Rate Changes! Evaluation and Management and Vaccine Administration Service Codes

"The Colorado Medicaid reimbursement rates for evaluation and management procedure codes and vaccine administration procedure codes are changing. The Department reimbursed these codes at a Medicare equivalent rate to comply with Section 1202 of the Affordable Care Act (ACA) for calendar years 2013 and 2014, and temporarily extended the Medicare equivalent rate through June 2016. The funding to reimburse the evaluation and management and vaccine administration codes at a Medicare equivalent rate ends on June 30, 2016.

From July 1, 2016 through June 30, 2017, through the efforts of the Department and provider associations, one year of additional funding is authorized to reimburse several evaluation and management categories and vaccine administration at higher than the Medicaid rates in place in December 2012, prior to the implementation of Section 1202. The evaluation and management categories with temporary funding are:

· Standard office visits

· Preventive care office visits

· Newborn visits

· Neonatal and pediatric critical care visits

· Counseling visits

While rate changes take effect on July 1st, the Centers for Medicare and Medicaid Services (CMS) must approve changes to the Department’s State Plan before the rates may be paid. Due to the timing on CMS approval, the new rates may not be paid starting on July 1. If needed, the Department will mass adjust all qualified claims in the system once CMS approval is received.

The FY16-17 reimbursement rates for these procedure codes are available online at E&M_and Vaccine Code reimbursement. These rates are scheduled to return to the December 2012 level on July 1, 2017. Categories of evaluation and management that did not receive additional funding will be reimbursed at the December 2012 level starting July 1, 2016. These include emergency room visits, inpatient visits, critical care visits (excluding neonatal and pediatric critical care visits), home visits, when visits are prolonged, and standby/warfarin/interdisciplinary conference visits.

If you have questions, please contact Richard Delaney, Policy Specialist, at richard.delaney@state.co.us.

[Source: HCPF]

Vital Clinical Documentation for the CHC Provider

"Provider documentation is at the core of effective, safe and reimbursable patient care. Yet coding, a key component of documentation, continues to be challenging for both providers and coders. CCHN created a training that includes an accessible web-based curriculum offering a step-by-step training module where participants will learn everything they need to know about: coding patient histories, physical exams and medical decision-making. The curriculum includes real life examples, and participants will see that it's not the quantity of documentation that matters--it's the quality. All CHC providers and coders are encouraged to take advantage of this training opportunity."

Cost: $100 (If cost is a barrier, please contact Sarah Macrander.)
Audience: Community Health Clinic providers and coders.
Click here to register.

[Source:  CCHN]

Training Opportunities: From Coding to Teambuilding

Vital Clinical Documentation and Coding Training for Providers and Coders
CCHN created an accessible web-based curriculum offering a step-by-step training module where participants will learn everything they need to know about: coding patient histories, physical exams and medical decision-making.  All providers and coders are encouraged to take advantage of this training opportunity.
registration closes August 12, 2016
Cost: $100 (If cost is a barrier, please contact Sarah Macrander.)
Audience: Providers and coders.
Click here to register.

Texting and Emailing with Patients – HIPAA Compliance Training
MentorHealth's web-based session will focus on the rights of individuals to communicate in the manner they desire, and how a medical office can decide what is an acceptable process for communications with individuals.
June 28, 2016, 11:00 a.m. – 12:00 p.m.
Cost: $139 per participant
Click here to learn more and register.

Enhancing Teambuilding 
Edward Leigh Center for Healthcare Communication
May 18, 2016, 12:00-1:00 p.m.
This session will provide tools to understand vital steps of the team-building process.  The session focuses on these key areas: a clear understanding of each individual’s responsibilities in a team; keeping a team motivated; and handling team conflict.  Click here to register.

Software and Technology
Teaming for Technology is a Colorado nonprofit that offers cost effective training on a variety of software and technology.
Cost: $20 per person per class
To register and view a complete list of training opportunities click here.

[Source: CCHN]

Overview of Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) presentation available

“Centers for Medicare & Medicaid Services (CMS) CPT, HCPCS, and Bundling 2015 presentation is available for review. The presentation provides an overview on CPT and HCPCS history, how changes in coding are determined, and how to use both manuals. The presentation also provides additional resources for agency staff that work with coding and billing.” [Source: CMS]

UPDATE: Medicaid and Medicare Coding Available for Integrated Care

"As part of completing the Colorado (Promoting Integrated Care Sustainability (PICS) project recommendations, Medicaid and Medicare coding worksheets have been completed to assist in billing for integrated primary and behavioral care services.

A webinar and slides explaining the coding worksheets and their use can be found online. Scroll down to the billing/coding presentation called "Billing for Integrated Care Services — CO PICS" to access..."

Click the following links to access the documents:

• Medicaid Codes Available for Integrated Care 
• Medicare Codes Available for Integrated Care
• Medicare SBIRT (Screening, Brief Intervention & Referral to Treatment) document 

For more information, contact Marilyn S. Gaipa with Care Solutions, LLC.

Medicaid and Medicare Coding Available for Integrated Care

"As part of completing the Colorado (Promoting Integrated Care Sustainability (PICS) project recommendations, Medicaid and Medicare coding worksheets have been completed to assist in billing for integrated primary and behavioral care services.

A webinar and slides explaining the coding worksheets and their use can be found online. Scroll down to the billing/coding presentation called "Billing for Integrated Care Services — CO PICS" to access..."

Click the following links to access the documents:

• Medicaid Codes Available for Integrated Care 
• Medicare Codes Available for Integrated Care

For more information, contact Marilyn S. Gaipa with Care Solutions, LLC."