CMS is implementing the building blocks to support the establishment of a value-based purchasing program for health professionals. These include initiatives on quality and efficiency measurement and reporting, incentive alignment approaches, care coordination, prevention, and health information technology. In early 2009, CMS produced a Roadmap for Implementing Value Driven Healthcare in the Traditional Medicare Fee-for-Service Program, which can be found at www.cms.hhs.gov/QualityInitiativesGenInfo/downloads/VBPRoadmap_OEA_1-16_ 508.pdf. This report sets forth the vision of value-based purchasing as patient-centered, high-quality care delivered efficiently, and it details the many goals for value-based purchasing.
In order to move towards realizing these goals, the report states that CMS will need to work in partnership with physicians, providers, beneficiaries, Congress, and other stakeholders to create a healthcare financing system that promotes joint clinical and financial accountability. For this to happen, CMS will seek to restructure the payment systems to provide incentives for physicians and providers to work together to develop new ways to deliver high-quality, efficient care while maintaining beneficiary access.
In the next two issues, “From the College” will take a closer look at the four cornerstones of value-based purchasing in Medicare and explore current pilots and demonstration programs, as well as plans for future development in each of these areas. For questions regarding value-based purchasing and how it applies to your practice, contact Itara Barnes at [email protected]
Do You Know the Three Rs of Consultations?
With the Recovery Auditor Contractors (RACs) gearing up to begin auditing physicians’ practices, the ACR is encouraging its members to be prepared.
The RACs will be focusing on high error-rate codes, and it has been reported by the Office of the Inspector General that consultations are high among codes that are incorrectly billed. When looking at consultations, it has been reported that they have been billed in error at least 86% of the time—which does not mean the physician did not provide the service but shows that there was insufficient documentation to support the level of service billed.
When billing for a consultation you must follow the rules of coding for consults, which are known as the Three Rs.
- Request: There must be documentation of the request and a reason for the consultation. A request can be written or verbal, but must be documented in the patient’s record. Keep in mind that the referring physician should be requesting your medical opinion or advice. A consultation is based on the intent of the referring physician and not the specialty of the consulting physician.
- Render: The specialist must render an evaluation and management (E/M) service related to the problem stated in the request.
- Respond: After treating the patient, the consulting physician must submit a written report of the findings of the E/M visit. When coding, do not believe the myth of, “I am a rheumatologist, so all new patient visits are consults.” This way of thinking will not serve you well in the long run. Patient visits are only consults if the referring physician is seeking your medical opinion or advice.
Visit www.rheumatology.org/practice to download the ACR’s documentation tools to help with consultation documentation. If you have any questions about consultations or other coding issues, contact Melesia Tillman, CPC, CRHC, CCP, at (404) 633-3777, ext. 820, or [email protected].
