Navigating rheumatology practice management in 2024 and beyond requires a broad knowledge of many key areas, including coding, revenue cycle, denials management, compliance and other general business processes. Balancing all the various aspects of managing a high-quality and efficient practice to ensure patient satisfaction may seem like an uphill battle.
Ms. Chung
“With all the changes happening in the healthcare sector, consistent training and support in practice management is necessary in adapting to the evolving regulations and payer changes,” says ACR Director of Practice Management Antanya Chung, MBA, CPC, CPC-I, CRHC, CCP. Along with ACR Coding and Reimbursement Specialist Melesia Tillman, CPC, CPC-I, CRHC, CHA, the team works full time to support members with practice questions spanning clinical documentation, audits, coding, Medicare, HIPAA regulations, clinical onboarding and practice compliance.
A few key areas the ACR practice management staff are working on include the newly assigned Medicare Healthcare Common Procedure Code (HCPCS) G2211, remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) treatment management codes, HCPCS drug changes and the increase in audit request reviews.
Learn More About G2211 at a Lunch Series
For calendar year 2024, the Centers for Medicare & Medicaid Services (CMS) finalized a new add-on code G2211 for outpatient office visits to acknowledge the complexity of care for services related to ongoing care for a patient’s singular chronic or complex condition. The ACR strongly supported the creation of G2211 and led advocacy efforts for its implementation this year.
G2211 is defined as, “Visit complexity inherent to evaluation and management (E/M) associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient’s single, serious condition or a complex condition.” This Medicare-specific add-on code is identified primarily for primary care providers and those delivering chronic care to patients, including rheumatology care providers who meet the coding criteria.
The ACR practice management team currently offers a free, tailored, one-hour lunch-and-learn series on coding and compliance for G2211 to ensure billing accuracy with E/M services.
The webinar is the latest in a series of resources developed to assist ACR/ARP members, practices and their staff with coding updates. Members have reported it as very helpful, especially given the nervousness often associated with billing new codes. Lillian Maric, MS, CPC, CPMA, a coding and auditing consultant with HonorHealth in the Phoenix area, said, “The ACR G2211 Lunch and Learn was insightful and exactly what the staff needed to help with addressing the gray guidelines associated with the new code. We were also impressed that the ACR offers the opportunity for staff and clinicians to discuss issues affecting their practices.”
The goal of the ACR practice management team is to provide hands-on training for members to help rheumatology practices maximize reimbursements and minimize claim denials or rejections, Ms. Chung says.
Resolving Coding Questions & Denials
Coding and billing issues represent the most common questions that practice managers, billers and even physicians ask the ACR, and many of these questions seek answers to why a claim was denied.
To help members, Ms. Tillman speaks directly with practice managers and takes a stepwise approach to investigate all coding questions and denied claims. She starts by finding out what service was provided, then reviews the medical policy to verify all the covered services and check for any frequency limitations. She also makes sure all services can be billed on the same claim and sends a copy of the policy to verify that the practice is following all the guidelines before submitting a claim.
Medical codes are an integral part of revenue cycle management, making it important to understand the adjustments and modifications to ensure proper reimbursement, reduce denials and deliver quality patient care. For example, the CMS’ revisions to the HCPCS drug codes for methylprednisolone and methotrexate had a ripple effect with coding and billing drug wastage in rheumatology practices.
“Sometimes, a very simple coding error can result in a denial that can be corrected and resubmitted for payment,” Ms. Tillman explains. For example, she says, if a provider is using a multi-dose vial to administer a drug, they will be reimbursed for only the amount administered to the patient and not for any discarded amounts of the drug.
E/M Coding Changes in Practice
This year, Ms. Tillman and Ms. Chung are still seeing an uptick in questions from practice managers about how to accurately code the updated E/M services. Although the E/M coding update was implemented in 2021, there are still many questions on the coding guidelines on medical decision making and time as it relates to clinical documentation.
“Although these changes were made to make coding easier, adapting to these changes continues to present challenges due to payer policies denials,” Ms. Chung notes.
For example, providers are no longer subjected to the three key components of E/M for both new and established patients, but they can make their code selection based on the medical decision-making level or time spent on that date of service. If time is chosen, time must be documented specifically and include total time of care provided for that day. Additionally, time can now include both face-to-face and non-face-to-face time, such as reviewing a patient’s test results in preparation for their clinical visit, as long as the non-face-to-face time is provided on the date of service, Ms. Tillman explains. In addition, the history and examination component of E/M is no longer required for visits using codes 99202–99215; instead, each service should include “a medically appropriate history and/or examination” and be documented in the patient’s medical record, Ms. Chung adds.
Getting the Support You Need
Ms. Chung and Ms. Tillman encourage rheumatologists and practice managers to reach out to the ACR with questions. They also point to the ACR’s extensive collection of practice support resources, including guidance and FAQs for common administrative questions:
- Practice publications, such as a manual on the business side of rheumatology;
- Coding resources, such as guidelines on understanding G2211, drug wastage and coding & reimbursement for interprofessional consultation codes, and how to select an E/M code based on medical decision making or based on time;
- FAQs on E/M, infusion, injection and incident-to services; and
- Current issues on insurance advocacy.
Members can reach out to the ACR directly with business practice questions by sending an email to Ms. Tillman and Ms. Chung at [email protected].
