Monday, 23 January 2017

Alcohol Misuse Screening Covered by Medicare

Medicare expanded its Preventive Services program to include steps to reduce alcohol misuse.  See table below for reimbursement details.

The National Council on Alcoholism and Drug Dependence is sponsoring April as the month to raise the awareness of alcohol use.   Since alcohol use can range from never to occasional to the far extremes of alcohol abuse and Alcoholism (alcohol dependence), healthcare providers can benefit from various educational tools available to assist in the evaluation of their patients. 

Reviewing up to date statistics on the prevalence of alcohol use are a great place to start.  On the National Institutes of Health website for National Institute on Alcohol Abuse and Alcoholism (NIAAA) you can get find some of the following facts:

Of those adult Americans (ages 18 and over)that drank in the past year, 21.9% of       women and 42.3% of men consumed 3 or more drinks.

Daily consumption of adult Americans in the last year is 2.45% for women, and 5.78% for men. 

In the United States, one "standard" drink contains roughly 14 grams of pure alcohol, which is found in:
12 ounces of regular beer, which is usually about 5% alcohol
5 ounces of wine, which is typically about 12% alcohol1
5 ounces of distilled spirits, which is about 40% alcohol

Numerous health conditions can be brought on or exacerbated by alcohol use. 

Alcohol interferes with the brain’s communication pathways, disrupting brain function that can lead to mood or behavioral changes, thought processing and physical movement. 

High consumption of alcohol either over time or on one instance can cause heart problems like cardiomyopathy, arrhythmias, stroke and high blood pressure. 

The liver and pancreas can be affected in a variety of ways by heavy drinking including: steatosis (Fatty liver), alcoholic hepatitis, fibrosis and cirrhosis of the liver, and pancreatitis. 

High levels of alcohol consumption can increase risks of developing cancers in areas such as:  mouth, esophagus, throat, liver and breast. 

A weakened immune system can make heavy and/or chronic drinkers more susceptible to infections such as pneumonia and tuberculosis.

Primary Care Physicians should review the following basic Medicare coverage information:

Service \ HCPCS Codes \ ICD-9 Codes \ Coverage \ Frequency \ Beneficiary Financial Responsibility

Alcohol misuse screening in Primary Care setting
Contact local Medicare Contractor for guidance.
All Medicare beneficiaries are eligible.
Once per year
Deductible and coinsurance are waived.

Behavioral counseling intervention
Contact local Medicare Contractor for guidance.
All Medicare beneficiaries are eligible.
Up to four times per year
Deductible and coinsurance are waived.

Are you feeling STRESSED OUT?

With today being the day after “Tax Day”, many people are probably feeling the effects of the dreaded tax filing deadline.   Many others may attribute their stress to what they feel is the overload of their daily responsibilities and routines.   

What is psychological stress?  

Psychological stress describes what people feel when they are under mental, physical, or emotional pressure. Although it is normal to experience some psychological stress from time to time, people who experience high levels of psychological stress or who experience it repeatedly over a long period of time may develop health problems (mental and/or physical).

The National Institute of Mental Health states stress can be defined as the brain's response to any demand. Many things can trigger this response:

Change - The changes can be positive (marriage) or negative (divorce or illness), as well as real or perceived.  Other changes are extreme, such as exposure to violence, and can lead to traumatic stress reactions.

Recurring, short-term, or long-term events - like commuting to and from school or work every day, traveling for a yearly vacation, or moving to another home.

How does the body respond during stress? stress awareness day

The body responds to stress by releasing stress hormones that increase blood pressure, speed heart rate, and raise blood sugar levels. Long term stress can cause:
  • digestive problems
  • fertility problems
  • urinary problems
  • headaches
  • difficulty sleeping
  • depression
  • anxiety
  • increased susceptibility to viral infections

Ways to cope with stress are:

Family support Maintain contact with friends and loved ones that can offer emotional support

Learn about relaxation stress management techniques

Massage therapy relieves stress

Mental health professional Seek counseling from a healthcare professional

Exercise regularly benefits of regular exercise

3 Part Series: Medical Practice Vital Signs-Part 3

A Medical Practice is a unique business in many ways, but it is still a business and must be treated as such.  Checking the health of your practice is similar to checking the health of your patients.  In this three part series, we will look at these Vital Signs, pulse, blood pressure and temperature, to help you assess the financial well-being of your medical practice.

Previously in Part 1, we discussed the pulse of your practice: reviewing new patient growth and referral sources.  If you missed Part 1, please select this link: Check the Vital Signs of Your Medical Practice-Part 1

Following pulse, Part 2,  examined  blood pressure:  trending patterns of procedures billed and verifying proper claims reimbursement.  If you missed Part 2, please select this link: Check the Vital Signs of Your Medical Practice-Part 2

Our third and last vital sign is Temperature- 

What is the aging breakdown of your accounts receivable?

A basic Accounts Receivable report typically includes monies due in aging “buckets”:

Less than 30 days
31-60 days
61-90 days
91-120 days
121-150 days
Over 151 days

Ideally you want to see the largest percentage of receivables in the less than 30 days bucket with balances diminishing as you progress through the older buckets.  The older the receivables get, the more difficult it is to collect from the payer.  It can also snowball into an increasing amount of information to go through if not addressed in a timely fashion.  It can become so overwhelming, office staff may not know where to start.

Do you have adequate procedures to ensure quick collection of monies due?

Your receivables in the 31-60 days category, when analyzed by payer, can indicate if most of the money is based on secondary payer balances.  Due to the nature of processing turnaround time, it is not unusual to see secondary payer balances in this bucket and to some extent in 61-90 days also.  If you notice a large amount of primary payer monies landing in the 31-60 days bucket, checking the claim status with the payer is advised.  It could indicate the claim was not received by the payer and resubmittal is necessary in order to avoid those timely filing issues.  

If you wait until they hit 61-90 days or more, it could be too late.  Claim denials should also be addressed frequently; if not daily as received by the payer, but at least monthly during the accounts receivable analysis.  Payers also have timely filing limits for appeals that are usually only 60 -180 days after the date of the EOB.  The quicker the appeal is sent, the quicker you may receive your reimbursement.

These two reports are just a small sampling of the extensive selection of practice management reporting options built into the Report Center module of Iridium Suite Medical Billing Software.

Now that we have completed a review of the medical practice vital signs, adhere to the same recommendations you give to your patients.  Follow through with regular check-ups to maintain your practice health.  A medical practice management software like Iridium Suite has built in report scheduling to assist you in keeping that close eye on the pulse, blood pressure and temperature of your medical practice.                         

The Benefits of a Care Team Approach for Head and Neck Cancer Treatment

As part of Oral, Head and Neck Cancer Awareness Week, I have reached out to South Florida Radiation Oncologist, Dr. James T. Parsons for some professional insight.  Dr. Parsons is an internationally recognized expert in the field of Head and Neck Cancer treatment.  

We would like to emphasize the importance of a coordinated team approach for successful treatment of one of the most complex of all cancer diagnoses.

Unless they have a previous experience or personal knowledge, when most people think of cancer treatment, rarely do they truly understand that it will require a finely choreographed coordination amongst several healthcare professionals and other caregivers.

I posed the following questions to Dr. Parsons about the “Care Team” approach in the treatment of Head and Neck Cancers.

Q:  Who would you say are the necessary healthcare professionals that a patient should consult when he or she is diagnosed with Head and Neck Cancer?

Head and Neck Surgeon
Medical Oncologist
Radiation Oncologist
Oral Surgeon

Q:  How do patients navigate through the many treatment options, such as chemotherapy, radiation therapy and surgery or combinations of multiple modalities, to make the right decision about their treatment course?

A:  This is one of the benefits of having a “Care Team” approach.  If all the healthcare providers work together in evaluating the patient’s treatment needs, usually this provides a consensus of opinion, simplifying the decision-making process for the patient.  Occasionally, providers may agree on multiple treatments options, this is when assistance from family and/or close friends can be extremely helpful in the decision making process.

Q:  You mention the patient’s family and friends; I assume these persons can also have a tremendous impact on the well-being of the patient during and after treatment.  Do you consider family and friends to be part of the patient “Care Team” as well?

A:  Definitely.  Treatment for Head and Neck type cancers, like most cancers, can produce multiple side effects.  A strong at home support system is just as crucial to the success of the treatment as any medical service.  Once treatment begins, additional healthcare resources may join the “Care Team” such as: social workers, registered dieticians, and home health nurses or aides.  

Q:  Any final thoughts on the “Care Team” approach?

A:  Early intervention by the surgeon, medical oncologist, radiation oncologist, dentist and oral surgeon ensure that a rational plan of care can be developed, reducing the occurrence of any surprises along the way.

You can follow this link to the National Institutes of Health’s website for more information on Oral Cancer:

No comments:

Post a Comment

Popular Posts