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

Get Smart! Office Practice Management

Billing Basics: Office PracticeMay 28, 2015

Dr Wendy Tink, BSc, CCFP, FCFP

- 1 -Practice Management Billing . Department of Family Medicine . Fee codes May 28, 2015 . Dr Wendy Tink

2 -Practice Management Billing . Department

of Family Medicine . Fee codes May 28 2015 . Dr Wendy Tink

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

Income streams

+

++

ContractsLeadership

Shared CareARP CUPS

Family Care Clinics

Uninsured Services (3rd Party)

Companies PayPatients Pay

Fee for Service

(FFS)Public Funds

PCN

Industry

WCB+

- 4 -



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 - 5 -

Practice Management Billing . Department of Family Medicine . Fee codes May 28,


•

FFS: OFFICE VISIT CODES

Office Visit fee codes

Counselling

pain 03.05O

cancer 03.05I

psych 08.19G

- 6 -

Complete Exam03.04A

Limited Exam03.03A

Pick one stream



•

Visit fee codes + pregnancy

Counselling

pain cancer

psych

St

- 7 -

Complete03.04

Limited03.03

03.04B03

03.03A 03.03B

Pick one stream

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

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

Pick one stream


Fee codes: dollar amounts

- 9 -

Comprehensive03.04A/B $101.93

03.04M preop $101.93

03.05H DLM $83.40

Up to 30 minPg22

Limited Visit03.03A/B $37.07

Limited Consult

03.07A $64.87

Up to 15 minPg22

Counselling

Pain* 03.05O $46.33

Palliative* 03.05I $50.66

Psych 08.19G $46.33

15 min units

Pg32,35

Pick one stream: choose wisely

Practice Management Billing . Department of Family Medicine . Fee codes May 28 2015 . Dr Wendy Tink

Fee codes: time modifiers direct/indirect

- 10 -

ComprehensiveAt 30 min add modifier

1 only $31.11

03.04A/B $101.9303.04A + cmxc 30

03.04M preop $101.9303.04M + 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 $92.66Palliative* 03.05I $50.66

Psych 08.19G $46.33

15 min units**Modify by

doubling** major portion

Pick one stream: longer visits add modifiers**


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

Limitedat 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 min03.03A +cmgp02

$72.29

CounsellingPer 15 min

Pain* 03.05O $46.33


Psych 08.19G $46.33

15 min

Double/major portion

* team

Pick one stream: best value


Fee codes: review

- 12 -

Comprehensive

First PNPeriodic exam

03.04A/Bdirect care

+ Time modifier at 30 min

direct / indirect

+1 cmxc30$31.11

Pg 21

Limited

Routine visit03.03A/B

direct care

+cmgp at 15 min and

+cmgp each next 10 mins max 10

direct / indirectcmgp each $17.61

Pg 20

CounsellingPer 15 min

Double at 1/2 int

Pain* 03.05O $46.33


Psych 08.19G $46.33

direct care

Pick one stream: insert into memory!


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 -


Overview

Practice Management Billing . Department of Family Medicine . Fee codes May 28, 2015 . Dr Wendy Tink - 14 -

Comprehensive Visits

At 30 min add

CMXC30 = $31.11Direct/IndirectOne only

Limited Visits03.03A

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

Visits Time Modifiers ProceduresPhone calls

Call back ltc ++ + +Complex Care

Plan +

Annual Complex Care Plan most responsible doc


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

PhoneCall to ltc+ +

Complex Care Plan

pg23PhoneProcedures+ ++

03.04J$193.97

• 2 chronic diseases A/B• smart goals patient &doc• signed doc* &patient• once yearly• review / follow up

Fee Codes: Add procedures


Visits Time Modifiers Procedures

Phone CallsHome, ltc

visits+ + +

M add visit ? add tray?

07.57A Initial Burn $37.07 + tray

98.03A I + D Abscess $28.23 + tray + v

98.12C Removal Seb. Cyst $47.12 + tray + v

13.59A IM / SQ Injection $9.88 + v

13.99BC Pap or gyne swab $27.80 + v

81.8 IUD Insertion $67.18 + tray + v

93.91A Joint Aspiration/ $36.71 + tray + vInjection (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

ALWAYS CHECK GP BILLING RULES AMA pg 50 April 2015

Complex Care Plan +

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 MonthlyPhysician to Physician * phone consult

03.01LG (H, I) $32.43/42.57/50.23

Physician to other Pg 25

03.01LM Ob outpatient worker $17.71/26.16/30.8703.01B Mental health worker $16.99/26.50/30.92

03.01NG Allied health - ltc, hosp+ $16.99/20.28/23.9403.01NM Pharmacist $15.1203.05JR Patient $15.12

Complex Care Plan

+

Phone Stuff

Fee codes: Out of office care $$

Home VisitsPg 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

+115.74

0700-17:00 WD

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

$148.27

$23.80

$108.11

+

+03.03E

A

+03.03E

A

+03.03E

A

+03.03E

A

$42.70

Practice Management Billing . Department of Family Medicine . Fee codes May 28 2015 . Dr Wendy Tink - 18 -

+ cmgp modifiers + 03.01AA time modifiers

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

TEVTWKTDES

W/D 17:00 – 22:00W/E 0700 – 22:00Des hol 07.00 – 22:00

22.22/ 15min

TSTTNTPTNTA

Stat hol 07:00 – 22:0022:00 – 24:0024:00 - 07:00

44.43/ 15min

2400 (midnight)

7:00 am 5:00 pm 10:00 pm 2400 (midnight)

TNTA

$44.43/15 min

TEV

$22.22/15 min

TNTP$44.43/15 min

ANY EVENING, NIGHTS

Office Fee Codes: Summary- 20 -

Whole Limited

PallPain

Psych

or

Complex Care Plan

Phone CallsProcedures

Resources: GP Billing Rules and Codes AMA April 1, 2015 ICD 9 Diagnostic codes

Time modifiersCmxc30

orCmgp01+

TimeModifierMultiples

NH / Home Visits /

OB / ER

+ + + +

03.04J Usually add to visit

Time of day

matters!

Visit +

Call back+

Modifiers


Choose

21

Become a skilled clinician …. … and PRACTICE BILLING … before it really matters!Small groups Fill in dx codes and billing

Patient totals and day total PRIZESPractice Management Billing . Department of Family Medicine . Fee codes May 28, 2015 . Dr Wendy Tink

22

Become a skilled clinician …. … and PRACTICE BILLING … before it really matters!Small groups Fill in dx codes and billing

Patient totals and day total PRIZESPractice Management Billing . Department of Family Medicine . Fee codes May 28, 2015 . Dr Wendy Tink