1. 2015 User Conference Getting Paid for Bright Futures (GEN-A90) April 25, 2015 Presented by: Susan M. Hannon Training Specialist General Session

2. 2015 Office Practicum User Conference The Gold Standard Why are we trying to implement Bright Futures standards…

3. 2015 Office Practicum User Conference ACA “The Patient Protection and Affordable Care Act (ACA) recognized the importance of preventive care for children by including a critical provision to ensure that children enrolled in all individual and group non-grandfathered health care plans receive the gold standard of preventive care—all preventive care screenings and services recommended by the AAP/Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents without cost-sharing.” 1

4. 2015 Office Practicum User Conference ● These are the guidelines for the Standard of Care, based on age and gender ● Can be performed without additional cost sharing to the patient ● Incorporating these recommendations and billing correctly is essential for the financial health of our practices What does that mean?

5. 2015 Office Practicum User Conference Where do we start? OP Well Visit Templates Set the Stage

6. 2015 Office Practicum User Conference How do we start? Case Study: 18 month visit - Interval Hx, Measurements Blood Pressure (if needed) Sensory Screening (if needed) Developmental Screen Autism Screen Psychological/Behavioral Assessment Physical Exam Immunizations Hemoglobin (if indicated) Oral Health Anticipatory Guidance How long do you book for this visit?

7. 2015 Office Practicum User Conference ➢ Utilize an iterative process for adoption ➢ Standing, Routine and Alternate orders as needed ➢ Patient Portal for pre-visit completion ○and a plan for when this doesn’t occur ➢ Utilize parent facing material ○patient education, patient instruction, anticipatory guidance and patient exit notes

8. 2015 Office Practicum User Conference Let’s Look!

9. 2015 Office Practicum User Conference Surveillance vs. Screening As many as one-half of American children with developmental delay will not be identified by the time they enter kindergarten, even though many will show mild developmental delays by two years of age. One reason for low detection rates is high dependence on clinical surveillance alone. Barriers to Screening ▪time constraints (#1) ▪competing clinical demands ▪cost burden ▪staffing requirements, high staff turnover ▪lack of consensus on the most suitable tools for the general childhood population ▪lack of physician confidence Because children's development is dynamic in nature, regular and repeated screening combined with surveillance is needed to detect developmental delays.

10. 2015 Office Practicum User Conference Surveillance Tools ❖ Surveillance is considered part of the well visit and can not be billed but it does take time. ❖ What is available... ➢ The Bright Futures questionnaires ➢ Developmental questions through age 60 months ❖ When time is a factor... ➢ have the Bright Futures questionnaires completed prior to the visit ➢ have the clinical staff record milestone achievements

11. 2015 Office Practicum User Conference Screening - surveys Validated Surveys for ★ Developmental ★ Psychosocial behavioral ★ Depression

12. 2015 Office Practicum User Conference Screening - labs Default charge in lab for screening labs in templates *** can make the test confidential, but if the parent gets the bill, cannot hide that from parents in most states with most insurances

13. 2015 Office Practicum User Conference Screening - labs or surveys ❖ Tuberculosis: TB testing (PPD) ➢ based on someone who is at high risk ➢ or if the payer (Medicaid) demands it for certain age groups ■CPT Code 86580 Skin test; tuberculosis, intradermal (no separate admin code) ■ICD-9-CM Code V74.1 Special screening examination for pulmonary tuberculosis ➢ 99420 can be used for a TB or lead risk questionnaire ■Administration and interpretation of health risk assessment instrument (eg, health hazard appraisal)

14. 2015 Office Practicum User Conference Let’s Look!

15. 2015 Office Practicum User Conference Billing Tools ➢ Automatic -33 modifier to anything that is “preventive” in nature ■ (Note: the 33 modifier means no patient cost sharing) ➢ Charges in your CPT code table ➢ Automatic administration codes on vaccines ■ global settings and payer specific differences ➢ CPT codes on validated screening tools and labs

16. 2015 Office Practicum User Conference ➢ What’s available and what’s new? ➢ CPT code 96127 ■applied to psychosocial behavioral assessment ■Examples: PHQ9 and Pediatrics Symptom Checklist ➢ CPT code 99188 ○ used for Oral health/fluoride varnish ○The new USPTF recommendations now mandate that all private insurers recognize and pay for this code. ○(AAP oral health resources)resources

17. 2015 Office Practicum User Conference How do we ensure patient’s preventive visits? Be proactive with Patient Recalls use Demographic Analysis and Recall

18. 2015 Office Practicum User Conference ❖ What are we up against? ❖ Retail medicine ❖ Urgent Care ➢ reduction in total visits ➢ reduction in revenue Remember P4P - Pay for Performance ➢ preventive visits and many of these screens are part of P4P, where compliance increases overall payment to the practice

19. 2015 Office Practicum User Conference Let’s Discuss!

20. 2015 Office Practicum User Conference As you implement the standard of care provided for in the ACA, how can OP assist you? ➢ Templates ➢ Surveillance and Screen Tools ➢ Delivery of surveys and surveillance tools through OP or CHADIS ➢ Patient Portal ➢ Billing Tools

21. 2015 Office Practicum User Conference Questions?

22. 2015 Office Practicum User Conference Resources and Footnotes “Recommendations for Preventive Pediatric Health Care”, American Academy of Pediatrics, aap.org Recommendations for Preventive Pediatric Health Care HealthyChildren.org, from the American Academy of Pediatrics HealthyChildren.org Affordable Care Act Affordable Care Act and Reconciliation Act FOOTNOTES: 1.“Achieving Bright Futures”, aap.org https://www.aap.org/en-us/professional-resources/practice-support/Pages/achieving-bright.aspx

23. 2015 Office Practicum User Conference American Academy of Pediatrics Membership in the American Academy of Pediatrics helps Pediatricians navigate these ever-changing waters “Recommendations for Preventive Pediatric Health Care”, American Academy of Pediatrics, aap.org Recommendations for Preventive Pediatric Health Care

24. 2015 Office Practicum User Conference We want your feedback!