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.
Leave a Reply