1. Welcome! Finance/Billing June 25, 2013 Geriatric Technical Assistance Center for Integrated Physical & Behavioral Health Care for the Elderly Grantees G ERIATRIC T ECHNICAL A SSISTANCE C ENTER

2. Today Contracts and licenses –Who can do what to whom? Old husband’s tales –Can’t, never and always Warm handoffs may not be enough –Have a strategy for information, too Multiple same day services –Examples Radical Recommendation Yours

3. Contracts and Licenses Medicaid and MMC –Consistency, at least for awhile Medicare –Very few changes –Relies on state scope of practice Commercial –Mixed bag QHP in HIEs –More mixed

4. Old Tales (Can’t, Always and Never) We can’t do it that way – because They always deny the second claim for the same day, So, we never charge for the second service. --------------------------------------------------------------- We always zero fill We can’t see Medicare patients We never do “incident to” because we heard---------

5. Information Strategy Specifics

6. Multiple Services – Same Day The “Big Picture” ROI Risk Management Reduce stress Sustained System Volume Technical Service Income Reduced Administrative Costs for MSD services Payers want you to do it (end of story)

7. Multiple Services – Same Day Commercial payer policy – –Why do I care? –EHBs Integration included –Churn

8. Multiple Services – Same Day Medicaid v. Medicare; –E/M + psychotherapy was not adopted to cover integrated care situations. –Medicare has always paid (get the modifiers right) –Medicaid has seldom paid (the modifiers are only right for them)

9. Multiple Services – Same Day Billing under A28 and A31; –Two clinic types – Two rate codes –Two rate codes – Two claims –Modifiers

10. Multiple Services - Same Day When the service (1) is and (2) is not covered by Medicare: –Medicare “Statutorily non-covered” –Incident to –Add 59 to the original?

11. Radical Strategy Specifics You have to start somewhere: –Treatment Planning in the Continuum – All step down services below admission LOC –Generally: In – PHP – IOP – OPD 5-7d; 1-3wks; 2-4wks; PRN ICM/BHO/UM

12. Radical Strategy Specifics Be flexible! –Infrastructure – Revenue Cycle Registration and Scheduling –Capacity increases – Filling continuum pushes stress downward in the continuum –Employ “best practice” scheduling strategies – much more rapid change process –Reduce first visit no shows

13. Radical Strategy Specifics Flexible staffing for more intensive ambulatory services: –The total of outpatients (PC, MH, SA) need not change in the beginning, only the intensity (frequency of services)

14. Radical Strategy Specifics Infrastructure – Revenue Cycle –Charge capture – Coding – Billing Bundled and unbundled –Multiple days, multiple services on the same day »Same clinician/different clinician »Integrate (PC and BH/SA) –Multiple payers, same patient, same day, multiple services

15. Sustaining Redesign/System Transformation: Organizations sustain change intentionally. Sustained change and accommodation to change are processes that require attention and understanding. 15

16. Yours

17. To arrange 1:1 calls - Derek at: drdj@diligence.pro