Get Smart! Office Practice Management Billing Basics: Office Practice May 28, 2015 Dr Wendy Tink, BSc, CCFP, FCFP - 1 - Practice Management Billing. Department

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  • Slide 1
  • Get Smart! Office Practice Management Billing Basics: Office Practice May 28, 2015 Dr Wendy Tink, BSc, CCFP, FCFP - 1 - Practice Management Billing. Department of Family Medicine. Fee codes May 28, 2015. Dr Wendy Tink
  • Slide 2
  • 2 - Practice Management Billing. Department of Family Medicine. Fee codes May 28 2015. Dr Wendy Tink
  • Slide 3
  • Become a skilled clinician . and PRACTICE BILLING before it really matters! Practice Management Billing. Department of Family Medicine. Fee codes May 28 2015. Dr Wendy Tink 3
  • Slide 4
  • Income streams + + + Contracts Leadership Shared Care ARP CUPS Family Care Clinics Uninsured Services (3 rd Party) Companies Pay Patients Pay Fee for Service (FFS) Public Funds PCN Industry WCB + - 4 - Practice Management Billing. Department of Family Medicine. Fee codes May 28 2015. Dr Wendy Tink
  • Slide 5
  • 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/3 rd Party (MAYBE) Part 5 Summary - 5 - Practice Management Billing. Department of Family Medicine. Fee codes May 28, 2015. Dr Wendy Tink
  • Slide 6
  • Office Visit fee codes FFS: OFFICE VISIT CODES Office Visit fee codes Counselling pain 03.05O cancer 03.05I psych08.19G - 6 - Complete Exam 03.04A Limited Exam 03.03A Practice Management Billing. Department of Family Medicine. Fee codes May 28 2015. Dr Wendy Tink
  • Slide 7
  • Visit fee codes + pregnancy Visit fee codes + pregnancy Counselling pain cancer psych St - 7 - Complete 03.04 Limited 03.03 03.04B03 03.03A 03.03B 03.04A 03.04B If pregnant change the letter A to B Practice Management Billing. Department of Family Medicine. Fee codes May 28, 2015. Dr Wendy Tink
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  • Fee codes: values April 1, 2015 Fee codes: values April 1, 2015 - 8 - 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, 2015. Dr Wendy Tink
  • Slide 9
  • Fee codes: dollar amounts Fee codes: dollar amounts - 9 - 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 Pg22 Counselling Pain* 03.05O $46.33 Palliative* 03.05I $50.66 Psych 08.19G $46.33 15 min units Pg32,35 Practice Management Billing. Department of Family Medicine. Fee codes May 28 2015. Dr Wendy Tink
  • Slide 10
  • Fee codes: time modifiers direct/indirect - 10 - 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* 03.05O $46.33 x2 $92.66 Palliative* 03.05I $50.66 Psych 08.19G $46.33 15 min units **Modify by doubling ** major portion Practice Management Billing. Department of Family Medicine. Fee codes May 28 2015. Dr Wendy Tink
  • Slide 11
  • Fee codes: relative value Fee codes: relative value - 11 - Comprehensive +1 cmxc30 $31.11 Periodic exam 30 min 03.04A + cmxc30 $101.93 + $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 $37.07 + $17.61 $54.68/15 min Visit 25 min 03.03A +cmgp02 $72.29 Counselling Per 15 min Pain* 03.05O $46.33 Palliative* 03.05I $50.66 Psych 08.19G $46.33 15 min Double/major portion * team Practice Management Billing. Department of Family Medicine. Fee codes May 28, 2015. Dr Wendy Tink
  • Slide 12
  • Fee codes: review Fee codes: review - 12 - 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 direct care +cmgp at 15 min and +cmgp each next 10 mins max 10 direct / indirect cmgp each $17.61 Pg 20 Counselling Per 15 min Double at 1/2 int Pain* 03.05O $46.33 Palliative* 03.05I $50.66 Psych 08.19G $46.33 direct care Practice Management Billing. Department of Family Medicine. Fee codes May 28 2015. Dr Wendy Tink
  • Slide 13
  • Add diagnostic codes to get paid complexity measure Diagnostic Codes ICD 9 465 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 - 13 - Practice Management Billing. Department of Family Medicine. Fee codes May 28, 2015. Dr Wendy Tink
  • Slide 14
  • Overview Practice Management Billing. Department of Family Medicine. Fee codes May 28, 2015. Dr Wendy Tink - 14 - 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$44.90 *increase the number of units for the time modifiers VisitsTime ModifiersProcedures Phone calls Call back ltc + +++ Complex Care Plan +
  • Slide 15
  • Annual Complex Care Plan most responsible doc Practice Management Billing. Department of Family Medicine. Fee codes May 28, 2015. Dr Wendy Tink - 15 - Group A Hypertension 401 DM 250 COPD 496 Asthma 493 Heart Failure 428 Ischemic HD 413-414 Chr Renal Failure 585,586 Group B Mental Health 290 - 319 Obesity 278 Addictions 303 304 Tobacco 305 Visits Time Modifiers Phone Call to ltc ++ Complex Care Plan pg23 Phone Procedures +++ 03.04J $193.97 2 chronic diseases A/B smart goals patient &doc signed doc* &patient once yearly review / follow up
  • Slide 16
  • Fee Codes: Add procedures Practice Management Billing. Department of Family Medicine. Fee codes May 28, 2015. Dr Wendy Tink - 16 - VisitsTime Modifiers Procedures Phone Calls Home, ltc visits + + + M add visit ? add tray? 07.57AInitial Burn $37.07 + tray 98.03AI + D Abscess $28.23 + tray + v 98.12CRemoval Seb. Cyst $47.12 + tray + v 13.59AIM / SQ Injection $9.88 + v 13.99BC Pap or gyne swab $27.80 + v 81.8IUD Insertion $67.18 + tray + v 93.91AJoint Aspiration/ $36.71 + tray + v Injection (Hip) M + add visit 80.83BEndometrial Bx $42.75 98.12AExcisional Bx, skin $41.25 98.81BPunch Bx $26.94 97.81Needle or Bx Breast $44.28 ALWAYS CHECK GP BILLING RULES AMA pg 50 April 2015 Complex Care Plan +
  • Slide 17
  • Fee Codes : Remember phone calls Practice Management Billing. Department of Family Medicine. Fee codes May 28,2015. Dr Wendy Tink - 17 - Visits Time Modifiers Procedures Called away Home visits NH, ER, OB, Hosp +++ INR ( pt advise coumadin) 03.01N $16.99 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 Complex Care Plan + Phone Stuff
  • Slide 18
  • 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 +115.74 0700-17:00 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 $108.11+ +03.03EA $42.70 Practice Management Billing. Department of Family Medicine. Fee codes May 28 2015. Dr Wendy Tink - 18 - + cmgp modifiers + 03.01AA time modifiers
  • Slide 19
  • Fee codes: After hours out of office Time modifiers Add 03.01AA Page 19, 39 Practice Management Billing. Department of Family Medicine. Fee codes May 28 2015. Dr Wendy Tink - 19 - ER, OP, Hospital, LTC, UCC, AACC Add 03.01AA each direct care 15 min completed TEV TWK TDES W/D 17:00 22:00 W/E 0700 22:00 Des hol 07.00 22:00 22.22/ 15min TST TNTP TNTA Stat hol 07:00 22:00 22:00 24:00 24:00 - 07:00 44.43/ 15min 2400 (midnight) 7:00 am 5:00 pm 10:00 pm2400 (midnight) TNTA $44.43/15 min TEV $22.22/15 min TNTP $44.43/15 min ANY EVENING, NIGHTS
  • Slide 20
  • Office Fee Codes: Summary - 20 - Whole Limited Pall Pain Psych or Complex Care Plan Phone Calls Procedures Resources: GP Billing Rules and Codes AMA April 1, 2015 ICD 9 Diagnostic codes Time modifiers Cmxc30 or Cmgp01+ Time Modifier Multiples NH / Home Visits / OB / ER ++++ 03.04J Usually add to visit Time of day matters ! Visit + Call back + Modifiers Practice Management Billing. Department of Family Medicine. Fee codes May 28 2015. Dr Wendy Tink Choose
  • Slide 21
  • Become a skilled clinician . and PRACTICE BILLING before it really matters! Small groups Fill in dx codes and billing Fill in dx codes and billing Patient totals and day total PRIZES Patient totals and day total PRIZES Practice Management Billing. Department of Family Medicine. Fee codes May 28, 2015. Dr Wendy Tink21
  • Slide 22
  • Become a skilled clinician . and PRACTICE BILLING before it really matters! Small groups Fill in dx codes and billing Fill in dx codes and billing Patient totals and day total PRIZES Patient totals and day total PRIZES Practice Management Billing. Department of Family Medicine. Fee codes May 28, 2015. Dr Wendy Tink22