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Get Smart! Office Practice Management
Billing Basics: Office Practice May 28, 2015 Dr Wendy Tink, BSc, CCFP, FCFP Practice Management Billing . Department of Family Medicine . Fee codes May 28, Dr Wendy Tink
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Practice Management Billing. Department of Family Medicine
Practice Management Billing . Department of Family Medicine . Fee codes May Dr Wendy Tink
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Become a skilled clinician ….
… and PRACTICE BILLING … before it really matters! Practice Management Billing . Department of Family Medicine . Fee codes May Dr Wendy Tink
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Income streams Fee for Service Uninsured Services + (FFS) Public Funds
Contracts Leadership Shared Care ARP CUPS Family Care Clinics Uninsured Services (3rd Party) Companies Pay Patients Pay Fee for Service (FFS) Public Funds + + + Industry WCB + Primarily FFS ( billing the government) Uninsured services if time. PCN Practice Management Billing . Department of Family Medicine . Fee codes May Dr Wendy Tink
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Get Smart! Agenda Part 1 Large group presentation (HELPFUL)
How to think, codes, tools to use, practice Part 2 Small group practice (FUN) Patient day sheet, tools Fill in dx codes and fee codes Patient totals and day total Part 3 Present results (PRIZES) Discussion/pearls Part 4 Uninsured Services/3rd Party (MAYBE) Part 5 Summary Practice Management Billing . Department of Family Medicine . Fee codes May 28, Dr Wendy Tink
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FFS: OFFICE VISIT CODES Office Visit fee codes. Counselling. pain 03
FFS: OFFICE VISIT CODES Office Visit fee codes Counselling pain O cancer I psych 08.19G Pick one stream Complete Exam 03.04A Limited Exam 03.03A Practice Management Billing . Department of Family Medicine . Fee codes May Dr Wendy Tink
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Visit fee codes + pregnancy Counselling pain cancer psych St
Pick one stream Complete 03.04 Limited 03.03 03.04B03 03.03B 03.03A 03.04A 03.04B If pregnant change the letter A to B Practice Management Billing . Department of Family Medicine . Fee codes May 28, Dr Wendy Tink
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Fee codes: values April 1, 2015
Pick one stream Comprehensive 03.04A/B $101.93 03.04M (preop) $101.93 03.05H DLM * $83.40 * age 74.5 Limited 03.03A/B $36.64 Limited Consult 03.07A $64.87 Counselling pain cancer psych Practice Management Billing . Department of Family Medicine . Fee codes May 28, Dr Wendy Tink
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Fee codes: dollar amounts
Pick one stream: choose wisely Comprehensive 03.04A/B $101.93 03.04M preop $101.93 03.05H DLM $83.40 Up to 30 min Pg22 Limited Visit 03.03A/B $37.07 Limited Consult 03.07A $64.87 Up to 15 min Counselling Pain* O $46.33 Palliative* I $50.66 Psych G 15 min units Pg32,35 Practice Management Billing . Department of Family Medicine . Fee codes May Dr Wendy Tink
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Fee codes: time modifiers direct/indirect
Pick one stream: longer visits add modifiers** Comprehensive At 30 min add modifier 1 only $31.11 03.04A/B $101.93 03.04A + cmxc 30 03.04M preop $101.93 03.04M + cmxc30 03.05H DLM $83.40 03.05H + cmxv30 $31.11 Limited at 15 min + cmgp01* $17.61 + cmgp each next 10 mins (max 10) 03.03A/B $36.64 15 min 03.03A + cmgp01 $54.68 25 min 03.03A + cmgp02 $72.29 35 min 03.03A + cmgp03 $89.90 Limited consult 03.07A $64.87 Counselling Pain* O $46.33 x2 $92.66 Palliative* I $50.66 Psych G 15 min units **Modify by doubling ** major portion Comprehensive and limited modifiers direct and indirect Other Pain, palliative psych whites of eyes/face to face Practice Management Billing . Department of Family Medicine . Fee codes May Dr Wendy Tink
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Fee codes: relative value
Pick one stream: best value Comprehensive +1 cmxc30 $31.11 Periodic exam 30 min 03.04A cmxc30 $ $31.11 $133.04/30min $66.52/15min Limited at 15min +cmgp $17.61 +cmgp each next 10 mins max 10 Visit 15 min 03.03A + cmgp01 $ $17.61 $54.68/15 min Visit 25 min 03.03A +cmgp02 $72.29 Counselling Per 15 min Pain* O $46.33 Palliative* I $50.66 Psych G 15 min Double/major portion * team Practice Management Billing . Department of Family Medicine . Fee codes May 28, Dr Wendy Tink
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Pick one stream: insert into memory!
Fee codes: review Pick one stream: insert into memory! Comprehensive First PN Periodic exam 03.04A/B direct care + Time modifier at 30 min direct / indirect +1 cmxc30 $31.11 Pg 21 Limited Routine visit 03.03A/B +cmgp at 15 min and +cmgp each next 10 mins max 10 cmgp each $17.61 Pg 20 Counselling Per 15 min Double at 1/2 int Pain* O $46.33 Palliative* I $50.66 Psych G Practice Management Billing . Department of Family Medicine . Fee codes May Dr Wendy Tink
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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 Practice Management Billing . Department of Family Medicine . Fee codes May 28, Dr Wendy Tink
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Palliative Chronic Pain Psychiatry
Overview Phone calls Call back ltc + Visits + Time Modifiers + Complex Care Plan + Procedures + Comprehensive Visits At 30 min add CMXC30 = $31.11 Direct/Indirect One only Limited Visits 03.03A At 15 min 03.03A +CMGP 01 >25 min 03.03A +CMGP02 >35 min 03.03A +CMGP 03 >45 min 03.03A +CMGP 04 $37.07 $54.68 $72.29 $89.90 $107.51 Palliative Chronic Pain Psychiatry 03.05I* $49.09 03.03O* $44.90 08.19G *increase the number of units for the time modifiers Practice Management Billing . Department of Family Medicine . Fee codes May 28, Dr Wendy Tink
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Annual Complex Care Plan most responsible doc
pg23 Phone Call to ltc Visits Procedures + Time Modifiers + + + Phone + 03.04J $193.97 2 chronic diseases A/B smart goals patient &doc signed doc* &patient once yearly review / follow up Group A Hypertension DM COPD Asthma Heart Failure Ischemic HD Chr Renal Failure 585,586 Group B Mental Health Obesity Addictions – 304 Tobacco 1 A and 1 B Or 2 B Ask your preceptors if you can do this. Practice Management Billing . Department of Family Medicine . Fee codes May 28, Dr Wendy Tink
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Fee Codes: Add procedures
Phone Calls Home, ltc visits Visits Time Modifiers Complex Care Plan Procedures + + + + M add visit ? add tray? 07.57A Initial Burn $ tray 98.03A I + D Abscess $ tray + v 98.12C Removal 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 + add visit 80.83B Endometrial Bx $42.75 98.12A Excisional Bx, skin $41.25 98.81B Punch Bx $26.94 97.81 Needle or Bx Breast $44.28 Usually add to visit Check for tray Fee No additional time modifiers ALWAYS CHECK GP BILLING RULES AMA pg 50 April 2015 Practice Management Billing . Department of Family Medicine . Fee codes May 28, Dr Wendy Tink
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Fee Codes: Remember phone calls
Phone Stuff Called away Home visits NH, ER, OB, Hosp Visits + Time Modifiers + Complex Care Plan + Procedures + INR ( pt advise coumadin) N $ Twice Monthly Physician to Physician * phone consult 03.01LG (H, I) $32.43/42.57/50.23 Physician to other Pg 25 03.01LM Ob outpatient worker $17.71/26.16/30.87 03.01B Mental health worker $16.99/26.50/30.92 03.01NG Allied health - ltc, hosp+ $16.99/20.28/23.94 03.01NM Pharmacist $15.12 03.05JR Patient $15.12 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 Practice Management Billing . Department of Family Medicine . Fee codes May 28, Dr Wendy Tink
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Fee codes: Out of office care $$
Home Visits Pg 37 Time of day Matters Nursing home Pg 36 Auxiliary Hospital Visits 03.03N OFEV OFEVWK OFNTPM OFNTAM $83.40 +43.06 +50.48 :00 WD Priority call 17:00-22:00 WD 07:00-22:00 WE/STATS 22:00-24:00 24:00-07:00 *record times Visit LTC Admit 03.04D 03.03KA 03.03LA 03.03MC 03.03MD 03.03E +cmxc30 $74.13 $111.20 $148.27 $23.80 $ +03.03EA $42.70 OP/AACC/UCC similar approach + cmgp modifiers AA time modifiers Practice Management Billing . Department of Family Medicine . Fee codes May Dr Wendy Tink
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Fee codes: After hours out of office Time modifiers Add 03
Fee codes: After hours out of office Time modifiers Add 03.01AA Page 19, 39 TEV TWK TDES W/D 17:00 – 22:00 W/E 0700 – 22:00 Des hol – 22:00 22.22/ 15min TST TNTP TNTA Stat hol 07:00 – 22:00 22:00 – 24:00 24: :00 44.43/ 15min ER, OP, Hospital, LTC, UCC, AACC Add 03.01AA each direct care 15 min completed TNTA $44.43/15 min TEV $22.22/15 min TNTP $44.43/15 min 2400 (midnight) 7:00 am 5:00 pm 10:00 pm 2400 (midnight) ANY EVENING, NIGHTS Practice Management Billing . Department of Family Medicine . Fee codes May Dr Wendy Tink
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Office Fee Codes: Summary
Resources: GP Billing Rules and Codes AMA April 1, ICD 9 Diagnostic codes Choose Whole Limited or Pall Pain Psych NH / Home Visits / OB / ER Complex Care Plan Phone Calls + + Procedures + + Time modifiersCmxc30 or Cmgp01+ Time Modifier Multiples 03.04J Usually add to visit Time of day matters! Visit + Call back Modifiers Dx codes ( billing + complexity + panels) Practice Management Billing . Department of Family Medicine . Fee codes May Dr Wendy Tink
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Become a skilled clinician ….
… and PRACTICE BILLING … before it really matters! Small groups Fill in dx codes and billing Patient totals and day total PRIZES Practice Management Billing . Department of Family Medicine . Fee codes May 28, Dr Wendy Tink
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Become a skilled clinician ….
… and PRACTICE BILLING … before it really matters! Small groups Fill in dx codes and billing Patient totals and day total PRIZES Practice Management Billing . Department of Family Medicine . Fee codes May 28, Dr Wendy Tink
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