Practice Management

USEFUL LINKS

AAO OSTEOPATHIC MEDICAL ECONOMICS SUBCOMMITTEE

The AAO Board of Trustees created the Osteopathic Medical Economics subcommittee as an informational resource for members dealing with difficulties regarding reimbursement for osteopathic manipulative treatment (OMT). The committee also reviews documents and audiovisual materials pertaining to medical economics issues, which can be used to influence coverage and reimbursement policies of third-party and legislators alike. The committee serves as a resource for members, insurance companies and attorneys who need access to osteopathic manipulative medicine experts for medical opinions, depositions, and court testimony.

Accurate coding is a skill needed to correctly code for the services/procedures provided will have a positive Impact on your reimbursement. Current Procedural Terminology (CPT) codes and guidelines are accepted by the Centers for Medicare and Medicaid Services (CMS) and commercial payers. However, some Medicare contractors and commercial payers may have varying interpretations of some of the CPT guidelines.

In addition, the American Osteopathic Association has many valuable resources for physicians in practice, including HIPAA guidance, billing and coding information, ICD-10 FAQs, a Medicare enrollment guide and advice for physician who are starting, selling or closing a practice.

CMS PHYSICIAN FEE SCHEDULE

CMS Physician Fee Schedule look-up provides information on services covered by the Medicare Physician Fee Schedule (MPFS). It provides more than 10,000 physician services, the associated relative value units, a fee schedule status indicator and various payment policy indicators needed for payment adjustment (i.e., payment of assistant at surgery, team surgery, bilateral surgery, etc.). Physician Fee Schedule Look-up - https://www.cms.gov/medicare/physician-fee-schedule/search

HOW TO RESPOND TO MEDICAL RECORD REQUESTS (AUDITS)

AAO ASSISTANCE FOR PRACTICE MANAGEMENT

The AAO understands the difficulties members face with practice management issues (e.g., claims denial, documentation, coding, etc.).  A new member benefit will provide you with support in navigating these issues. Our staff has partnered with Sunrise2Sunrise Home Services (SR2) to answer your questions, provide useful information, and find effective solutions. SR2 has more than 20 years of experience in the clinical, practice management, payment resolution and revenue cycle arenas.

They have expertise in Medicare and commercial payers’ reimbursement policies and developing Current Procedural Terminology (CPT) codes through the American Medical Association’s CPT editorial Panel and the subsequent valuation of physician services and procedures the Relative Value Scale Update Committee (RUC) processes. Additionally, SR2 has experience working with osteopathic physicians and has extensive knowledge of reporting osteopathic manipulative treatment (OMT).

Contact the AAO for help finding solutions to your CPT and ICD-10 coding questions, examining Explanation of Benefits to understand claims denial, or drafting first- or second-level appeal letters. Fees may apply. The AAO will continue to analyze changes to existing payment policies to determine the impact on AAO members. For additional information, email the AAO at [email protected] or call the office at 317-879-1881.

DEFINITIONS

New patient: A new patient is one who has not received any professional services from the physician or other qualified health care professional or another physician or other qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years. Therefore, if an established patient has not received care from you or your group in the past 3 years, patient can be billed as a new patient.

Group Practice: Physicians belonging to the same Medicare billing group identification in the same specialty.

WHAT ARE THE CRITERIA FOR E&M VISITS?

History

  • Chief complaint (CC)
  • History of Present Illness (HPI)
  • Review of Systems
  • Past History, Family History, Social History

Other important information to help with grading your medical decision-making should include: Source of Information, e.g., patient, chart or other; miscellaneous information important to physicians, e.g., allergies, prior infectious diseases.

Physical Exam

  • Based on time

Medical Decision Making (MDM)

  • Number and Complexity of Problem Addressed
  • Amount and/or Complexity of Data to be Reviewed and Analyzed
  • Risk of Complication and/or Morbidity of Mortality of Patient Management

To establish how many systems are needed to determine a level of billing, please refer to www.cms.hhs.gov or www.acofp.org.

Modifier 25 details

ACCEPTABLE TIPS ON DOCUMENTATION

  • All other review of systems are negative.
  • Family history unchanged since last visit or give a date.

LIST OF CPT CODES

  • New office codes: 99202-99205
  • Established office codes: 99211-99215
  • Initial Hospital Inpatient or Observation Care Services 99221-99223
  • Subsequent Hospital Inpatient or Observation Care 99231-99233

If you have any questions regarding physician services, billing and coding, reimbursement or practice-related issues, email us at [email protected].