welcome! finance/billing june 25, 2013 geriatric technical assistance center for integrated physical...
TRANSCRIPT
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Welcome!
Finance/Billing June 25, 2013
Geriatric Technical Assistance Center for
Integrated Physical & Behavioral Health Care for the Elderly Grantees
GERIATRIC TECHNICAL ASSISTANCE CENTER
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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
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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
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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---------
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Information Strategy Specifics
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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)
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Multiple Services – Same Day
• Commercial payer policy – – Why do I care?– EHBs
• Integration included– Churn
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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)
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Multiple Services – Same Day
• Billing under A28 and A31;– Two clinic types – Two rate codes– Two rate codes – Two claims– Modifiers
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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?
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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
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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
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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)
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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
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Sustaining Redesign/System Transformation:
• Organizations sustain change intentionally.
• Sustained change and accommodation to change are processes that require attention and understanding.
15
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Yours
