Get Smarter!!! Billing Basics and Beyond R2 Practice

Get Smarter!!! Billing Basics and Beyond R2 Practice

Get Smarter!!! Billing Basics and Beyond R2 Practice Management Review basics Expand scope Billing: Out of office Billing: Keeping up to date Billing practice: AB R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP -1- Skilled Clinician Competent Billing PGY 2 R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP -2- Get Smarter!!! R2 Agenda 9:00 am Review: Get Smart R1 billing basics Dx & Fee Codes/add-ons 9:30 am Billing: Outside the Office Acute care * Obstetrics * Long term care 10:00 am Break 10:15 am Small group session 1 30 mins (FUN) choose A, B or C (all FFS not hourly wage) Group Acute Acute care + office practice Group Baby Obstetrics care + office practice Group Cenior Long term care + office practice 10:45 am

Small group session 2 30 mins (FUN) switch A, B or C above 11:15 am Present results Acute groups - compare and teach key messages Baby groups - compare and teach key messages Cenior groups - compare and teach key messages 11:45 am Discussion/pearls/evaluation (PRIZES) R2 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 + Rural and Remote Northern Program RRNP Business Cost Program BCP for h c t a W ed blend n tio a t i p a

c Contracts Uninsured Services (3rd Party) Companies Pay Patients Pay Hospitalists Industry Leadership Shared Care ARP CUPS Family Care Clinics WCB + R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP -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 V04.8 influenza immunization assessment V65 consultation, not sick V20.1 growth & development R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP -5- Office Fee Codes: R1 Summary Resources: GP Billing Rules and Codes AMA April 1, 2016 ICD 9 Diagnostic codes Whole person * Modifier 1 CMXC30 OR Complex Care Plan Procedures Phone Calls 03.04J Usually add to visit Time?

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 CMGP01-10 R2 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 03.04A Special Codes Cancer Chronic Pain Psych/Mood Limited 03.03 03.04B 03.03A

03.03B If pregnant change the letter A to B R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP -7- Fee Codes: Amounts Pick one stream: consider time Comprehensive 03.04A/B $103.41 03.04M pre-op $103.41 03.05H DLM $84.61 Up to 30 min Special Codes 15 min units Limited Visit 03.03A/B $37.35 Limited Consult 03.07A $65.80 Up to 15 min Cancer 03.05I Chronic Pain

03.05O Psych/Mood 08.19G 15 min/major portion units p22 p22 R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP p35, 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 CMXC30 $31.27 CMXV30 (DLM) $31.27 At 15 mins add CMGP modifiers For each next 10 mins CMGP $23.50 MAX 10 Per 15 min DOUBLE if get to major portion of next 15 mins Periodic exam 1st PN Pre-op 03.04A

03.04B 03.04M 03.04A/B/M + CMCX30 $103.41 + 31.27 = $134.68 DLM 03.05H 03.05H + CMCV30 $84.61 + 31.27 = $115.88 p21 Cancer Limited visit 03.03A/B $37.35 03.05I X2 Limited consult 03.07A $65.80 15 min 03.03A + CMGP01 = $60.85 25 min 03.03A + CMGP02 = $84.35 35 min 03.03A + CMGP03 = $107.85 p20 R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP $51.39 $102.78 Chronic Pain 03.05O X2 $44.90 $89.80 Psych/Mood

08.19G X2 $47.00 $94.00 p23+ -9- Review: Office Visit Fee Codes Visits Time Modifiers Complex Care Plan Procedures Phone calls Call back, LTC+ Limited Visits 03.03A $37.35 Limited Consults 03.07A $60.85 Comprehensive Visits At 30 min add At 15 min add CMGP ($23.50) for each next 10 min period Cancer Chronic Pain Psych/Mood CMXC30 OR CMXV30 (DLM) 03.03/7A + CMGP01

$23.50 03.05I $51.39 03.03O $44.90 08.19G $47.00 $31.27 Direct/indirect One only At 25 min 03.03/7A + CMGP02 $47.00 * Multiples of 15 min unit/major portion At 35 min 03.03/7A + CMGP03 $60.50 R2 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 Procedures Phone calls Call back, LTC+ 03.04J $188.01 Group A Hypertension 401 DM 250 COPD 496 Asthma 493 Heart Failure 428 Ischemic HD 413-414 Chr Renal Failure 585-586 Group B Mental Health 290-319 Obesity 278 Addictions 303-304 Tobacco 305 R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP - 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 07.57A Initial Burn $37.60 + tray $38.59 98.03A I + D Abscess $25.41 + tray $13.04 + v 98.12C Seb. Cyst $42.41 + tray $38.59 + v 13.59A IM / SQ Injection $10.03 + v 13.99BC Pap or gyne swab $28.21 + v 81.8

IUD Insertion $67.73 + tray $13.04 + v 93.91A Joint Aspiration/ Injection (Hip) $37.10 + tray + v Phone calls Call back, LTC+ always add visit Check for tray fees 80.83B Endometrial Bx $42.75 98.12A Excisional Bx, skin $41.76 98.81B Punch Bx $23.28 97.81 Needle or Bx Breast $44.75 ALWAYS CHECK GP BILLING RULES AMA NOTE: BMIPRO BMI greater than 40 +25% pap/pelvic swab

R2 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) 03.01N Complex Care Plan Procedures Phone calls Call back, LTC+ Phone stuff $17.23 twice monthly Physician to Physician * phone consult (pg 26/27 electronic communications) 03.01LG $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 03.01LM $17.71 03.01B $17.23Mental health worker * Allied health - LTC, hosp * 03.01NM $17.23

03.05JR $15.88 Ob outpatient worker * 03.01NG $17.23 Pharmacist Patient R2 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 03.05JB 03.05JC $51.39 $51.39 15min or major portion 15min or major portion By phone Community pt Regional facility pt 03.05JH 03.05JP

$15.12 $40.70 15min or major portion Multiple health discipline Multiple health discipline NH/LTC 03.05JA 03.05JD $41.99 $14.10 15min or major portion Per 5 min (max 12/hr) R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP Phone calls Call back, LTC+ Phone stuff Family Conferences (p46) - 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 R2 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 CMXC30 OR Complex Care Plan Procedures Phone Calls 03.04J Usually add to visit Time? 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 CMGP01-10 R2 Practice Management: Billing Basics and Beyond | 2017 |

Dr. Wendy Tink BSc., CCFP, FCFP - 16 - Out of Office Billing: Routine Home Visit Codes Patients Home Assisted Living Long Term Care p41 p39-40 Designated Assisted Living (DAL) Group Home/Senior Lodge Personal Care Homes Nursing Homes Auxiliary Hospitals p41 03.03N $84.61 03.03NA $84.61 03.03E +CMGP01-10 $28.20 1st + +CMGP01-10 +CMGP01-10 03.03P 2 + pt nd

$31.31 03.03NB $84.61 2nd + pt R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP - 17 - Out of Office Billing: Urgent Call Back Home Visits Forget memorizing, just remember the concepts! Patient Home Priority attend 03.03N $84.61 +CMGP01-10 Assisted Living/DAL+ p39 Attend within 24 hours LTC Routine visit 03.03NA $84.61 +CMGP01-10 03.03E $28.20 Add modifier to routine visit code based upon time urgent visit started +Modifiers OFEV OFEVWK OFEVNTPM

OFEVNTAM 1700 2200 W/D 0700 2200 W/E//STAT 2200 2400 2400 0700 Total $43.29 $50.75 $116.35 $116.35 $127.90 $135.36 $200.96 $200.96 R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP Urgent call 03.03EA $53.37 Different LTC modifiers - 18 - Out of Office Billing: Urgent Call Back Home Visits LTC Patient home Living/DAL Attend within 24 hours Assisted 03.03N $84.61 03.03NA $84.61 +CMGP01-10

+CMGP01-10 Add modifier to routine visit code based on time urgent visit started OFEV OFEVWK OFEVNTPM OFEVNTAM Urgent call back visit Priority attend 1700 2200 WD 0700 2200 W/E/STAT 2200 2400 2400 0700 $43.29 $50.75 $116.35 $116.35 03.03EA $53.37 Add call back LTC modifiers to urgent call back based on time visit started 03.03KA 03.03LA 03.03MC 03.03MD 0700 1700 WD 1700 2000 WD 0700 2200 WE/ST 2200 2400 2400 0700 R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP $75.21 $112.81 $150.41

$150.41 19 Fee codes: Visit time after hours Add 03.01AA 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 p19 $22.34/15min Active treatment hospitals/LTC/ UCC/AACC Excludes homes/DALS $44.66/15min Add 03.01AA 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 R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP - 20 - 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. R2 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? How to bill 03.03EA

$53.37 Call back Which time modifier code to use? LTC Choose call back modifier based upon visit start time. 03.03LA $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 03.01AA TEV05 22.34 x 5 = $111.70 $277.88 R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP - 22 - Fee codes: Visit time after hours Add 03.01AA 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 p19 $22.34/15min Active treatment hospitals/LTC/ UCC/AACC Excludes homes/DALS $44.66/15min Add 03.01AA 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 R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP - 23 - Admission to Hospital or NH Admission

Acute care Nursing home 03.04A $128.48 03.04D $109.67 + Visit time modifier CMXC30 CMXC30 + RELEVANT after hours time of call back modifier HA codes (p42) 03.03KA/LA/MC/MD (p19) + After hours priority or routine visit modifiers 03.01AA (p19) R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP - 24 - After Admission Visits: Hospital or Nursing Home Routine Acute care (p43-44) 03.03D 20min $43.87 1-7 days $31.67 8+ days Nursing Home 03.03E

$28.20 +1 time modifier COINPT $40.21 co-morbid conditions/complex Urgent Call Back Acute care 03.03DF urgent visit $43.87 + call back 03.05P W/D 1700-2200 Nursing Home 03.03EA + call back time modifiers +03.01AA per 15 min visit modifier (p39) $112.81 + visit modifier 03.01AA/15 mins 22.34 x 3 $67.02 R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP - 25 - FP Fee Codes: Review Resources: GP Billing Rules and Codes AMA April 1, 2016 ICD 9 Diagnostic codes AMA fee navigator AMA website/EMR In Office Choose Whole person * Modifier 1

CMXC30 OR Admissions Complex Care Plan 03.04J Procedures OR Per 15 min or major portion Home Visits pt home/DAL? Routine/urgent? Time? Cancer Chronic Pain Psych/Mood OR Limited exam * Modifiers CMGP01-10 Out of Office Hosp/LTC? Visit time? Call back modifiers? After hour 03.01AA? LTC Visits Routine/urgent? Time? Usually add to visit

Obstetrics p50-53 Modifier multiples Phone Calls Consults Time? Emergency p44-45, 47-49 R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP - 26 - 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 discussing. R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP - 27 - Practice for Practice! Small groups dx/fee codes/totals Group Acute office + acute care Group Baby office + obstetrics Group C (seniors) office + LTC/DAL/home PRIZES * FUN * CONFIDENCE

R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP - 28 - Plan Your Time Wisely 10:30 Small group session #1 30 mins (FUN) choose A, B or C Complete day sheet, pick a presenter, identify key messages for 11:30 Acute group Baby group Cenior group 11:00 Small group session #2 30 mins (FUN) switch A, B or C Complete day sheet, pick a presenter, identify key messages for 11:30 11:30 Resident Presentn: A, B, and C Teach key messages to large group Acute Baby Cenior 11:45 Discussion/pearls/evaluation (PRIZES) R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP - 29 - wise

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