Reeham Neshiwat

prof. @ CWcollege , instructor @St Johns hosp.,CEO at WMCC med billing& coding EHR, CPC CPCI, partner with AAPC &NHA

[Reeham Neshiwat @renesh07]

Medicare vs. Medicaid Dental Coverage in New York

Understanding dental benefits under Medicare and Medicaid is important:
•Medicare (Original): Does not cover routine dental services like cleanings, fillings, extractions, or dentures. Exceptions only apply if the dental service is tied to a medical procedure, such as preparing for organ transplants or radiation therapy.
•Medicare Advantage: Some plans offer additional dental coverage for routine care. Check your plan details to understand what’s included.
•Medicaid in New York: Provides broader dental benefits, covering services like regular cleanings, exams, fillings, crowns, and dentures. This ensures access to essential dental care for eligible individuals.

Review your coverage options to make the most of your benefits!

[Reeham Neshiwat @renesh07]

New urgent update from Medicare

Codes G0463 and G2211

G0463
Represents hospital outpatient clinic visits for the assessment and management of patients.
•Modifiers:
•PO: For excepted off-campus provider-based departments.
•PN: For non-excepted off-campus provider-based departments.
•Usage Examples:
•GI Clinic: Follow-up on GERD management.
•Orthopedics: Evaluation of knee pain and treatment planning.
•Podiatry: Diabetic foot ulcer care with procedures like debridement.
•Vascular Surgery: Comprehensive vascular assessment for leg ulcers.
Important Notes:
G0463 is specific to hospital outpatient settings and does not apply to regular office E/M codes like 99202-99205 or 99211-99215.

G2211
Designed for outpatient office visits to reflect visit complexity.
No changes in its usage for outpatient settings.
Cannot be paired with G0463.

G2211 is intended for office visits only, while G0463 is strictly for hospital outpatient visits with the required PO/PN modifiers.

[Reeham Neshiwat @renesh07]

🚨 Exciting News for Healthcare Providers! 🚨

Medicare telehealth flexibilities have been extended through March 31, 2025! This is a game-changer for both patients and providers, ensuring care remains accessible, innovative, and seamless.

Here’s what’s important:
✅ Applies to all specialties – Primary care, mental health, and more.
✅ Nationwide coverage – Including right here in Westchester County, NY.
✅ Convenience for patients – Telehealth visits can be done from home.
✅ Expanded options – Both audio-only and video visits are eligible!

💡 Key Codes You Need to Know:
•99212, 99213, 99214 for standard telehealth visits.
•Use Modifier 95 for video or Modifier 93 for audio-only visits.
•Apply POS 10 for home-based visits or POS 02 for other locations.

Let’s keep transforming healthcare with telehealth! This extension means we can continue delivering exceptional care, anywhere, anytime.

[Reeham Neshiwat @renesh07]

🌟 Why HEALTHCON 2025 is My Must-Attend Event! 🌟

As a dedicated healthcare professional, I believe in lifelong learning and staying ahead in the ever-evolving field of medical coding and healthcare. Attending HEALTHCON 2025 in Orlando is not just a conference for me – it’s an opportunity to:

✅ Enhance my expertise with cutting-edge knowledge and insights.
✅ Connect with inspiring professionals from across the industry.
✅ Earn valuable CEUs to keep my skills sharp and my certifications up to date.
✅ Explore innovative tools and strategies to make an impact in patient care and administrative excellence.

Being at HEALTHCON empowers me to be the best in my field, and I’m ready to take my career to the next level! 🌟

📌 Bonus: It’s in the magical city of Orlando – what could be better than mixing learning with a little fun at Walt Disney World? 🏰

#HEALTHCON #HEALTHCON2025 #HealthcareConference #MedicalCoding #MedicalCoder #Healthcare #HealthcareEducation #Orlando #AAPC

#healthcareconference #medicalcoding #medicalcoder #healthcare #healthcareeducation #orlando #florida #aapc #aapcstudent #disneyworld

[Reeham Neshiwat @renesh07]

Merry Christmas and happy holidays

[Reeham Neshiwat @renesh07]

#MentalHealthMatters #YouAreNotAlone #EndTheStigma #MentalHealthSupport #ItsOkayToNotBeOkay #HolidayBlues #SelfCareHolidays #CopingDuringTheHolidays #HolidayMentalHealth #StressFreeHolidays #988Lifeline #TalkToSomeone #SuicidePrevention #EmotionalWellbeing #HelpIsHere #BeKindToYourMind #SpreadKindness #ReachOutForHelp #SupportEachOther #HopeForTomorrow #CommunityCare #WeAreInThisTogether #SupportIsAvailable #FindYourLifeline #CheckOnYourLovedOnes

[Reeham Neshiwat @renesh07]

Are Prior Authorizations Helping or Hurting Healthcare?

Have you ever wondered why getting approval for a routine test or medication can feel like jumping through hoops? Whether you’re a patient, physician, or part of the administrative team, chances are you’ve felt the frustration of prior authorizations (PA).

Let’s talk about the real impact:
•Patients waiting for critical care get stuck in limbo because of delays. Imagine needing your monthly medication for diabetes or a life-saving test for cancer, only to face endless paperwork and approvals. For some, it’s not just frustrating—it’s dangerous.
•Physicians and staff are drowning in administrative work, spending hours fighting with insurance companies instead of focusing on care. Burnout isn’t just a buzzword; it’s the reality.
•Insurance companies, while trying to manage costs and prevent unnecessary treatments, risk losing trust as these processes seem to value budgets over lives.

Now, let’s add another layer: the difference between HMO and PPO plans.
•If you have a PPO plan, you’re likely paying higher premiums, but you avoid many of these headaches. Less hassle, more freedom.
•But for HMO patients, with lower costs, the system often feels like a maze of rules, delays, and denials. Should access to care really depend on how much someone can afford to pay upfront?

Here’s the catch—prior authorizations do have a purpose. They prevent unnecessary procedures, control costs, and protect against fraud. But somewhere along the way, the process became the problem.

Is There a Solution?

How did we do it in the ’90s, when it felt simpler and less burdensome? Can we find a middle ground that protects against misuse without hurting patients and overloading staff?

Some ideas to consider:
•Streamline the process. Chronic conditions shouldn’t require repeated approvals for the same medication month after month.
•Balance equity. Patients on HMO plans shouldn’t have to jump through endless hoops while PPO patients sail through.
•Automate where possible. Use technology to cut the red tape and reduce the burnout on staff.
•Focus on transparency. Help patients understand what’s covered and why—without the fine print that confuses everyone.

It’s time to rethink and rebuild a system that works for everyone—patients, providers, and payers alike.

Do you think we can make it happen?

#HealthcareReform #PriorAuthorization #QualityCare #EquityInHealthcare #StopBurnout

[Reeham Neshiwat @renesh07]

Are physicians being unfairly penalized for patients’ lab choices?

As a physician advocate, I find this policy from UnitedHealthcare Oxford deeply concerning. They now require physicians to submit a Laboratory & Pathology Services Consent Form if patients use out-of-network labs. Failure to comply results in:
•Reversal of Evaluation & Management (E&M) codes.
•Recovery of payments already made.

This raises serious questions:
•How can physicians be expected to track every lab’s participation with every insurance plan?
•Are we supposed to refuse care or results if patients unknowingly visit an out-of-network lab?
•Should doctors now hold patients’ hands to ensure they go to the “right” lab?

Physicians are already overloaded, focusing on what truly matters: patient care. Adding administrative burdens like this is unfair and distracts from the patient-physician relationship.

Why does the financial burden fall on physicians when the claim department approved and paid the lab initially?

#HealthcarePolicy #PhysicianAdvocacy #InsuranceChallenges #PatientCareFirst #MedicalCoding #HealthcareReform #AdministrativeBurden #PhysiciansSpeakOut #UnitedHealthcare #HealthcareProviders

[Reeham Neshiwat @renesh07]

🎉 Great News for Patients and Providers!

Anthem Blue Cross Blue Shield has reversed its decision to limit payment for anesthesia based on time. This proposed policy, which would have affected surgeries in New York, Connecticut, and Missouri, sparked strong pushback from healthcare professionals who highlighted potential risks to patient safety.

Thanks to the collective voice of the medical community and advocates, this decision ensures patients will continue to receive the care they need without unnecessary restrictions. A victory for patient safety and quality healthcare!

💡 Let’s keep speaking up for better healthcare policies.

#PatientSafety #HealthcareUpdates #MedicalNews #AnesthesiaCare #QualityCare #HealthcarePolicy #DoctorsVoiceMatters #MedicalCoding #InsuranceUpdates #AnesthesiaMatters

[Reeham Neshiwat @renesh07]

🌟 Exciting Updates for Dental Practices in 2025! 🌟
Starting January 1, 2025, the ADA is rolling out new changes to CDT codes, including 10 new codes, 8 revisions, 2 deletions, and 4 editorial changes. These updates reflect advancements in dental care and support accurate billing and documentation.

💡 Key Highlights:
•New Codes: Covering innovative procedures like neuromodulators and dermal fillers for both therapeutic and cosmetic uses.
•Revised Codes: Streamlined descriptors for easier documentation, like updates to interim restorations (D2940).
•Deleted Codes: Simplified coding by removing redundancies.

🦷 Why It Matters:
Staying updated ensures accurate claims, faster reimbursements, and improved practice efficiency. Let’s embrace these changes to provide better care and keep our practices running smoothly!

#DentalBilling #DentalCoding #CDT2025 #DentistryUpdates #HealthcareInnovation #DentalPracticeManagement #AccurateBilling #PatientCare #DentalProfessionals #BillingAndCoding

[Reeham Neshiwat @renesh07]

As of January 1, 2025, Medicare will implement significant changes to telehealth policies, impacting both audio-only and video-based services.

Audio-Only Telehealth (Phone Calls):
•Discontinuation of Certain CPT Codes: Medicare will no longer reimburse audio-only telephone services under CPT codes 99441-99443.
•Impact: Practices that have relied on phone consultations will need to transition to video-based services or in-person visits to ensure continued reimbursement.

Video Telehealth (Zoom or Similar Platforms):
•Reinstatement of Pre-Pandemic Restrictions: Medicare telehealth coverage will revert to pre-pandemic regulations, requiring patients to be in specific geographic areas (e.g., rural Health Professional Shortage Areas) and receive services at designated originating sites (e.g., doctor’s offices or hospitals). Home-based telehealth services for routine care will no longer be reimbursed unless specific exceptions apply.
•Limited Exceptions: Behavioral and mental health services will continue to allow home-based care without geographic restrictions. Additionally, services such as acute stroke evaluations and monthly End-Stage Renal Disease (ESRD) visits for home dialysis patients will remain covered regardless of location.

What This Means for Healthcare Providers:
•Audio Services: Phone consultations will no longer be a viable option for Medicare patients unless they fall under the brief virtual check-in category.
•Video Platforms: Patients may face challenges accessing telehealth from home unless they qualify under specific exceptions, potentially reducing the number of eligible telehealth patients.

Unless Congress acts to extend the current flexibilities or amend these policies, these changes will take effect as planned. Healthcare providers should begin planning to adapt to these changes to minimize disruptions for patients and maintain the quality of care.

#Telehealth #Medicare #HealthcarePolicy #AudioOnlyTelehealth #VideoTelehealth #MedicareChanges #HealthcareProviders #PatientCare #Telemedicine #HealthPolicy #MedicareReimbursement #TelehealthServices #HealthcareAccess #Telehealth2025 #MedicalUpdates #HealthcareNews

[Reeham Neshiwat @renesh07]

Starting April 1, 2025, Rural Health Clinics (RHCs) can include CPT Category II codes on Medicare claims. This advancement enhances quality reporting and aligns with value-based care initiatives, as these codes offer detailed insights into patient care. Previously, such submissions led to claim rejections; now, they aim to improve reporting accuracy without altering payment policies.

Integrating these codes into the revenue cycle offers several benefits:
1.Accelerated Claims Processing: Detailed documentation reduces the need for additional payer audits, leading to quicker payments and less administrative burden.
2.Improved Quality Metrics: Tracking performance in areas like diabetes management aligns with programs such as Medicare’s Quality Payment Program, potentially resulting in higher reimbursements or bonuses.
3.Error Reduction: Precise coding minimizes errors in claims submissions, decreasing rework and payment delays.
4.Enhanced Negotiation Leverage: Demonstrating high-quality care through data enables better terms with private insurers, leading to higher payment rates or inclusion in premium networks.
5.Alignment with Value-Based Care: Participation in value-based contracts, where outcomes and quality metrics drive revenue, can unlock shared savings and incentive payments.

While CPT Category II codes themselves are not reimbursable, their strategic use supports faster payments, fewer denials, and operational efficiency, positively impacting cash flow and the revenue cycle.

#Medicare2025 #RuralHealthCare #CPTCodes #QualityReporting #HealthcareUpdates #ValueBasedCare #HealthTech #RHCUpdates #MedicalCoding #HealthPolicy #RevenueCycle #HealthcareInnovation #PatientCareQuality #HealthCareReform

[Reeham Neshiwat @renesh07]

https://t.co/3YtQwcGssc Ep7 of #RiversideReflections premieres next week! Revisit Ep6 with Lawrence Neshiwat, MD & Patrick Neshiwat, DO discussing generations of medical care and how St.
John's is ready for the future.
WATCH: https://t.co/voniXlQ3yT Like & Subscribe on YouTube! #CommunitySTRONG

[Reeham Neshiwat @renesh07]

@elonmusk Elon, your innovative vision is truly inspiring! Being a proud supporter of Tesla and SpaceX has been an incredible journey, and I’m excited to see Starship take humanity to new heights.