Plugging the Leaks: Leveraging Available Tobacco Cessation Resources

Transcription

1 Plugging the Leaks: Leveraging Available Tobacco Cessation Resources Welcome Please Stand By. We will begin Shortly Friday, November 7 th, :30am CST (1 hour)

2 Moderator, LTCC and LPHI Alex Hurst Cessation Manager, Louisiana Campaign for Tobacco Free-Living Louisiana Tobacco Cessation Consortium is a collaborative group of cessation professionals who use the principles of Partnerships, Programs and Policy to expand comprehensive tobacco cessation services and initiatives.

3 Welcome Alex Hurst Agenda Smoking Cessation Trust Overview Mike Rogers Gilsbar 360 Credentialing Karen Dixon Billing for Cessation Services Dennis Keller Clinic Testimonial Amy Sonnier

4 Webinar Objectives By the end of the presentation, attendees will: Have a general understanding of the cessation resources available through the Smoking Cessation Trust; Be able to initiate the process that will allow for your clinic or facility to get reimbursed through the Smoking Cessation Trust; Be able to implement/enhance existing tobacco cessation services by leveraging the referral process through the Smoking Cessation Trust.

5 Poll Question #1

6 Poll Question #2

7 Poll Question #3

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9 Funded by a 2010 Court of Appeal decision, affirming the decision in the Scott v. American Tobacco Co., et al class action lawsuit, the Smoking Cessation Trust was created in 2011 to provide smoking cessation programs for Louisiana residents who began smoked cigarettes prior to September 1, 1988 (Scott Class).

10 To be covered by the Smoking Cessation Trust fund, members must: Complete an Application for participation in the Scott Class Have begun smoking cigarettes prior to September 1, 1988 Reside in Louisiana Be approved by the Judge Presiding over the Scott Class

11 Telephone quit-lines The smoking cessation program defined by the Court is comprised of four evidence-based components: Health systems interventions (covers costs associated with major modifications to systems of care related specifically to cessation) Intensive cessation programs (programs offering combination of treatment regimens) Reimbursement for smoking cessation Nicotine Replacement Therapy (NRT) and related Medications

12 SCT s Program : Based on U.S. Public Health Service s Treating Tobacco Use and Dependence: 2008 Update, a Public Health Servicesponsored Clinical Practice Guideline Product of the Tobacco Use and Dependence Guideline Panel Panel responsible for identifying effective, experimentally validated tobacco dependence treatments and practices Guideline update reflects the distillation of a literature base of more than 8,700 research articles Updated coding

13 Our services are provided by:

14 Baton Rouge General (2) Provider Programs Contracted with SCTMS for: Clinic-based programs Group counseling programs Health systems interventions Cardiovascular Institute of the South (14) Ochsner Health System (3) Mary Bird Perkins Cancer Center (5) Slidell Memorial Hospital (1) West Jefferson Medical Center (1) LSU Health Sciences Centers/Charity Hospitals (State-wide) (11) Louisiana Heart Hospital (Lacombe) Rapides Foundation (Alexandria)

15 Provider Programs in Discussions with SCTMS for: Clinic-based programs St. Francis Medical Center (Monroe) Our Lady of the Lake RMC (Baton Rouge) Group counseling programs Health systems interventions

16 The smoking cessation program defined by the Court is to provide payment for smoking cessation services for 10 years.

17 Hi-lights of Smoking Cessation Trust Development To-date Completed design & implemented program Nov to Sept First Member: April 2012 Open for business: Oct. 1, 2012 Serve + 17,109 Members in all Louisiana Parishes (as of 06/30/14) 2014 Average +1,397 new applicants/month

18 SCTMS Mission SCT Management Services, L3C (SCTMS) was created by the Smoking Cessation Trust to manage the daily activities necessary to execute the Trust s mission. In that regard, SCTMS has exclusive operational responsibility for the execution of all relationship and/or infrastructure needs required to meet the goals of the Trust. Arrange for the highest level of smoking cessation services possible to the greatest number of Scott Class Members. Increase the number of exsmokers (smokers who quit) in Louisiana. Make significant positive contributions to improving Louisiana s clinical smoking cessation services for smokers in Louisiana.

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20 Gilsbar 360 Alliance Provider Participation Process A non-contracted provider can request participation in one of two ways; by *Calling our provider contracting number at , Option 4 or *Accessing our provider website at selecting the Provider Enrollment tab, and completing and submitting the provider enrollment request form.

21 Gilsbar 360 Alliance Provider Participation Process When the provider enrollment request is received, if further information is needed, the provider will be contacted by a network representative in order to obtain necessary information and send appropriate enrollment documentation. The following Smoking Cessation information is sent with the enrollment documentation that includes: A La Standardized Credentialing Application Provider agreement Details on credentialing documentation required Relevant contact and submission information

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23 Gilsbar 360 Alliance Provider Participation Process Along with this overview, we attach the listing of eligible provider CPT codes with descriptions that can be billed for reimbursement when services are rendered to a SCT enrolled member. Many providers will request these codes so they will know what is appropriate to bill up front, and also to obtain their reimbursement for these services. We provide this documentation as an added service explaining participation as it relates to a Gilsbar 360⁰ Alliance contracted provider. This information can also be obtained from the Smoking Cessation Trust.

24 Physician Participation and Credentialing Standards You will comply with our plan participation requirements, including our credentialing guidelines, which include: 1. Physician will provide upon enrollment in the plan: A current and complete copy of the Louisiana Standardized Credentialing Form or a copy of your CAQH application with attestation signature within 180 days of contract effective date. Copies of the following documents: Gilsbar 360 Alliance Provider Participation Process Current state license Current DEA certificate Current CDS certificate Current liability or malpractice insurance certificate Current board certification document with effective date Current W-9 form Written verification of admitting privileges at a participating hospital, or where specialty requires, consulting or other necessary privileges. 2. Physician will provide updated credentialing information as part of our provider file maintenance and re-credentialing requirements. Enrollment period is between days.

25 Gilsbar 360 Alliance Provider Participation Process Contracted providers can obtain information about the program by Calling our provider line at Visiting our provider at Faxing a request to Provider Relations at The following overview will be sent to the provider giving them all of the information needed to render services to the member, billing guidelines and obtaining member benefits and claims information.

26 The Louisiana Smoking Cessation Trust Fund Program is being administered by Gilsbar. Please note the below: Your patients utilizing this program, must be set up with The Smoking Cessation Trust in order for claims to pay. (A person applies for coverage on-line through the Smoking Cessation Trust (SCT) website. Their application is then pended until approved by the judge overseeing the program (he is verifying that the person meets the requirements for participation). Once the application is approved SCT sends Gilsbar eligibility and we set the individual up in our system and send the participant a packet and their identification card. The providers must be participating in the Gilsbar 360 Alliance Network in order for the claim to pay on a fee schedule. If the provider has questions or is not participating in the network, they may access our website and complete the enrollment request form at and they will be contacted or forwarded the appropriate enrollment documentation. The provider may call the Customer Contact Center at to verify if the member is active in the system and eligible to receive benefits for the program. (Copy of ID card is included in the attached listing of codes below). If a claim has rejected, it may be because the member is not set up in the system for the DOS on the claim; once the member is set up, the claim can be re-filed and will pay accordingly. Checking member s eligibility should be done in all instances prior to rendering services. The provider must file the CPT Codes listed on the attached brochure in order for the claims to process for the member who is participating in the Smoking Cessation Trust Program.

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29 Smoking Cessation Trust Medical Claims Administration SCT Management Services uses Gilsbar as it s TPA (Third Party Administrator) for Medical Claim processing. SCTMS also utilizes the Gilsbar 360 Alliance PPO network (Over 13K providers in network). Provider s not currently part of the Gilsbar 360 Alliance PPO network can easily join the network by calling Gilsbar at or contracting directly with SCTMS.

30 Medical Benefit Coverage Approved SCT Members will be eligible for up to two 120-day benefit coverage periods in their benefit year *. SCT members will need to notify SCTMS by or (504) to activate their second 120 day benefit coverage period should additional smoking cessation services be desired or the provider can activate 2 nd benefit period using the online SCT member portal. * Benefit Year Represents a 365 day period beginning with the SCT members effective coverage date.

31 Medical Services covered under the Smoking Cessation Trust program Three Categories of Medical Services Covered 1. Group Counseling 2. Individual Counseling 3. Provider Based Office Visits ICD-9 Codes Covered (305.1, 649.0X, , & V15.82) No Copays or Coinsurance to Patient if properly billed

32 Service Coverage and Limits Smoking Cessation Trust Eligible CPT Codes (When Billed with ICD-Codes 305.1, 649.0X, , V15.82) Eligible Group Counseling CPT Codes Up to 18 visits per Benefit Year (or 9 visits per each 120 day benefit period) Group psychotherapy (other than a multiple-family group) Health & Behavior Intervention, each 15 Minutes, Face to Face; Group (2 or More Patients) Health & Behavior Intervention, each 15 Minutes, Face to Face; Family (With Patient Present ) Health & Behavior Intervention, each 15 Minutes, Face to Face; Family (Without patient present) Physician educational services in a group setting Preventive medicine counseling and/or intervention to treat the risk factor of tobacco use provided to an individual in group setting (separate procedure); approximately 30 minutes Preventive medicine counseling and/or intervention to treat the risk factor of tobacco use provided to an individual in group setting.

33 Service Coverage and Limits continued Eligible Individual Counseling CPT Codes Up to 4 visits per Benefit Year ( or 2 visits per each 120 day benefit period) Psychotherapy, 30 minutes face-to-face services with the patient and/or family member, with the patient present for some or all of the service Psychotherapy, 30 minutes with patient and/or family member when performed with an evaluation and management service Psychotherapy, 45 minutes face-to-face services with the patient and/or family member, with the patient present for some or all of the service Psychotherapy, 45 minutes with patient and/or family member when performed with an evaluation and management service Psychotherapy, 60 minutes face-to-face services with the patient and/or family member, with the patient present for some or all of the service Psychotherapy, 60 minutes with patient and/or family member when performed with an evaluation and management service Health & Behavior Assessment/Intervention, each 15 Minutes, Face to Face; Individual Preventive medicine counseling and/or intervention to treat the risk factor of tobacco use provided to an individual treat the risk factor of tobacco use provided to an individual (separate procedure); approximately 15 minutes Preventive medicine counseling and/or intervention to treat the risk factor of tobacco use provided to an individual (separate procedure); approximately 30 minutes Preventive medicine counseling and/or intervention to treat the risk factor of tobacco use provided to an individual (separate procedure); approximately 45 minutes Preventive medicine counseling and/or intervention to treat the risk factor of tobacco use provided to an individual (separate procedure); approximately 60 minutes. D1320 Tobacco Counseling; Oral Diseases.

34 Service Coverage and Limits continued Eligible Provider Based Office Visit CPT Codes Up to 4 visits per Benefit Year ( or 2 visits per each 120 day benefit period) Health & Behavior Assessment, each 15 Minutes, Face to Face with the Patient (Initial Assessment) Health & Behavior Assessment, each 15 Minutes, Face to Face with the Patient (Re-Assessment) Initial comprehensive preventive medicine evaluation and management of an individual including age & gender appropriate history, exam, counseling/anticipatory guidance/risk factor reduction interventions, new patient age years Initial comprehensive preventive medicine evaluation and management of an individual including age & gender appropriate history, exam, counseling/anticipatory guidance/risk factor reduction interventions, new patient age years Initial comprehensive preventive medicine evaluation and management of an individual including age & gender appropriate history, exam, counseling/anticipatory guidance/risk factor reduction interventions, new patient age 65 years and older Periodic comprehensive preventive medicine reevaluation and management of an individual including age & gender appropriate history, exam, counseling/anticipatory guidance/risk factor reduction interventions, established patient age years Periodic comprehensive preventive medicine reevaluation and management of an individual including age & gender appropriate history, exam, counseling/anticipatory guidance/risk factor reduction interventions, established patient age years Periodic comprehensive preventive medicine reevaluation and management of an individual including age & gender appropriate history, exam, counseling/anticipatory guidance/risk factor reduction interventions, established patient age 65 years and older Smoking and tobacco-use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes. Short descriptor: Smoke/Tobacco counseling Smoking and tobacco-use cessation counseling visit; intermediate, greater than 10 minutes. Short descriptor: Smoke/ Tobacco counseling greater than 10 minutes G0436 Smoking and tobacco cessation counseling visit for the asymptomatic patient; greater than 3 minutes, up to 10 minutes G0437 Smoking and tobacco cessation counseling visit for the asymptomatic patient; intensive, greater than 10 minutes

35 Medical Coverage or Billing Questions? Please call SCT Management Services at if you have any questions regarding benefit coverage limits.

36 86 approved applications 102 reimbursable visits

37 Questions and Answers Feel Free to submit questions via the Chat Box