Healthcare in Idaho: Will There Be a Doctor in the House?

By Idaho Capital Sun, Guest Columnist Toni Lawson, Idaho Hospital Association VP of Government Relations

As one of the fastest-growing states, Idaho finds itself at a crossroads in healthcare policy with important decisions on the horizon. The Idaho Hospital Association has been closely monitoring this evolving landscape and how voters see the issues. Recent statewide polling reveals a clear message: Idahoans are concerned about access to healthcare in the coming years and willing to pay to preserve those services. 

With the rise in population comes an increased demand for healthcare. The poll asked voters if Idaho has enough healthcare resources like doctors and hospitals for everyone in the next 10 years. A resounding 68 percent of people said no. This speaks volumes about the concerns that our residents have regarding the future of healthcare availability.

When asked about the idea of controlling healthcare costs and/or limiting services, two out of three Idaho voters said they want to safeguard access to services, even if it means higher costs. They understand healthcare is not just another resource; it’s a lifeline that can mean the difference between survival and tragedy. With increasing challenges to recruit and retain healthcare professionals in Idaho, I wonder … when your family needs that lifeline, will there be a doctor in the house? 

Access to healthcare is part of a strong foundation of a healthy community. When individuals can readily access the care they need, preventative measures can be taken, early diagnoses can be made, and chronic conditions can be managed effectively, reducing the burden on the system. 

We cannot ignore the issue of cost associated with preserving access to services. No one wants to see healthcare expenses spiral out of control. That’s why Idaho hospitals are investing in coordinated healthcare models that are demonstrating real cost savings. By catching health issues early and providing timely care, we can avoid more costly treatments. Simply cutting services is not the secret to effectively cutting costs.

It’s time to invest in healthcare infrastructure, increase the number of healthcare professionals, expand capacity, and improve access in rural areas. The goal should be to ensure that quality care remains within reach for all Idahoans, regardless of location or financial status.

Idahoans understand there is a critical connection between health and access to care. Policymakers should take these findings to heart as they shape the future of our state. It’s time to ask lawmakers to commit to creating a healthier, more resilient Idaho.

Noridian Ask the Contractor Meeting (ACM) - Recent FAQ's

By Jana Weis, Gill Compliance Solutions

Several times during the year, Noridian hosts a live Q&A for the general public to vet issues around coding, billing, and claims. We encourage providers to use this resource if they need directives outside IMA or Gill Compliance Solutions. Gill Compliance Solutions often submits questions on behalf of providers if they wish to remain anonymous. If you are interested in joining the next ACM meeting with Noridian on October 11^th, you can register at - https://register.gotowebinar.com/register/8372410938014290777.

Here are a few recent questions submitted by practices that you might find of interest regarding E/M services, SNF, and prolonged care.

Can physicians performing interdisciplinary rounds include "discussion of management with an external physician" as a data component to determine the level for evaluation and management (E/M) service?

Yes. See CPT guidelines definition for an external physician or other qualified health care professional in the same group practice or is of a different specialty.

Can we bill an office visit for a patient seen in our office when they are listed as an inpatient at a skilled nursing facility (SNF) or rehab hospital?

Yes. Providers can bill Part B for a separate "office" visit, as the SNF Consolidated Billing does not bundle office visits into the Part A stay. When the service is rendered to a patient registered as an inpatient in a rehab hospital or SNF, regardless of where the face-to-face encounter occurred, place of service (POS) 21 or 31 is billed, instead of POS 11 (office). Read more at https://www.cms.gov/medicare/snf-consolidated-billing/2023-part-b-mac-update. The Internet Only Manual (IOM) excerpt explains https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c26pdf.pdf.

How many days count time towards an E/M visit for office or outpatient services? 

Time is limited to the date of the patient's visit. CMS includes the time required to bill the office or outpatient code. Internet Only Manual (IOM) Publication 100-04, Chapter 12, Section 30.6.15.1.F at https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c12.pdf. Updates for 2023 can be found in change request (CR) 13064 at this link: https://www.cms.gov/files/document/r11842cp.pdf.

Do two separate offices within the same building qualify as the same "office suite"?

This depends. We consider "office suite" as limited to the dedicated area, or suite, designated by records of ownership, rent, or other agreement with the owner, in which the supervising physician or practitioner maintains his or her practice or provides his or her services as part of a multi-specialty clinic.

If the diagnostic imaging center is separate from the supervising provider's dedicated office area, then the physician would need to be in attendance in the imaging center to qualify as "direct supervision." For direct supervision, the physician does not need to be in the same room during the procedure.

Which E/M code category should be used by the other physician (not the primary treating physician) evaluating the patient in observation status? 

Other practitioners providing services to a patient in observation would submit the appropriate outpatient E/M service codes with the correct place of service, per CR 13064 and under Section 30.6.8.B at https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c12.pdf.

Can HCPCS G2212 (Prolonged office or other outpatient service(s) beyond the maximum required time of the primary procedure; each additional 15 minutes by the physician or qualified healthcare professional, with or without direct patient contact) be reported for time spent on the same day or even time on a different day? 

HCPCS G2212 includes time spent only on the date of the encounter. It's only added to an E/M CPT 99205 or 99215 for clinician time only. The full 15 minutes or maximum time must be met to bill G2212. Medicare Administrative Contractors (MACs) will process claims per the IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 12, Section 30.6.15.