Pinnacle's Blog & Publications

  • The How, Why, and Who: Capturing Social Determinants of Health (SDoH)

    Posted On: October 19, 2023

    The Centers for Medicare and Medicaid Services (CMS) issued the FY 2023 Final Rule, which required hospitals to report the new Inpatient Quality Reporting (IQR) program to submit two (2) new measures (SDOH-1) and (SDOH-2).  The measures were voluntary in FY 2023; however, are required in FY 2024.

    On September 6, 2023, CMS released the Improving the Collection of Social Determinants of Health (SDOH) Data with ICD-10-CM Z-Codes.  The data informatic was very “busy,” so Pinnacle is going to break down the information for you!

     

    What Are Z-Codes?

    • SDoH-related Z-Codes are located within categories Z55-Z65 in the ICD-10-CM diagnosis coding manual.
    • Used to ...
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  • Teaching Physician Basics

    Posted On: October 12, 2023

    Some facilities allow for a medical graduate training program where residents and medical students can participate in the care of patients under the direction of a licensed attending physician (teaching physician). This allows the residents and medical students to further expand their medical knowledge and get real-world experience with their patients and colleagues.  Teaching physician services have specific documentation requirements, and it is important to understand these requirements to stay in compliance with CMS regulations.

    Per CMS guidance and policy, “When billing Evaluation and Management (E/M) services for a teaching physician you must look for, at a ...

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  • Determining the Fair Market Value of HCP Compensation: Five Considerations When Engaging Speakers, Consultants, and Researchers Outside the U.S.

    Posted On: October 10, 2023

    In many countries and regions of the world, access to valid, reliable, and comprehensive healthcare professional (“HCP”) compensation data can be a challenging task. Notwithstanding, in countries outside of the U.S. (“OUS”), determining FMV compensation for speakers, advisory board members, consultants, researchers, and others is crucial to maintaining compliance with global laws (e.g., FCPA, U.K. Bribery Act), country-specific laws (e.g., France, Portugal, others), and industry organizations (e.g., EFPIA, IFPMA, MedTech Europe, GMTA, etc.). Consequently, companies often utilize a range of informal sources of information to obtain what is erroneously represented as the FMV of HCP compensation. Typically, informal ...

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  • Decoding 2024 ICD-10 CM Changes: A Four-Part Series

    Posted On: September 14, 2023

    Pinnacle is conducting a four-part series to delve into the upcoming 2024 ICD-10 CM code changes and break them down chapter by chapter.  On June 16, 2023, The Centers for Medicare and Medicaid Services (CMS) released the fiscal year (FY) 2024 ICD-10-CM code set, which is set to take effect October 1, 2023.  With 395 new code additions, 25 deletions, and 13 revisions, read on to learn more about changes within chapters 1-22.

    Part One: Chapters 1-6

    Chapter 1 – Certain infectious and parasitic diseases (A00-B99)

    Two (2) new code additions ...

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  • CMS Proposes Significant Changes to the Medicare Shared Savings Program for 2024 – How will they affect ACOs? A Three-Part Blog Series

    Posted On: September 7, 2023

    The Centers for Medicare & Medicaid Services (CMS) has put forth a proposed rule that outlines significant changes to the Medicare Shared Savings Program (Shared Savings Program) for the calendar year (CY) 2024. The aim of these proposed changes is to further advance CMS’ value-based care strategy, promote growth, alignment, and equity in the program, and address concerns raised by stakeholders, particularly accountable care organizations (ACOs). A large part of the strategy refresh for value-based care comes from the bold goal to have all Medicare fee-for-service beneficiaries in a care relationship with accountability for quality and total cost ...

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  • Emergency Department Staffing: What’s the Trouble and Where are we Headed?

    Posted On: August 31, 2023

    Abstract

    On May 15, 2023, Envision Healthcare Corp. (“Envision”) announced that it and several of its subsidiaries had filed voluntary petitions for reorganization under Chapter 11 of the United States Bankruptcy Code.  This news prompted a swift reaction within the healthcare industry as Envision reports itself as “one of the nation’s leading medical groups, delivering physician and advanced practice provider care in settings where patients have the most acute and life-changing needs – emergency departments, surgical suites, intensive care units and birthing suites – through Envision Physician Services.”   Because of its large role in the ...

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  • PHC August 2023 Real Estate Practice Newsletter

    Posted On: August 23, 2023

    Healthcare Real Estate Transactions

    Mountain Point Medical Center – Salt Lake City, UT.  JLL Capital Markets, Medical Properties Group announced the sale of Mountain Point Medical Center, a 60,000 square foot medical office building connected to the 40-bed Holy Cross – Mountain Point hospital in Lehi, Utah. The property is 100 percent leased to Centura Health, a non-profit faith-based health care system based in Colorado with 25 hospitals located throughout Colorado, Utah, and Kansas.

    Charleston Cancer Center – Charleston, SC.  JLL Capital Markets announced it arranged the $10.1 million sale of the Charleston Cancer Center, totaling 26,256 ...

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  • CMS Proposes Expanded Coverage for Carotid Artery Stenting (“CAS”)

    Posted On: August 10, 2023

    Traditionally, carotid endarterectomy has been the primary method of treating high-grade asymptomatic and symptomatic carotid artery stenosis. However, a minimally invasive technique known as carotid artery stenting (“CAS”) has evolved over the years.  This technique offers reduced postoperative pain, reduced potential for postoperative wound complications, and shorter hospital stays.

    On July 13, 2023, The Centers for Medicare and Medicaid Services (CMS) released a draft decision memorandum regarding carotid artery stenting that would expand coverage of the procedure and remove certain requirements for CAS facilities and operators.

    The proposal is a result of a national coverage analysis ...

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  • Telehealth Changes After Public Health Emergency

    Posted On: August 8, 2023

    COVID-19 public health emergency (PHE) ended on May 11, 2023.

    Medicare’s coverage of telehealth for outpatient services will be extended through the end of 2024. Patients may continue to receive telehealth services no matter where they are in the United States and may receive services in their home rather than going to the health care facility.  Although private insurance often follows Medicare’s lead, they may decide to alter their telehealth coverage earlier.

     

    Permanent Medicare Changes

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  • Mental Health Changes V24 to V28

    Posted On: August 3, 2023

    While mental health awareness month occurred in May, we need not forget the upcoming changes to Medicare Advantage members in CY 2024 and beyond.

    On March 31, 2023, The Centers for Medicare and Medicaid Services (“CMS”) released the CY 2024 Advance Notice for Medicare Advantage and Part D.  This advance notice will change everything we know about Risk Adjustment and Hierarchical Condition Category (HCC) Coding.

    In the final notice, CMS deleted forty (40) ICD-10-CM diagnosis codes that currently map to an HCC in version 24 that will no longer map to a payable HCC in version ...

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Claire Falcone

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