Primary Health Care

The struggle of primary care physicians with dynamic medical billing rules

Medical billing is a complex process and it’s 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.

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 code’s 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.

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.

Apart from Add-on code G2211, CMS also finalized proposals to increase the values of certain codes, including those for the following services:

  • Maternity services,
  • Transitional care management services,
  • Initial preventive physical examinations and initial and subsequent annual wellness visits
  • Emergency department visits.
  • Some behavioral health services.

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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