Developing an Action Plan Once the Covid-19 pandemic hit, Qual-Care’s telehealth visit volume increased by 500%. The following codes are some of the ways that these visits are coded in order to bill the insurance companies:
Code Description 99421 Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes 99422 Online digital evaluation and management service, for an established patient, for up to 7 days cumulative time during the 7 days; 11– 20 minutes 99423 Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes. G2010 Remote evaluation of a recorded video or images (photo) submitted by an established patient, resulting in an appointment within 24 hours or soonest available G2012 Brief 5-10-minute check-in with the provider via telephone or other device to decide whether an office visit or other service is needed, for an established patient, leading to an appointment within 24 hours or soonest available Through a quarterly, internal audit, you notice that the revenue (from insurance reimbursements) for Telehealth Visits has actually increased by 1000%. After a brief discussion with the Jenny Nguyen, the office’s CPC (certified professional coder), it is clear that she does not have a lot of experience coding telehealth visits and that there has been insufficient medical record documentation by the providers, and this is leading to the incorrect coding of these Telehealth visits. Since you know that the Qual-Care clinic services many Medicare and Medicaid patients, this issue may be a violation of the False Claims Act which could end up causing a big problem for the clinic. You decide to do a more thorough audit, identify any overpayments, and disclose them to the OIG along with an appropriate refund. To avoid this situation moving forward, you also decide to create an Action Plan to address these areas of risk. Using Table 13.2 in your textbook as a guide, create an Action Plan using the attached word document that addresses the Action Areas of: Coding Medical Claims and Medical Record Documentation. Create at least two tasks in each Action Area of your plan (No less than a 5 total tasks). This action plan should not extend past 12 months from the time it is implemented.
