Get Smarter Billing Basics and Beyond R 2
Get Smarter!!! Billing Basics and Beyond R 2 Practice Management Review basics Expand scope Billing: Out of office Billing: Keeping up to date Billing practice: AB R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP -1 -
Skilled Clinician Competent Billing PGY 2 R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP -2 -
Get Smarter!!! R 2 Agenda 1: 30 am Review: Get Smart R 1 billing basics Dx & Fee Codes/add-ons 2: 00 pm Billing: Outside the Office Acute care * Obstetrics * Long term care 2: 30 pm Break 2: 40 pm Small group choose 2 practice types, complete day sheet Acute care + office practice Long term care + office practice Obstetrics care + office practice 3: 50 pm Large group Present results/ discussion 4: 15 pm Wrap Up Pearls/ Prizes/ Evaluation R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP -3 -
Review: Income streams PCN Fee For Service Office Acute care Long term care Obstetrics + h for c t a W ed blend n tio capita Uninsured Services (3 rd Party) Companies Pay Patients Pay Note: related additional $ Rural and Remote Northern Program Business Cost Program Contracts Hospitalists Leadership Shared Care ARP CUPS Family Care Clinics R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP Industry WCB + -4 -
Add Diagnostic Codes to get Paid complexity measure Diagnostic Codes ICD 9 EMR tools AMA fee navigator • • • 465 URTI 706 acne 724 back pain 250 diabetes 314 ADHD 428 heart failure • V 04. 8 influenza immunization assessment V 65 consultation, not sick V 20. 1 growth & development • • R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP -5 -
Office Fee Codes: R 1 Summary Resources: GP Billing Rules and Codes AMA – April 1, 2017 ICD 9 Diagnostic codes Whole person * Modifier 1 CMXC 30 Complex Care Plan Procedures Phone Calls 03. 04 J Usually add to visit Time? OR NH/Home Visits/OB/ER Visit + call back + modifiers Cancer Chronic Pain Psych/Mood OR Per 15 min or major portion Modifier multiples Limited exam * Modifiers CMGP 01 -10 R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP -6 -
Office Visit Fee Codes: Billing Basics Pick one stream Complete 03. 04 A Special Codes Palliative 03. 05 Chronic Pain 03. 05 Psych/Mood 08. 19 G Limited 03. 03 03. 04 B 03. 03 A 03. 03 B If pregnant change the letter A to B R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP -7 -
Fee Codes: Amounts Pick one stream: consider time Comprehensive 03. 04 A/B $103. 41 03. 04 M pre-op $103. 41 03. 05 H DLM $84. 61 Up to 30 min Special Codes 15 min units Limited Visit 03. 03 A/B $37. 35 Limited Consult 03. 07 A $65. 80 Up to 15 min Palliative 03. 05 I $51. 39 Chronic Pain 03. 05 O $44. 90 Palliative 08. 19 G $47. 00 15 min/major portion units p 22 R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP p 35, 38 -8 -
Fee Codes: Time Modifiers direct/indirect Pick one stream: use correct modifiers Comprehensive Limited Visit Special Codes At 30 mins add 1 modifier CMXC 30 $31. 27 CMXV 30 (DLM) $31. 27 At 15 mins add CMGP modifiers For each next 10 mins CMGP $18. 27 MAX 10 Per 15 min DOUBLE if get to major portion of next 15 mins Periodic exam 1 st PN Pre-op 03. 04 A 03. 04 B 03. 04 M 03. 04 A/B/M + CMCX 30 $103. 41 + 31. 27 = $134. 68 DLM 03. 05 H + CMCV 30 $84. 61 + 31. 27 = $115. 88 p 21 Limited visit 03. 03 A/B $37. 35 Limited consult 03. 07 A $65. 80 15 min 03. 03 A + CMGP 01 = $55. 62 25 min 03. 03 A + CMGP 02 = $73. 89 35 min 03. 03 A + CMGP 03 = $92. 16 p 20 R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP 03. 05 I Palliative X 2 03. 05 O X 2 08. 19 G X 2 $51. 39 $102. 78 Chronic Pain Psych/Mood $44. 90 $89. 80 $47. 00 $94. 00 p 23+ -9 -
Review: Office Visit Fee Codes Visits Comprehensive Visits Time Modifiers Complex Care Plan Limited Visits 03. 03 A $37. 35 Limited Consults 03. 07 A $60. 85 Special Codes At 30 min add At 15 min + CMGP each next 10 min CMXC 30 OR CMXV 30 (DLM) Max 10 $31. 27 Direct/indirect One only 03. 03 A/7 A + CMGP 01 $18. 27 Procedures Phone calls Call back, LTC+ Direct care/15 mins Palliative 03. 05 I $51. 39 Chronic Pain 03. 03 O $44. 90 At 25 min 03. 03 A/7 A + CMGP 02 $36. 54 Psych/Mood 08. 19 G $47. 00 At 35 min 03. 03 A/7 A + CMGP 03 $54. 81 * Multiples of 15 min unit/major portion R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP - 10 -
Annual Complex Care Plan most responsible doc Visits • • • Time Modifiers 2 chronic diseases A/B smart goals patient &doc signed doc* &patient once yearly review / follow up Complex Care Plan Phone calls Call back, LTC+ Procedures 03. 04 J $188. 01 Group A Hypertension DM COPD Asthma Heart Failure Ischemic HD Chr Renal Failure Group B 401 250 496 493 428 413 -414 585 -586 Mental Health Obesity Addictions Tobacco R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP 290 -319 278 303 -304 305 - 11 -
Fee Codes: Add procedures Pg 54 April 2016 Visits M Time Modifiers Complex Care Plan Procedures M+ can you add a visit? Minor tray $13. 04 or major tray $38. 59 always added Phone calls Call back, LTC+ always add visit Check for tray fees 80. 83 B Endometrial Bx $42. 75 98. 12 A Excisional Bx, skin $41. 76 98. 81 B Punch Bx $23. 28 97. 81 Needle or Bx Breast $44. 75 07. 57 A Initial Burn $37. 60 + tray $38. 59 98. 03 A I + D Abscess $25. 41 + tray $13. 04 + v 98. 12 C Seb. Cyst $42. 41 + tray $38. 59 + v 13. 59 A IM / SQ Injection $10. 03 + v 13. 99 BC Pap or gyne swab $28. 21 + v 81. 8 IUD Insertion $67. 73 + tray $13. 04 + v ALWAYS CHECK GP BILLING RULES AMA 93. 91 A Joint Aspiration/ Injection (Hip) $37. 10 + tray + v NOTE: BMIPRO –BMI greater than 40 +25% pap/pelvic swab R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP - 12 -
Fee Codes: Remember phone calls Visits Time Modifiers INR (pt advise coumadin) 03. 01 N Complex Care Plan $17. 23 Procedures twice monthly Phone calls Call back, LTC+ Phone stuff Physician to Physician * phone consult (pg 26/27 electronic communications) 03. 01 LG $32. 90 before 5 pm LH $38. 32 5 -10 pm LI $45. 21 after 10 pm Physician to other (Pg 28) * time of service changes fee 03. 01 LM $17. 71 03. 01 B $17. 23 03. 01 NG $17. 23 03. 01 NM $17. 23 03. 05 JR $15. 88 Ob outpatient worker * Mental health worker * Allied health - LTC, hosp * Pharmacist Patient R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP - 13 -
Fee Codes: Family and Team Conferences Visits Time Modifiers Complex Care Plan Procedures Community office Acute/ER/OP/NH/AAC/UCC 03. 05 JB 03. 05 JC $51. 39 15 min or major portion By phone Community pt Regional facility pt 03. 05 JH 03. 05 JP $15. 12 $40. 70 15 min or major portion Multiple health discipline NH/LTC 03. 05 JA 03. 05 JD $41. 99 $14. 10 15 min or major portion Per 5 min (max 12/hr) R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP Phone calls Call back, LTC+ Phone stuff Family Conferences (p 46) - 14 -
Forget? Search Tools www. albertadoctors. org • Fee navigator – Enter word or code ie family conference • Online billing advice • SOMB Extract Apr/Oct yearly Med Access EMR: reference links • ICD 9 codes • Fee Navigator R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP - 15 -
Office Fee Codes: Review Resources: GP Billing Rules and Codes AMA – April 1, 2016 ICD 9 Diagnostic codes Whole person * Modifier 1 CMXC 30 OR Special Codes Complex Care Plan Procedures Phone Calls 03. 04 J Usually add to visit Time? NH/Home Visits/OB/ER Visit + call back + modifiers Palliative Chronic Pain OR Psych/Mood Limited exam Per 15 min or major portion * Modifiers CMGP 01 -10 Modifier multiples R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP - 16 -
NEW Out of Office Competent Billing* o o Home Care Homes Acute Obstetrics *General Practice Billing April 2017 SOMB AMA R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP - 17 -
Out of Office Billing: Routine “Home” Visit Codes Patient’s Home Assisted Living Long Term Care Designated Assisted Living (DAL) Group Home/Senior Lodge Personal Care Homes Nursing Homes Auxiliary Hospitals p 41 03. 03 N $84. 61 +CMGP 01 -10 03. 03 P 2 nd + pt 03. 03 NA $84. 61 +CMGP 01 -10 $31. 31 03. 03 NB $84. 61 p 39 -40 03. 03 E $28. 20 1 st + +CMGP 01 -10 2 nd + pt R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP - 18 -
Out of Office Billing: Urgent Call Back Home Visits Forget memorizing, just remember the concepts! Patient Home Priority attend 03. 03 N $84. 61 +CMGP 01 -10 Assisted Living/DAL+ Attend within 24 hours p 39 LTC Routine visit 03. 03 NA $84. 61 +CMGP 01 -10 03. 03 E $28. 20 Add modifier to routine visit code based upon time urgent visit started +Modifiers OFEVWK OFEVNTPM OFEVNTAM 1700 – 2200 W/D 0700 – 2200 W/E//STAT 2200 – 2400 – 0700 $43. 29 $50. 75 $116. 35 Total $127. 90 $135. 36 $200. 96 R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP Urgent call 03. 03 EA $53. 37 Different LTC modifiers - 19 -
Out of Office Billing: Urgent Call Back Home Visits Patient home LTC Assisted Living/DAL Attend within 24 hours Priority attend 03. 03 N $84. 61 03. 03 NA $84. 61 +CMGP 01 -10 Add modifier to routine visit code based on time urgent visit started OFEVWK OFEVNTPM OFEVNTAM 1700 – 2200 WD 0700 – 2200 W/E/STAT 2200 – 2400 – 0700 $43. 29 $50. 75 $116. 35 Urgent call back visit 03. 03 EA $53. 37 Add call back LTC modifiers to urgent call back based on time visit started 03. 03 KA 03. 03 LA 03. 03 MC 03. 03 MD 0700 – 1700 WD 1700 – 2000 WD 0700 – 2200 WE/ST 2200 – 2400 – 0700 R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP $75. 21 $112. 81 $150. 41 20
Fee codes: Visit time after hours Add 03. 01 AA priority or routine TEV W/D 1700 – 2200 TWK W/E 0700 – 2200 TDES Des hol 0700 – 2200 TST Stat hol 0700 – 2200 TNTP 2200 – 2400 TNTA 2400 – 0700 p 19 $22. 34/15 min Active treatment hospitals/LTC/ UCC/AACC Excludes homes/DALS $44. 66/15 min Add 03. 01 AA each direct care 15 min completed TNTA $44. 66/15 min TEV $22. 34/15 min 0700 0500 TNTP $44. 66/15 min 2000 2400 (midnight) ANY EVENING, NIGHTS R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP - 21 -
You are called to see your LTC patient on a weekday, visit time is 2000 – 2115 How to think Routine visit or call back? Which time modifier code to use? Choose call back modifier based upon visit start time. Choose after hours time premium amount based upon duration of visit and time period of visit. R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP - 22 -
You are called to see your LTC patient on a weekday, visit time is 2000 – 2115 How to think Routine visit or call back? How to bill 03. 03 EA $53. 37 Call back Which time modifier code to use? LTC Choose call back modifier based upon visit start time. 03. 03 LA $112. 81 1700 – 2200 WD Choose after hours time premium amount based upon duration of visit and time period of visit. Visit time 1 hr 15 min 03. 01 AA TEV 05 22. 34 x 5 = $111. 70 $277. 88 R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP - 23 -
Fee codes: Visit time after hours Add 03. 01 AA priority or routine TEV W/D 1700 – 2200 TWK W/E 0700 – 2200 TDES Des hol 0700 – 2200 TST Stat hol 0700 – 2200 TNTP 2200 – 2400 TNTA 2400 – 0700 p 19 $22. 34/15 min Active treatment hospitals/LTC/ UCC/AACC Excludes homes/DALS $44. 66/15 min Add 03. 01 AA each direct care 15 min completed TNTA $44. 66/15 min TEV $22. 34/15 min 0700 0500 TNTP $44. 66/15 min 2000 2400 (midnight) ANY EVENING, NIGHTS R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP - 24 -
Admission to Hospital or NH Admission Acute care Pg 42 03. 04 A $128. 48 Nursing home Pg 39 03. 04 D $109. 67 + Visit time modifier CMXC 30 + RELEVANT after hours time of call back modifier HA/EV/EVWK/NTAM/NTPM codes (p 42) 03. 03 KA/LA/MC/MD (p 19) + After hours priority or routine visit modifiers 03. 01 AA (p 19) R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP - 25 -
After Admission Visits: Hospital or Nursing Home Routine Acute care daily visits 03. 03 D 20 min Nursing home daily visits Pg 43 -44 $43. 87 1 -7 days $31. 67 8+ days 03. 03 E Pg 39 $28. 20 +1 time modifier COINPT $40. 21 co-morbid conditions/complex Urgent Call Back * check time of day and relevant modifiers Acute care 03. 03 DF urgent visit $43. 87 + call back time modifiers Nursing Home Urgent visit 03. 03 EA $53. 57 + call back time modifiers 03. 05 P W/D 1700 -2200 03. 05 R W/E, Stat 0700 -2200 03. 05 QA/QB 2200 -2400/ 2400 -0700 03. 05 N Call from home/office 0700 -1700 + visit time modifier 03. 01 AA per whole 15 min 03. 03 KA 0700 -1700 WD 03. 03 LA 1700 -2200 W/D, 0700 -2200 W/E & Stats 03. 03 MC/MD 2200 -2400/2400 -0700 + visit time modifier 03. 01 AA per whole 15 min Pg 39 R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP - 26 -
FP Fee Codes: Review Resources: GP Billing Rules and Codes AMA – April 1, 2017 ICD 9 Diagnostic codes AMA fee navigator – AMA website/EMR In Office Choose Out of Office Whole person Complex Care Plan Home Visits * Modifier 1 CMXC 30 03. 04 J pt home/DAL? Palliative OR Chronic Pain Limited exam Psych/Mood * Modifiers CMGP 01 -10 OR Per 15 min or major portion Routine/urgent? Procedures Usually add to visit Time? Acute Care Admission/Visit? Visit start time? Modifiers? Call back? Visit modifier? 03. 01 AA LTC Admission/Visit? Routine/Urgent? Modifiers? Call back? Visit modifier? 03. 01 AA Obstetrics p 50 -53 OR Modifier multiples Consults Phone Calls Emergency Time? p 44 -45, 47 -49 R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP - 27 -
Practice for Practice! Build Confidence Small groups choose 2 minimum dx/fee codes/totals acute care LTC/DAL/home obstetrics R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP - 28 -
Practice for Practice Acute, LTC/DALs or Obstetrics 2: 40 pm Small groups (2 -3 people) choose two practice types: Acute, LTC/DALS, Ob complete day sheets all codes and total prepare to report results 3: 50 pm Large group discussion/comparison 4: 15 pm Wrap up/pearls/prizes/evaluation R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP - 29 -
Summary: Get Smarter FFS Use diagnostic and fee code resources Ask your peers about billing. Who bills? Will they help you? How will you be paid? Will you see your billing statements and payments? Will you pay a percentage or flat rate? Uninsured Services Ask about uninsured services Posted fees, who submits and reconciles? Value your time. Practice: “This is an uninsured service and the fee is $$ ”. R 2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc. , CCFP, FCFP - 30 -
be wise
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