Update on Billing and Coding in Geriatrics and PALTC
By Todd H. Goldberg MD CMD FACP AGSF, Chief of Geriatrics, Jefferson-Abington Hospital and Medical Director, Artman Lutheran Home
As a geriatrician doing both clinical and administrative work (medical director, division chief, program director), even if not in private practice we still need to have a good understanding of billing and coding for both personal productivity and income, and administratively. Most of our geriatrics work involves Medicare so we need to be on top of CMS/Medicare policies. Some of you attended my lecture on this topic at the fall 2023 PMDA Annual Meeting, this past October in Gettysburg. I am happy to take this opportunity to reiterate in writing for posterity some of the points I made and some additional updates that have come around since October.
Background: What healthcare providers actually do are provide services and procedures, counseling, prescriptions, advice, and testing. Since we are not surgeons or proceduralists doing caths or endoscopies, most of what we do as family doctors, internists and geriatrics is referred to as “Cognitive” or “Evaluation & Management Services,” which have a variety of numeric billing codes for each type/location and intensity/length of service. Some examples are 99307 for a brief/uncomplicated 10- minute nursing home visit or 99211 for a brief/uncomplicated 10- minute office visit. The numerous billing codes for E&M Services come mostly from the AMA’s CPT book (Common Procedural Terminology), with some different codes and tweaks directly from Medicare/CMS concerning what codes they will pay for and what the detailed requirements are (usually published in the Federal Register and the Medicare Claims Processing Manual). Diagnosis codes come from the ICD-10.
Since Medicare (except for Annual Wellness Visits) doesn’t usually pay for routine/preventive services; in general CPT codes have to correspond to an appropriate ICD-10 diagnosis code documented in your notes. Virtually every CPT code has a relative value and price attached to it by Medicare and other insurers, updated every year. There are a few CPT codes that Medicare doesn’t pay for at all such as “routine physicals,” though private insurers might. All these facts have been true for many years, since at least the 1990’s, but every year there is something new to learn. Unfortunately, this is a constantly evolving topic since every year Medicare comes out with updates in the “Physician Fee Schedule” in terms of not only prices and requirements for different codes, but also new and changed codes every year. So in order to get appropriately and maximally reimbursed for the valuable work we do, it is incumbent on both providers and billing staff to be familiar with all the latest information, codes, and requirements. This is covered virtually every year at AMDA and PMDA meetings and is the purpose of this article. If you would like a copy of my full slides from PMDA or similar presentations from PMDA or AGS please feel free to email me directly at todd.goldberg@jefferson.edu. The latest official CMS/Medicare document on physician payment for 2024 was published in the November 16, 2023 Federal Register (web reference: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-final-rule).
The biggest change for 2023 was that all families of E&M codes can now be based on either medical complexity as before, or simply time. This continues in 2024.
|
|
Join our mailing list and be the first to hear about our 2024 Spring Symposium! |
|
Job Bank
Community LIFE is a program of all-inclusive care for the elderly, committed to empowering older adults to remain at home while preserving their dignity, independence, and quality of life. Our program brings the region’s experts in geriatric medicine and care together to work as a team in specialized Day Centers. Our wide range of services are designed to meet the varied needs of seniors, and include medical care, social services, meals, activities, transportation and much more.
Shift: Mon-Fri, 7:30am-4:00pm
Location: Pittsburgh, PA
We are seeking an MD or DO for periodic and episodic assessment and management of geriatric participants’ medical conditions, and for oversight of their use of medical specialists and inpatient care.
Required Education: Graduate of an accredited school of medicine. Completion of residency in Internal Medicine or Family Medicine. Fellowship training in geriatrics preferred.
Required Licensure: Must have a current license to practice medicine in Pennsylvania (MD or DO), current DEA license, Medicare provider enrollment, and a valid PA driver’s license.
Required Experience: A minimum of one year of primary care experience with a frail or elderly population.
Benefits:
Community LIFE offers a generous benefit package, including Medical, Dental and Vision insurance, Life insurance, Short Term & Long Term Disability insurance, 5 weeks Paid Vacation, Paid Holidays, Company contribution to a 403(b) retirement plan, Tuition Reimbursement, Mileage Reimbursement, Employee Appreciation events, and more!
|
|
Still NOT a PMDA Member?
You can become a member of PMDA by clicking on the membership application below.
To pay for your membership dues, you may either mail a check to PMDA (400 Winding Creek Blvd., Mechanicsburg, PA 17050) or complete the credit card/billing information in the membership application or call Jill Bennish, Finance Coordinator at 717-909-2679 to pay via credit card over the phone. And If you have any questions about membership, please contact PMDA at pmda@pamedsoc.org.
|
|
If you have any questions about membership, please contact PMDA at pmda@pamedsoc.org.
|
|
Partnership in Leadership: An Administrator and DON Share Their Success Stories and Lessons Learned
More of a Good Thing: A Framework to Grow and Strengthen the PALTC Careforce is back with a new series of roundtable discussions designed to highlight and share effective strategies being used to improve staff retention and recruitment in PALTC settings. Each roundtable begins with a brief presentation about a project or strategy that is seeing success in growing the PALTC careforce, then participants can ask questions and share their own successes and challenges, so we can all benefit from what others are learning.
Date: December 14, 2023
Time: 4:00 – 4:45 PM ET
Fee: FREE
|
Register for PALTC24 by January 4 to Take Advantage of the Early Bird Rate
Embark on a memorable journey in San Antonio, TX, where you'll have the opportunity to fully engage in a dynamic program offering valuable sessions, stimulating discussions, and ample networking opportunities. View Full Program.
While you're in San Antonio, immerse yourself in the city's rich heritage by exploring iconic sites like the Alamo and indulge your tastebuds in the vibrant Tex-Mex culinary scene. Experience the enchanting River Walk, where lively restaurants and shops line the scenic waterways.
Can't make it to San Antonio? No problem! AMDA’s offering a Virtual Learning Track which will provide you with access to the live-streamed General Sessions, nine live-streamed sessions, and all concurrent session recordings through March 31, 2024. View Virtual Learning Track.
|
|
|
Celebrate this season of gratitude with the Foundation’s Giving Thanks Campaign!
Your gift supports initiatives like the Futures Program, a workforce development initiative for burgeoning practitioners developing their PALTC knowledge, and research grants & programs benefitting the PALTC community. Together, we are building a better PALTC.
Make a gift in honor & gratitude of someone special and they’ll receive a holiday gratitude card! Donate now by visiting paltcfoundation.org.
|
|
Finding Your Value in Evolving Payment Models Recordings
Miss AMDA’s virtual policy forum—Finding Your Value in Evolving Payment Models? No worries, the recording is now available! Whether you practice using traditional fee-for-service or value-based payment models, you'll want access to this information.
|
|
|
|
|
|
|
