How early SBIRT adopters became SBIRT billing innovators in Hospital Settings
|
|
- Barry Washington
- 8 years ago
- Views:
Transcription
1 How early SBIRT adopters became SBIRT billing innovators in Hospital Settings
2 WARNING Medical billing and/or clinical acronyms might be used during this presentation.
3 A Little Foreshadowing SBIRT stands for screening, brief intervention, and referral to treatment. Visit OHSU Family Medicine Oregon SBIRT webpage at Our SBIRT approach was centered in outpatient primary care then expanded to include hospitals services and emergency departments.
4 Presentation Outcomes Outcomes include: How SBIRT is imbedded and operates within clinical out-patient settings, community center clinics, ED/ER and hospital health systems. Business/billing practices to maintain successful SBIRT integration. Use of electronic record integration to secure billing efficiency/training. Making documentation/billing easier for your clinicians How billing practices and workflows can be implemented.
5 Presentation Outcomes SBIRT success recipe in all major healthcare settings: Partnership with business office Leadership. Gain a Clinician Champion. Focus on front-end training. Show clinicians incentives (patient/clinician) from training. Include Team Based Coordination with existing Medical Home or Hospital staff.
6 What is OHSU Family Medicine U.S. News & World Report ranks our department among the nation's best academic family medicine departments, and we're very proud of the programs that have led to this national reputation. In the last 40 years, we ve gone from a tiny two-doctor clinic to a nationally-ranked major department in the medical school. We are a true integrated primary care location with a hospital structure. Meaning if we can do it, so can you..
7 What is OHSU Family Medicine Today we have four clinics, three hospital services at OHSU Hospital, residency programs in Portland and in Klamath Falls We have more than 50 residents, a required third-year medical school clerkship and a faculty of 95 clinicians, educators, and researchers In addition, we have over 250 volunteer faculty located throughout Oregon Again if we can do it, so can you.
8 What is OHSU Family Medicine We have five Oregon State Tier 3 Primary Care Medical Homes. We have integrated our primary care medical home care teams into In-Patient teams. We are also a complex health organization with various ways of billing and performing services. Yes again, if we can do it, so can you.
9 Usual Approach to SBIRT
10 Usual Approach to SBIRT
11 New Medicare CPT Codes No co-insurance/deductible G0442 Fee $17.33 Work RVU.18 (in addition to E&M code) Screening for alcohol misuse in adults including pregnant women once per year (Compare to.18 for a Work RVU 99211) G0443 Fee $25.14 Work RVU.45 (in addition to E&M code) Up to four, 15 minute, brief face-to-face behavioral counseling interventions per year for individuals, including pregnant women, who screen positive for alcohol misuse (Compare to.48 for a Work RVU 99212)
12 Our Approach to SBIRT Let providers do what they do best, TREAT PATIENTS!! Create a system that maximizes your Electronical Medical Record (EMR) or Health Information Technology (HIT)
13 Our Approach to SBIRT Epic Smart Phrases Epic Smart Sets
14 If we code it wrong.
15 Payer Involvement/Advocacy 3 Medicare Intermediaries (Cahaba, NGS, Noridian) Worked with State Medicaid: Addiction and Mental health Division. Called our top 14 payers Regence Blue Cross (local + out-of-state), Aetna, Cigna- Greatwest, United healthcare, Pacificsource, Premera, Providence, Lifewise, ODS, Healthnet, Tricare, PHCS, and Humana.
16 Epic Smart-Set
17 Epic Smart-Set
18
19
20 OHSU FM Approach to SBIRT Create front-end training that will carry forward to successful back-end billing. See Demo:
21
22 The Twist There are various other ways to bill for SBIRT: Current literature focused in a Primary Care Private Practice Model. Out-Patient: Provider Bases Billing Facility Billing Home HealthCare Residency Program Urgent Care Facility FQHC/RHC/TRIBAL/IMM In-Patient: ED/ER/Observation Hospital Admissions
23 Coding and Billing
24
25 Full Screening
26 Full Screening Professional billing Full screen no intervention Bill with CPT code No WRVU: Discuss load custom Reimbursed by Medicaid at $7.23 Commercial $18-$25 Medicare $0
27 Annual screen
28 AUDIT
29 AUDIT
30 Clinician Out-Patient Focus SBIRT WRVU: Clinic Setting Code: 99408, Work RVU:.65 (in addition to E&M code) Clinician must spend at least 15 min (Compare to.97 for a Work RVU 99213) Code: 99409, Work RVU: 1.30 (in addition to E&M code) Clinician must spend at least 30 min (Compare to 1.42 for a Work RVU 99214) Code: no W/RVU paid at $ $18.00
31 Clinician In-Patient Focus SBIRT WRVU: Professional In-Patient Code: 99408, Work RVU:.65 (in addition to E&M code) Clinician must spend at least 15 min (Compare to a low-level for a work RVU of.76) Code: 99409, Work RVU: 1.30 (in addition to E&M code) Clinician must spend at least 30 min (Compare to a mid-level for a work RVU of 1.39) Code: no W/RVU paid at $ $18.00
32 Hospital In-Patient Focus SBIRT WRVU: Facility In-Patient Widely accepted method of using DRG s to increase or provided added reimbursement for in-patient substance or alcohol abuse services. Revenue can vary from $50 greater than $350 respectively.
33 OHSU Care Team Approach See Demonstration: Facility Billing
34 Facility Billing Staff Time Based on the physical time spent with a patient. Staff Intervention: Based on the number or type of staff interventions by nursing or ancillary staff. Resources Used: Based on points assigned to each staff intervention. Created by integration: Time, Intensity, and Staff type. Acuity Point Scoring: Complexity of decision making, patient severity, and point tally.
35 Sample Facility Billing Sheet
36 Sample Facility Billing Sheet
37 EMR Epic
38 EMR Epic
39 EMR Epic
40 EMR Epic
41 EMR Epic
42 EMR Epic
43 EMR Epic
44 OHSU Billing Epic Smart-Phrase/Smart-Set
45 OHSU FM SBIRT Documentation Purpose: facilitate and track SBIRT Tools built in EPIC, OCHIN/EPIC Also built in Meditech, and Centricity systems at first for three clinics EPIC has limited options for customization
46 Coding: Documentation for Billing Who can bill? DO; MD; PA; NP; RN; LPN: Some states reimburse non-physicians at 85% physician payment schedule. Ancillary staff, including health educators, behavioral health councilors, licensed clinical social workers, may perform SBIRT services under the supervision of a credentialed provider. The services should relate to a plan of care and will require billing under the supervising physician. Other screening tools eligible for include the AUDIT-C, ASSIST, CAGE- 4, TWEAK and T-ACE, DAST, CRAFT, DUDIT, and GAIN. Reimbursement rates vary depending on payer contracts.
47 99211 VS. Facility Billing Lets discuss who/how/when/should
48 OHSU FM SBIRT Documentation Billing Requirements: PAYER INTERACTION Imbed SBIRT billing logic with our OHSU Epic EHR/Practice Management System. Create documentation that flows with Clinicians responses. Focus on front-end training and use follow-up to teach clinicians/staff. Clinical Champion.
49 SBIRT Outlooks SBIRT services imbedded within clinics to hospital systems have been shown to improve patient healthy outcomes. Any Health facility can run a successful SBIRT program with the right preparation and ongoing dedication. Use of electronic record integration (Epic, Centricity, NextGen, MediTech) can secure billing efficiency/training. SBIRT respectively does not add extraneous overhead to implement and provides revenue.
50 Comments or Questions? Joseph Hurley OHSU Family Medicine Tel (503) Fax (503)
SBIRT Success: Clinical and patient success coexist. Joseph A Hurley MediCenter Executive Director President of Primary Care National
SBIRT Success: Clinical and patient success coexist Joseph A Hurley MediCenter Executive Director President of Primary Care National WARNING Medical billing and/or clinical acronyms might be used during
More informationQuestions asked on SBIRT TA Webinar
Questions asked on SBIRT TA Webinar Housekeeping Could you send out the link to download the updated SBIRT guidance document? The updated SBIRT guidance document is available online here: http://www.oregon.gov/oha/pages/cco-baseline-data.aspx
More informationScreening, Brief Intervention and Referral to Treatment SBIRT Coding, Billing and Reimbursement Manual
Screening, Brief Intervention and Referral to Treatment SBIRT Coding, Billing and Reimbursement Manual Prepared For: Wisconsin Initiative to Promote Healthy Lifestyles (WIPHL) January 2010 Table of Contents
More informationUnderstanding Coding & Reimbursement for SBI. Presented By: Jen Cohrs CPC, CPMA, CGIC Director of Educational Strategies Wisconsin Medical Society
Understanding Coding & Reimbursement for SBI Presented By: Jen Cohrs CPC, CPMA, CGIC Director of Educational Strategies Wisconsin Medical Society CPT codes, descriptions and material only are Copyright
More informationNew Substance Abuse Screening and Intervention Benefit Covered by BadgerCare Plus and Medicaid
Update December 2009 No. 2009-96 Affected Programs: BadgerCare Plus, Medicaid To: All Providers, HMOs and Other Managed Care Programs New Substance Abuse Screening and Intervention Benefit Covered by BadgerCare
More informationNational Screening, Brief Intervention, and Referral to Treatment, Addiction Technology Transfer Center
National Screening, Brief Intervention, and Referral to Treatment, Addiction Technology Transfer Center Presenters: Holly Hagle, PhD Director of the National SBIRT-ATTC and Eric Goplerud, PhD Senior Vice
More information2010 Medicare Part B Consultation Coding Changes 1/26/2010 & 1/27/2010
2010 Medicare Part B Consultation Coding Changes 1/26/2010 & 1/27/2010 Consultations The Centers for Medicare/Medicaid Services (CMS) finalized its proposal to require claims for consultation services
More informationUpdate January 2008. BadgerCare Plus Information for Providers. BadgerCare Plus Overview. Definition of the New Benefit. No.
Update January 2008 No. 2008-04 BadgerCare Plus Information for Providers To: All Providers, HMOs and Other Managed Care Programs Mental Health and Substance Abuse Screening, Preventive Mental Health Counseling,
More informationAlcohol and Opiates Disorders
BRIEF SCREENING, INTERVENTION, AND REFERRAL The Problem According to the National Institute on Alcohol Abuse and Alcoholism 3 in 10 adults drink at levels that elevate their risk of physical, mental health,
More informationPREVENTIVE MEDICINE AND SCREENING POLICY
REIMBURSEMENT POLICY PREVENTIVE MEDICINE AND SCREENING POLICY Policy Number: ADMINISTRATIVE 238.13 T0 Effective Date: January 1, 2016 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION...
More informationTelemedicine Reimbursement. and Credentialing
Kim Hoffman Telehealth Coordinator OHSU Telemedicine and Credentialing Kate Kenemer Client Service Analyst University Professional Services Why is it important? Encourages use of telemedicine services
More informationCrosswalk of 2012 CPT 4 codes to 2013 CPT 4 codes
The following code changes for behavioral health are effective January 1, 2013. Crosswalk of 2012 CPT 4 codes to 2013 CPT 4 codes 2012 Code (Deleted as of January 1, 2013) 90801 Psychiatric diagnostic
More informationBrief Screening, Intervention, and Referral for Alcohol and Opiate Disorders. An Effective Three-Step Process. Provider Guidelines
Brief Screening, Intervention, and Referral for Alcohol and Opiate Disorders An Effective Three-Step Process Provider Guidelines The Problem According to the National Institute on Alcohol Abuse and Alcoholism,
More informationSBIRT: Behavioral Health Screenings & Patient- Centered Care. Presented By: Zoe O Neill July 24, 2013
SBIRT: Behavioral Health Screenings & Patient- Centered Care Presented By: Zoe O Neill July 24, 2013 Welcome! Type questions into the Questions Pane Patient-Centered Primary Care Institute History and
More informationPayment Policy. Evaluation and Management
Purpose Payment Policy Evaluation and Management The purpose of this payment policy is to define how Health New England (HNE) reimburses for Evaluation and Management Services. Applicable Plans Definitions
More informationThe following instructions are taken directly from the Consultations section of CPT:
Heading: Clarification Title: Consultations Noridian Administrative Services (NAS) published this article on Consultations in Medicare B News, Issue 222, which was dated September 7, 2005. This article
More informationCollaborative Care Tips for Sustainability. Virna Little, PsyD, LCSW r, SAP The Institute for Family Health NYS Collaborative Care Initiative
Collaborative Care Tips for Sustainability Virna Little, PsyD, LCSW r, SAP The Institute for Family Health NYS Collaborative Care Initiative Teamwork Applies to Billing Too!!! Combine with other initiatives
More informationManagement of Substance Use in the Pregnancy Medical Home Setting Sara McEwen, MD, MPH Executive Director, Governor s Institute
Management of Substance Use in the Pregnancy Medical Home Setting Sara McEwen, MD, MPH Executive Director, Governor s Institute 1 Webinar Objectives Describe SBIRT approach to manage substance use in pregnancy
More informationCompliance Risks with Non-Physician Practitioners
Compliance Risks with Non-Physician Practitioners Kim Huey, MJ, CPC, CCS-P, PCS HCCA 2013 Compliance Institute April 2013 NPP Coding and Billing Definitions Compliance Issues Medicare Incident-to Split/Shared
More informationDe Paul Treatment Centers
CSSI Conference October 11, 2012 De Paul Treatment Centers SBIRT Collaboration De Paul and Legacy Project Aim To provide Screening, Brief Intervention and Referral to Treatment (SBIRT) to Legacy primary
More informationAmbulatory Patient Groups (APG) Policy and Medicaid Billing Guidance OASAS Certified Outpatient Chemical Dependence Programs
Ambulatory Patient Groups (APG) Policy and Medicaid Billing Guidance OASAS Certified Outpatient Chemical Dependence Programs www.oasas.ny.gov TABLE OF CONTENTS SECTION: PAGE 1. Background and Introduction
More informationEHR s-new Opportunities for the Confident Coder
EHR s-new Opportunities for the Confident Coder Angela Jordan, CPC Chair AAPCCA Board of Directors Manager Coding and Compliance EvolveMD amjordan.cpc@gmail.com Objective EHR basics Basic knowledge of
More informationTom Freese, PhD Sherry Larkins, PhD Clayton Chau, MD (Planner) - Medical Director Behavioral Services; L.A. Care Health Plan
Tom Freese, PhD Sherry Larkins, PhD Clayton Chau, MD (Planner) - Medical Director Behavioral Services; L.A. Care Health Plan UCLA Integrated Substance Abuse Programs UCLA David Geffen School of Medicine,
More informationFrequently Asked Questions (FAQs) from December 2013 Behavioral Health Utilization Management Webinars
Frequently Asked Questions (FAQs) from December 2013 Behavioral Health Utilization Management Webinars 1. In the past we did precertifications for Residential Treatment Centers (RTC). Will this change
More informationCompliance Risks with Non-Physician Practitioners
Compliance Risks with Non-Physician Practitioners Kim Huey, MJ, CPC, CCS-P, PCS Health Care Compliance Association Clinical Practice Compliance Conference October 2013 NPP Coding and Billing Definitions
More informationImplementation of SBIRT onto Electronic Health Records: From Documentation to Data
Implementation of SBIRT onto Electronic Health Records: From Documentation to Data John R. McAteer, LCSW-R New York City Department of Health and Mental Hygiene Bureau of Alcohol and Drug Use Prevention,
More informationInnerview Reimbursement in the Physician Office Setting * 2014
OVERVIEW This Guide is intended to assist with the process of billing and coding for Innerview, a Mental Health Clinical Decision Support System used in the primary care setting. Billing, coding and payment
More informationSection: Administrative Subsection: None Date of Origin: 7/25/2011 Policy Number: RPM040 Last Updated: 11/6/2014 Last Reviewed: 11/11/2015
Manual: Policy Title: Reimbursement Policy Incident-To Services Section: Administrative Subsection: None Date of Origin: 7/25/2011 Policy Number: RPM040 Last Updated: 11/6/2014 Last Reviewed: 11/11/2015
More informationBlue Cross Blue Shield of Michigan Medicare Plus Blue SM and BCN Advantage SM High Intensity Care Model
Blue Cross Blue Shield of Michigan Medicare Plus Blue SM and BCN Advantage SM High Intensity Care Model Version 2.0 June 2015 Billing Frequently Asked Questions High Intensity Care Model Billing Frequently
More informationMidlevel Practitioner Billing and Incident To
Midlevel Practitioner Billing and Incident To Health Care Compliance Association North Central Regional Conference October 5, 2012 Presented by Joy Newby, LPN, CPC, PCS Newby Consulting, Inc. 5725 Park
More informationFAQs on Billing for Health and Behavior Services
FAQs on Billing for Health and Behavior Services by Government Relations Staff January 29, 2009 Practicing psychologists are eligible to bill for applicable services and receive reimbursement from Medicare
More informationThe Collaborative Models of Mental Health Care for Older Iowans. Model Administration. Collaborative Models of Mental Health Care for Older Iowans 97
6 The Collaborative Models of Mental Health Care for Older Iowans Model Administration Collaborative Models of Mental Health Care for Older Iowans 97 Collaborative Models of Mental Health Care for Older
More informationAlcohol and Drug Rehabilitation Providers
June 2009 Provider Bulletin Number 942 Alcohol and Drug Rehabilitation Providers New Modifier and s for Substance Abuse Services Effective with dates of service on and after July 1, 2009, eligible substance
More informationPalliative Care Billing, Coding and Reimbursement
Palliative Care Billing, Coding and Reimbursement Anne Monroe, MHA Physician Practice Manager Hospice of the Bluegrass and Palliative Care Center of the Bluegrass Kentucky 1 Objectives Review coding and
More informationProvider Training. Behavioral Health Screening, Referral, and Coding Requirements
Provider Training Behavioral Health Screening, Referral, and Coding Requirements Training Outline I. Behavioral Health Screening Requirements and Referrals II. Healthy Behaviors Substance and Alcohol Abuse
More informationSBIRT in Primary Care Settings. José Esquibel SBIRT Project Director
SBIRT in Primary Care Settings José Esquibel SBIRT Project Director SBIRT Screening Brief Intervention and Referral to Treatment (SBIRT) is a public health approach to preventing risky substance use behavior.
More informationReimbursement Questions and Answers for IBCLCs Judith L. Gutowski, BA, IBCLC, RLC Chair, USLCA Licensure and Reimbursement Committee June 2012
Reimbursement Questions and Answers for IBCLCs Judith L. Gutowski, BA, IBCLC, RLC Chair, USLCA Licensure and Reimbursement Committee June 2012 The USLCA often receives inquiries about insurance and Medicaid
More informationQuestion and Answer Submissions
AACE Endocrine Coding Webinar Welcome to the Brave New World: Billing for Endocrine E & M Services in 2010 Question and Answer Submissions Q: If a patient returns after a year or so and takes excessive
More informationSubstance Abuse Treatment Services Objectives and Performance Measures Progress: First Annual Report
Report to The Vermont Legislature Substance Abuse Treatment Services Objectives and Performance Measures Progress: First Annual Report In Accordance with Act 179 (2014) Sec. E.306.2 (a)(1) Submitted to:
More informationDevelopmental. SBIRT Substance Abuse (AUDIT & DAST Scales)
s Tools Developmental 96110 Developmental testing; limited (e.g., Pediatric Symptom Checklist, Vanderbilt AD/HD, Developmental Screening Test II, Early Language Milestone Screen), with interpretation and
More informationSuggestions for Billing Codes for IBCLCs
Suggestions for Billing Codes for IBCLCs There are several classifications of CPT or HCPCS Codes which IBCLCs can theoretically use to bill for their services. There are advantages and disadvantages to
More informationCoding for Evaluation and Management Services
Coding for Evaluation and Management Services Joanne Mehmert, CPC Joanne Mehmert & Associates, LLC fmeh@aol.com 2006 CPT E&M Updates May 2006 2 1 E&M Deleted Codes Deleted codes 99261-99263 Follow-up consultation
More information. Health MEMORANDUM. Rex M. McCallum, MD Vice President & Chief Physician Executive, Faculty Group Practice TO:
. Health MEMORANDUM TO: FR OM: DATE: Rex M. McCallum, MD Vice President & Chief Physician Executive, Faculty Group Practice Kimberly K. Hagara, CPA, CIA, CISA, CR r.. Associate Vice President, (_J ()'
More informationMedicare Chronic Care Management Service Essentials
Medicare Chronic Care Management Service Essentials As part of an ongoing effort to enhance care coordination for Medicare beneficiaries, the Centers for Medicare & Medicaid Services (CMS) established
More informationTriple aim of ACA. Shanty Creek, November 2015. 1. Improved patient experience easier acess 2. Improved quality of healthcare 3.
Theresa Anderson, West Shore Medical Center Tracey Chappel, West Shore Medical Center Ingemar Johansson, Centra Wellness Network Shanty Creek, November 2015 Triple aim of ACA 1. Improved patient experience
More informationRemote Access Technologies/Telehealth Services Medicare Effective January 1, 2016
Remote Access Technologies/Telehealth Services Medicare Effective January 1, 2016 Prior Authorization Requirement Yes No Not Applicable * Not covered by Medicare but is covered by HealthPartners Freedom
More informationSan Diego County Managed Care Behavioral Health Overview. Presented by George Scolari, Chair Healthy San Diego Behavioral Health Work Group
San Diego County Managed Care Behavioral Health Overview Presented by George Scolari, Chair Healthy San Diego Behavioral Health Work Group 1 Healthy San Diego Overview Healthy San Diego is the collaborative
More informationImplementing Chronic Care Management (CCM) - CPT 99490
Implementing Chronic Care Management (CCM) - CPT 99490 Dulcian, Inc. May 2015 The Need Population-based statistics published by the Centers for Medicare and Medicaid Services (CMS) tell the story. Most
More informationTELEMEDICINE POLICY. Page
TELEMEDICINE POLICY REIMBURSEMENT POLICY Policy Number: ADMINISTRATIVE 4.8 T0 Effective Date: May, 203 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS.. APPLICATION... OVERVIEW... REIMBURSEMENT
More informationA Clinician s Perspective on Reimbursement of Genetic Technology and Services
A Clinician s Perspective on Reimbursement of Genetic Technology and Services Dr. Marc S. Williams Clinical Geneticist Associate Medical Director Gundersen Lutheran Health Plan Clinician s Perspective
More informationSplit/Shared Services Documentation & Billing
Split/Shared Services Documentation & Billing Jointly Presented by the Clinical Enterprise Compliance Department and the Department of Revenue Management June 6, 2012 DISCLAIMER Disclaimer This module
More informationACO Performance Model Increase Revenue while Building for Value Based Care
Value Ahead Integrate - Measure - Improve ACO Performance Model Increase Revenue while Building for Value Based Care Frank Ross CIO, Cumberland Center for Healthcare Innovation Overview of our ACO Cumberland
More informationReducing Adolescent Substance Abuse Initiative (RASAI) Learning Community
Howard Zucker, Acting Commissioner Arlene González-Sánchez, M.S., L.M.S.W. Commissioner Ann Marie T. Sullivan, M.D., Commissioner Reducing Adolescent Substance Abuse Initiative (RASAI) Learning Community
More informationTurning on the Care Coordination Switch in Rural Primary Care Practices
Turning on the Care Coordination Switch in Rural Primary Care Practices AHRQ Master Contract Task Order #5 HHSA2902007100016I (9/07-11/09) Care Management Plus research at OHSU is supported by funding
More informationCAGE. AUDIT-C and the Full AUDIT
CAGE In the past have you ever: C tried to Cut down or Change your pattern of drinking or drug use? A been Annoyed or Angry because of others concern about your drinking or drug use? G felt Guilty about
More informationUSF Physicians Group. Picture here with me and student. Joseph M. Jackson, MBA Executive Director
USF Physicians Group Picture here with me and student August 6, 2001 IDX National Users Conference Joseph M. Jackson, MBA Executive Director Usfpg/exec/2006/jackson/bot hsc mtg april 2006 Faculty Practice
More informationHow To Calculate Pca Productivity
Demonstrating Your Value Oregon Society of PAs October 25, 2014 Gleneden Beach, OR Michael L. Powe, Vice President Reimbursement & Professional Advocacy Disclaimer Although every reasonable effort is made
More informationDemonstrating Your Value
Demonstrating Your Value Oregon Society of PAs October 25, 2014 Gleneden Beach, OR Michael L. Powe, Vice President Reimbursement & Professional Advocacy Disclaimer Although every reasonable effort is made
More informationOBSERVATION CARE EVALUATION AND MANAGEMENT CODES
REIMBURSEMENT POLICY OBSERVATION CARE EVALUATION AND MANAGEMENT CODES Policy Number: ADMINISTRATIVE 232.8 T0 Effective Date: April, 205 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS... APPLICATION...
More informationOregon Standards for Certified Community Behavioral Health Clinics (CCBHCs)
Oregon Standards for Certified Community Behavioral Health Clinics (CCBHCs) Senate Bill 832 directed the Oregon Health Authority (OHA) to develop standards for achieving integration of behavioral health
More informationCPT Coding Changes for 2013
CPT Coding Changes for 2013 Getting Prepared Presenter Ronald Burd, MD Psychiatrist, Stanford Health, Fargo, ND Chair, APA Committee on Codes, RBRVS and Reimbursements APA Representative, AMA s RBRVS Update
More informationPromising Practices. Screening, Brief Intervention, Service Utilization within
College of Social Work University of South Carolina Promising Practices Screening, Brief Intervention, & Referral to Treatment (SBIRT) Service Utilization within Hospital Systems SBIRT 1 is recognized
More informationPhysician Extenders: Know the Compliance Risks Surrounding Midlevel Practitioners. January 24, 2014
Physician Extenders: Know the Compliance Risks Surrounding Midlevel Practitioners January 24, 2014 Tizgel K. S. High, Esq. LifePoint Hospitals, Inc. Catherine (Kate) S. Stern, Esq. King & Spalding LLP
More informationUnited States Senate Special Committee on Aging Testimony of Scott Ekblad, Director
Oregon Office of Rural Health Mail code: L593 3181 S.W. Sam Jackson Park Road Portland, Oregon 97239-3098 tel 503 494-4450 fax 503 494-4798 toll free 866 674-4376 www.ohsu.edu/oregonruralhealth United
More informationOptimizing Your Billing System to Produce Clean Claims
Optimizing Your Billing System to Produce Clean Claims Chris Peters, ACL Laboratories Road to Billing Optimization Missing Billing Information Missing test modifiers Wrong billing address Insurance coverage
More informationAdvanced Forms Automation and the Link to Revenue Cycle Management
Advanced Forms Automation and the Link to Revenue Cycle Management Chris Joyce Director of Healthcare Solutions Engineering Today s healthcare providers are facing growing financial pressures that can
More informationStatus Active. Assistant Surgeons. This policy addresses reimbursement for assistant surgical procedures during the same operative session.
Status Active Reimbursement Policy Section: Surgery/Interventional Procedure Policy Number: RP - Surgery/Interventional Procedure - 001 Assistant Surgeons Effective Date: June 1, 2015 Assistant Surgeons
More informationBilling an NP's Service Under a Physician's Provider Number
660 N Central Expressway, Ste 240 Plano, TX 75074 469-246-4500 (Local) 800-880-7900 (Toll-free) FAX: 972-233-1215 info@odellsearch.com Selection from: Billing For Nurse Practitioner Services -- Update
More informationScreening, Brief Intervention and Referral to Treatment
Screening, Brief Intervention and Referral to Treatment Inside front cover Today, there are 23 million people in the United States who are either addicted to or abuse illegal drugs and alcohol. Over 95%
More informationMapping the Work Flow and Coding. Alabama Early Screening Improvement Training. Commercial Interests Disclosure. Commercial Interests Disclosure
Alabama Early Screening Improvement Training Saturday, October 29, 2011 Tuscaloosa, Alabama Mapping the Work Flow and Coding Produced by the Alabama Department of Public Health Video Communications and
More informationVirginia Mason Insurance Grid (2014-2015)
Aetna HMO Plans: Aetna Select Aexcel Plus Elect Choice EPO Open Access Managed Choice * *Insurance approved specialty care referral is not required if patient has PCP. POS Plans: QPOS Managed Choice POS
More informationCHRONIC 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 informationTARGET DATE for completion of this MAPPING is November 30, 2011.
The Behavioral Health Planning Council s Adult and Substance Abuse Subcommittees have undertaken the task of putting together a statewide services directory. The goal of this project is to secure information
More informationTELEMEDICINE POLICY. Page
TELEMEDICINE POLICY REIMBURSEMENT POLICY Policy Number: ADMINISTRATIVE 4.23 T0 Effective Date: July, 205 Table of Contents APPLICABLE LINES OF BUSINESS/PRODUCTS.. APPLICATION... OVERVIEW... REIMBURSEMENT
More informationADDENDUM 1 MEDICAL HOME TO SOONERCARE PHYSICIAN AGREEMENT FOR CHOICE PRIMARY CARE PROVIDERS
ADDENDUM 1 MEDICAL HOME TO SOONERCARE PHYSICIAN AGREEMENT FOR CHOICE PRIMARY CARE PROVIDERS 1.0 PURPOSE The purpose of this Addendum is for OHCA and PROVIDER to contract for PCP services in OHCA s SoonerCare
More informationIntroduction. Procedure
Page 1 of 8 Training Guide Clinical Evaluation Criteria for Technical Services TRAINING GUIDE FOR USE OF CLINIC EVALUATION & MANAGEMENT (E&M) CRITERIA FOR TECHNICAL CHARGES Introduction The following guidelines
More informationMedical Office Billing
Medical Office Billing A Self-Study Training Manual Sarah J. Holt, PhD, FACMPE Medical Group Management Association 104 Inverness Terrace East Englewood, CO 80112-5306 877.275.6462 mgma.com Introduction
More informationQ&A with Harvard Vanguard Medical Associates and Atrius Health about Health Systems Change to Address Smoking
Q&A with Harvard Vanguard Medical Associates and Atrius Health about Health Systems Change to Address Smoking Background on Harvard Vanguard Medical Associates and Atrius Health Harvard Vanguard Medical
More informationAdvanced Models of Primary Care: Care Management Plus pilot and dissemination
Advanced Models of Primary Care: Care Management Plus pilot and dissemination Presented by David A. Dorr, MD, MS; Oregon Health & Science University, dorrd@ohsu.edu Funded by The John A. Hartford Foundation,
More informationTelemedicine Policy Annual Approval Date
Policy Number 2016R0046A Telemedicine Policy Annual Approval Date 4/08/2015 Approved By REIMBURSEMENT POLICY CMS-1500 Payment Policy Oversight Committee IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY You
More informationPsychotherapy Professional Services
Status Active Reimbursement Policy Section: Behavioral Health Section Policy Number: RP - Behavioral Health - 001 Psychotherapy Professional Services Effective Date: June 1, 2015 Psychotherapy Professional
More informationAmong the many challenges facing health care
The Value of Visit Management at Your Organization BY ELIZABETH WEIDMAN, SENIOR ANALYST Catch Data Systems April 2014 Among the many challenges facing health care organizations today, few have the potential
More informationLocal Education Agency
KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL Local Education Agency Updated 08/07 PART II Introduction Section BILLING INSTRUCTIONS Page 7000 Local Education Agency Billing Instructions...........
More informationMedicaid Services for Substance Abuse
Medicaid Services for Substance Abuse Community Behavioral Health Services Coverage and Limitations Handbook 2007 FADAA Annual Conference-Orlando Making Medicaid Work for Substance Abuse Agenda Overview
More informationBilling for Non-Physician Practitioners
Billing for Non-Physician Practitioners Incident to and Shared Services 2007 Betsy Nicoletti 1 Betsy Nicoletti www.mpconsulting.org Author: 2007 Physician Auditing Workbook The Field Guide to Physician
More informationHEALTHCARE REFORM OCTOBER 2012
HEALTHCARE REFORM Tracking ACO Growth Nationally OCTOBER 2012 The enclosed slides are intended to provide you with a snapshot of how private sector accountable care organizations (ACOs) have formed since
More informationProvider Delivered Care Management Payment Policy and Billing Guidelines for Medicare Advantage
Provider Delivered Care Management Payment Policy and Billing Guidelines for Medicare Advantage Purpose Beginning April 1, 2012, BCBSM began accepting and paying claims for Provider Delivered Care Management
More informationOptimize Your Practice
Optimize Your Practice Billing and Coding, the Role of Fellows and Physician Extenders, Band Adjustments and Diversifying Strategies to Increase Revenue Philip Clark, MBA, CMPE Business Manager, Duke Metabolic
More informationHow Physicians Get Paid: It's as Easy as: CMS, RVUs, ICD-9, and CPT
How Physicians Get Paid: It's as Easy as: CMS, RVUs, ICD-9, and CPT Aaron Michelfelder, M.D. Associate Professor of Family Medicine, and Bioethics & Health Policy Goals Define the Acronyms CMS, RVU, ICD-9,
More informationAll payment rates and their effective dates shall be reflected in the Division's website at www.med-quest.us.
ATTACHMENT 4.19-B State: HAWAII NONINSTITUTIONAL ITEMS AND SERVICES: The State assures that the reimbursement to public and private providers of Medicaid services, products or items are the same and does
More informationMaryland Data as of July 2003. Mental Health and Substance Abuse Services in Medicaid and SCHIP in Maryland
Mental Health and Substance Abuse Services in Medicaid and SCHIP in Maryland As of July 2003, 638,662 people were covered under Maryland's Medicaid/SCHIP programs. There were 525,080 enrolled in the Medicaid
More informationCoding Tips Changes & Challenges
Coding Tips Changes & Challenges What s s New in 2008 CPT, ICD-9? Perinatal Workshop April, 2008 Code idea Perinatal Coders COCN AAP CPT Application CPT Panel Facilitation RUC for Value Federal Register
More informationConsidering Adding a NP or PA to the Practice?
Considering Adding a NP or PA to the Practice? Stuart B Black MD, FAAN TNS Medical Economics Chair With the implementation of the Affordable Care Act compounded by the recent multiple changes medicine,
More informationATTENTION: ALTERNATIVE BILLING CONCEPTS (ABC) CODES FOR BEHAVIORAL HEALTH SERVICES TO END AS OF 12/31/2009
ATTENTION: ALTERNATIVE BILLING CONCEPTS (ABC) CODES FOR BEHAVIORAL HEALTH SERVICES TO END AS OF 12/31/2009 Alaska Medical Assistance will transition from use of Alternative Billing Concepts (ABC) procedure
More informationState of Payor Network and Reimbursement for Telehealth Services. Tim Maloney, UC Health Vice President of Payor Relations
State of Payor Network and Reimbursement for Telehealth Services Tim Maloney, UC Health Vice President of Payor Relations Introduction Reimbursement for services delivered via telehealth varies greatly
More informationTransitional Grant Area (TGA) Definition
S OF CARE Oakland Transitional Grant Area Care and Treatment Services O CTOBER 2006 Office of AIDS Administration 1000 Broadway, Suite 310 Oakland, CA 94607 Tel: 510.268.7630 Fax: 510.268.7631 AREAS OF
More informationBENEFITS AND IMPACTS OF SUD INTEGRATION WITH PRIMARY AND ACUTE MEDICAL CARE. Les Sperling Central Kansas Foundation Salina, Kansas
BENEFITS AND IMPACTS OF SUD INTEGRATION WITH PRIMARY AND ACUTE MEDICAL CARE Les Sperling Central Kansas Foundation Salina, Kansas Central Kansas Foundation CKF is a not-for-profit corporation whose mission,
More informationTelemedicine Policy. Approved By 1/27/2014
REIMBURSEMENT POLICY Policy Number 2015R0046F Annual Approval Date Telemedicine Policy 1/27/2014 Approved By National Reimbursement Forum United HealthCare Community & State Payment Policy Committee IMPORTANT
More informationNetworks and products
Welcome! 2 Agenda o Networks and products Beacon Community Care Network (CCN) Rose City Synergy/Summit o Membership map and locations o ICD 10 o Claim edits policy o National Drug Codes (NDC) o Magellan
More informationNew Patient Visit. UnitedHealthcare Medicare Reimbursement Policy Committee
New Patient Visit Policy Number NPV04242013RP Approved By UnitedHealthcare Medicare Committee Current Approval Date 12/16/2015 IMPORTANT NOTE ABOUT THIS REIMBURSEMENT POLICY This policy is applicable to
More information