WIPHL Meeting on Promoting Sustainability Through Billing and Tracking Claims Experience Friday, December 3, 12:00 to 12:30 Wednesday, December 9, 8:30 to 9:00 Wednesday December 9, 12:00 to 12:30

Sustainability = Provide sufficient numbers of reimbursable services Submit claims Collect on claims

Sustainability = Provide sufficient numbers of reimbursable services Submit claims Collect on claims

Recommendation: Expand to tobacco Leading cause of death in Wisconsin Prevalence = 20% 70% of smokers want to quit QUIT RATES

Optimal Intervention Physician or non-physician >1 clinician 31 to 300 minutes over >8 sessions Face-to-face counseling Combine with phone, group, or self-help Medications & counseling

Address huge clinical need More individuals with alcohol problems die from their tobacco use than alcohol use Allow health educators to generate more reimbursement Recommendation: Expand to tobacco Why?

Sustainability = Provide sufficient numbers of reimbursable services Submit claims Collect on claims

Billing PlanTobaccoAlcohol/drugs Commercial $15 Medicare $ >3 to 10 minutes >10 minutes

PlanTobaccoAlcohol/drugs Commercial $ $30 Medicare $ $29 Billing

PlanTobaccoAlcohol/drugs Commercial $ $ $33 Medicare $ $29 G0396 $ >3 to 10 minutes >10 minutes G0396/ to 30 min G0397 / >30 min Billing

PlanTobaccoAlcohol/drugs Commercial $ $ $ $66 Medicare $ $29 G0396 $30 G0397 $ >3 to 10 minutes >10 minutes G0396/ to 30 min G0397/ >30 min Billing

PlanTobaccoAlcohol/drugs Commercial $ $ $ $66 Medicare $ $29 G0396 $30 G0397 $ >3 to 10 minutes >10 minutes G0396/ to 30 min G0397/ >30 min * HE services billable: place of service code 11 & no other provider * Billing

PlanTobaccoAlcohol/drugs Commercial $ $ $ $66 Medicare $ $29 G0396 $30 G0397 $ >3 to 10 minutes >10 minutes G0396/ to 30 min G0397/ >30 min * HE services billable: place of service code 11 & no other provider Medicaid $ $22 * Billing

PlanTobaccoAlcohol/drugs Commercial $ $ $ $66 Medicare $ $29 G0396 $30 G0397 $ >3 to 10 minutes >10 minutes G0396/ to 30 min G0397/ >30 min * HE services billable: place of service code 11 & no other provider H full screen H per 15 min intervention - up to 4/d Medicaid $ $22 H0049 $35 * Billing

PlanTobaccoAlcohol/drugs Commercial $ $ $ $66 Medicare $ $29 G0396 $30 G0397 $ >3 to 10 minutes >10 minutes G0396/ to 30 min G0397/ >30 min * HE services billable: place of service code 11 & no other provider H full screen H per 15 min intervention - up to 4/d Medicaid $ $22 H0049 $35 H0050 $20 * Billing

PlanTobaccoAlcohol/drugs Commercial $ $ $ $66 Medicare $ $29 G0396 $30 G0397 $ >3 to 10 minutes >10 minutes G0396/ to 30 min G0397/ >30 min * HE services billable: place of service code 11 & no other provider H full screen H per 15 min intervention - up to 4/d Medicaid $ $22 H0049 $35 H0050 $20 * Billing

Sustainability = Provide sufficient numbers of reimbursable services Submit claims Collect on claims

Assumptions 80% commercial, 20% Medicaid 60% tobacco, 40% alcohol/drugs Medicaid tobacco and Commercial 75% receive lower level service Medicaid alcohol/drugs - 50% bill for H0050 Time spent min min min min H minH min

Per Health Educator... # Reimbursed Services per Day Contact Time per Day Revenue per Year hours$71, hours$107, hours$142,740

WIPHL is Promoting “Effective Reimbursement” 1. Reimburse under tobacco, alcohol and drug billing codes 2. Reimburse when paraprofessionals deliver the services 3. Reimburse when paraprofessionals and credentialed providers deliver services at the same visit 4. No cost sharing with patients

WE NEED YOU TO Submit claims Appeal denials Keep us informed SO WE CAN Document which payers “effectively reimburse” Advocate with payers who don’t

Claims Tracking System Retrospective entry - entire claim history Prospective entry - Enter initial claim data - Enter payer response > Paid satisfactorily> Paid unsatisfactorily > Declined> Declined due to error - Enter site action > Close> Appeal - Enter payer response to appeal $4 Database system designed by Steve Baillies

Claim Data Entry Form

Data Submission Alternatives Enter claims directly into the database Electronically transfer the data to WIPHL – eg, Excel file Send/fax printouts from your billing system (Covered by our business associate agreement)

Requests Site administration - Agree to help with this effort - Ask your billing staff to help Steve the name and contact information of your billing staff Complete and submit your quarterly report on unreimbursed expenses Start tobacco services

Thank you! Together we will make tobacco, alcohol and drug screening and intervention sustainable in Wisconsin!