-meal glucose drops, the children saw the peak decrease 30-60 minutes after inhalation. All of that shows Afrezza works the same in children as it does in adults. While there was a slight cough observed for some after inhalation, there was no severe hypoglycemia. This research shows a final phase 3 clinical study can now move forward, paving the way for eventual pediatric approval.
As for T2 adults, Afrezza improved their TIR throughout the day to a total 62 percent of time, or 4 additional hours each day with lower amounts of highs and lows.
Medtronic’s new products
Medtronic presented important data on its future technology, including its Extended Wear Infusion Set that is already approved in Europe but is still in development for the U.S. This infusion set could last twice as long as existing infusion sets available for insulin pumps today — meaning it could be worn on the body for up to 7 days, compared with the traditional 2 or 3 days. Research presented at the ADA conference shows that Medtronic’s extended wear set lasted that long for up to 75 percent of the 350+ study participants, which beat out the 67 percent for the current 2-3 day sets.
This extended wear set is already filed with the Food and Drug Administration (FDA) and is awaiting review and approval, and if OK’d it would be the first time the U.S. would see an infusion set allowed to be worn for this long.
Medtronic also presented data on Time in Range for its Bluetooth-connected 770G system, keeping up with competing diabetes device companies that presented TIR research but also setting the foundation for its upcoming 780G device (aka the Advanced Hybrid Closed Loop system) that is pending before the FDA.
With that approval, we will soon have a trio of closed loop commercial systems to choose from: Medtronic’s 780G, Tandem’s Control-IQ and Omnipod 5, the latter of which will be the first tubeless patch pump option with automated glucose control.
CamAPS FX closed loop system
In a clinical study from the University of Cambridge, Dr. Julia Fuchs presented data on the future CamAPS FX closed loop system in kids and teens with T1D. This technology is U.K.-based CamDiab’s version of a hybrid closed loop system, combining an Android smartphone app with a Dexcom G6 CGM and an internationally available insulin pump (either the Dana Diabecare RS pump or the Dana i-pump by Korean company SOOIL).
This system adjusts insulin every 8-12 minutes based on the user’s needs, with a set target glucose of 105 mg/dL. For study participants in the U.S. who didn’t have access to those international pumps, the researchers used a Medtronic insulin pump and CGM. After 6 months, participants spent an average of 3.6 hours more time in range each day, or 68 percent TIR. Their A1C results also dropped by 1.1 percent, and use of the system also had other glucose-lowering benefits, they say.
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WHAT YOU SHOULD KNOW EXACTLY ABOUT TELEHEALTH BILLING
Tele-health billing has been the talk of the trend on national media during the past few months of the increase of the COVID-19 pandemic. Even before the new coronavirus hit the people in the USA, 76% of the US hospitals were offering telehealth medicine to patients from distant locations.
Telehealth refers to telemedicine encompasses patient and physician’s communication through tele tools such as phone calls, emails, and text messages. On the other way around, telemedicine even caters remote clinical services through using technologies for remote patient monitoring and live video conferencing as well.
Though telemedicine is in practice, there are certain guidelines imposed by the CMS pertained to telehealth, along with some variations in reimbursement of claims as well, from payer to payer. To avoid the risk of the increase in the COVID-19 due to the current condition, extension has been provided to Medicare enrolees to get in touch with physicians on emergency and no other option cases only.
What procedure does telehealth billing follow according to new rules imposed by CMS?
· For initiating reimbursement of telehealth services, an interactive audio and video telecommunications system that enables communication between the service provider and the beneficiary should be in real-time.
· There is a change in the category of services due to the pandemic outbreak, which needs to be followed properly before claims submission/reimbursements. It may not completely change to the existing telehealth billing rules, yet there are notable changes as well.
· Earlier to COVID-19, telehealth was considered as a benefit of coverage only if the originating site was outside the country of a Metropolitan Statistical Area, but now there is more liberalness to many medical practices, health centres, individual practitioners, etc.
· Prior to COVID-19, all doctors, nurse practitioners, nurse-midwives, clinical nurse specialists, certified and registered nurse anesthetists, etc. were eligible to receive telehealth reimbursements, but now telehealth billing is all about distant site, where the provider who delivers the service is located.
Some of frequently used telehealth billing codes for your knowledge
· New patient visits: 99201–99205
· Consultations: 99241–99245
· Codes for behavioural change interventions: 99406– 99408
· Established patient visits: 99212–99215
Changes in telehealth coding due to COVID-19:
In case you are an individual telehealth service provider, then according to CMS, these are the codes you should follow for evaluation and management visits, to Medicare:
· 99421: If the patient is an established one and opting for online digital evaluation and management service for up to 7days, and the consultation lasts for 5–10 minutes during the 7days, then the provided code should be used.
· 99422: In the same pattern, if the patient’s consultation lasts for 11–20 minutes, then apply this code.
· 99423: In case the duration of tele-consultation exceeds 21 or more minutes, then this code has to be considered.
If you are a commercial player, then you might be required to use Modifier 95 on a need basis for tele-health billing with Medicare. However, providers will make use of the same POS code like how they use it for in-person services, as long as the rules remain imposed and the COVID-19 outbreak continues.
Conclusion
Changes in telehealth billing and coding are common anytime no matter whatever the situation we are. But keeping those changes in tele-health coding updated regularly is highly critical for medical practices, due to the increase in the number of patients who opt for telemedicine during this pandemic.
Therefore, to control such complex situations and streamline to telehealth billing process, thinking of outsourcing will be a great choice. 24/7 Medical Billing Services offer a wide range of medical billing and coding services at high quality. The company is especially good at staying in line to the changing rules and trends in medical billing and coding, to provide a great service to medical practices.
About 24/7 Medical Billing Services:
24/7 Medical Billing Services is the nation’s leading medical billing service provider catering services to more than 42 specialties across the entire 50 states. You can rely on us for end-to-end revenue cycle management. We guarantee up to 10-20% increase in the revenue with cost reduction of your practice for up to 50%. Call us today at 888-502-0537 to know more on how we can help boost profitability for your practice.
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How Much Medicaid and Medicare Cost Americans
Medicare and its means-tested sibling Medicaid are the only forms of health coverage available to millions of Americans today. They represent some of the most successful social insurance programs ever, serving tens of millions of people including the elderly, younger beneficiaries with disabilities, and those with low incomes or limited resources. Everyone in the workforce is required to pony up their share to fund these programs—either through payroll deductions or when they file taxes each year.
In an unprecedented move, both programs will receive major additional funding in the wake of the coronavirus outbreak. On March 27, President Trump signed the CARES (Coronavirus Aid, Relief, and Economic Security) Act—a $2 trillion coronavirus emergency relief package—into law. A sizeable chunk of those funds is earmarked for healthcare providers, including those that are Medicare and Medicaid enrolled.
Medicare is administered by The Centers for Medicare and Medicaid Services (CMS), which is a component of the Department of Health and Human Services. CMS works alongside the Department of Labor and the Treasury to enact insurance reform. The Social Security Administration determines eligibility and coverage levels.
Medicaid, on the other hand, is administered at the state level. Although all states participate in the program, they aren't required to do so. The Affordable Care Act (ACA) increased the cost to taxpayers—particularly those in the top tax brackets—by extending medical coverage to more Americans.
According to the most recent data available from the CMS, national healthcare expenditure (NHE) grew 4.6% to $3.6 trillion in 2018. That's $11,172 per person. This figure accounted for 17.7% of gross domestic product (GDP) that year. If we look at each program individually, Medicare spending grew 6.4% to $750.2 billion in 2018, or 21% of total NHE, while Medicaid spending grew 3% to $597.4 billion in 2018, or 16% of total NHE.
The CMS projects that healthcare spending is estimated to grow by 5.4% each year between 2019 and 2028. This means healthcare will cost an estimated $6.2 trillion by 2028. Projections indicate that health spending will grow 1.1% faster than GDP each year from 2019 to 2028. This projection in growth is primarily due to higher Medicare enrollments.
The projected health care spending estimates by the CMS do not take into account costs related to coronavirus pandemic.
Additional CARES Act Funding
The CARES Act will provide additional funding to healthcare providers and suppliers—including those that are Medicare and Medicaid enrolled—by $100 billion for expenses related to COVID-19.
Below are some examples of what the additional funding will cover:
A 20% increase in Medicare payments to hospitals for COVID-19 patients
A scheduled payment reduction will be eliminated for hospitals treating Medicare patients from May 1 through the end of 2020
An increase in Medicaid funds for states
Medicare Taxes
Taxpayers who receive wages, salaries, or self-employment income are required to pay Medicare tax on all of their wages. There was previously a limit on the amount of income on which Medicare tax was assessed, but this was eliminated in 1993. Now all earned income of any kind is assessed a 2.9% tax. Employers who pay their employees W-2 income cover half of this amount, or 1.45%, and the employee must pay the other half.
In most cases, the employer withholds the amount the employee owes so no balance is owed at tax time. Self-employed taxpayers must pay the entire amount themselves but are allowed to deduct half of this cost as a business expense. This amount is coded as a deduction for adjusted gross income (AGI), so it isn't necessary for the taxpayer to have to itemize.
Fast Fact
Although self-employed taxpayers are responsible for the entire 2.9% Medicare tax, they may deduct half of this cost as a business expense.
On Jan. 1, 2013, the ACA also imposed an additional Medicare tax of 0.9% on all income above a certain level for high-income taxpayers. Single filers have to pay this additional amount on all earned income they receive above $200,000 and married taxpayers filing jointly owe it on earned income in excess of $250,000. The threshold is $125,000 for married taxpayers who file separately.
Unearned Income Medicare Contribution Tax
There is also an additional tax on unearned income, such as investment income, for those with AGIs higher than the thresholds mentioned above. It is known as the unearned income Medicare contribution tax. Taxpayers in this category owe an additional 3.8% Medicare tax on all taxable interest, dividends, capital gains, annuities, royalties, and rental properties that are paid outside of individual retirement accounts or employer-sponsored retirement plans. It also applies to passive income from taxable business activity and to income earned by day traders.
This tax is applied to the lower of the taxpayer’s net investment income or modified AGI exceeding the listed thresholds. This tax is also levied on income from estates and trusts with income exceeding the AGI threshold limits prescribed for estates and trusts. Deductions that can reduce the amount of taxable net investment income include early withdrawal penalties, investment interest and expenses, and the amount of state tax paid on this income.
When this tax was legislated in 2010, the IRS stated in the preamble to its list of regulations that this was a surtax on Medicare. The Joint Committee on Taxation specifically stated: "No provision is made for the transfer of the tax imposed by this provision from the General Fund of the United States Treasury to any Trust Fund." This means that the funds collected under this tax are left in the federal government's general fund.
Example of Medicare Tax Bill for High Earner
The total tax bill for Medicare that could be paid by a high-income taxpayer could look something like this:
Jerry is single and has inherited several pieces of land that produce oil and gas income at the wellhead. He also works as a salesman for a local technology company and earned $225,000 of 1099 income this year. His oil and gas royalties for the year total $50,000, and he also realized capital gains of about $20,000 from the sale of stock.
Jerry will owe 2.9% on his $225,000 of earned income, which equals $6,525. He also will owe another 0.9% on the amount of his earnings in excess of $200,000, which in this case is $25,000. This comes to $225. Finally, he must pay 3.8% of his $70,000 of combined investment income, which is an additional $2,660. The grand total he will pay to Medicare for the year is $9,410 ($225 + $6,525 + $2,660).
How Medicare Is Funded
Medicare is funded via two trust funds that can only be used for Medicare. The hospital insurance trust fund is funded via payroll taxes paid by employees, employers, and the self-employed. These funds are used to pay for Medicare Part A benefits. Medicare's supplementary medical insurance trust fund is funded via Congress, premiums from people enrolled in Medicare, and other avenues such as investment income from the trust fund. These funds pay for Medicare Part B benefits, Part D benefits, and program administration expenses. The standard monthly premium set by the CMS for 2020 for Medicare Part B is $144.60, although that number increases for higher-income earners.
Benefit payments made by Medicare cover the following services:
Home health care
Skilled nursing facilities
Hospital outpatient services
Outpatient prescription drugs
Physician payments
Hospital inpatient services
Medicare Advantage Plans, also known as Part C or MA Plans, which are offered by Medicare-approved private companies
Other services
The CARES Act expands Medicare's ability to cover treatment and services for those affected by COVID-19 including:
Providing more flexibility for Medicare to cover telehealth services
Authorizing Medicare certification for home health services by physician assistants, nurse practitioners, and certified nurse specialists.
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Code and Bill Correctly During COVID-19
What your doctor is reading on Medscape.com:
MAY 18, 2020 — The Coding Expert Answers Your Questions
Betsy Nicoletti, MS, a nationally recognized coding expert, will take your coding questions via email and provide guidance on how to code properly to maximize reimbursement. Have a question about coding? Send it here.
In this column, Nicoletti discuses a recent decision by the government to align rates for telephone-based visits with those for face-to-face office visits.
Getting Paid for Patient Visits Over the Phone
Q: The Centers for Medicare & Medicaid Services (CMS) says it will now pay for telephone visits during the public health emergency at the same rate as for in-office visits. How does my internal medicine practice code for these visits correctly? How do these codes differ from telemedicine codes?
A: With all of the changes that CMS has implemented since the beginning of the COVID-19 crisis, this one has generated a great deal of questions; several physicians have asked about this.
In March, CMS announced that it would pay for telephone call codes, using codes that were previously noncovered, for services provided with audio only. The change in policy was part of a wide package announced by the Trump Administration amid the COVID-19 pandemic and came on the heels of earlier announcements broadening the use of telemedicine.
Many medical practices were disappointed in telehealth rates and told Medicare that not all of their patients have the equipment needed for evaluation and management (E/M) services via telemedicine, which requires audio and visual real-time interactive technology.
On April 30, CMS announced that it would increase the payment for audio-only phone calls and made the increased payment retroactive to March 1, 2020.
It added the codes 99441-99443 to the Medicare telehealth list, for practitioners who have E/M in their scope of practice. This includes physicians, nurse practitioners, clinical nurse specialists, certified nurse midwives, and physician assistants.
Here are details on the codes:
99441: Telephone E/M service by a physician or other qualified healthcare professional who may report E/M services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.
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Telehealth Billing – What You Should Know Exactly?
Tele-health billing has been the talk of the trend on national media during the past few months of the increase of the COVID-19 pandemic. Even before the new coronavirus hit the people in the USA, 76% of the US hospitals were offering telehealth medicine to patients from distant locations.
Telehealth refers to telemedicine encompasses patient and physician’s communication through tele tools such as phone calls, emails, and text messages. On the other way around, telemedicine even caters remote clinical services through using technologies for remote patient monitoring and live video conferencing as well.
Though telemedicine is in practice, there are certain guidelines imposed by the CMS pertained to telehealth, along with some variations in reimbursement of claims as well, from payer to payer. To avoid the risk of the increase in the COVID-19 due to the current condition, extension has been provided to Medicare enrolees to get in touch with physicians on emergency and no other option cases only.
What procedure does telehealth billing follow according to new rules imposed by CMS?
For initiating reimbursement of telehealth services, an interactive audio and video telecommunications system that enables communication between the service provider and the beneficiary should be in real-time.
There is a change in the category of services due to the pandemic outbreak, which needs to be followed properly before claims submission/reimbursements. It may not completely change to the existing telehealth billing rules, yet there are notable changes as well.
Earlier to COVID-19, telehealth was considered as a benefit of coverage only if the originating site was outside the country of a Metropolitan Statistical Area, but now there is more liberalness to many medical practices, health centres, individual practitioners, etc.
Prior to COVID-19, all doctors, nurse practitioners, nurse-midwives, clinical nurse specialists, certified and registered nurse anesthetists, etc. were eligible to receive telehealth reimbursements, but now telehealth billing is all about distant site, where the provider who delivers the service is located.
Some of frequently used telehealth billing codes for your knowledge
New patient visits: 99201–99205
Consultations: 99241–99245
Codes for behavioural change interventions: 99406– 99408
Established patient visits: 99212–99215
Changes in telehealth coding due to COVID-19:
In case you are an individual telehealth Billing service provider, then according to CMS, these are the codes you should follow for evaluation and management visits, to Medicare:
99421: If the patient is an established one and opting for online digital evaluation and management service for up to 7days, and the consultation lasts for 5–10 minutes during the 7days, then the provided code should be used.
99422: In the same pattern, if the patient’s consultation lasts for 11–20 minutes, then apply this code.
99423: In case the duration of tele-consultation exceeds 21 or more minutes, then this code has to be considered.
If you are a commercial player, then you might be required to use Modifier 95 on a need basis for tele-health billing with Medicare. However, providers will make use of the same POS code like how they use it for in-person services, as long as the rules remain imposed and the COVID-19 outbreak continues.
Conclusion
Changes in telehealth billing and coding are common anytime no matter whatever the situation we are. But keeping those changes in tele-health coding updated regularly is highly critical for medical practices, due to the increase in the number of patients who opt for telemedicine during this pandemic.
Therefore, to control such complex situations and streamline to telehealth billing process, thinking of outsourcing will be a great choice. 24/7 Medical Billing Services offer a wide range of medical billing and coding services at high quality. The company is especially good at staying in line to the changing rules and trends in medical billing and coding, to provide a great service to medical practices.
Know More About Telehealth Billing Services
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Top 5 Milestones That Made Telehealth Possible
Telehealth has been making its mark on the healthcare community for decades. Today, over 90% of healthcare executives say their organizations are developing or have already developed a telehealth application. But this is a recent development made possible by years of technological innovation and federal regulation. Learn more about the history of telehealth and how we got to where we are today.
1948 – First Radiological Images Sent Via Telephone
The telephone proved more useful than just connecting folks all over the country. Doctors started using this new communications tool to send radiological images to other specialists, speeding up the data transfer process.
1959 – University of Nebraska Uses Telemedicine to Transmit Neurological Examinations
This is the first case of health professionals using the telephone to send and receive medical documents across long distances.
1960s – Nebraska Psychiatry Institute Uses Closed-Circuit TV for Psychiatric Consultations
The television was changing the ways people send and receive information all over the country, but the Nebraska Psychiatry Institute took things one step further. By broadcasting live, psychiatrists could interact with their patients even though they weren’t in the same room.
1961 – U.S. Space Program Conducts Test Flights with Animals Using Remote Medical Monitoring Systems
Before the U.S. shot a man into space, the Space Program sent animals into space and used remote sensors to monitor their condition as they left the earth’s atmosphere. This paved the way for remote patient monitoring commonly used today.
1990s – The Internet Is Born
We wouldn’t have telehealth without the internet. With a globally interconnected computer network, healthcare professionals can send and share information with just a few clicks. This laid the foundation for our modern healthcare system.
1993 – Founding of the American Telemedicine Association
With the internet up and running, the healthcare community started realizing the potential of these new communication tools. This non-profit organization is designed to promote and expand telehealth technology companies as a way of increasing patient access to care. The organization stays on top of the latest telehealth news, educating patients and healthcare professionals about the benefits of telehealth.
2009 – ARRA Drives Digital Connectivity in Medical Technology
In the wake of the Great Recession of 2008, the country was suffering from mass unemployment and slow economic growth. The federal government tried to boost the domestic economy and replenish the country’s infrastructure with the American Recovery and Reinvestment Act of 2009. This landmark legislation poured money into the American Healthcare system, including HITECH (Health Information for Economic and Clinical Health), spending a total of $155 billion. The bill allocated over $25 billion to health information technology, which spurred growth in healthcare digital connectivity. Telehealth would be nearly impossible unless every healthcare provider is using the same system. This bill gave health systems the support they need to get online and connect with other systems in the field.
2010 – CMS Rules on Meaningful Use of Electronic Health Records
Once the ARRA was passed, the Centers for Medicare & Medicaid Services ruled on what constituted as meaningful use regarding electronic health records. Citing concerns over patient privacy, the organization tried to clarify how this information should be shared in the digital age. Meaningful use is defined by the use of certified EHR technology in a meaningful manner, such as prescribing medication and improving the quality of care.
2016 – HRSA Receives Funding to Expand Use of Telehealth in Rural Areas
Studies have shown that individuals living in rural communities can benefit the most from telehealth. The Health Resources and Services Administration received $16 million in 2016 to expand access to telehealth services in rural areas.
Telehealth still has a long way to go before it becomes the backbone of our healthcare system, but these accomplishments and milestones illustrate how far this technology has come over the years.
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