MiPCT Billing Collaborative Physician Webinar: Good for Patients – Good for Providers: Creating Sustainability for Care Management

Why are you here?? A.Better understanding generating billing of care management B.Trying to grasp what my role in care management billing is C.Figure out how to work with my care manager to support care management D.All of the above E.None of the above - fill in the blank…………………………….. F.My office manager told me I had to attend

Why we should be here --- Patients need care management Billing appropriate will allow us to sustain care management for our patients

Billing for Sustaining Care Management Fee for service revenue ▫ G/CPT codes ▫ TOC codes ▫ Care oversight codes ▫ End of life discussion codes Improvement in patient satisfaction optimizes star ratings for plan with more potential revenue for Physician Organizations

Physician Billing – polling question Of the following codes, which have you billed for, and how many times A.Any/All G/CPT Care Management Codes A.Once a day B.Once a week C.Occasionally D.Never have

Physician Billing – polling question Of the following codes, which have you billed for, and how many times B.Transitional Care Management (TCM) codes (99495, 99496) A.Once a day B.Once a week C.Occasionally D.Never have

Physician Billing – polling question Of the following codes, which have you billed for, and how many times C.Engagement Fee for Physician Coordinated Care Oversight Services (G9008) A.Once a day B.Once a week C.Occasionally D.Never have

Physician Billing – polling question Of the following codes, which have you billed for, and how many times ? D.End of life discussion code (S0257) A.Once a day B.Once a week C.Occasionally D.Never have

MiPCT Multi-payer G and CPT Care Code Summary-1

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Physician Role in Billing for Care Management Engagement of the patient – ▫ You are the key champion for care management ▫ Getting consent is a key hurdle identified in the Billing Collaborative to getting a successful claim for care management ▫ Make sure the patient understands the value ▫ Partnership with the care manager

Billing Care Management – Right Person, Right Time, Right Code Appropriateness of care management ▫ Make sure they are folks that need it --- ▫ Do not burden care managers with things the other team members can do ▫ Patient must have applicable conditions to warrant care management codes Are we using palliative care appropriately?

What are you challenges with Billing – Vote Early Vote Often – polling question A.Not sure what code to use B.Not sure who would be eligible C.Not sure how to document it D.Not enough contact with the care manager to make this work E.Too much else going on – so don’t think to do it F.Other ……….. Fill in the blank

Answers to the Questions A. Step one B. Step two Go to Resources tab –Billing, Coding and Payment C. Step three Go to particular area of question All Payers MiPCT Multipayer G and CPT Code Billing Summary MiPCT Multipayer G and CPT Code Documentation Summary MiPCT Payment Flow 2015 Blue Cross Blue Shield of Michigan/Blue Care Network BCBSM PDCM Billing Roadshow Presentation v2 ( ) BCBSM PDCM Billing Roadshow Presentation v2 BCBSM-PDCM-medicare_advantage_billing_guidelines_aug_2014_v1 BCBSM PDCM_Road_Show_Questions ( ) BCBSM PDCM_Road_Show_Questions BCBSM PDCM_FAQ ( ) BCBSM PDCM_FAQ BCBSM PDCM Billing Guidelines – Commercial May 2015 v1 (May 2015)PDCM Billing Guidelines – Commercial May 2015 v1 BCBSM-PDCM_PARS_IVR_Web-Denis_Instructions ( ) BCBSM-PDCM_PARS_IVR_Web-Denis_Instructions

Answers to the Questions Step 3 (continued): Priority Health Link containing updated information care management billing and coding for Priority Health: payment/services/care-management-codeshttp:// payment/services/care-management-codes Medicare Medicare Chronic Care Code Whitepaper from PYA (non-MiPCT patients are eligible) Medicare Chronic Care Code Whitepaper from PYA CMS Transition of Care Codes FAQ from AAFP (MiPCT and non-MiPCT patients are eligible) CMS Transition of Care Codes FAQ from AAFP Michigan Data Collaborative G and CPT Code Reporting Materials G and CPT Code Report Quick Reference G and CPT Code Claim Detail Report Quick Reference

Conclusion IF Billing Revenue AND Revenue Sustaining Care Management Capacity in our practices AND Sustaining Improves Quality & Care Management Experience in Our Practices THEREFORE Billing Improves Quality & Experience for Our Patients