Chronic Care Management. Sharon A. Shover, CPC, CEMC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Chronic Care Management. Sharon A. Shover, CPC, CEMC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky"

Transcription

1 Chronic Care Management Sharon A. Shover, CPC, CEMC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky

2 Agenda Chronic Care Management (CCM) History Define Requirements 2016 Specifications for RHC/FQHC Revenue Benefits Quality Score Benefits Implementation Suggestions 2

3 Chronic Care Management We have already cut back on our schedule because of the time it takes to document It s another government regulation we need to document for Another item I need to document I don t have time... LET S TAKE A DEEPER LOOK! THIS IS MORE POSITIVE THAN WHAT YOU MAY THINK! 3

4 CCM Background Effective January 1, 2015, implementation of CCM for Medicare Fee for Service providers Effective January 1, 2016, CMS regulations allow for CCM service in RHC/FQHC Reimbursement under Medicare Physician Fee Schedule CPT Code

5 CCM Background Quality Patients managed under CCM will lead to improvement in quality scores and provide an overall reduction in healthcare spending. Quality Cost 5

6 CCM Requirements Patients with 2 or more chronic conditions: Lasting for the next 12 months, or Until death of the patient These conditions would place the patient at significant risk of death, exacerbation or functional decline. CMS maintains a Chronic Condition Warehouse (CCW) 6

7 CCM Consent Prior to providing CCM services we will need to obtain written consent. Consent includes: Nature of CCM How CCM is accessed One provider at a time to furnish CCM Health information will be shared with other providers for care Patient may stop CCM at any time by revoking Patient is responsible for co-insurance/deductible 7

8 CCM Providers Majority of CCM services are directed by: Primary Care Providers: MD, DO, NP, PA Specialists: only if providing the majority of services Clinical Staff can assist: RN LPN CMA Pharmacists Technicians Therapists 8

9 CCM Providers CMS has indicated that other staff may help facilitate CCM services but only time spent by clinical staff may be counted towards the 20 minute minimum time. 9

10 CCM Requirements 20 minutes of non face-to-face per encounter per month: Certified healthcare professional under general supervision of Primary Care Provider Incident-to exceptions to include that provider does not need to be in the same location as the professional providing coordination Exception: RHC/FQHC 10

11 CCM Requirements Direct Supervision in RHC/FQHC: Requires that a RHC/FQHC practitioner be present in the RHC/FQHC and immediately available to furnish assistance and direction. The RHC/FQHC practitioner does not need to be present in the room when the service is furnished. There is no exception to the direct supervision requirement at this time for CCM services furnished by auxiliary staff in RHCs/FQHCs. 11

12 CCM Requirements Structured recording of demographics, problems, medications, medication allergies, and the creation of a structured clinical summary record: Using a certified EHR Not required to be a meaningful user of the technology but is required to utilize elements of the EHR technology = using CCM certified technology 45 CFR (a)(3)-(7) 12

13 CCM Requirements Clinical summary record: Provider s name and office contact information Date and location of visit Reason for visit Immunizations/medications administered during visit Diagnostic tests Clinical instructions Future appointments and scheduled tests Referrals to other providers Recommended patient decision aids 45 CFR (e)(2) 13

14 CCM Requirements The provider must be able to transmit the summary care record electronically for purposes of care coordination. CMS does not specify acceptable methods of transmission but does state that facsimile transmission is not acceptable. This is not to say that you can not transmit via fax, but that if you do not have a means to electronically transmit, you will not meet the requirements of CCM. 14

15 CCM Requirements Summary of Care Record Electronic Comprehensive Care Plan 15

16 CCM Requirements Comprehensive Plan of Care: Physical body Mental brain Cognitive understanding Psychosocial interactions Functional abilities Environmental surroundings 16

17 CCM Requirements Comprehensive Plan of Care (continued): A current list of providers that are involved in providing medical care An assessment of patient s preventive healthcare needs Plan should address all health issues (not just the chronic conditions) Applicable to patient s choices 17

18 CCM Requirements Comprehensive Plan of Care (continued): Problem List Medication Management Expected outcome and prognosis Measurable treatment goals Symptom management and planned interventions 18

19 CCM Requirements The preparation and updating of this care plan is not part of a reimbursable visit for CCM services. This will be billed separately as an evaluation and management service, annual wellness visit, or an initial preventive physical exam. The plan, once developed, will need to be updated annually. 19

20 CCM Requirements 24/7 access to care management services Patient to access a member of care team Remote access, web-based access Contact with a healthcare provider for urgent chronic care needs Regardless of time or day of week Access to a designated practitioner with whom the patient is able to get routine successive appointments Continuity of care with provider team 20

21 CCM Requirements Management of care transitions examples include: Referrals Emergency Department Inpatient Stay Skilled Nursing Facility Transitional Care Management (TCM) services and CCM cannot be billed during the same month. 21

22 CCM Requirements Coordination of home and community clinical based service providers to support psychosocial needs and functional deficits Document as CCM service: Home Health Hospice Outpatient therapy Durable Medical Equipment Transportation Services Nutrition Services 22

23 CCM Requirements Opportunity for patient and any relevant caregiver to communicate with provider: Phone Secure Messaging Internet Asynchronous non face-to-face method 23

24 Digging Into the Details of CCM 24

25 CCM Consent Document the beneficiary s written consent and authorization in the EHR using CCM certified technology. Inform beneficiaries in advance of their eligibility for CCM, documenting the explanation and offer. Document written informed consent (or decline), including permission to electronically share relevant medical information with other providers. Inform of the right to discontinue CCM, verbally or in writing, at any time (effective at the end of the service period) and the effect of revoking the agreement. Inform that only one practitioner can furnish and be paid by Medicare for CCM within a service period. Inform that cost sharing applies. Retroactive consent is not allowed. 25

26 CCM Documentation Details Some items we already address: Medication Reconciliation Medication Management (refills) Completion of forms (DME) Coordination of Care Referrals 26

27 CCM Documentation Details CMS does not specifically address the documentation requirements for CCM: Recommended: Date of service CCM provided Time (start and stop) Name of individual providing service and credentials Description of service provided 27 27

28 Prior to CCM Billing Make sure patient is seen by a provider prior to starting CCM billing. Obtain an informed written consent for CCM services; let them know 20% co-insurance applies. Explain to patient they can only be enrolled with one provider for CCM within the calendar period provide information on how they can revoke consent. 28

29 Prior to CCM Billing Document in patient s medical record that they opted to accept or decline CCM services. Ensure patient receives copy of consent and care plan; documented in medical record. Documentation of the 20 minute cumulative non face-to-face encounters. Phone calls s with patient Medication reconciliation, prescription management Time spent coordinating care and resources 29

30 Prior to CCM Billing Ensure that all elements for calendar month are met prior to billing CPT code Avoid duplicate billing for Transitional Care Management (TCM) or Telemedicine billing codes in the same month. 30

31 RHCs and FQHCs Beginning on January 1, 2016, RHCs/FQHCs may receive an additional payment for the costs of CCM services that are not already captured in the RHC all-inclusive rate or the FQHC prospective payment system (PPS) rate for CCM services to Medicare beneficiaries. 31

32 RHCs and FQHCs Can bill for CCM services when a practitioner furnishes a comprehensive evaluation and management (E/M) visit, Annual Wellness Visit (AWV), or an Initial Preventive Physical Examination (IPPE) to the patient prior to billing the CCM service and initiates the CCM service as part of the visit. 32

33 RHCs and FQHCs The Direct Supervision Requirement applies for the 20 minute non face-to-face. This is a new regulation for the RHCs/FQHCs Payment for this service is based on the Medicare PFS national average non-facility payment rate when CPT code is billed alone or with other payable services on a RHC or FQHC claim. 33

34 RHCs and FQHCs Coinsurance will be applied as applicable to FQHC claims. Coinsurance and deductibles would apply as applicable to RHC claims. The rate for CPT code will be updated annually and has no geographic adjustment rate is $ % coinsurance applies $38.28 Per CGS Kentucky 34

35 RHCs and FQHCs RHC and FQHC face-to-face requirements are waived when CCM services are furnished to a RHC/FQHC patient. Cannot bill for CCM services for a beneficiary during the same service period as billing for transitional care management (TCM) or any other program that provides additional payment for care management services (outside the RHC/FQHC payment) for the same patient. 35

36 RHCs and FQHCs Billing for CCM services: UB-04 Revenue Code 52X CPT code Date of service is the date that 20 minutes of non face-to-face has been met or any date after that prior to the end of the month. 36

37 Return on Investment Scenario: Reimbursement is $38 per patient, per month 150 Medicare FFS patients qualify for CCM $456 per patient, per year x 150 CCM patients $68,400 Total Revenue 1.0 FTE for Care Coordinator $40 - $50,000/year ROI = $18,400 - $28,400/year 37

38 CCM Outcomes CCM billing income to cover Care Coordinator Effective care coordination to improve patient outcomes and reduce cost Needed to participate in value based payment models in the future 38

39 Getting Started 39

40 CCM Process - Stage 1 Who are your eligible patients? Use your EHR to search for patients that have 2 or more chronic conditions. Run internal reports sorted by provider. Make sure you cross-check for duplicates. The patient must have 2 or more chronic conditions that have the following required elements: Chronic conditions that are expected to last at least 12 months or until death; and Place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline. 40

41 CCM Process - Stage 1 Recommended to start small with a specific chronic condition such as diabetes, COPD, hyperlipidemia. Create a log of participating CCM patients, referred to as a registry. 41

42 CCM Process - Stage 2 Select staff based on need for each identified patient primary clinician, nurse, and other staff helping with consents and scheduling. Patients per hour 3 Patients per day 24 Patients per week 120 Patients per month 480 Patient should be able to access successive routine appointments with the designated clinician. 42

43 CCM Process - Stage 2 Other clinical staff can provide services incident to the primary clinician, as long as the primary provider is providing general supervision (physician practice). Direct supervision (RHC/FQHC) 43

44 CCM Process - Stage 3 Build a CCM process Set up appointment codes for new CCM visits and nurse assessment calls as needed Templates for documentation References supporting CCM discussions Protocols for disease management discussions; standing orders As enrollment increases, consider designating time schedule for clinician visits and nurse calls. 44

45 CCM Process - Stage 3 Educate all staff regarding CCM nurse(s) and staff to assist with enrollment, consents, scheduling, and other related CCM activities. Consider a dedicated phone line that would be answered by designated CCM staff and forwarded to on-call clinician after hours, if needed. 45

46 CCM Process - Stage 4 Inform the Patient Educate patients to participate Phone education in the beginning Brochures; pamphlets Letter Explain how it works and that they can decline, transfer, or terminate at any time. Provide information on how to terminate or transfer 46

47 CCM Process - Stage 4 Inform patients regarding authorization of electronic communication of medical information with other clinicians. Provide designated provider s name as well as the CCM nurse. Explain the monthly scheduled nurse discussion, which should be treated like a regular visit even though it will occur by phone, or discussions with other clinical staff can be considered part of the service Explain how and when the bills will be submitted and what the patient s obligations are for payment of coinsurance and deductibles. 47

48 CCM Process - Stage 4 Review participation agreement with patients and confirm their understanding. In person or via phone Record in the electronic chart that CCM was explained and written consent obtained to accept or decline services, from whom (name of clinician), receive electronic care plan, and of the right to stop CCM services at any time. 48

49 CCM Process - Stage 5 Create and document a Comprehensive Care Plan. As appropriate, share the Comprehensive Care Plan with other clinicians and providers. Created through the office visit, AWV or IPPE 49

50 CCM Process - Stage 6 Provide the patient with the written or electronic copy of the comprehensive care plan. Using the patient portal is a low cost way to deliver the care plan, so encourage all participating patients (or their designated caregiver) to join and become familiar with use of the portal. 50

51 CCM Process - Stage 7 Document the Time Spent Set up a system that can keep track of time spent on non-face-to-face services provided, including: phone calls and with patient; time spent coordinating care (by phone or other electronic communication) with other clinicians, facilities, community resources, and caregivers; and time spent on prescription management/medication reconciliation. 51

52 CCM Process - Stage 8 Termination from program Document death, transfer of patient to another clinician, or termination from the CCM 52

53 E/M, Annual Wellness and Subsequent Wellness Visit 53

54 RHC Changes Effective April 1, 2016 Effective April 1, 2016, RHCs, are required to report the appropriate HCPCS code for each service line along with the revenue code, and other required billing codes. Example: Revenue Code HCPCS Code Charge Amount $75 54

55 Evaluation and Management Consider the requirements: History History of Present Illness Review of Systems Past, Family, Social History Examination 1995 or 1997 Documentation Guidelines Medical Decision Making Number of Diagnosis Complexity of Data Risk 55

56 E/M to Comprehensive Care Plan HPI elements Same for chronic conditions Stable or worsening? Same for review of systems Past, Family, Social History Add Psychosocial -? Add Environmental -? Medication Reconciliation 56

57 E/M to Comprehensive Care Plan Examination Head to Toe Mental Cognitive Psychosocial -? Functional -? 57

58 E/M to Comprehensive Care Plan Medical Decision Making Based upon reason for visit Data reviewed Risk Example: Patient has two stable chronic conditions, labs ordered, medication refilled Medical Decision Making = Low 58

59 E/M to Comprehensive Care Plan Medical Necessity is the driving force for selection of an evaluation and management code. Do we consider the key elements of an examination? Do we consider counseling or coordination of care? 59

60 E/M to Comprehensive Care Plan Counseling or Coordination of Care Acceptable examples of documenting time during a patient visit: "75% of the 45 minute visit was spent counseling the patient on the prognosis of..." "45 minutes of the 60 minute visit was spent counseling the patient on the prognosis of..." minutes minutes minutes 60

61 Annual Wellness to CCP RHCs Annual Wellness Visit (AWV) may be billed as a visit if it is the only medical service on that day with a RHC practitioner. If AWV is furnished on the same day as a medical visit, it is not separately billable as an RHC visit. IPPE is separately billable 61

62 Annual Wellness to CCP Annual Determine Health Risk Assessment Demographic Data Self-Assessment of health status Psychosocial risks Behavioral risks Activities of Daily Living Establish a list of current providers Establish medical and family history CCP Social History 62

63 Annual Wellness to CCP Annual (continued) Review potential risk factors for depression Review functional ability Ability to perform ADL Fall risk Hearing impairment Home safety Assess Height, weight, BMI, blood pressure CCP Complete Exam (including chronic conditions) Cognitive Impairment 63

64 Annual Wellness to CCP Annual (continued) Establish written screening schedule United States Preventive Services Task Force Establish risk factor conditions Health education: Fall prevention Nutrition Physical Activity Tobacco-use Weight loss 64

65 Annual Wellness to CCP If completed at annual to include CCP, will also need: Medication Management Expected Outcome Expected Goals Measurable Treatment Symptom Management and planned interventions 65

66 Considerations Medical necessity Three chronic conditions. RHC AIR payment the same Looking at detailed data submitted RHC multiple visit regulations AWV and medical = 1 billable visit IPPE and medical = 2 billable visits Mental and medical = 2 billable visits 66

67 CCM Frequently Asked Questions 67

68 CCM Frequently Asked Questions Can the 20% co-insurance be waived? You must bill for the co-insurance. If the patient is unable to pay, refer to your organization s charity care policy for further instruction. 68

69 CCM Frequently Asked Questions Does the provider need to see the patient before CCM starts? The provider must make the referral to CCM. This can be done during an E/M visit, AWV or IPPE. 69

70 CCM Frequently Asked Questions Can staff complete the consent paperwork and other documents after the provider discusses CCM program and obtains patients consent? The administrative staff within the clinic or the Care Coordinator can complete consent, care plan and initial encounter elements once the provider sees the patient. 70

71 CCM Frequently Asked Questions How long is the Patient Authorization/ Signed Informed Consent form good for? The consent is valid indefinitely and does not have to be renewed, however, it will expire and become invalid if patient sees an alternate provider for their CCM services. 71

72 CCM Frequently Asked Questions What if CCM is interrupted and patient does not have an encounter for one month? Consent is still active. If 20 minutes not documented for that month, you would not bill that month for CCM. 72

73 CCM Frequently Asked Questions Can staff complete the consent paperwork and other documents after the provider discusses CCM program and obtains patients consent? The auxiliary staff within the clinic or Care Coordinator can complete consent, care plan and initial encounter elements once the provider sees the patient. 73

74 CCM Frequently Asked Questions Does the patient need to sign their care plan? They must receive a copy of their care plan and you must document in the EHR that they received a copy. 74

75 CCM Frequently Asked Questions Are there services that can t be billed by a provider while billing for CCM? Transitional Care Management (CPT and 99496) Home Healthcare Supervision (HCPCS G0181) Hospice Care Supervision (HCPCS G0182) End-Stage Renal Disease services (CPT ) 75

76 CCM Frequently Asked Questions RHC practitioner discusses CCM with patient during an E&M, IPPE or AWV, patient doesn t decide until following week that he wants the service, can patient get or wait until next E&M? If patient comes back a week later and says they thought about it and they want to sign up for CCM services, as long as discussion was documented they can complete process by signing the consent form. 76

77 CCM Frequently Asked Questions Will the CCM reimbursement rate change throughout the year? The rate is set annually and will be applied to CCM claims from January 1 st December 31 st. There is no geographic adjustment. 77

78 CCM Frequently Asked Questions Does CCM have to be billed on a claim with an RHC visit? CCM services can be billed alone or on the same claim as a billable visit. 78

79 CCM Frequently Asked Questions Will CCM cost such as software and management oversight be included in the RHC cost report? Cost incurred should be included on the Medicare Cost Report: CMS will be adding a line to report costs associated with CCM costs Reimbursed on the fee schedule Excluded from RHC cost per visit Separately identify and track CCM costs 79

80 CCM Frequently Asked Questions How does a beneficiary revoke his or her consent? CMS does not specify the manner in which a beneficiary must revoke consent. If a beneficiary gives written consent to a second provider to furnish CCM service, that will revoke the consent given to the first practitioner. 80

81 CCM Frequently Asked Questions Does the 20 minutes count if patient gets lab work and staff contacts the patient to explain the results and provides recommendations based upon those results? This would be considered part of the CCM services. 81

82 CCM Frequently Asked Questions Each time we speak to the patient, does that count towards the 20 minute time? If the conversation is between the patient and the clinical staff and the conversation addresses the chronic conditions then it can count towards the 20 minutes Face-to-face (if patient presents to office & no billable visit) Phone 82

83 CCM Frequently Asked Questions Since this is a timed code, would you expect to see start and stop times documented in order to support the 20 minutes? Time must be documented as either total time OR start/stop times. 83

84 CCM Frequently Asked Questions Can CCM services be subcontracted out to a case management company? What if the clinical staff employed by the case management company are located outside of the United States? A billing physician (or other appropriate practitioner) may arrange to have CCM services provided by clinical staff external to the practice (for example, in a case management company) if all of the incident to and other rules for billing CCM to the PFS are met. Because there is a regulatory prohibition against payment for non-emergency Medicare services furnished outside of the United States (42 CFR 411.9), CCM services cannot be billed if they are provided to patients or by individuals located outside of the United States. 84

85 CCM Frequently Asked Questions Can I bill CPT if the beneficiary dies during the service period? CPT can be billed if the beneficiary dies during the service period, as long as at least 20 minutes of qualifying services were furnished during that calendar month and all other billing requirements are met. 85

86 Questions? Thank You! 86

Care Management Services in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Frequently Asked Questions

Care Management Services in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Frequently Asked Questions Care Management Services in Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) Frequently Asked Questions February 2018 Care Management in RHCs and FQHCs: I. General Information...Page

More information

CHRONIC CARE MANAGEMENT IMPLEMENTATION GUIDE

CHRONIC CARE MANAGEMENT IMPLEMENTATION GUIDE CHRONIC CARE MANAGEMENT IMPLEMENTATION GUIDE TABLE OF CONTENTS What is Chronic Care Management (CCM)?... 2 Why CCM?... 2 Clinician/Practice Benefits... 3 Patient Benefits... 4 What is Included in CCM?...

More information

Providing and Billing Medicare for Chronic Care Management Services

Providing and Billing Medicare for Chronic Care Management Services Providing and Billing Medicare for Chronic Care Management Services (and Other Fee-For-Service Population Health Management Services) No portion of this white paper may be used or duplicated by any person

More information

Provider-Based RHC Billing June 8, 2018

Provider-Based RHC Billing June 8, 2018 Provider-Based RHC Billing June 8, 2018 Sharon Shover, CPC, CEMC 502.992.3511 Provider-Based RHC Billing Agenda RHC Encounters Payment for RHC Services Same Day Visits Revenue Codes CG Modifier & QVL Non-RHC

More information

CHRONIC CARE MANAGEMENT TOOL KIT What Practices Need to Do to Implement and Bill CCM Codes

CHRONIC CARE MANAGEMENT TOOL KIT What Practices Need to Do to Implement and Bill CCM Codes CHRONIC CARE MANAGEMENT TOOL KIT What Practices Need to Do to Implement and Bill CCM Codes Understanding CCM Chronic Care Management (CCM) is defined as the non-face-to-face services provided to Medicare

More information

Providing and Billing Medicare for Chronic Care Management Services

Providing and Billing Medicare for Chronic Care Management Services Providing and Billing Medicare for Chronic Care Management Services (and Other Fee-For-Service Population Health Management Services) Updated March 2018 No portion of this white paper may be used or duplicated

More information

RHC TA Webinar/Call August 6, 2015

RHC TA Webinar/Call August 6, 2015 RHC TA Webinar/Call August 6, 2015 Proposed Medicare Policy to: 1. Allow Medicare payments for Chronic Care Management services provided by Federally Certified RHCs; 2. Mandate use of HPCPS/CPT codes on

More information

Chronic Care Management Coding Guidelines Effective January 1, 2017

Chronic Care Management Coding Guidelines Effective January 1, 2017 Capture Billing & Consulting, Inc. 25055 Riding Plaza, Suite 160 South Riding, VA 20152 (703) 327-1800 Chronic Care Management Coding Guidelines Effective January 1, 2017 The Centers for Medicare and Medicaid

More information

CHRONIC CARE MANAGEMENT. A Guide to Medicare s New Move Toward Patient-Centric Care

CHRONIC CARE MANAGEMENT. A Guide to Medicare s New Move Toward Patient-Centric Care CHRONIC CARE MANAGEMENT A Guide to Medicare s New Move Toward Patient-Centric Care The future of healthcare is here; Medicare has begun to shift away from fee-forservice care and move toward value based

More information

Clinically Focused. Outcomes Oriented. Technology Driven. Chronic Care Management. eqguide. (CPT Codes 99490, 99487, 99489)

Clinically Focused. Outcomes Oriented. Technology Driven. Chronic Care Management. eqguide. (CPT Codes 99490, 99487, 99489) Clinically Focused. Outcomes Oriented. Technology Driven. 2017 Chronic Care Management eqguide (CPT Codes 99490, 99487, 99489) www.eqhs.org Table of Contents 01 State of Population Health and Chronic Care

More information

Transitional Care Management We provide these services a-la-carte...

Transitional Care Management We provide these services a-la-carte... Transitional Care Management We provide these services a-la-carte... Initial Patient Outreach* This must be done within 2 days of the patient s discharge from the hospital. During this call patient s medications

More information

Chronic Care Management

Chronic Care Management Chronic Care Management Increase Practice Revenue, While Increasing Patient Care Presented by Steven Kress CEO, Renova PCA Introduction Mr. Kress is a founding Member and Serves on the Board of Directors

More information

RHC Advanced Billing. Janet Lytton RHIT, NHA Director of Reimbursement Rural Health Development

RHC Advanced Billing. Janet Lytton RHIT, NHA Director of Reimbursement Rural Health Development RHC Advanced Billing Janet Lytton RHIT, NHA Director of Reimbursement Rural Health Development Learn how to bill preventive care, nonrhc & Incident to services & what Revenue code to use Learn how to handle

More information

EVALUATION AND MANAGEMENT: GETTING PAID FOR WHAT YOU DO

EVALUATION AND MANAGEMENT: GETTING PAID FOR WHAT YOU DO EVALUATION AND MANAGEMENT: GETTING PAID FOR WHAT YOU DO Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO Sandy Giangreco, RHIT, CCS, CCS-P, CHC, CPC, COC, CPC-I, COBGC Agenda 2014 OIG Report CMS Documentation

More information

Optimizing Reimbursement

Optimizing Reimbursement Optimizing Reimbursement of the Clinical Team in Long Term Care Carolyn K Clevenger, DNP, GNP BC, AGPCNP BC, FAANP Katherine A. Evans, DNP, FNP C, GNP BC, ACHPN, FAANP Physician and Nurse Practitioner

More information

Providing and Billing Medicare for Chronic Care Management

Providing and Billing Medicare for Chronic Care Management Providing and Billing Medicare for Chronic Care Management 2015 Medicare Physician Fee Schedule Final Rule November 2014 (PYA). No portion of this white paper may be used or duplicated by any person or

More information

Frequently Asked Questions about Physician Billing for Chronic Care Management Services

Frequently Asked Questions about Physician Billing for Chronic Care Management Services Frequently Asked Questions about Physician Billing for Chronic Care Management Services This document answers frequently asked questions about billing chronic care management (CCM) services to the Physician

More information

Chronic Care Management Services. Presented by Noridian Part B Medicare Provider Outreach and Education April 2015

Chronic Care Management Services. Presented by Noridian Part B Medicare Provider Outreach and Education April 2015 Chronic Care Management Services Presented by Noridian Part B Medicare Provider Outreach and Education April 2015 Continuing Education Unit (CEU) When registering, add all additional attendees First and

More information

Reducing Clinician Burnout in Implementing Chronic Care Management

Reducing Clinician Burnout in Implementing Chronic Care Management Reducing Clinician Burnout in Implementing Chronic Care Management Learning Objectives Describe the benefits of Chronic Care Management (CCM) for patients and practices; Create a high-level workflow for

More information

Coding Guidance for HIV Clinical Practices: Care Management Services

Coding Guidance for HIV Clinical Practices: Care Management Services Coding Guidance for HIV Clinical Practices: Care Management Services HIV medical practices and clinicians provide many services outside of a face-to-face encounter with a patient. Some of these services

More information

Chronic Care Management Services: Advantages for Your Practices

Chronic Care Management Services: Advantages for Your Practices Chronic Care Management Services: Advantages for Your Practices Rachel S. Eichenbaum, RN, MSN Yvonne La-Garde, M.ED Susan Whittaker, CPC, CPMA This material was prepared by the New England Quality Innovation

More information

Claim to RHC Medicare; 1 AIR pd, copay $41. IRHC claim to Mcr Pt B per the fee schedule PBRHC Hospital would submit UB04 claim with OP prov.

Claim to RHC Medicare; 1 AIR pd, copay $41. IRHC claim to Mcr Pt B per the fee schedule PBRHC Hospital would submit UB04 claim with OP prov. Claim to RHC Medicare; 1 AIR pd, copay $41 IRHC claim to Mcr Pt B per the fee schedule PBRHC Hospital would submit UB04 claim with OP prov. #s 91 I.e. Lesion removal, joint injection, wound closure, AND

More information

2017 Physician Fee Schedule Impact on Medicare ACOs REGULATORY UPDATES

2017 Physician Fee Schedule Impact on Medicare ACOs REGULATORY UPDATES 2017 Physician Fee Schedule Impact on Medicare ACOs REGULATORY UPDATES 2017 Physician Fee Schedule Impact on Medicare ACOs 1. Allowing ACO Participants to report PQRS separately from ACO 2. ACO Quality

More information

Care Coordination between Primary Care Practices and Hospitals: A Formula for Positive Health and Financial Outcomes for All

Care Coordination between Primary Care Practices and Hospitals: A Formula for Positive Health and Financial Outcomes for All Coordination between Primary Practices and Hospitals: A Formula for Positive Health and Financial Outcomes for All 1 Faith M Jones, MSN, RN, NEA-BC Director of Coordination and Lean Consulting Faith Jones

More information

Chronic Care Management (CCM): An Overview for Pharmacists. March Developed Through a Collaboration Among:

Chronic Care Management (CCM): An Overview for Pharmacists. March Developed Through a Collaboration Among: Chronic Care Management (CCM): An Overview for Pharmacists March 2017 Developed Through a Collaboration Among: Overview of CCM and Complex CCM Beginning January 1, 2015, the Medicare Physician Fee Schedule

More information

Rick Bikowski MD Chief Quality Officer, EVMS Medical Group CARE MANAGEMENT

Rick Bikowski MD Chief Quality Officer, EVMS Medical Group CARE MANAGEMENT Rick Bikowski MD Chief Quality Officer, EVMS Medical Group CARE MANAGEMENT Medicare Wellness Visit: Background Until recently, Medicare did not pay for preventive services Welcome to Medicare visit initiated

More information

WHY SHOULD A CHC/FQHC CARE?

WHY SHOULD A CHC/FQHC CARE? Suzanne Niemi, CPA, CMPE, CCE Alaska Primary Care Association April 2017 Medicare Part A & Part B MACRA / MIPS Chronic Care Management Billing WHY SHOULD A CHC/FQHC CARE? 2 DEFINITIONS FQHC Federally Qualified

More information

Telehealth. Administrative Process. Coverage. Indications that are covered

Telehealth. Administrative Process. Coverage. Indications that are covered Telehealth These services may or may not be covered by your HealthPartners plan. Please see your plan documents for your specific coverage information. If there is a difference between this general information

More information

Disclosure Statement

Disclosure Statement 2017 Coding and Medicare Changes for Physician Fee Schedule Billing Presented by Jean Acevedo, CHC CPC CENTC LHRM Disclosure Statement No financial relationships to disclose. 1 Disclaimer The information

More information

The Business Case for Chronic Care Management in the Ambulatory Care Practice

The Business Case for Chronic Care Management in the Ambulatory Care Practice The Business Case for Chronic Care Management in the Ambulatory Care Practice Debbie Rozanski, CMC Practice Transformation Coach Michigan Rural Health Association Soaring Eagle Casino & Resort May 4-5,

More information

Advance Care Planning Billing Resource Guide

Advance Care Planning Billing Resource Guide Advance Care Planning Billing Resource Guide Historically, physicians have understood the necessity and benefits of advance care planning (ACP) conversations with patients. The challenges of a busy clinic

More information

Chronic Care Management Lesa Schlatman RN, BSN Care Coordination Specialist ICAHN

Chronic Care Management Lesa Schlatman RN, BSN Care Coordination Specialist ICAHN Chronic Care Management Lesa Schlatman RN, BSN Care Coordination Specialist ICAHN CHRONIC CARE MANAGEMENT: It can transform your quality of care Presented By: Lesa Schlatman RN, BSN Director Clinical Transformation

More information

Maintaining the Primary Care Relationship

Maintaining the Primary Care Relationship Maintaining the Primary Care Relationship 0 in the Long Term Care Setting: Creating Care Coordination Synergy Faith M Jones, MSN, RN, NEA-BC Director of Care Coordination and Lean Consulting Faith Jones

More information

REIMBURSEMENT. Bills are submitted on a Form UB-04. Claims related information can be found in Section

REIMBURSEMENT. Bills are submitted on a Form UB-04. Claims related information can be found in Section REIMBURSEMENT With the exception of payment for physician services, Medicaid reimbursement for hospice care is made at one of four predetermined per diem rates for each day in which a Medicaid recipient

More information

Telemedicine and Telehealth Services

Telemedicine and Telehealth Services INDIANA HEALTH COVERAGE PROGRAMS PROVIDER REFERENCE M ODULE Telemedicine and Telehealth Services L I B R A R Y R E F E R E N C E N U M B E R : P R O M O D 0 0 0 4 8 P U B L I S H E D : J A N U A R Y 1

More information

8/24/2018. Behavior Health Integration: The Next Step in Chronic Care Management. Following this presentation, the participant will: Objectives 2

8/24/2018. Behavior Health Integration: The Next Step in Chronic Care Management. Following this presentation, the participant will: Objectives 2 Behavior Health Integration: The Next Step in Chronic Care 0 Building Leaders Transforming Hospitals Improving Care 1 Faith M Jones, MSN, RN, NEA-BC Director of Care Coordination and Lean Consulting Faith

More information

MEDICAL POLICY No R2 TELEMEDICINE

MEDICAL POLICY No R2 TELEMEDICINE Summary of Changes Clarifications: Page 1, Section I. A 6, additional language added for clarification. Deletions: Additions Page 4, Section IV, Description, additional language added in regards to telemedicine.

More information

TELECOMMUNICATION SERVICES CSHCN SERVICES PROGRAM PROVIDER MANUAL

TELECOMMUNICATION SERVICES CSHCN SERVICES PROGRAM PROVIDER MANUAL TELECOMMUNICATION SERVICES CSHCN SERVICES PROGRAM PROVIDER MANUAL NOVEMBER 2017 CSHCN PROVIDER PROCEDURES MANUAL NOVEMBER 2017 TELECOMMUNICATION SERVICES Table of Contents 38.1 Enrollment......................................................................

More information

A Walkthrough of Healthcare Revenue Cycle Management. Presented by: Robert Urquhart Senior Vice President Chief Financial Officer

A Walkthrough of Healthcare Revenue Cycle Management. Presented by: Robert Urquhart Senior Vice President Chief Financial Officer A Walkthrough of Healthcare Revenue Cycle Management Presented by: Robert Urquhart Senior Vice President Chief Financial Officer Basic Revenue Cycle Process across all service lines Call Center Manage

More information

THE MEDICARE ANNUAL WELLNESS VISIT

THE MEDICARE ANNUAL WELLNESS VISIT OBJECTIVES THE MEDICARE ANNUAL WELLNESS VISIT Learn the required components of the AWV Consider the benefits to the patient and primary care provider Discuss the logistics of performing the AWV Learn appropriate

More information

MEDICAL POLICY No R1 TELEMEDICINE

MEDICAL POLICY No R1 TELEMEDICINE Summary of Changes MEDICAL POLICY TELEMEDICINE Effective Date: March 1, 2016 Review Dates: 12/12, 12/13, 11/14, 11/15 Date Of Origin: December 12, 2012 Status: Current Clarifications: Deletions: Pg. 4,

More information

Rural Health Clinic Overview

Rural Health Clinic Overview TrailBlazer Health Enterprises Rural Health Clinic Overview Steven W. Mildward Published March 2012 108724 2012 TrailBlazer Health Enterprises /TrailBlazer. All rights reserved. Important The information

More information

Medicare Preventive Services

Medicare Preventive Services Medicare Preventive Services Presented by Part B Provider Outreach & Education December 16, 2015 Event Instructions Today s event is a teleconference Slides will not be advanced during the presentation

More information

Updates in Coding & Billing Strategies.

Updates in Coding & Billing Strategies. Lehigh Valley Health Network LVHN Scholarly Works Department of Family Medicine Updates in Coding & Billing Strategies. Drew Keister MD, FAAFP Lehigh Valley Health Network, Drew_M.Keister@lvhn.org Follow

More information

Third Party Payer Days. IMGMA February 25, 2015

Third Party Payer Days. IMGMA February 25, 2015 Third Party Payer Days IMGMA February 25, 2015 Agenda 2015 Medicare Physician Fee Schedule Medicare Physician Fee Schedule Database Transitional Care Management - Reminder Medicare - Coverage Guidelines

More information

Medicare Chronic Care Management. November 8, 2017

Medicare Chronic Care Management. November 8, 2017 Medicare Chronic Care Management November 8, 2017 2 Overview 1) Overview of the Medicare CCM program 2) Chronic Care Management 2018 Service Update 3) Implementing at your Organization 1) Key Questions

More information

NARHC Spring Institute

NARHC Spring Institute NARHC Spring Institute Tuesday, March 15, 2016 San Antonio Conference Breakouts Your choice Regency Ballroom E Mac Discussion: Novitas Kim Robinson Live Oak Mac Discussion: Noridian Tana Williams You are

More information

Monday, October 24, :15 a.m. to 10:45 a.m. Great Halls 1 & 2

Monday, October 24, :15 a.m. to 10:45 a.m. Great Halls 1 & 2 Expanding Pharmacy Impact: Transitional Care Management and Chronic Care Management Activity Number: 0217-0000-16-1118-L04-P 1.50 hours of CPE credit; Activity Type: A Knowledge-Based Activity Monday,

More information

Presented by Karrie May, CPC. April, Karrie May, CPC. Been in the medical field in some capacity for over 20 years.

Presented by Karrie May, CPC. April, Karrie May, CPC. Been in the medical field in some capacity for over 20 years. Presented by Karrie May, CPC April, 2012 1 Karrie May, CPC Been in the medical field in some capacity for over 20 years. Currently work for a large multi specialty medical group as a provider educator.

More information

FQHC Behavioral Health Billing Codes

FQHC Behavioral Health Billing Codes FQHC s Eligible Documentation Assessment 90792 Psychiatric Prescribers only (MD, NP, PA, APRN) Psychiatric diagnostic evaluation with medical services. Medical though process clearly reflected in assessment

More information

TIPS FROM OUR CONSULTANT By: Joy Newby, LPN, CPC, PCS Newby Consulting

TIPS FROM OUR CONSULTANT By: Joy Newby, LPN, CPC, PCS Newby Consulting TIPS FROM OUR CONSULTANT By: Joy Newby, LPN, CPC, PCS Newby Consulting CONFUSED ABOUT MEDICARE PREVENTATIVE VISITS? SO ARE YOUR PATIENTS! Congress legislated coverage for two preventive visits for Medicare

More information

RHC Billing Updates, Qualifying Visit, IPPE, AWV. By: Joanie Perkins, CPC

RHC Billing Updates, Qualifying Visit, IPPE, AWV. By: Joanie Perkins, CPC RHC Billing Updates, Qualifying Visit, IPPE, AWV By: Joanie Perkins, CPC Objectives What services qualify for RHC AIR Understand what to bundle How to bill RHC IPPE exams How to bill RHC AWV Important

More information

Multi-payer G and CPT Care Management Code Summary v7

Multi-payer G and CPT Care Management Code Summary v7 Purpose This document is a guide to help care management team members quickly understand the requirements and documentation fields required for billing care management-related G and CPT codes. Please note

More information

Clinical Webinar: Integrated Pharmacy

Clinical Webinar: Integrated Pharmacy Clinical Webinar: Integrated Pharmacy Benjamin Gross, Pharm D, MBA, BCPS, BCACP, CDE, BC ADM, ASH CHC Associate Professor Director of Residency Programs Lipscomb University College of Pharmacy Objectives

More information

Providing and Billing Medicare for Transitional Care Management

Providing and Billing Medicare for Transitional Care Management PYALeadership Briefing Providing and Billing Medicare for Transitional Care Management Updated November 2014 2014 Pershing Yoakley & Associates, PC (PYA). No portion of this white paper may be used or

More information

Texas Medicaid. Provider Procedures Manual. Provider Handbooks. Telecommunication Services Handbook

Texas Medicaid. Provider Procedures Manual. Provider Handbooks. Telecommunication Services Handbook Texas Medicaid Provider Procedures Manual Provider Handbooks December 2017 Telecommunication Services Handbook The Texas Medicaid & Healthcare Partnership (TMHP) is the claims administrator for Texas Medicaid

More information

RE: CMS-1631-PM Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2016

RE: CMS-1631-PM Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2016 September 8, 2015 Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-2333-P Mail Stop C4-26-05 7500 Security Boulevard Baltimore, MD 21244-1850 Main Office

More information

My Notes on Today s CMS Call on the Initial Preventive Physical Exam (Not a Physical Exam) and the Annual Wellness Visit

My Notes on Today s CMS Call on the Initial Preventive Physical Exam (Not a Physical Exam) and the Annual Wellness Visit My Notes on Today s CMS Call on the Initial Preventive Physical Exam (Not a Physical Exam) and the Annual Wellness Visit Today s CMS call reviewed the guidelines for the IPPE (Initial Preventive Physical

More information

REVISION DATE: FEBRUARY

REVISION DATE: FEBRUARY Mary Ann Hodorowicz, MBA, RDN CDE, CEC, Owner, Mary Ann Hodorowicz Consulting LLC, Palos Heights, IL Coverage: In-Person Payable Places of Services Excluded Places for Part B Payment Excluded Places: 0

More information

Objectives. Caring for the Aging Population. Presenter Disclosure Information

Objectives. Caring for the Aging Population. Presenter Disclosure Information 9:15 10:30 am Chronic Care Management (CCM): Optimizing Practice Revenue and Improving Care SPEAKER Kenneth Giacobbo, DO Presenter Disclosure Information The following relationships exist related to this

More information

2019 Medicare Physician Fee Schedule Proposed Rule

2019 Medicare Physician Fee Schedule Proposed Rule 2019 Medicare Physician Fee Schedule Proposed Rule OVERVIEW On July 12 th, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would update the Physician Fee Schedule (PFS)

More information

Primary Care Setting Behavioral Health Billing Codes

Primary Care Setting Behavioral Health Billing Codes Primary Care Setting s Medicaid Medicare Third Eligible Documentation Assessment 90792 Psychiatric Prescribers only (MD, NP, PA, APRN) Psychiatric diagnostic evaluation with medical services. Medical though

More information

How do you bill noncovered charges? If all charges are noncovered, send 710 TOB with all charges as noncovered and condition code 21.

How do you bill noncovered charges? If all charges are noncovered, send 710 TOB with all charges as noncovered and condition code 21. How do you bill noncovered charges? If all charges are noncovered, send 710 TOB with all charges as noncovered and condition code 21. If only some of the charges are noncovered, per CMS Internet-Only Manual,

More information

Cost Reporting Pitfalls and Big Rocks

Cost Reporting Pitfalls and Big Rocks National Association of Rural Health Clinics Cost Reporting Pitfalls and Big Rocks Jeff Bramschreiber, CPA Health Care Partner October 18, 2017 Wipfli LLP 1 RHC Medicare Cost Report Overview Non-RHC Costs

More information

RHC Billing for Provider-Based RHCs. Charles A. James, Jr. President and CEO North American Healthcare Management Services

RHC Billing for Provider-Based RHCs. Charles A. James, Jr. President and CEO North American Healthcare Management Services RHC Billing for Provider-Based RHCs Charles A. James, Jr. President and CEO North American Healthcare Management Services Presentation Objectives Provider-Based Requirements Provider-based Enrollment Issues

More information

THE REIMBURSEMENT SHIFT: PREPARING YOUR PRACTICE FOR PATIENT-CENTERED PAYMENT REFORM. November 20, 2015

THE REIMBURSEMENT SHIFT: PREPARING YOUR PRACTICE FOR PATIENT-CENTERED PAYMENT REFORM. November 20, 2015 THE REIMBURSEMENT SHIFT: PREPARING YOUR PRACTICE FOR PATIENT-CENTERED PAYMENT REFORM November 20, 2015 TODAYS PRESENTERS Kavon Kaboli Consultant Galen Healthcare Solutions Cece Teague Consultant Galen

More information

Medication Therapy Management (MTM) CMS Annual Wellness Visits (AWV) Diabetes selfmanagement. Collection and interpretation of physiologic data

Medication Therapy Management (MTM) CMS Annual Wellness Visits (AWV) Diabetes selfmanagement. Collection and interpretation of physiologic data Understanding Billing Opportunities for Pharmacists Eric Dietrich, PharmD, BCPS, CPC-A, CEMC Julie Nickerson-Troy, PharmD, MS, BCACP Disclosure Neither of the speakers (nor immediate family members) have

More information

Chronic Care Management INFORMATION RESOURCE

Chronic Care Management INFORMATION RESOURCE Contents Chronic Care Management INFORMATION RESOURCE Purpose... 1 What Is CCM?... 1 Background... 1 Initiating Visit and Person-Centered Plan... 2 Clinical Supervision... 2 Qualifications for Personnel

More information

Telehealth 101. Telehealth Summit May 24, 2018

Telehealth 101. Telehealth Summit May 24, 2018 Telehealth 101 Telehealth Summit May 24, 2018 Tim Bickel Telehealth Director, University of Louisville Deborah Burton, Telehealth Program Manager, KentuckyOne Health, Lexington; Chair, Kentucky Teleheath

More information

Medicare Telehealth & Connected Care Policies for 2019

Medicare Telehealth & Connected Care Policies for 2019 Medicare Telehealth & Connected Care Policies for 2019 Background According to the Medicare Payment Advisory Commission (Medpac), telehealth visits per beneficiary increased by 79% between 2014 and 2016,

More information

EXECUTIVE SUMMARY Billing for Part B Drugs Administered Incident to a Physician s Services II. DME Face-to-Face Documentation Requirements a.

EXECUTIVE SUMMARY Billing for Part B Drugs Administered Incident to a Physician s Services II. DME Face-to-Face Documentation Requirements a. Revisions to Payment Policies Under the Physician Fee Schedule, DME Face to Face Encounters, Elimination of the Requirement for Termination of Non-Random Prepayment Complex Medical Review and Other Revisions

More information

Care Plan Oversight Services and Physician Services for Certification

Care Plan Oversight Services and Physician Services for Certification Education Makes the Difference Care Plan Oversight Services and Physician Services for Certification and Recertification of Medicare-Covered Home Health Services A CMS CONTRACTED INTERMEDIARY CARRIER The

More information

Independence at Home Demonstration Solicitation

Independence at Home Demonstration Solicitation Independence at Home Demonstration Solicitation Background Section 1866E of the Social Security Act, as added by Section 3024 of the Affordable Care Act (P.L. 111-148), directs the Centers for Medicare

More information

OCTOBER 19, 2018 PROMOTING INTEROPERABILITY- UPDATES ANNUAL MEETING 2018

OCTOBER 19, 2018 PROMOTING INTEROPERABILITY- UPDATES ANNUAL MEETING 2018 OCTOBER 19, 2018 PROMOTING INTEROPERABILITY- UPDATES ANNUAL MEETING 2018 AGENDA The MU name change changes-our focus is on the nuances and workflow changes Is it time for an EHR optimization review? AGENDA

More information

WHAT YOU NEED TO KNOW! CMS (Medicare)! and! The Joint Commission CSC! Updates!

WHAT YOU NEED TO KNOW! CMS (Medicare)! and! The Joint Commission CSC! Updates! !!! Lombardi Hill Consulting Group WHAT YOU NEED TO KNOW!! CMS (Medicare)! and! The Joint Commission CSC! Updates! Debbie Lombardi Hill, FAHA Dunedin, Florida w May 4, 2016 Lombardi Hill Consulting Group!

More information

Reference Guide for Hospice Medicaid Services

Reference Guide for Hospice Medicaid Services Reference Guide for Hospice Medicaid Services for Florida s Statewide Medicaid Managed Care Plans (MMA & LTC) This reference guide is intended to provide general hospice information on Florida Medicaid.

More information

Rural Health Clinic Billing

Rural Health Clinic Billing Critical Access Hospital and Rural Health Clinic Billing September 12, 2017 1 Rural Health Clinic Overview Rural Health Clinic Services Preventive Services in the RHC Non-RHC Services/Non-Covered Services

More information

Transitional Care Management (TCM) and Chronic Care Management (CCM) Overview and Billing Process. April 19, :00 PM

Transitional Care Management (TCM) and Chronic Care Management (CCM) Overview and Billing Process. April 19, :00 PM Transitional Care Management (TCM) and Chronic Care Management (CCM) Overview and Billing Process April 19, 2016 2:00 PM 2 Discussion Topics TCM Requirements TCM Services and C247 Process Medical Decision

More information

Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive Services

Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive Services Intensive Behavioral Therapy (IBT) Obesity and Cardiovascular Disease Medicare Preventive Services Index Stand Alone Benefit 2 G Codes for Intensive Behavioral Therapy 3 The content of the Intensive Behavioral

More information

2015 Annual Convention

2015 Annual Convention 2015 Annual Convention Date: Tuesday, October 13, 2015 Time: 8:00 am 9:30 am Location: Gaylord National Harbor Resort and Convention Center, National Harbor 10 Title: Activity Type: Speaker: Opportunities

More information

Coding Coach Monthly Coding Tips

Coding Coach Monthly Coding Tips An Independent Licensee of the Blue Cross and Blue Shield Association Coding Coach Monthly Coding Tips Quality Tracking for HEDIS Prenatal and Postpartum Maternity Care (posted December 2015) In support

More information

Fact Sheet: Advance Care Planning as a Billable Medicare Service starting Jan. 1, 2016

Fact Sheet: Advance Care Planning as a Billable Medicare Service starting Jan. 1, 2016 Fact Sheet: Advance Care Planning as a Billable Medicare Service starting Jan. 1, 2016 What constitutes Advance Care Planning? Getting information on the types of life-sustaining treatments that are available

More information

Reimbursement Environment

Reimbursement Environment Reimbursement Environment 1 2017 Medicare Physician Fee Schedule Enhancing Integrative Medicine: CMS adopting additional care management codes in 2017 MPFS. Support patient centered and collaborative strategies.

More information

MLN Matters MM11063 Related CR 11063

MLN Matters MM11063 Related CR 11063 Summary of Policies in the Calendar Year (CY) 2019 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT Modifier Reduction

More information

Annual Wellness Visit (AWV) Delivery Business Case

Annual Wellness Visit (AWV) Delivery Business Case Annual Wellness Visit (AWV) Delivery Business Case The implications of the adopting and/or actively promoting AWV services for the practice s bottom line are dependent on a number of factors, including:

More information

Reporting Preventive Services & Problem-Oriented E & M in RHCs

Reporting Preventive Services & Problem-Oriented E & M in RHCs Reporting Preventive Services & Problem-Oriented E & M in RHCs John Burns, CPMA, CEMC, CPC, CPC-I Vice President, Audit and Compliance Services John.Burns@RuralHealthCoding.com Your Faculty John F. Burns,

More information

Telemedicine and Reimbursement

Telemedicine and Reimbursement Telemedicine and Reimbursement Presented for : March 14 th 2018 About Acevedo Consulting Incorporated Acevedo Consulting Incorporated prides itself on not providing cookie-cutter programs, but a quality

More information

TELEMEDICINE POLICY. Policy Number: ADMINISTRATIVE T0 Effective Date: January 1, 2018

TELEMEDICINE POLICY. Policy Number: ADMINISTRATIVE T0 Effective Date: January 1, 2018 TELEMEDICINE POLICY UnitedHealthcare Oxford Reimbursement Policy Policy Number: ADMINISTRATIVE 114.28 T0 Effective Date: January 1, 2018 Table of Contents Page INSTRUCTIONS FOR USE... 1 APPLICABLE LINES

More information

Coding and Reimbursement Tip Sheet for Transition from Pediatric to Adult Health Care

Coding and Reimbursement Tip Sheet for Transition from Pediatric to Adult Health Care P R A C T I C E R E S O U R C E A P R I L 2015 NO.2 Coding and Reimbursement Tip Sheet for Transition from Pediatric to Adult Health Care By Margaret McManus, MHS The National Alliance to Advance Adolescent

More information

Calendar Year (CY) 2019 Medicare Physician Fee Schedule (PFS) Final Rule

Calendar Year (CY) 2019 Medicare Physician Fee Schedule (PFS) Final Rule Calendar Year (CY) 2019 Medicare Physician Fee Schedule (PFS) Final Rule Barbara J. Connors, DO, MPH Patrick M. Hamilton, MPA Centers for Medicare & Medicaid Services December 13, 2018 This presentation

More information

Medicare and Medicaid EHR Incentive Program. Stage 3 and Modifications to Meaningful Use in 2015 through 2017 Final Rule with Comment

Medicare and Medicaid EHR Incentive Program. Stage 3 and Modifications to Meaningful Use in 2015 through 2017 Final Rule with Comment Medicare and Medicaid EHR Incentive Program Stage 3 and Modifications to Meaningful Use in 2015 through 2017 Final Rule with Comment Measures, and Proposed Alternative Measures with Select Proposed 1 Protect

More information

LOUISIANA MEDICAID PROGRAM ISSUED: 12/21/16 REPLACED: 04/15/12 CHAPTER 24: HOSPICE SECTION 24.10: CLAIMS RELATED INFORMATION PAGE(S) 6

LOUISIANA MEDICAID PROGRAM ISSUED: 12/21/16 REPLACED: 04/15/12 CHAPTER 24: HOSPICE SECTION 24.10: CLAIMS RELATED INFORMATION PAGE(S) 6 CLAIMS RELATED INFORMATION Reimbursement requires compliance with all Medicaid requirements. Hospice providers bill for room and board using the standard 837 Institutional (837I) electronic claim transaction

More information

Independent RHC Billing Introduction Session 3 Spring, 2018

Independent RHC Billing Introduction Session 3 Spring, 2018 Independent RHC Billing Introduction Session 3 Spring, 2018 Contact Information Mark Lynn, CPA (Inactive) RHC Consultant Healthcare Business Specialists Suite 214, 502 Shadow Parkway Chattanooga, Tennessee

More information