Medicare Billing for Behavioral Health Screenings: From Reimbursement Policies to Best Practices in Primary Care

Transcription

1 Medicare Billing for Behavioral Health Screenings: From Reimbursement Policies to Best Practices in Primary Care Collaboration between HealthInsight, HSAG and Noridian November 8,

2 Who is HealthInsight? Our business is redesigning health care systems for the better HealthInsight is a private, non-profit, communitybased organization dedicated to improving health and health care in the western United States. 2

3 Arizona and California Providers: Where to Go for Help? Debashish Dave Mittra, MBA, PMP Executive Director, Physician Office Quality Health Services Advisory Group (HSAG) November 8, 2017

4 Disclosure I have nothing to report, nor are there any real or perceived conflicts of interest, implied or expressed, in the following presentation. Debashish Mittra, Executive Director 2

5 Agenda Introduce HSAG Resources available for depression and alcohol misuse screening Resources available for assistance with QPP and MIPS Questions 3 QPP = Quality Payment Program MIPS = Merit-based Incentive Payment System

6 HSAG: Your Partner in Healthcare Quality HSAG is the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands. Committed to improving healthcare quality for more than 35 years. QIN-QIOs in every state/territory are united in a network under the Centers for Medicare & Medicaid Services (CMS). The Medicare QIO Program is the largest federal program dedicated to improving healthcare quality at the community level. 4

7 HSAG s QIN-QIO Territory Nearly 25 percent of the nation s Medicare beneficiaries HSAG is the Medicare QIN-QIO for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands. 5

8 How Can HSAG Help?

9 Depression and Alcohol Misuse Screenings Tools and resources to support screenings Assistance to train staff in conducting screening and document in the electronic health record (EHR) Access to best practices and webinars Integrate screenings in your practice workflow Benefits Improve screening rates Increase reimbursements 7

10 Participation in QPP and MIPS No-cost HSAG QPP Service Center Help to select quality measures and improvement activities Tools and resources to improve MIPS Quality Scores Access to exclusive on-demand live agents to answer your questions Invitations to webinars 8

11 How to Get Help For questions related to screening and billing Medicare for depression and alcohol misuse screenings: For Arizona, contact Padma Taggarse For California, contact Debashish Dave Mittra For questions and assistance related to QPP and MIPS, please contact our QPP Service Desk: 9

12 Questions 10

13 Thank you! Debashish Mittra, MBA, PMP HSAG, Executive Director, Physician Office Quality

14 This material was adapted by Health Services Advisory Group, the Medicare Quality Improvement Organization for Arizona, California, Florida, Ohio, and the U.S. Virgin Islands, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services, based on original content from CMS. The contents presented do not necessarily reflect CMS policy. Publication No. QN-11SOW-G

15 Today s Presenters Christopher Wells assists clinics, hospitals, in-patient psychiatric facilities and other health care organizations in quality improvement around provider process and patient outcomes. He has worked as a research associate for a non-profit public health evaluation firm. He has experience working with behavioral health providers and served as a research coordinator in a busy Los Angeles medical practice. Christopher received his Master s in Public Health from UCLA and his undergraduate degrees in psychology and sociology from Georgia State University. He is a regular contributor to Oregon-based Patient-Centered Primary Care Home Institute s Technical Assistance Network Online Community for practice managers and facilitators. Lori Weber is the current Idaho, Oregon and Utah Provider Outreach and Education (POE) representative with Noridian Healthcare Solutions, LLC. She joined Noridian, the current Medicare Part B fee-for-service contractor for 13 states and 3 islands, in She is a local chapter member of the American Academy of Professional Coders or AAPC, on the CMS/Noridian Carrier Advisory Committee (CAC), co-chairman of the Idaho HealthCare Conference (IHCC) and board advisor to Carrington College. She enjoys assisting and educating the provider community. 3

16 Welcome and Introductions Please type in the chat: Your geographical location Position within your organization (e.g., provider, biller, MA, office manager) 4

17 Alcohol and Depression in Older Adults: The Numbers Percentage of older adults who die from alcohol-related deaths each year Number of older adults who suffer from depression 5

18 Depression Screening PHQ-2 PHQ-9 6

19 Alcohol Screening 7

20 Poll How often do you screen Medicare patients for depression and alcohol use? - Not at all - Less than 25% % % - 75% or more 8

21 Poll How often do you bill for depression and alcohol use screening? - Not at all - Less than 25% % % - 75% or more 9

22 Revenue Potential 10

23 Behavioral Health Screening Presented by: Medicare Part B Provider Outreach and Education November 2017

24 DISCLAIMER This information release is the property of Noridian Healthcare Solutions, LLC. It may be freely distributed in its entirety but may not be modified, sold for profit or used in commercial documents. The information is provided as is without any expressed or implied warranty. While all information in this document is believed to be correct at the time of writing, this document is for educational purposes only and does not purport to provide legal advice. All models, methodologies and guidelines are undergoing continuous improvement and modification by Noridian and CMS. The most current edition of the information contained in this release can be found on the Noridian website at and the CMS website at The identification of an organization or product in this information does not imply any form of endorsement. CPT codes, descriptors, and other data only are copyright 2017 American Medical Association. All rights reserved. Applicable FARS/DFARS apply. November

25 Helpful Acronyms Acronym CCI CR E/M F2F IOM POS USPSTF Description Correct Coding Initiative Change Request Evaluation and Management Face to Face Internet Only Manual Place of Service United States Preventive Services Task Force November

26 Agenda Behavioral Health Screening Overview Alcohol Misuse Depression Screening, Brief Intervention and Referral to Treatment (SBIRT) Annual Wellness Visit (AWV) with above Resources November

27 Behavioral Health Screening

28 Screening Services Services detecting undiagnosed disease Early detection may prevent harm where and when patient has no Signs Symptoms Laboratory evidence Radiological evidence Personal history of disease November

29 USPSTF U.S. Preventive Services Task Force (USPSTF) makes recommendations to guide medical practices, patients and payers to determine Preventive or screening services recommended for individual Medicare patients Affordable Care Act (ACA), otherwise known as the health care reform bill, requires Medicare Cover services with A or B rating at 100%, without copay or deductible for Medicare patients November

30 Alcohol Misuse Screening G0442 Annual screening Up to 15 minutes If screening is positive, may have up to 4 counseling sessions in 12-month period G0443 Brief F2F counsel once/day Up to 15 minutes All Medicare beneficiaries eligible Coinsurance and deductible waived Allowed in POS 11, 22, 49, 71 November

31 Alcohol Misuse Screening 2 Medicare beneficiary counseling eligibility: Alcohol misuse where levels/patterns of consumption do not meet alcohol dependence and desire to quit Competent/alert at time of counseling and furnished by qualified primary care physician or practitioner in primary care setting Noridian s Portal contains eligibility G0442/G0443 (updated 11/8/17) November

32 Alcohol Misuse Screening 3 Counseling completed with Five A s Approach: 1. Assess: Ask about or assess behavioral health risks and factors affecting choice of behavior change goals/methods. 2. Advise: Give clear, specific and personalized behavior change advice, including personal health harms and benefits. 3. Agree: Collaboratively select appropriate treatment goals and methods based on the patient s interest in and willingness to change the behavior. November

33 Alcohol Misuse Screening 4 Counseling continued: 4. Assist: Using behavior change techniques (self-help and/or counseling), aid patient in achieving agreed upon goals by acquiring the skills, confidence and social/environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate. 5. Arrange: Schedule follow-up contacts (in person/telephone) to provide ongoing assistance/support and adjust treatment plan as needed, include referral to more intensive or specialized treatment. November

34 Eligible Providers May submit claims for G0442 & G0443: 01-General Practice 08-Family Practice 11-Internal Medicine 16-Obstetrics/Gynecology 38-Geriatric Medicine 42-Certified Nurse Midwife (CNM) 50-Nurse Practitioner (NP) 89-Certified Clinical Nurse Specialist (CNS) 97-Physician Assistant (PA) November

35 Depression Screening NCD G0444 Annual depression screening Up to 15 minutes with all elements met No specific screening tools POS 11,19, 22, 71 Deductible/coinsurance waived AWV same day per CCI? Initial (G0438) no; Established (G0439) yes Noridian Portal contains eligibility November

36 Depression Screening 2 Estimate 1 in 6 (over 65) suffer depression Does not include treatment options, therapeutic interventions such as: Counseling, pharmacotherapy, phone calls, selfhelp or medications are non covered Primary care setting with clinical staffassisted support (e.g., RN) Assures accurate diagnoses, effective treatment, coordinate referrals and follow up Not considered primary care: ED, IP hospital, IP rehab facility, ASC, IDTF, SNF or hospice November

37 SBIRT Services Screening, Brief Intervention and Referral to Treatment (SBIRT) G0396 (alcohol/other substance abuse assessment/intervention mins.) G0397 (additional 30 mins) Need start/stop times with time-based codes Eligible MD, NP, PA, CNM, CNS, CP, CSW POS 11 (office) or 22 (outpatient hospital) November

38 SBIRT Services 2 Identifies, reduces & prevents problematic substance use disorders with early intervention; 3 major components: 1. Screening: risky substance use behaviors using standardized assessment tools 2. Brief Intervention: short conversation providing feedback, motivation and advice up to 5 counseling sessions 3. Treatment Referral: provide to brief therapy/additional treatment if show need November

39 SBIRT Services 3 March pages -and-education/medicare- Learning-Network- MLN/MLNProducts/downloads /SBIRT_Factsheet_ICN pdf Documentation requirements and billing dual eligible May perform Telehealth -and-education/medicare- Learning-Network- MLN/MLNProducts/downloads /TelehealthSrvcsfctsht.pdf November

40 Annual Wellness Visit (AWV)

41 AWV G0438 Once in a lifetime (initial) G0439 Annually (subsequent) No specific diagnosis code required Coinsurance/deductible waived Performed by health professional: MD, PA, NP, CNS Other medical professional (health educator, registered dietitian, nutrition professional or other licensed practitioner) Team of such medical professionals, working under direct supervision of physician (e.g. RN) November

42 Initial AWV Components Acquire Beneficiary History Health risk assessment Establish current providers Establish medical/family history Potential depression risk review factors Review of functional ability/level of safety Assessment Obtain measurements Detection of cognitive impairment Counsel Beneficiary Establish of written screening schedule Establish list of risk factors and conditions for intervention Personalized health advice November

43 Subsequent AWV Components Update Beneficiary History Update health risk assessment Update current provider list Update medical and family history Assessment Obtain measurements Detect cognitive impairment Counsel Beneficiary Update written screening schedule Update intervention risk factors/conditions Personalized health advice November

44 Prepare for AWV Visit Suggested Information Needed From Patient Medical records, including immunization Family health history, as much detail possible Full list of medications and supplements Include calcium and vitamins How often/how much of each taken Full list of current providers and suppliers involved in providing care November

45 Preventive Services Checklist November

46 Miscellaneous Tips Check CCI if screening allows same day AWV G0396/G0397 (SBIRT) = allowed (no CCI) G0442/G0443 (Alcohol Misuse) = allowed G0444 (Depression) cannot bill same day as IPPE or initial AWV Subsequent AWV allowed (G0439) Noridian Portal has eligibility searches: Alcohol Misuse G0442/G0443 Depression (G0444) Cannot search portal: AWV (G0438/G0439) SBIRT G0396/G0397 November

47 In Conclusion. Today, we spoke to Behavioral Health Screenings for Alcohol Misuse, Depression, SBIRT and the AWV More Noridian Preventive/Screening PDFs: JF education/event-materials JE education/event-materials November

48 RESOURCES

49 National Coverage Determination (NCD) IOM References Medicare Internet Only Manual (IOM) , Chapter 15, Section , Chapter 1, Part 4, Section 210 National Coverage Determination (NCD) and , Chapter 18, Sections 140,180, 190 November

50 CMS Preventive Services Chart ninfo/medicare-preventive-services/mps- QuickReferenceChart-1.html November

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52 Paper Billing with High Return From Electronic Tracking back to Paper Tracking Behavioral Health Billing Best Practice 1 of 2 Medical Assistant Physically highlights the necessary lines (services) on billing Clips billing document to front of physical paper chart Provider Using traditional pre-emr billing checklist document, weekly/bi-weekly meetings are used to indicate which measures should be looked at closely by individual providers or the group as a whole Reviews completed screenings, ensures documentation within EMR prior to closing chart Physically checks depression or alcohol screening on the billing document Closes chart and returns physical chart to biller for review Billing Add relevant encounter and service codes that were checked on the billing document

53 Using an EMR s Fullest Potential Keeping Everyone Accountable Behavioral Health Billing Best Practice 2 of 2 Medical Assistant Provider Morning chart scrubbing to include whether annual screenings were conducted Collects completed screening and enters into EMR If high score on depression/alcohol screen(s) then verbally mentions to provider and leaves completed form on front of chart Closes encounter and ensures documentation that screening occurred has been delineated Billing After chart close, biller reviews the electronic chart to ensure documentation of service provided and proper coding If does not contain both documentation or coding biller contacts provider to close loop

54 Questions?

55 Questions and More Information HealthInsight Support Call: Web: This material was prepared by HealthInsight, the Medicare Quality Innovation Network-Quality Improvement Organization for Nevada, New Mexico, Oregon and Utah, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-G /8/17 14