welcome! finance/billing june 25, 2013 geriatric technical assistance center for integrated physical...

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w w w .TheN ationalCouncil.org 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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Page 1: Welcome! Finance/Billing June 25, 2013 Geriatric Technical Assistance Center for Integrated Physical & Behavioral Health Care for the Elderly Grantees

www.TheNationalCouncil.org

Welcome!

Finance/Billing June 25, 2013

Geriatric Technical Assistance Center for

Integrated Physical & Behavioral Health Care for the Elderly Grantees

GERIATRIC TECHNICAL ASSISTANCE CENTER

Page 2: Welcome! Finance/Billing June 25, 2013 Geriatric Technical Assistance Center for Integrated Physical & Behavioral Health Care for the Elderly Grantees

www.TheNationalCouncil.org

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

Page 3: Welcome! Finance/Billing June 25, 2013 Geriatric Technical Assistance Center for Integrated Physical & Behavioral Health Care for the Elderly Grantees

www.TheNationalCouncil.org

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

Page 4: Welcome! Finance/Billing June 25, 2013 Geriatric Technical Assistance Center for Integrated Physical & Behavioral Health Care for the Elderly Grantees

www.TheNationalCouncil.org

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---------

Page 5: Welcome! Finance/Billing June 25, 2013 Geriatric Technical Assistance Center for Integrated Physical & Behavioral Health Care for the Elderly Grantees

www.TheNationalCouncil.org

Information Strategy Specifics

Page 6: Welcome! Finance/Billing June 25, 2013 Geriatric Technical Assistance Center for Integrated Physical & Behavioral Health Care for the Elderly Grantees

www.TheNationalCouncil.org

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)

Page 7: Welcome! Finance/Billing June 25, 2013 Geriatric Technical Assistance Center for Integrated Physical & Behavioral Health Care for the Elderly Grantees

www.TheNationalCouncil.org

Multiple Services – Same Day

• Commercial payer policy – – Why do I care?– EHBs

• Integration included– Churn

Page 8: Welcome! Finance/Billing June 25, 2013 Geriatric Technical Assistance Center for Integrated Physical & Behavioral Health Care for the Elderly Grantees

www.TheNationalCouncil.org

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)

Page 9: Welcome! Finance/Billing June 25, 2013 Geriatric Technical Assistance Center for Integrated Physical & Behavioral Health Care for the Elderly Grantees

www.TheNationalCouncil.org

Multiple Services – Same Day

• Billing under A28 and A31;– Two clinic types – Two rate codes– Two rate codes – Two claims– Modifiers

Page 10: Welcome! Finance/Billing June 25, 2013 Geriatric Technical Assistance Center for Integrated Physical & Behavioral Health Care for the Elderly Grantees

www.TheNationalCouncil.org

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?

Page 11: Welcome! Finance/Billing June 25, 2013 Geriatric Technical Assistance Center for Integrated Physical & Behavioral Health Care for the Elderly Grantees

www.TheNationalCouncil.org

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

Page 12: Welcome! Finance/Billing June 25, 2013 Geriatric Technical Assistance Center for Integrated Physical & Behavioral Health Care for the Elderly Grantees

www.TheNationalCouncil.org

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

Page 13: Welcome! Finance/Billing June 25, 2013 Geriatric Technical Assistance Center for Integrated Physical & Behavioral Health Care for the Elderly Grantees

www.TheNationalCouncil.org

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)

Page 14: Welcome! Finance/Billing June 25, 2013 Geriatric Technical Assistance Center for Integrated Physical & Behavioral Health Care for the Elderly Grantees

www.TheNationalCouncil.org

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

Page 15: Welcome! Finance/Billing June 25, 2013 Geriatric Technical Assistance Center for Integrated Physical & Behavioral Health Care for the Elderly Grantees

www.TheNationalCouncil.org

Sustaining Redesign/System Transformation:

• Organizations sustain change intentionally.

• Sustained change and accommodation to change are processes that require attention and understanding.

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Page 16: Welcome! Finance/Billing June 25, 2013 Geriatric Technical Assistance Center for Integrated Physical & Behavioral Health Care for the Elderly Grantees

www.TheNationalCouncil.org

Yours

Page 17: Welcome! Finance/Billing June 25, 2013 Geriatric Technical Assistance Center for Integrated Physical & Behavioral Health Care for the Elderly Grantees

www.TheNationalCouncil.org

To arrange 1:1 calls -

Derek at:

[email protected]