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Happy 2nd Birthday IHM!

Two years ago, on February 1st, 2011, Illinois Health Matters was created to be a source for straight-forward, factual info on the progress of health care reform in Illinois. Before we head into our 3rd year, here are some highlights from the past year:

Affordable Care Act (ACA) implementation moved forward:

As a communication tool, Illinois Health Matters hit some major milestones:

We released our first interactive data tool last year—the Visualizing Reform map, which displays the impact of the ACA on communities in IL, and made a big impression on policymakers, advocacy groups and health professionals from all across the nation. It also placed second in the Civic Data Challenge!

In October, IHM participated in the Escape Fire movie premiere, hosted by our parent organization, Health & Disability Advocates. The premiere was a fundraising success, the movie was impactful and informative, and we had a great time seeing many of our Chicago-area supporters and collaborators.

IHM content has reached close to 20,000 people (many of whom use it on an ongoing basis) and this blog has reached almost 33,000 more. With 2014 as a pivotal year for the Affordable Care Act implementation, we have more exciting, groundbreaking and informative plans in store for the next 12 months.

In lieu of birthday gifts, please sign up for our monthly e-newsletter or connect with us via Twitter, Facebook or LinkedIN.

Illinois Health Matters Staff

Illinois Essential Health Benefits Benchmark Plan

The State of Illinois has selected its Essential Health Benefits benchmark plan - the Blue Cross Blue Shield of Illinois BlueAdvantage Entrepreneur plan.

This plan sets the bar for 10 categories of health care benefits (called "Essential Health Benefits" by the Affordable Care Act), and all non-grandfathered individual and small group health plans sold in Illinois must measure up to this plan in "actuarial value." Actuarial value is an estimate of the overall financial protection provided by a health plan. (For a great explanation of Actuarial Value, check out this recent Consumers' Union report).
 
The Blue Cross Blue Shield of Illinois BlueAdvantage Entrepreneur plan is the largest small group plan in Illinois, making it the default plan if Illinois failed to select a plan, as stated in the Affordable Care Act. According to this Illinois Department of Insurance report, the plan was the third leanest plan out of the 10 options considered. It is a PPO and it covers all of the services that Illinois law mandates, such as treatment for autism and infertility. But it doesn't cover extra services such as massage or acupuncture. The plan is supplemented by All Kids for pediatric dental and the Federal Vision Insurance Plan for children’s vision.
 
We have been following the establishment of an EHB benchmark in the state closely; you can read up on the EHB selection process in Illinois here and here.

Illinois Medicaid Redetermination -- What It is & What To Tell Your Clients

In 2012, the Illinois Legislature passed the Save Medicaid and Resources Together (SMART) Act. One portion of this Act aimed to address the backlog of Medicaid redeterminations that has accumulated over the years. From this Act came the 'Illinois Medicaid Redetermination Project' (ILRP), more informally known as "Enhanced Eligibility Verification" (EEV).

The goal of EEV is to determine the eligibility status of current Medicaid recipients and adjust or eliminate benefits accordingly. This will be the system that redetermines Medicaid eligibility annually for current and newly enrolled recipients. The circumstances under which individuals may be removed from Medicaid include death, relocation out of state, or excess income, amongst many others.

The State has contracted with MAXIMUS Health Services Inc. and developed a case review system that categorizes Medicaid cases as those most likely eligible and those potentially ineligible for medical services. To this end, MAXIMUS has begun its operation and as early as this week will be reaching out to current Medicaid recipients who they believe are no longer eligible for Medicaid benefits.

As early as this week, these enrollees will receive a letter in the mail from the Illinois Medicaid Redetermination Project requesting they submit the appropriate eligibility verification documents.

PLEASE NOTE:

  • The envelope that the redetermination letter will arrive in is non-descript with nothing distinguishing it from junk mail. Advocates have made HFS aware of this issue and they have said they will be changing it.
  • Current Medicaid enrollees will have only 10 business days to submit the proper eligibility verifying documents.
Once Medicaid enrollees submit the necessary verifying information, the file will be sent back to their case manager in the local office. At this time, the case manager will have 20 days to review the information provided and make a determination of eligibility. To be clear, MAXIMUS will not make final decisions related to Medicaid eligibility, but will collect all necessary and relevant information for the Department of Human Services who will use that to make a final decision.

If Medicaid enrollees fail to provide the proper documentation after receiving a letter of notice in the mail, their file will also be sent back to a case manager and their benefits likely eliminated. Although the state has implemented a new system to redetermine Medicaid eligibility, the appeal rights of applicants remains intact.

As Medicaid enrollees will only have 10 business days to submit the required verifying documentation, it's extremely important that advocates and providers provide support to their participants who receive Medicaid benefits that may need to submit such additional documents. With such a short turn-around time and in order to ensure continuity of care, it's imperative that Medicaid enrollees understand what they must provide and submit that information within the allotted time frame.

Contact information for the Illinois Medicaid Redetermination Project can be found below and summary of the program can be found here.

Illinois Medicaid Redetermination Program Hotline Information
Hours of Operation: Monday - Friday, 7:00 am - 9:00 pm, Central Time
Saturday, 8:00 am - 1:00 pm, Central Time
Phone Number: 1-855-HLTHYIL (1-855-458-4945)
TTY: 1-855-694-5458

Mailing Address: Illinois Medicaid Redetermination, PO Box 1242, Chicago, IL 60690-9992
FAX: 1-855-394-8066

Nadeen Israel & Molly McAndrew
Heartland Alliance for Human Needs & Human Rights

Hospitalist Wingman Response: GOMERology as a New Subspecialty.

I have been a practicing hospitalist now since 2003.  In that ten years, hospitalist medicine has been the fasting growing medical specialty in America.  Our tentacles run deep and they run far.  We offer incredible value, directly and indirectly,  in the delivery of hospital based medicine.  We are maturing as a field and we shall continue to define our role in the constantly changing Medicare landscape.

Hospitalist medicine even has its own focused maintenance of certification board exam.  I believe this vindicates the field as a stand alone specialty.  However, just as it took a decade to divide internal medicine into an inpatient vs outpatient experience, a great divide is occurring within the field of hospitalist medicine that is spilling over into the field of  emergency medicine too.

I present to you the fastest growing subspecialist in hospitalist and emergency medicine:  The  GOMERologist.  That's right folks.  You heard it here first on The Happy Hospitalist.   Mark your calendars.  In ten years, the fields of hospitalist medicine and emergency medicine are going to offer a combined subspecialty board in GOMERology.   I sat for my internal medicine boards late last year and rocked them solidly.    Ten years from now I am going kill my GOMERology boards without even lifting a finger.

Emergency Medicine News recently published an article by Dr Edwin Leap titled Second Opinion:  The Hospitalist's Wingman.  Dr Leap eloquently described the fraternal relationship hospitalists have with emergency medicine physicians.  We are the last men and women standing in a rapidly collapsing health care financial tsunami coming our way.  He feels our pain.  We feel his pain.  We are the poster children for it hurts all over.

The Baby Boomers are here and they aren't going away.  They're getting older.  They're getting weaker.  They're getting too old to go home from the ER.  As Dr Leap astutely points out, they see the GOMERs first.  We are their wingman to get them out of the emergency room.  Us hospitalists are not alone in our on the job training to become experts in managing suboptimal wound care orders and strange tube feed regimens that pepper the nursing home landscapes of America.  Excuse me, I meant skilled nursing facilities (SNF).

We are in this together.  The old are getting older and the younger generation is too busy sharing the latest cat picture on Facebook to jimmy rig their basement bathroom with handicap toilet bars  for grandma and grandpa to live out their final decade of life with family.  Nope,  they have Medicare and the three midnight rule, which if played correctly, will provide decades of fraudulent  nursing home care on the backs of half the tax paying American public who are stricken with such difficult life decisions  about whether to pay the cable bill or the data plan on their smart phone that is 2 months overdue.

Every year that passes in my tenure as a hospitalist, I admit more and more GOMERs to the hospital.  I  work feverishly to maximize their intensity of service and create complexity where none exists, all in an effort to qualify this Medicare beneficiary for their three midnight stay and a 100 day ride on the Medicare National Banks' merry-go-round of life.  You see, it's not good enough anymore to be a great doctor providing great care.  What hospitals really need these days are experts in optimizing the game of Medicare 2.0.

What better way to process old people in the ER than to combine emergency medicine's expertise in  initial point of care contact with the GOMExpertise of hospitalists who excel in this madness consuming inpatient medicine.  In a few short years emergency medicine physicians and hospitalists will have the opportunity to combine forces as expert GOMERologists to provide care for Medicare patients that are too wrinkled to see  or too crooked to stand.  GOMER patrols promise  to revolutionize the delivery of hospital based nursing home care forever.

Ten years from now I can see myself working full time from home as a GOMERologist, using our MARTI translation system to personally speak GOMER with my patients to complete my 10 point review of systems and physical exam.  I'll even get to fill out my prepopulated level three hospital followup electronic progress note template while drinking a pot of coffee and watching cartoons with my kids.
Subjective:  ROS and HPI unable.  Patient is a GOMER
Objective:  VSS--see EMR
                   Head:  Looks normal
                   Eyes: closed:  Exam unable
                    Mouth:  Q-sign present
                   Neck: No JVD
                   CV:  Chest wall motion means blood is flowing.
                   Lungs:  Normal chest wall movement.
                   Abdomen:  Constipated
                   MS and skin:  Both are present
                   Neuro: Arms flailing
                    Psychiatric:  Crazy
Assessment:  GOMER: Too weak to go home with major complicating condition of too     old to order telemetry.
Plan:    Q 4 hour neurochecks, IVFs at 125 cc/hour.  IV vancomycin in case there is infection.  Blood cultures to verify presence of blood flow.  Qualify for 3 midnight SNF stay and discharge when nursing home has a bed next month.  Reviewed case details with RN.  
Hey docs.  Yeah you, the ones that mock hospitalists and ER physicians as beneath your skill set .  Our day has arrived.  Who's laughing now.  If only you knew just how great a life you could have as a GOMERologist, submitting 100 E/M charges a day from the comforts of your own home.  We're livin' the American dream! Someday you're going to be a GOMER too.  When that day comes, you're going to thank us for our skills.  This original Happy Hospitalist ecard helps explain.

"Let's just be honest, shall we?  We aren't hospitalists.  We are GOMERologists."

Let's just be honest, shall we? We aren't hospitalists. We're GOMERologists doctor ecard humor photo.


This post is for entertainment purposes only and likely contains humor only understood by those in a healthcare profession. Read at your own risk.

Incidentalomas Explained With Case History and Humor.

Turn on the television these days and it's impossible to escape news stories describing breakthroughs in cancer diagnosis and treatment.  Excluding squamous cell and basal cell cancers of the skin, over 1.6 million Americans were diagnosed with cancer last year.  This cancer.org file has some great graphics and up-to-date data on America's cancer statistics from 2012.  Unfortunately, I believe  our cancer societies have failed to properly recognize the biggest threat to public safety since the invention of the doctor.  What might that be, you ask?  Incidentalomas.    I searched the  entire pdf file linked above and I couldn't find a single reference to this kind of tumor.    What is an incidentaloma?  Wikipedia has a nice review on the rapid rise in prevalence of this tumor.  Here is their definition:
In medicine, an incidentaloma is a tumor (-oma) found by coincidence (incidental) without clinical symptoms or suspicion.
What does that mean Wikipedia?  No clinical symptoms?  No suspicion?  Suspicion of what?  This sounds like a conspiracy theory to me.  Not to mention, what is the patient supposed to think about all this?
ER:  Hi ma'am.  Remember that CT scan you demanded we get?  It shows you have an incidentaloma.
Ma'am:  An incidental what?
ER:  An incidentaloma.
Ma'am.  Did my boyfriend do this to me? I'm going to kill him!
ER:  No ma'am.  It's not his fault.
Ma'am:  Who's fault is it?
ER:  It's a tumor, ma'am.  Nobody gave you this tumor.
Ma'am.  Are you saying I have cancer?
ER:  No.  It's not cancer.  It's benign.  At least I think it is.
Ma'am:  You think it is?
ER:  You know, in medicine, nothing is 100% certain.  Would you like us to stick a needle in it just to be sure it's not cancer?
Ma'am:  I came in here by ambulance saying I had chest pain so I could get through triage and get my free pregnancy test  with my Medicaid card and now you want to stick a needle in my lung? What's wrong with you?
ER:  I take that as a no.
Ma'am:  I'm taking my tumor outa here and going to MickyDs.
ER:  If there's anything I can do to make you happy before you leave let me know. My job is to make sure I get great satisfaction scores for me and my hospital before you leave. Would you like a free coupon to the Golden Corral?
Enjoy this original Happy Hospitalist ecard, part of a collection of hundreds on Pinterest.

"No ma'am.  Your boyfriend did not give you the incidentaloma.  Please don't go home and kill him."

No ma'am. Your boyfriend did not give you incidentaloma. Please don't go home and kill him nurse ecard humor photo.


I am ashamed at our cancer societies for not recognizing the incredible physical and mental burden incidentalomas are causing Americans.  It's  time to include these tumors on all their fancy charts and graphs.  These tumors are a cancer of our soul.  In fact, I recently read a discharge summary  on a patient of mine who visited the Mayo Clinic.  That's right.  The Mayo clinic.  There it was.  Discharge diagnosis #5:  Left adrenal mass incidentaloma:  No further work up necessary.   I suppose if the resident at the Mayo clinic isn't worried about incidentalomas, I shouldn't be either.    But, try being the patient with the tumor.  All they hear is, "I have a tumor".  Try going through your life with that nagging feeling that maybe the doctor isn't right.  Maybe it is cancer.  Maybe I should get a biopsy.

Many doctors reserve use the term incidentaloma to describe  tumors that are benign non-issues.  Why?  If your doctor found a tumor incidentally and it looked malignant and they recommended further workup,  they want to take credit for finding it.  There is no coincidence in these cases.  These tumors were not found incidentally.   Your doctor is the best doctor in the world for finding your cancer when nobody else could.

Why are incidentalomas being diagnosed with such frequency?  The rapid rise in advanced radiology imaging has lead to their discovery.   Every CT scan patients demand or physicians order to rule out a diagnosis, however unlikely, risks finding an incidentaloma.  Once this diagnosis is made, physicians and patients must go through painful decisions and wishy-washy informed consent to decide what to do next.

Should that spot on the lung be biopsied?  Should that tumor in the adrenal gland be ignored because it's just an adrenal incidentaloma?  Should that asymptomatic pituitary tumor undergo a transsphenoidal biopsy (sticking a needle through the nose into the brain) just to be sure it's not cancer?

The more scans we order, the more incidentalomas we are going to find. Should these tumors be ignored?   Should they be followed through time with highly radiating CT scans that will surely cause cancer that makes the charts and graphs in the future?   It's times like this I'm glad I'm a hospitalist who can write an order to:
Follow up with PCP regarding incidentaloma.  No inpatient workup indicated.
This post is for entertainment purposes only and likely contains humor only understood by those in a healthcare profession. Read at your own risk.

What is the Illinois Partnership Health Insurance Marketplace?

The Affordable Care Act requires each state to have a health insurance marketplace (otherwise known as a "health insurance exchange"). Originally, the plan was for each state to establish its own health insurance marketplace, or default to a federally-run exchange. After the ACA passed, the federal government offered a new “partnership exchange” model, which is to relieve some of the administrative burden on the state by providing federal assistance. Illinois sent the federal government a blueprint application in November 2012 to establish a state-federal partnership exchange in 2014, with plan to transition to a state based exchange after 2015. The state is waiting for final approval of the blueprint.

On January 3, 2013, the federal Center for Consumer Information and Insurance Oversight sent out guidance on how a partnership health insurance exchange will work. The guidance allows states like Illinois who plan to transition to a state based exchange to take on as much responsibility as possible for exchange activities such as administration, plan selection, and consumer assistance. This model is referred to as a State Plan Management Partnership Exchange.

A key role of a state exchange is to provide consumers assistance in enrolling in the exchange, understand their options for insurance coverage, make decisions about coverage, and coordinate with community based organizations. This consumer help will be provided by two programs, In-Person Assisters (IPA) and Navigators, which will be separate but closely coordinated. The Navigator program will be run by the Federal government, and Illinois will develop the IPA program. Since Illinois has historic connections in the community and their understanding of the state-specific insurance, Medicaid and supplemental state health programs, the IPA program will be the primary contact for consumers and for insurance companies.

Community Based Organizations, consumer assistance organizations, medical and social service providers will all play an important role in ensuring that the Illinois state federal partnership exchange is efficient and accessible. Consumer advocates should work cooperatively with the state and federal governments to ensure that whichever agencies are responsible for administering parts of the exchange, that the end result is a coordinated system that works well for the people who need insurance coverage, including the small employers who need to purchase insurance for their employees.

Stephanie Altman
Programs & Policy Director
Health & Disability Advocates

Wong-Baker Faces Vs Pain In My Ass Rating Scale Reviewed.

Neither medicine nor nursing is practiced at the bedside anymore.  Charting has consumed our professions.  Charting is the act of writing and documenting patient care details. Do you want to know where your doctor or nurse is?  More than likely, they have their heads buried in a computer somewhere far away from your every need.

You're having pain, you say?  Your call light is going unanswered, you say?  Don't worry, your nurse is probably at the computer down the hall charting your Wong-Baker Faces Pain Rating Scale.  If you've ever been admitted to a hospital, I'm sure you've seen these cartoon-like facial images depicting pain and a number associated with that level of pain.  The scale offers a number from 0-10 with zero indicating no pain and ten meaning "hurts worst." For the general public, please note the scale ends at ten.  If you say you have 12/10 pain, your electronic charting will spit out a value of not acceptable (N/A).  Nurses have been instructed to treat N/A as 0/10 pain.

I'm sorry Mrs Wong and or whomever you are.  Your pain scale is irrelevant into today's excessive charting environment.  Nurses just don't have time to care about answering their patient's call light in a reasonable amount of time.  They don't have time to provide bedside pain scale evaluations that your organization is so proud of.  They are  too busy trying to figure out the newest change of the week in their EHR.  

So, what's important for nurses to know and to document these days?  Welcome to  Happy's Pain In My Ass Scale.  Nurses don't care if their patients are having pain.  During nursing checkout, they want to know from their colleagues if their patient is going to be a pain in the ass today.  So The Happy Hospitalist has created a proprietary new pain scale for use by nurses, for nurses, to help them summarize how their day is going to be.  By charting this 5th vital sign, nurses can emotionally prepare for their tough day in the trenches.  Go forth great nurses.  Help your fellow nurses prepare for their day by always charting your Pain In My Ass Scale!

"Pain in my ass rating scale."

Nursing call light scale 0 to 10 humor


Now, please enjoy some original crude medical humor, only from The Happy Hospitalist.

"I'll answer your call light as soon as I'm done charting your pain in my ass scale."

I'll answer your call light as soon as I'm done charting your pain in my ass scale photo.

Please remember though, patient selection bias is an important variable when determining how to interpret the pain in my ass scale. For example, the pretest probability for successful use is high when patients are directly admitted from a primary care physician's office with 10/10 abdominal pain, but shows up 6 hours later from their 3 mile distance because they went home for a nap and some KFC, as this original Happy crude medical e-card helps to explain.

"If it takes you six hours to get to the hospital from clinic because you went home for a nap and some KFC, you're not going to get my A-game when you show up at my inconvenience."

If it takes you six hours to get to the hospital from the clinic doctor ecard humor



Gomerblog 10 out of 10 pain explanation photo


"Sometimes the doctors are a bigger pain in my ass than the patient."

Sometimes the doctors are a bigger pain in my ass than the patients nurse ecard humor photo.


"ER universal pain scale."

ER-Universtal-Pain-Scale-10-Or-12


"I have a very low pain in my ass threshold.  Just so you know."

I have a very low pain in my ass threshold just so you know doctor ecard humor photoMedical Humor Store Banner

To view this ecard product selection, turn off the “content filter” function on the left hand side of the Zazzle store linked above.



"No ma'am.  Your not being a pain in my ass.  My charting can wait while I tend to your lazy adult son's every need."

No ma'am. You're not being a pain in my ass. My charting can wait while I tend to your lazy adult son's every need nursing ecard humor photo.


This post is for entertainment purposes only and likely contains humor only understood by those in a healthcare profession. Read at your own risk.



Hospitalist Charge Capture Daily Rounding Cards (With PQRS).

I've been a hospitalist now for ten years.  In those ten years I have continued to use a manual process for capturing patient billing information during daily rounds.  These cards contain all the information necessary to generate payment claims from Medicare and other third party insurance companies.  Over the years the cards have changed to add or remove elements required to receive payments and stay in compliance with third party payers.  These cards fit nicely into our scrubs or white coat pockets.

I know many organizations have moved to real time submission of daily rounding charges to their billing company.  I have seen a few smart phone applications out there that allow physicians to provide bedside charge capture with immediate transmission to their billing company or staff.  In addition, some EHR products provide algorithms that provide physicians with the correct CPT code and electronic transmission of the charges in real time.  This software and the fees that come with them can be quite expensive. As a group, we have  continued to use our billing and coding cards as a  manual physician data entry process that is scanned to the billing company for claims processing.

In my five years at The Happy Hospitalist, realized I have never given the general public a sense of how complex every single patient encounter is from the insurance side of daily hospitalist rounds.  I'm not talking about how to choose the correct CPT® code to submit for each and every patient encounter.  That's an entirely different topic for discussion.  For that I created a  bedside E/M reference card  to help me stay in compliance with  complex CMS billing rules.

I wrote this article to show the public how complex the business side of medicine is for every single encounter we generate and how we have chosen  to organize all the necessary elements of a daily encounter, including CPT® codes,  ICD codes and the PQRS elements.  We created these cards in house.  Through trial and error,  we have found a layout for our daily charge capture card that works with great efficiency and accuracy.

Many physicians who don't do their own charge capturing do not appreciate how complex this process is.   I have provided below our most updated daily rounding charge capture cards currently in use for 2013.  Each component is described below.  This is the present state of American medicine.  Physicians must comply with this process thousands of times a year with every patient encounter to get paid for the work they have provided.   The first card is the side scanned to our billing company on every patient. The second picture is the backside of the card used only as a reference for physicians to determine the correct information to submit.  See, you didn't just get a $90 out-of-pocket high deductible  copay from doctor to tell you there is no treatment for you cold.  You got a $10 opinion and an $80 bill to pay for all this madness.





  1. Room number.  Where is the patient at?  This information is not necessary for getting paid, but can be helpful for our colleagues at times.  Most of the time though, we'll use our hospital generated patient census to find you.
  2. Code status.  Do you want to be resuscitated in case your heart stops?  Again, this information is not mandatory but is helpful to know if all heck breaks loose.  Many hospitals have no hospital wide standard for capturing accurate information for the patient record.  
  3. Patient information.  This is were we place our patient sticker with that contains the patient's name, hospital ID numbers and date of birth necessary to submit payment to third parties.
  4. Site of service.  I work at two hospitals.  This information lets us and the billing company know which hospital this service was provided at.
  5. Attending or consultant.  This information is helpful to know whether we are required to provide the discharge summary.  The discharge summary is provided by the attending physician or their representative.  I don't know what effect this has on getting paid.
  6. PCP and referring physicians.  We use this information to internally track who our referring physicians.  This information is also helpful to know who to contact on discharge when patients leave the hospital and whom we should send our discharge summary.
  7. Diagnosis.  We have 13 lines to provide our diagnoses.  These are the ICD codes.  It's a free-for-all here.  Most physicians have never been trained in ICD coding, including me.  I'm sure 90% of my codes make no sense, forcing  some coding person is trying to decipher what I write to the nearest applicable ICD code.  I can't wait for ICD-10.  
  8. More lines for diagnosis.  Yes, sometimes we fill all the lines, and more.
  9. PQRS ICD codes.  These are the ICD codes we have chosen for our PQRS program.  There aren't a lot of PQRS measures applicable to hospitalist medicine, but we have found these ICD codes capture the intent of our PQRS process.  In 2015, if physicians have chosen not to participate in PQRS, they will be penalized 1.5% of  all Medicare charges.  This penalty will be based on 2013 PQRS data. These ICD codes are linked to the CPT codes in line 13, when applicable,  to remain in compliance with PQRS requirements.  
  10. Time of referral.  We use this information to understand the busiest times of day for new encounters.  Medicare does not pay more for a 2 am admission, but your plumber will.  This is helpful for creating staffing solutions for our hospitalist program.
  11. Date of service.  This information is mandatory for generating claims.
  12. Doctor providing service.  This information is mandatory for generating claims.  We use a number system to define the doctor.  It's much shorter than writing out all the names.  We hand over our cards to other doctors when we go off service so there may be more than one doctor with billing information on one card.  We trust each other not to lose the cards or change our billing information.
  13. Diagnosis for that visit.  This is where we write the number of the diagnosis (#7,8) to link the ICD code to our CPT code (#14).  These are mandatory for claims submission.  I usually pick the four most important ICD codes for my visit and write them here, even though I may manage 18 different issues during an encounter.  We don't get paid based on how many ICD codes we write and I believe Medicare carriers only allow up to  four ICD codes to be submitted during the claims process.
  14. CPT code number.  All these numbers here are the CPT codes us doctors choose that we believe accurately reflects the level of service we have provided and that our documentation supports.  The CPT code determines how much the doctor gets paid for that day's visit.  It is the most important part of the whole card.  Physicians should learn how to choose the correct code every time.  This code is mandatory for claims submission.  
  15. CPT code description.  These are the general descriptive categories of our CPT codes.
  16. PQRS explanation.  Here, we are attempting to help the physician define which ICD code to use with which PQRS G code.  PQRS codes only apply to certain ICD codes.  Certain PQRS codes only apply to certain CPT codes.  Got it?  Yeah, us too.
  17. PQRS G codes.  This is the actual code we need to choose for our visit.  Just pick one for each PQRS measure.  Got it?  Make sure you pick the right one!
  18. CPT options.  Here we attempt to describe what the options are for our CPT codes (#14).  Please pick the correct code doctor.  We don't want you being accused of fraud.
  19. Admit/Consult/Discharge codes.  We have elected to pull out these CPT codes from the above madness to allow more clarity for us and our billing company.  As you can see,  these codes require all the same elements of our daily rounding.  But remember, Medicare does not recognize consult codes anymore.  I know,  it's too complicated. 
  20. PQRS for admit/consult/discharge codes.  This is self explanatory.
  21. CPT codes for additional procedures.  We use this as reference for the CPT codes of additional procedures we may provide that aren't listed on the front of our cards.  There just isn't room for everything!  
  22. In depth PQRS descriptions.  For our reference to decide which correct PQRS code is required.  
  23. I have no idea what this is.
Any questions?  



A New Year and New Medicaid Awaits Us


What an amazing and historic beginning to the start of 2013. This week an Illinois legislative body advanced a major piece of the Affordable Care Act (ACA), when the House Human Services Appropriation Committee passed HB 6253, Medicaid Financing for the Uninsured.

After the committee vote, the waning hours of the current term of the General Assembly did not provide enough time to advance the bill further. Nevertheless, our momentum continues with renewed commitment and excitement.

This effort brought together an unusual mixture of health care providers, business interests, patients and advocates, demonstrating as great a degree of consensus on an issue like this as you are likely ever to find. We know it is right and advantageous for Illinois to accept new federal Medicaid funding, fill a historic gap in the Medicaid program and provide health care coverage for hundreds of thousands of the lowest income uninsured Illinois residents.

The fight continues and we have laid the scaffolding for us to build upon as we enter the 98th General Assembly today. Illinois House and Senate members will file new Medicaid bills, and once the new General Assembly begins, your voices will need to be heard again with in-district meetings, emails and phone calls to your Senators and Representatives, many of whom will be new in office or serving from redrawn districts. It will be critical that these legislators hear from you.

Thank you for all you have done. And thank you, in advance, for all the help you will provide in helping to achieve federal Medicaid funding for the uninsured in Illinois.

Ramon Gardenhire
Director of Government Relations
AIDS Foundation of Chicago

Start Your Week Right! Contact Springfield Today.





 
Leveraging Federal Financing for the Uninsured (HB 6253) Reaches the Illinois House THIS WEEK!
This week (and possibly TODAY)  the Illinois House will consider HB 6253 House Amendment 1 (HA 1), a bill to leverage federal financing of the state’s Medicaid program in 2014 to cover the uninsured, made eligible by the Affordable Care Act (ACA).

In Illinois today, thousands of low-income adults without dependent children are not eligible for Medicaid. This major gap in healthcare coverage would be eliminated by HB 6253 under the ACA. This Medicaid option is expected to bring $4.6 billion additional federal dollars into the state of Illinois just in the first three years, making it a great fiscal deal for Illinois!

HB 6253 authorizes Illinois to take advantage of the ACA to provide Medicaid to about 342,000 low-income Illinois citizens who are currently uninsured. Because of the ACA, Illinois can offer Medicaid to this population at no expense to the state for the first three years, and in later years the state will never pay more than 10% of the cost of this coverage (with federal funds covering the remaining 90%). Learn more about HB 6253 HA1.

2 Ways to Take Action TODAY:
  1. Tell your Illinois Representative to support HB 6253 today! Call the easy and toll-free ‘Illinois Affordable Health Care Hotline’ 1-888-616-3322 to be connected to your legislator. Need some talking points? Click here.  You can also look up your Illinois Representative’s contact information directly using this easy online tool!  Click here.
  2. Submit an electronic witness slip in favor of the bill: You can click here to file an electronic witness slip today.  Click on the icon on the right of the Appropriations committee to find the listing for HB 6253. Once you find HB 6253, click on “Create Witness Slip.” You should check the “proponent” box for House Amendment #1 (HA #1) and the “Record of Appearance Only” box.

*The 'Illinois Affordable Health Care Hotline’ is a function of the AARP Hotline. Please, do not be alarmed by the AARP phone recording. This phone line is open to everyone.
*The original House bill number (HB 5019) has changed since the recording of the Hotline to HB 6253, and may change again! Please, do not be alarmed by the incorrect bill number. This phone line is still active to support 'Medicaid Financing for the Uninsured'.
Thank you!

Questions? Contact Stephani Becker (312.265.9072) or Stephanie Altman (312.265.9070) at HDA.

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