AUC Medical Code Technical Advisory Group (MCT) Thursday, July 13, :00 a.m. to 12:00 p.m.

Transcription

1 AUC Medical Code Technical Advisory Group (MCT) Thursday, July 13, :00 a.m. to 12:00 p.m. HealthPartners, 8170 Building, Bloomington, St. Croix 1 st floor AGENDA WebEx Information 1. To start the WebEx session, go to: 2. Under Attend a Session click Live Sessions 3. Click on the session for AUC Medical Code TAG 4. Provide your name, address, and the following password: Mct2010! 5. Click Join now Teleconference Information Call-in line: Participant Access Code: ** Callers are responsible for any long distance charges ** Visit our website at: Page 1 of 2

2 AGENDA 1. Welcome and Introductions Attendance tracking: Deb Sorg Membership request and/or updates: Deb Sorg 2. Review of Antitrust Statement 3. Review of last meeting s minutes from April 13, Telemedicine The TAG has participated in discussion and education regarding recent CMS announcements, particularly regarding its adoption of the Place of Service code 02 to designate services delivered via telemedicine, as well as recent state laws regarding coding and billing for telemedicine. As part of these discussions, the TAG has been considering related questions, including: What additional information and clarification is needed to help ensure that coding and billing of telemedicine is being done correctly and consistently? What are the best ways to communicate the information? For today s meeting: possible follow-up, next steps? 5. Decision Tree/SBAR form update The TAG has been brainstorming a new combined SBAR/Decision tree form and a prototype was developed. Because some time has elapsed since the last discussion of the form, we will review it briefly to help bring it to completion. 6. Department of Human Services (DHS) updates DHS works with the MDH and the AUC to provide information, plan, discuss, and resolve coding and billing issues in a complex, often rapidly changing environment. DHS will provide updates regarding items discussed at the most recent TAG meetings as well as any other updates. 7. Additional Agenda Items/ Announcements Next scheduled meeting: August 10, 9:00-12:00, St. Croix 1st floor, HealthPartners, 8170 Building, Bloomington. Reminder: AUC UPDATE newsletter coding article volunteers needed. Page 2 of 2

3 AUC Medical Code Technical Advisory Group (MCT) Thursday, April 13, 2017 MINUTES 1. Welcome and Introductions Attendance tracking: Deb Sorg Membership request and/or updates: Deb Sorg Faith called for introductions and reminded everyone to forward updates and membership requests to Deb Sorg. She also instructed those participating by phone to their attendance to Deb. 2. Review of Antitrust Statement Faith read AUC anti-trust statement. 3. Review of last meeting s minutes March 9, 2017 Minutes approved with no changes. 4. Telemedicine JoAnne Wolf, Children s Health Network Scenarios submitted by Carolyn Larson were reviewed. The scenarios are helpful but should be more generic (no actual provider name should be included). Dave Haugen suggested that we may want to consider developing a Best Practice. Page 1 of 3

4 If the patient is not present (no patient involvement) telemedicine should not be billed. ACTION: JoAnne Wolf will present a policy to consider. OPEN 5. Decision Tree Creation Reminder Judy Edwards, MDH Waiting for AUC input. Dave Haugen noted that all forms may be revised. OPEN 6. Medicare Rounding Rules Guide Review Faith Bauer, BCBSMN It was noted that some therapists are used to Medicare s rounding rules. There should be an emphasis on education. This issue will be closed but Faith will write an SBAR. 7. Psychiatric Residential Treatment Facility Cher Vang, DHS There is no SBAR yet. Information about the facility includes: Freestanding facility. A new facility provider will be developed. Will not include substance abuse treatment. Two claims will be submitted: o Facility claim 837I (UB-04) Type of Bill 86x Revenue codes 1001 (R&B), 0180 or 0783 (Leave of absence) Occurrence span code 74 o Professional claim 837P (1500-HICF) Professional services as appropriate (outside of the per diem) OPEN 8. Certified Community Behavioral Health Clinics (CCBHC) Cher Vang, DHS There is no SBAR yet; however, DHS is not sure if one is needed. This is a federal demonstration project. Because this limited to six providers and is considered a demo project we should not be addressing this issue. If this is expanded to other providers and/or is expanded to other providers we may consider the issue at that time. Page 2 of 3

5 9. New Elderly Waiver and Alternative Care service for eligible older adults (ICLS) Andrea Agerlie, DHS CMS approved in 2/2017 and the benefit was effective 4/1/17. Currently there are no enrolled providers. endition=primary&allowinterrupt=1&nosaveas=1&ddocname=dhs This is a new benefit effective 4/1/17. There are no enrolled providers yet. The service is reported with two codes and one modifier H2015 U3 or H2015 U3. Eligible patients include older adults enrolled in MSHO and MCS+. This is an alternative elder waiver. The services can be face to face or remotely by a case manager. The practitioner is a Basic Support Service Provider More Information will be presented at the next meeting OPEN E/M Guide Changes Doris Barnes NGS is making the 1995 E/M guides more restrictive. Will payers follow the new guides? We currently do not address the guides in the guide. As this is NGS only, it may be more an education issue for each payer. 11. Additional Agenda Items/ Announcements Next scheduled meeting: March 11, 2017, 9:00-12:00, St. Croix 1st floor, HealthPartners, 8170 Building, Bloomington Reminder: AUC UPDATE newsletter coding article volunteers needed. Page 3 of 3

6 AUC BUSINESS NEED EXPLANATION FORM (SBAR) After completing sections I and II, submit to the AUC inbox at health.auc@state.mn.us. Section III (Medical Code TAG Decision Tree) must be completed for medical coding issues. It is recommended that the Decision Tree be completed first. Section IV to be completed by the Department of Health. Section I General Information All fields must be completed. Incomplete forms will be returned to the submitter. SBAR Information SBAR Title: Individual Community Living Support (ICLS) Version #: 1 Date Submitted to AUC: 5/5/2017 Contact Information for person completing this form Name: Cher Vang Title: Health Care Coding Compliance Officer address: cher.x.vang@state.mn.us Telephone: Organization Information Name: Minnesota Department of Human Services Address: 540 Cedar Street, Saint Paul, MN SBAR presenter (if different from above) The SBAR presenter must be in attendance or available during the meeting(s) for the SBAR to be discussed. Name: Title: Same as above address: Phone number: Page 1 of 5 DRAFT Revision

7 SBAR Title: Individual Community Living Support (ICLS) Section II SBAR Information Concise and specific description of the issue to be addressed. All fields must be completed before the SBAR will receive consideration. SITUATION Describe the problem or issue to be addressed (What is the current business practice?): Individual Community Living Support (ICLS) is an Elderly Waiver (EW) and Alternative Care (AC) service authorized by the Minnesota legislature (Minnesota Statutes, section 256B.0915, subdivision 3j). Federal approval for the new service was obtained in February ICLS is a bundled service that includes six service categories. ICLS services offer assistance and support for people who need reminders, cues, intermittent/moderate supervision or physical assistance to remain in their own homes. The service categories are as follows: Active cognitive support Adaptive support service Activities of daily living (ADLs) Household management Health, safety and wellness Community engagement Minnesota Statutes, section 256B.0915, subdivision 3j reads: ICLS providers may not be the landlord of recipients, nor have any interest in the recipient's housing. ICLS must be delivered in a single-family home or apartment where the service recipient or their family owns or rents, as demonstrated by a lease agreement, and maintains control over the individual unit. Case managers or care coordinators must develop individual ICLS plans in consultation with the client using a tool developed by the commissioner. The commissioner shall establish payment rates and mechanisms to align payments with the type and amount of service provided, assure statewide uniformity for payment rates, and assure cost-effectiveness. Licensing standards for ICLS shall be reviewed jointly by the Departments of Health and Human Services to avoid conflict with provider regulatory standards pursuant to section 144A.43 and chapter 245D. Eligible providers must complete a provider enrollment assurance statement to self-attest that they meet the policy requirement for use of video. For additional policy and coverage information, refer to DHS Bulletin # and ICLS section in the Minnesota Health Care Programs provider manual. Please note that the billing codes in these references will be updated according to our recommendation. Page 2 of 5 DRAFT Revision

8 BACKGROUND Explain the pertinent history of the business practice (How does this work today?): ICLS is a new service. ASSESSMENT Summarize your analysis of this issue (What are the challenges? Who does it impact? How does it apply to the AUC? Any standards that might help address the situation?): Benefit is available for Elderly Waiver (EW) program through Medicaid waiver program covered under Medical Assistance (MA), state funded Alternative Care (AC) program, Minnesota Senior Health Option (MSHO) and Minnesota Senior Care Plus (MSC+) enrollees. Discussion is necessary to develop a uniform billing method for ICLS. RECOMMENDATION Provide your recommendation (Including any known timing that needs to be considered): ICLS billing recommendation is effective retrospectively to April 1, DHS recommends the following billing procedure: 837P claim format Modifier U3 is used to indicate ICLS service Modifier U4 is used to indicate service delivered via non-face-to-face, e.g. telephone Modifier GT is used to indicate service delivered via interactive audio and video telecommunications systems Procedure and modifier codes: Service Procedure code Modifier Unit Max unit per day In person face-to-face H2015 U3 1 (per 15 min) 48 units or 12 hours Telephone H2015 U3, U4 1 (per 15 min ) 1 unit Video H2015 U3, GT 1 (per 15 min.) 1 unit Face-to-face in person support service must be provided at least once weekly. Telephone and video services are limited to one telephone or one video unit per day. Please note that the above codes have changed from what was previously shared at the April MCT meeting. Page 3 of 5 DRAFT Revision

9 SBAR Title: Individual Community Living Support (ICLS) Section III Medical Code TAG Decision Tree 1. Does Medicare apply and there are no other concerns? Yes - STOP - do not submit an SBAR, follow Medicare No - continue 2. Do the HCPCS/CPT code and/or guides apply and address the issue? Yes - STOP - do not submit an SBAR, follow HCPCS/CPT guides No - continue 3. Does the issue apply to more than one payer? Yes - submit the SBAR continue to determine what information needs to be included No - STOP - do not submit an SBAR, contact the payer 4. Identify the claim format. What needs to be included? a. 837P (professional) HCPCS/CPT: Modifier: Place of Service: b. 837I (institutional) Inpatient Revenue Code: Outpatient Revenue Code: HCPCS/CPT: Modifier: Page 4 of 5 DRAFT Revision

10 SBAR Title: Individual Community Living Support (ICLS) Section IV AUC Response Response Information Date Received: Log No.: Date Closed: Date Sent to AUC Executive Committee: Date Sent to AUC TAG Co-chair(s): TAG Recommendation Accept Reject Date [SBAR Response Approved by TAG]: Reviewed by [AUC TAG Name]: AUC Co-Chair(s): Discussion/Summary Key Findings and Recommendation(s): Disposition status: Decision Summary AUC Response Accept Reject AUC Approval Date: Date Decision Sent to Originator: Page 5 of 5 DRAFT Revision