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Get Smarter!!! Billing Basics and Beyond R2 Practice Management Review basics Expand scope Billing: Out of office Billing: Keeping up to date Billing.

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Presentation on theme: "Get Smarter!!! Billing Basics and Beyond R2 Practice Management Review basics Expand scope Billing: Out of office Billing: Keeping up to date Billing."— Presentation transcript:

1 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 Build confidence more during PGY 2, after grad other locations of practice ltc, ob, acute including more office; how to find resources now/after grad R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

2 Skilled Clinician Competent Billing PGY 2
R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

3 Get Smarter!!! R2 Agenda 1:30 am Review: Get Smart R1 billing basics Dx & Fee Codes/add-ons 2:00 pm Billing: Outside the Office Acute care * Obstetrics * Long term care 2:30 pm Break 2:40 pm Small group choose 2 practice types, complete day sheet Acute care + office practice Long term care + office practice Obstetrics care + office practice 3:50 pm Large group Present results/ discussion 4:15 pm Wrap Up Pearls/ Prizes/ Evaluation R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

4 Review: Income streams
PCN Fee For Service Office Acute care Long term care Obstetrics Note: related additional $ Rural and Remote Northern Program Business Cost Program Watch for blended capitation Uninsured Services (3rd Party) Companies Pay Patients Pay + Industry WCB + Primarily FFS ( billing the government) Uninsured services if time. Contracts Hospitalists Leadership Shared Care ARP CUPS Family Care Clinics R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

5 Add Diagnostic Codes to get Paid complexity measure
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 Diagnostic Codes ICD 9 EMR tools AMA fee navigator R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

6 Office Fee Codes: R1 Summary
Whole person * Modifier 1 CMXC30 Cancer Chronic Pain Psych/Mood Per 15 min or major portion Modifier multiples Limited exam * Modifiers CMGP01-10 Complex Care Plan J NH/Home Visits/OB/ER Visit + call back + modifiers Procedures Usually add to visit Phone Calls Time? Resources: GP Billing Rules and Codes AMA – April 1, 2017 ICD 9 Diagnostic codes OR OR Dx codes ( billing + complexity + panels) R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

7 Office Visit Fee Codes: Billing Basics
Pick one stream Complete 03.04 03.04A 03.04B Limited 03.03 03.03A 03.03B Special Codes Palliative Chronic Pain Psych/Mood 08.19G If pregnant change the letter A to B R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

8 Fee Codes: Amounts Pick one stream: consider time
Comprehensive A/B $ M pre-op $ H DLM $84.61 Up to 30 min p22 Limited Visit A/B $ Limited Consult A $65.80 Up to 15 min Special Codes 15 min units Palliative 03.05I $ Chronic Pain 03.05O $ Palliative 08.19G $ min/major portion units p35, 38 R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

9 Fee Codes: Time Modifiers direct/indirect
Pick one stream: use correct modifiers Comprehensive At 30 mins add 1 modifier CMXC30 $31.27 CMXV30 (DLM) $31.27 Periodic exam 03.04A 1st PN 03.04B Pre-op 03.04M 03.04A/B/M + CMCX30 $ = $134.68 DLM 03.05H 03.05H + CMCV30 $ = $115.88 p21 Limited Visit At 15 mins add CMGP modifiers For each next 10 mins CMGP $ MAX 10 Limited visit 03.03A/B $37.35 Limited consult 03.07A $65.80 15 min 03.03A + CMGP01 = $55.62 25 min 03.03A + CMGP02 = $73.89 35 min 03.03A + CMGP03 = $92.16 p20 Special Codes Per 15 min DOUBLE if get to major portion of next 15 mins Palliative 03.05I $51.39 X2 $ Chronic Pain 03.05O $44.90 X2 $ Psych/Mood 08.19G $47.00 X2 $94.00 p23+ Comprehensive and limited modifiers direct and indirect Other Pain, palliative psych whites of eyes/face to face (Comprehensive $67.32/15 min) 0 R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

10 Review: Office Visit Fee Codes
Visits Time Modifiers Comprehensive Visits At 30 min add CMXC30 OR CMXV30 (DLM) $31.27 Direct/indirect One only Limited Visits 03.03A $37.35 Limited Consults 03.07A $ At 15 min + CMGP each next 10 min Max A/7A + CMGP01 $ At 25 min 03.03A/7A + CMGP02 $ At 35 min 03.03A/7A + CMGP03 $54.81 Special Codes Direct care/15 mins Palliative 03.05I $51.39 Chronic Pain 03.03O $44.90 Psych/Mood 08.19G $47.00 * Multiples of 15 min unit/major portion Complex Care Plan Procedures Phone calls Call back, LTC+ R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

11 Annual Complex Care Plan most responsible doc
Visits Time Modifiers Complex Care Plan 03.04J $188.01 Procedures Phone calls Call back, LTC+ 2 chronic diseases A/B smart goals patient &doc signed doc* &patient once yearly review / follow up Group A Hypertension 401 DM 250 COPD 496 Asthma 493 Heart Failure 428 Ischemic HD Chr Renal Failure Group B Mental Health Obesity 278 Addictions Tobacco 305 1 A and 1 B Or 2 B Ask your preceptors if you can do this. R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

12 Fee Codes: Add procedures Pg 54 April 2016
Visits Time Modifiers Complex Care Plan Procedures Phone calls Call back, LTC+ M can you add a visit? Minor tray $13.04 or major tray $38.59 always added 07.57A Initial Burn $ tray $38.59 98.03A I + D Abscess $ tray $ v 98.12C Seb. Cyst $ tray $ v 13.59A IM / SQ Injection $ v 13.99BC Pap or gyne swab $ v 81.8 IUD Insertion $ tray $ v 93.91A Joint Aspiration/ $ tray + v Injection (Hip) M+ 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 Usually add to visit Check for tray Fee No additional time modifiers 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

13 Fee Codes: Remember phone calls
Visits Time Modifiers Complex Care Plan Procedures Phone calls Call back, LTC+ Phone stuff INR (pt advise coumadin) 03.01N $17.23 twice monthly Physician to Physician * phone consult (pg 26/27 electronic communications) 03.01LG $32.90 before 5 pm LH $ pm LI $45.21 after 10 pm Physician to other (Pg 28) * time of service changes fee 03.01LM $17.71 Ob outpatient worker * 03.01B $17.23 Mental health worker * 03.01NG $17.23 Allied health - LTC, hosp * 03.01NM $17.23 Pharmacist 03.05JR $15.88 Patient Phys to phys same or different day, add to visit if applicable. No prac id/non learner. Tel or other Patient phone call new April 1, 2015 R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

14 Fee Codes: Family and Team Conferences
Visits Time Modifiers Complex Care Plan Procedures Phone calls Call back, LTC+ Phone stuff Community office 03.05JB $ min or major portion Acute/ER/OP/NH/AAC/UCC 03.05JC $ min or major portion By phone Community pt 03.05JH $15.12 Regional facility pt 03.05JP $ min or major portion Multiple health discipline 03.05JA $ min or major portion Multiple health discipline NH/LTC 03.05JD $14.10 Per 5 min (max 12/hr) Family Conferences (p46) Phys to phys same or different day, add to visit if applicable. No prac id/non learner. Tel or other Patient phone call new April 1, 2015 R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

15 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 Mobility factors preclude in person meetings Use personal health number of patient Communication re patient condition or gather collateral info related to patient care/management. No governing rules no modifiers R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

16 Office Fee Codes: Review
Resources: GP Billing Rules and Codes AMA – April 1, 2016 ICD 9 Diagnostic codes Whole person * Modifier 1 CMXC30 Special Codes Palliative Chronic Pain Psych/Mood Per 15 min or major portion Modifier multiples Limited exam * Modifiers CMGP01-10 Complex Care Plan J NH/Home Visits/OB/ER Visit + call back + modifiers Procedures Usually add to visit Phone Calls Time? OR OR Dx codes ( billing + complexity + panels) R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

17 *General Practice Billing April 2017
NEW Out of Office Competent Billing* Home Care Homes Acute Obstetrics *General Practice Billing April 2017 SOMB AMA R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

18 Out of Office Billing: Routine “Home” Visit Codes
Patient’s Home p41 03.03N $ CMGP P $ nd + pt Assisted Living p41 Designated Assisted Living (DAL) Group Home/Senior Lodge Personal Care Homes 03.03NA $ CMGP NB $ nd + pt Long Term Care p39-40 Nursing Homes Auxiliary Hospitals 03.03E $ st + +CMGP01-10 Location matters R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

19 Out of Office Billing: Urgent Call Back Home Visits
Forget memorizing, just remember the concepts! Patient Home Assisted Living/DAL+ p39 Priority attend Attend within 24 hours N $ NA $ CMGP CMGP01-10 Add modifier to routine visit code based upon time urgent visit started +Modifiers Total OFEV 1700 – 2200 W/D $43.29 $ OFEVWK 0700 – 2200 W/E//STAT $50.75 $ OFEVNTPM 2200 – 2400 $ $ OFEVNTAM 2400 – 0700 $ $200.96 LTC Routine visit E $ Urgent call EA $ Different LTC modifiers Location matters R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

20 Out of Office Billing: Urgent Call Back Home Visits
Patient home Assisted Living/DAL Attend within 24 hours Priority attend 03.03N $ NA $84.61 +CMGP CMGP01-10 Add modifier to routine visit code based on time urgent visit started OFEV 1700 – 2200 WD $ OFEVWK 0700 – 2200 W/E/STAT $ OFEVNTPM 2200 – $ OFEVNTAM 2400 – $116.35 LTC Urgent call back visit 03.03EA $53.37 Add call back LTC modifiers to urgent call back based on time visit started 03.03KA 0700 – 1700 WD $ LA 1700 – 2000 WD – 2200 WE/ST $ MC 2200 – 2400 $ MD 2400 – 0700 $150.41 Location matters R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

21 Fee codes: Visit time after hours Add 03.01AA priority or routine
TEV W/D 1700 – 2200 p19 $22.34/15min TWK W/E 0700 – 2200 TDES Des hol 0700 – 2200 TST Stat hol 0700 – 2200 $44.66/15min TNTP 2200 – 2400 TNTA 2400 – 0700 Active treatment hospitals/LTC/ UCC/AACC Excludes homes/DALS Add 03.01AA each direct care 15 min completed TNTA $44.66/15 min TEV $22.34/15 min TNTP $44.66/15 min 0700 0500 2000 2400 (midnight) ANY EVENING, NIGHTS R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

22 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

23 Visit time 1 hr 15 min 03.01AA TEV05 22.34 x 5 = $111.70 $277.88
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. How to bill 03.03EA $53.37 Call back LTC 03.03LA $ – 2200 WD Visit time 1 hr 15 min 03.01AA TEV x 5 = $ $277.88 R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

24 Fee codes: Visit time after hours Add 03.01AA priority or routine
TEV W/D 1700 – 2200 p19 $22.34/15min TWK W/E 0700 – 2200 TDES Des hol 0700 – 2200 TST Stat hol 0700 – 2200 $44.66/15min TNTP 2200 – 2400 TNTA 2400 – 0700 Active treatment hospitals/LTC/ UCC/AACC Excludes homes/DALS Add 03.01AA each direct care 15 min completed TNTA $44.66/15 min TEV $22.34/15 min TNTP $44.66/15 min 0700 0500 2000 2400 (midnight) ANY EVENING, NIGHTS R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

25 Admission to Hospital or NH
Admission Acute care Pg 42 Nursing home Pg A $ D $ Visit time modifier CMXC30 CMXC30 RELEVANT after hours time of call back modifier HA/EV/EVWK/NTAM/NTPM 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

26 After Admission Visits: Hospital or Nursing Home
Routine Acute care daily visits Pg 43-44 Nursing home daily visits Pg 39 03.03D $ days 03.03E $28.20 $ days 20min +1 time modifier COINPT $40.21 co-morbid conditions/complex Urgent Call Back * check time of day and relevant modifiers Acute care Nursing Home 03.03DF urgent visit $43.87 + call back time modifiers 03.05P W/D 03.05R W/E, Stat 03.05QA/QB / 03.05N Call from home/office + visit time modifier 03.01AA per whole 15 min Urgent visit 03.03EA $53.57 03.03KA WD 03.03LA W/D, W/E & Stats 03.03MC/MD / + visit time modifier 03.01AA per whole 15 min Pg 39 R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

27 FP Fee Codes: Review In Office Choose Out of Office OR OR OR
Whole person * Modifier 1 CMXC30 Palliative Chronic Pain Psych/Mood Per 15 min or major portion Modifier multiples Limited exam * Modifiers CMGP01-10 Complex Care Plan J Consults Procedures Usually add to visit Phone Calls Time? Resources: GP Billing Rules and Codes AMA – April 1, 2017 ICD 9 Diagnostic codes AMA fee navigator – AMA website/EMR Home Visits pt home/DAL? Routine/urgent? Time? Acute Care Admission/Visit? Visit start time? Modifiers? Call back? Visit modifier? 03.01AA LTC Routine/Urgent? Obstetrics p50-53 Emergency p44-45, 47-49 In Office Choose Out of Office OR OR Dx codes ( billing + complexity + panels) OR R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

28 Practice for Practice! Build Confidence
Small groups choose 2 minimum dx/fee codes/totals acute care LTC/DAL/home obstetrics R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

29 Practice for Practice Acute, LTC/DALs or Obstetrics
2:40 pm Small groups (2-3 people) choose two practice types: Acute, LTC/DALS, Ob complete day sheets all codes and total prepare to report results 3:50 pm Large group discussion/comparison 4:15 pm Wrap up/pearls/prizes/evaluation R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

30 Summary: Get Smarter FFS Uninsured Services
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: “This is an uninsured service and the fee is $$ ”. R2 Practice Management: Billing Basics and Beyond | 2017 | Dr. Wendy Tink BSc., CCFP, FCFP

31 be wise


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