The struggle of primary care physicians with dynamic medical billing rules

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The struggle of primary care physicians with
dynamic medical billing rules
Medical billing is a complex process and its
always been a reason for the struggle of primary
care physicians. In addition, their practice is
often overwhelmed with constantly changing
information, including protocols and billing
codes which makes the situation more
challenging.   When the covid-19 pandemic strains
the U.S. healthcare system, primary care
physicians were working to educate their
patients, employ safety protocols, and handle
large volumes of calls. This large volume of
calls is creating administrative hurdles and
operational challenges. Hence in response, many
primary care practices are making changes to
their medical billing processes to accommodate
new patient needs.   The recent release of the
Medicare physician fee schedule final rule from
the Centers for Medicare Medicaid Services
(CMS) contains new hope for struggling primary
care physicians and you will get to know about it
in the following brief. Add-on code G2211 The
CMS feels the need to compensate physicians and
other qualified health care professionals for the
inherent complexity of primary care and other
office visits hence CMS is moving forward with
add-on code G2211.
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The struggle of primary care physicians with
dynamic medical billing rules
You may separately list this add-on code in
addition to office/outpatient (E/M) visits for
new or established patients (i.e. codes
99202-99215). Also, you can use this code even
when the E/M visit is done via telehealth as this
code is permanently added to the Medicare
telehealth list by CMS. One important point you
need to consider here is the codes Medicare
payment allowance will be approximately 15.88,
but will vary geographically. According to CMS,
The code G2211 is a reflection of the intensity,
time, and practice expense required to build
longitudinal relationships with patients as well
as these codes can address most of patients
health care needs with consistency and continuity
over long periods. In the context of primary
care, CMS believes the code recognizes the
resources inherent in holistic, patient-centered
care that combines the treatment of illness or
injury, the management of acute and chronic
health conditions, and the coordination of
specialty care in a collaborative relationship
with a clinical care team. After knowing about
the G2211, you should ware about visits for which
reporting code G2211 would not be appropriate.
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The struggle of primary care physicians with
dynamic medical billing rules

• Following are some examples that can help you to
  understand
• Care furnished by a professional whose
  relationship with the patient is of a discrete,
  routine, or time-limited nature (e.g. mole
  removal or referral for mole removal),
• Treatment of a simple virus
• Counseling related to seasonal allergies
• Initial onset gastroesophageal reflux disease
• Treatment for a fracture
• Treatment in which comorbidities are either not
  present or not addressed
• Situations in which the billing professional has
  not taken responsibility for ongoing medical care
  for that patient with consistency and continuity
  over time, or does not plan to take
  responsibility for subsequent, ongoing medical
  care for that patient with consistency and
  continuity over time.

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The struggle of primary care physicians with
dynamic medical billing rules

• Apart from Add-on code G2211, CMS also finalized
  proposals to increase the values of certain
  codes, including those for the following
  services
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• Maternity services,
• Transitional care management services,
• Initial preventive physical examinations and
  initial and subsequent annual wellness visits
• Emergency department visits.
• Some behavioral health services.
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• CMS has come up with changes in medical billing
  periodically which is the reason for complex
  medical billing. If you are not sure to handle
  the growing complexities of medical billing then
  you can outsource your billing to us and rest
  assured, we are one of the best medical billing
  and coding companies with extensive expertise in
  the healthcare domain.
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