What a joy it is to spend a day digging through New York OMH materials to make sense of the new clinic model for reimbursement. It was truly a test for the Attention Deficit Disorder that wants to take over my life. It is, however, something we need to concentrate on, and fast.
I just received a correction in my simple understanding of the restructure of billing, boiling it down to the lowest common denominator. I had thought CPT codes needed to be in the same APG to be reimbursed for a given day, however, I was told that’s not the case.
In order to get reimbursed under the new model for a day’s service,
– Multiple CPT codes can be billed for that day o e.g. 96118 (psych testing) and 90853 (1 hr group therapy) o Two services is supposed to be the daily limit, but OMH is still working on this – The CPT codes must be contained in separate APGs for a day’s billing o Per the example above o There will be exceptions, which haven’t been mapped out yet – The OMH provided spreadsheet-calculators rule regarding rates o They’re available on the OMH website, search for Clinic Restructuring – The provider simply bills for their base rate for appropriate APGs, to be reimbursed according to the weighted rate for each CPT code.
That being the case, the foundation work for clinics lies in scheduling the proper procedures for every patient visit in order to maximize revenue. These allowable procedures are designed to encourage better outcomes of treatment. Does your scheduling process include a person who can make these decisions, or appropriate logic built into your scheduling software?
These thoughts relate back to the October, 2009 David Lloyd presentation, Workshop A – Proven Strategies for Improving Clinic Operation, Profits and the Quality of Care. It’s almost like somebody had a plan.
Naturally the devil is in the details. It can be easy to loose track of foundation objectives and become embroiled in busywork…I think the point of the restructure is to eliminate that sort of wasted effort, be more productive and produce better outcomes.
OK, so once we understand the best way to maximize revenue for the resource spent to earn it, who implements this plan in the clinics? After all, people in the clinics already have jobs.
Terry McLeod stands ready to help.
Read more →By now, your Electronic Medical Record (EMR) should be changing out of necessity, and fast, to keep up with requirements.
In Health & Human Services, we can agree that software vendors are responsible to offer functionality and services that meet demands of major payors like Medicaid and Medicare, which change continuously. What about meeting “meaningful use” of the expensive software you own or are about to purchase? It seems commonly accepted that providers need to take responsibility to assure successful software implementation and its evolution for their agency.
For decades vendors have heard from users that the software they purchased doesn’t do what the users want. In many cases the software contains functionality to meet the need as expressed in an RFP, but fails in the trenches due to a configuration that doesn’t meet workflow requirements of the customer. Arguments over who’s responsible to fix problems can drag on for years.
There are likely as many ways to resolve EMR optimization problems as there are agency and software product combinations. The solution takes time, expertise, and some money.
The best place to start is when you purchase your system, and consultant Rich Temple has some good advice in his recent article “Vendor Viability Assessment – Financial/Strategic“. If you have a system that provides the essence of your enterprise system needs, and you wish to extend its value to your organization, it takes specialized work dealing with your vendor, your executives, supervisors and users to glue the project together. Mr Temple talks about the “seismic changes” in our industry, and what that points out to me is a lot of work most agencies are not staffed to carry out.
EMR optimization takes not only a specialized tool set, but also time that your staff probably can’t spare and complete their day job…the one you hired them to do. This is a new “hole” in the market where people like Terry McLeod come in.
That would be a shameless pitch for your host and his peers…I’m here to help.
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