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

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


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


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


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---------


Information Strategy Specifics


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)



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

• Integration included– Churn



• 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)



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


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?


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



• 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



• 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)



• 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


Sustaining Redesign/System Transformation:

• Organizations sustain change intentionally.

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

15


Yours


To arrange 1:1 calls -

Derek at:

[email protected]

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

Documents