Battle New Year's Cash Flow Crunch with Preventive Services

January 7th, 2016

One of KLA's goals this year is to help our providers have the best year ever!  As part of that, we hope to help you improve your bottom line.

Here's a tip:

Now is the perfect time of year to incorporate preventive services into your practice as they are covered by most insurance companies without a copayment or deductible.  Plus, many of these are the same services that will help boost your "value added modifier"  and lead to you being paid at the higher end vs. lower end of payment scales in the years to come.

The preventive services spreadsheet
includes both the CPT code that should be used and the required ICD-10 Code.  Selections must be used from this list in order for the services to be paid as preventive services.

Limitations as to who is covered and where the service must be rendered are listed under "Who is covered."  Services  such as tobacco counseling have no limitations as to where the services may be rendered. 

Other services require a specialist's knowledge.  Glaucoma Screening requires a optometrist or ophtalmologist.

Many services such as intensive behavioral therapy for obesity and depression screening must be done in a primary care setting. 

Please take a look to see what services can boost your bottom line during the coming months.

Of special interest for radiologists is Lung Cancer screening which does not include up to date information on the spreadsheet.

Medicare (and most private insurances) cover:

Lung cancer screening with Low Dose Computed Tomography (LDCT) once per year for patients who meet all of these conditions:

  • They're 55-77.
  • They're asymptomatic (they don’t have signs or symptoms of lung cancer).
  • They're either a current smoker or have quit smoking within the last 15 years.
  • They have a tobacco smoking history of at least 30 “pack years” (an average of one pack a day for 30 years).
  • They get a written order from their physician or qualified non-physician practitioner.

The decision memo may be found at:

https://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=274

Please note that non traditional Medicare programs and other capitated programs may include these services as part of their capitation agreements.  We have also seen some ACO contracts that retain some of these as ACO services.

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KLA is actively employing social media to pass on coding and other practice management tips to our clients and friends.  If you participate in social media, you may wish to follow KLA at:

Facebook:  https://www.facebook.com/KLA-Healthcare-Consultants-162506753773605/

Linked in:  https://www.linkedin.com/in/sharon-lusk-08976121

Google +:  https://plus.google.com/104175533097244309025?hl=en-US

Twitter:  https://twitter.com/klahealthcare

Thank you!

Tags: Preventive Services, Cash Flow

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