Transcript Getting Paid for Bright Futures (GEN

2015 User Conference
Getting Paid for Bright Futures (GEN-A90)
April 25, 2015
Presented by:
Susan M. Hannon
Training Specialist
General Session
The Gold Standard
Why are we trying to implement Bright
Futures standards…
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ACA
“The Patient Protection and Affordable Care Act
(ACA) recognized the importance of preventive
care for children by including a critical provision to
ensure that children enrolled in all individual and
group non-grandfathered health care plans receive
the gold standard of preventive care—all
preventive care screenings and services
recommended by the AAP/Bright Futures:
Guidelines for Health Supervision of Infants,
Children, and Adolescents without cost-sharing.”1
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What does that mean?
● These are the guidelines for the Standard of
Care, based on age and gender
● Can be performed without additional cost
sharing to the patient
● Incorporating these recommendations and
billing correctly is essential for the financial
health of our practices
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Where do we start?
OP Well
Visit
Templates
Set the
Stage
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How do we start?
Case Study:
18 month visit Interval Hx, Measurements
Blood Pressure (if needed)
Sensory Screening (if needed)
Developmental Screen
Autism Screen
Psychological/Behavioral Assessment
Physical Exam
Immunizations
Hemoglobin (if indicated)
Oral Health
Anticipatory Guidance
How long do you
book for this
visit?
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➢ Utilize an iterative process for adoption
➢ Standing, Routine and Alternate orders as
needed
➢ Patient Portal for pre-visit completion
○ and a plan for when this doesn’t occur
➢ Utilize parent facing material
○ patient education, patient instruction, anticipatory
guidance and patient exit notes
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Let’s
Look!
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Surveillance vs. Screening
As many as one-half of American children with developmental delay will not
be identified by the time they enter kindergarten, even though many will
show mild developmental delays by two years of age. One reason for low
detection rates is high dependence on clinical surveillance alone.
Barriers to Screening
▪
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time constraints (#1)
competing clinical demands
cost burden
staffing requirements, high staff turnover
lack of consensus on the most suitable tools for the general childhood
population
lack of physician confidence
Because children's development is
dynamic in nature, regular and repeated
screening combined with surveillance is
needed to detect developmental delays.
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Surveillance Tools
❖ Surveillance is considered part of the well
visit and can not be billed but it does take
time.
❖ What is available...
➢ The Bright Futures questionnaires
➢ Developmental questions through age 60 months
❖ When time is a factor...
➢ have the Bright Futures questionnaires completed
prior to the visit
➢ have the clinical staff record milestone
achievements
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Screening - surveys
Validated Surveys for
★ Developmental
★ Psychosocial behavioral
★ Depression
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Screening - labs
Default charge in lab for screening labs in templates
*** can make the test confidential, but if the parent gets the bill, cannot
hide that from parents in most states with most insurances
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Screening - labs or surveys
❖ Tuberculosis: TB testing (PPD)
➢ based on someone who is at high risk
➢ or if the payer (Medicaid) demands it for certain age
groups
■
CPT Code 86580 Skin test; tuberculosis, intradermal (no separate admin code)
■
ICD-9-CM Code V74.1 Special screening examination for pulmonary tuberculosis
➢ 99420 can be used for a TB or lead risk
questionnaire
■
Administration and interpretation of health risk assessment instrument (eg, health
hazard appraisal)
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Let’s
Look!
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Billing Tools
➢ Automatic -33 modifier to anything that is
“preventive” in nature
■ (Note: the 33 modifier means no patient cost sharing)
➢ Charges in your CPT code table
➢ Automatic administration codes on vaccines
■ global settings and payer specific differences
➢ CPT codes on validated screening tools and
labs
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➢What’s available and what’s new?
➢CPT code 96127
■ applied to psychosocial behavioral assessment
■ Examples: PHQ9 and Pediatrics Symptom Checklist
➢CPT code 99188
○ used for Oral health/fluoride varnish
○ The new USPTF recommendations now mandate that all
private insurers recognize and pay for this code.
○ (AAP oral health resources)
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How do we ensure patient’s preventive
visits?
Be proactive with Patient Recalls
use Demographic Analysis and Recall
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❖ What are we up against?
❖ Retail medicine
❖ Urgent Care
➢ reduction in total visits
➢ reduction in revenue
Remember P4P - Pay for Performance
➢ preventive visits and many of these screens are part
of P4P, where compliance increases overall
payment to the practice
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Let’s
Discuss!
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As you implement the standard of care
provided for in the ACA, how can OP assist
you?
➢ Templates
➢ Surveillance and Screen Tools
➢ Delivery of surveys and surveillance tools
through OP or CHADIS
➢ Patient Portal
➢ Billing Tools
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Questions?
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Resources and Footnotes
“Recommendations for Preventive Pediatric Health Care”, American Academy of
Pediatrics, aap.org
Recommendations for Preventive Pediatric Health Care
HealthyChildren.org, from the American Academy of Pediatrics
HealthyChildren.org
Affordable Care Act
Affordable Care Act and Reconciliation Act
FOOTNOTES:
1. “Achieving Bright Futures”, aap.org
https://www.aap.org/en-us/professional-resources/practice-support/Pages/achieving-bright.aspx
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American Academy of Pediatrics
Membership in the American Academy of Pediatrics
helps Pediatricians navigate these ever-changing
waters
“Recommendations for Preventive Pediatric Health Care”, American Academy of
Pediatrics, aap.org
Recommendations for Preventive Pediatric Health Care
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We want your feedback!
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