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 Dates April 1, 2016 HCPCS reporting became mandatory April 1 Sept 30 th Bundling all services into QV line (052X and/or 0900) October 1, 2016 CG modifier required on the QV line
Qualifying Visit List Groupings included from: Integumentary Musculoskeletal Respiratory System (5 codes) Digestive System (5 codes)
Qualifying Visit List Continued Groupings included Urinary Female Genital and Maternity Care Nervous System Vision Chiropractic Evaluation and Management Services
CW Modifier All charges subject to a co-pay and deductible should roll up to the QV line on the UB 04 (minus any charges for preventive services) Append the QV line with the CW modifier
Each Additional Service Should be reported using the appropriate revenue and HCPCS codes with a charge = to or > than.01 cent. Warning not reducing the totals on these lines will result in overstating your Medicare charges and adjustments.
IPPE Exam Once in a lifetime benefit Effective 1/1/09 RHC s may bill for the professional portion of the IPPE in addition to a daily encounter (G0402) Co-pays and deductibles are waived
IPPE Exam CMS states in rare circumstances, depending on the clinical appropriateness of a separate visit, to allow RHC s to receive separate payment for an encounter, in addition to the payment for IPPE when they are performed on the same day
IPPE Exam EKG The TC of the EKG is not included in waived co-pay and deductible Submit to MAC under main provider) number or Part B number
Required Components of the IPPE Medical, Social and Family History Review of Risk Factors Review of Functional Ability Exam End of Life Planning Educate, Counsel, and Refer based on the Previous Five Components Educate, Counsel, and Referral for Other Preventive Services in the Form of a Brief Written Plan
Medical, Social and Family History At a minimum, nurse collects information about. Past medical/surgical history Current medications and supplements Family history History of alcohol, tobacco, and illicit drug use; Diet; and Physical activities
Review of Risk Factors Nursing Staff Reviews the patient s potential risk factors for depression and other mood disorders by using a Depressing Scale for patients without a current diagnosis of depression or other mood disorders This is the Zung Scale http://healthnet.umassmed.edu/mhealth/ ZungSelfRatedDepressionScale.pdf
Review of Functional Ability and Level of Safety At a minimum, collect information about. Hearing impairment; Activities of daily living; Fall risk; and Home safety
Physical Exam Obtain the following. Height, weight, body mass index, and blood pressure; (Nurse/Triage) Visual acuity screen; and (Nurse/Triage) Other factors deemed appropriate based on the patient s medical and social history and current clinical standards. (MD/NP)
End of Life Planning Verbal or written information provided to the patient about. The ability to prepare an advance directive in case an injury or illness causes the patient unable to make health care decisions;(nurse/triage) and Whether or not you are willing to follow the patient s wishes as expressed in the advance directive.(md/np)
Educate, Counsel, and Refer based on the Previous Five Components Based on the results of the review and evaluation services in the previous five components, provide education, counseling, and referral as appropriate. (MD/NP)
Educate, Counsel, and Refer for Other Preventive Services Includes a brief written plan, such as a checklist, for the beneficiary to obtain. A once-in-a-lifetime screening electrocardiogram (EKG/ECG), as appropriate; and The appropriate screenings and other preventive services that Medicare covers
Coding Use the following Healthcare Common Procedure Coding System (HCPCS) codes when filing claims for the IPPE and screening ECG.
Annual Wellness Visit No other IPPE or AWV within 12 months What differs from the IPPE exam? Current list of medical providers involved in the patients current care Cognitive impairment identified by the patient Written screening schedule for the next 5 to 10 years (US Preventive Services Task Force and ACIP) Personalized Health Advice and referral(s) as appropriate aimed at reducing identified risk factors, i.e.; weight loss, physical activity, smoking cessation, etc.
Billing Requirements AWV Initial AWV = G0438 Subsequent AWV = G0439 For TOB 711 (RHC) use revenue code 521 HCPCS code with CG modifier on QVL Reimbursed at the AIR The AWV does not qualify for a separate payment with another RHC encounter Co-pay and Deductible do not apply
Thank you! Joanie Perkins, CPC joanie.perkins@northsunflower.com