Transcription
PULMONARY REHABILITATIONTOOLKITGuidance to CalculatingAppropriate Charges for G0424Developed by and in Cooperation WithThe American Association of Cardiovascular & PulmonaryRehabilitationThe American Association for Respiratory CareThe American College of Chest PhysiciansThe American Thoracic SocietyThe National Association for Medical Direction ofRespiratory Care
ionservicesunderthefee- ‐for- dapaymentrateofapproximately pitalssubmittingbillsforG0424:1. G0424was 150.2. sultedinapaymentrateof tionofhospitalchargesontheUB- thepaymentratewillremainproblematic.2
TABLE OF CONTENTSSection I: Reduction in Payment for Pulmonary Rehabilitation ServicesDelivered to COPD Patients 4Executive Summary .4Section II: Pulmonary Rehabilitation – Strategies to AddressMedicare Payment Reductions 4Background 4How CMS Derived the PR Payment Rate .5Options That Were Considered 5What the Future Holds .6Section III: Strategic Plan to Address Medicare ReductionsOverview . 6Checklist . 7Multi-society Contacts .8Section IV: Variables in Determining an Appropriate Charge for HCPCSCode G0424 .9Services .9Variation in Services for Patients with Differing Diagnoses .11Exercise Equipment .15Department Equipment and Supplies .15Software .16Written supplies 16Books .16Department Furniture, Accessories 16Uncompensated services 18Section V: Glossary of Terms .193
RreimbursementtoolkitoffersPRproviders:1. graltobundledcodeG0424,and2. rsementofPRservicesbyCMS.Formorein- glossaryoftermsonthisimportantissue,seepages19- entservices,fromapproximately 63to hat4
heUB- ervices,thenapplyinga“cost- ‐to- eof 50for2010and Scalculatedthe f stothechargesforG0237- ‐39,withonehugeflawintheirpremise.CodesG0237- ‐38areone- ‐on- MSwoulduseproxydatafromG0237- thepaymentratesforG0424accordingly.5
roach.Theyinclude:1. eatthelowendofthebillablespectrum.2. SFUL,itwouldtakeatleast6- 13attheearliest,2014asamorelikelytargetdate.3. lledthruG0424)withnon- ‐COPDpatients(billedthruG0237- for2013atapproximately tservices,thenapplyinga“cost- ‐to- eof 50for2010and Scalculatedthe ntheirclaimssubmittedtoMedicare.6
PanelcreatedCPTcode77338(Multi- enewcode,under- services,supplies7
imsubmittedtoMedicareonaUB- dingtoCMS,themedianchargeon2010claimsdatawas 150,resultinginapaymentrateof hefollowing: beenadjustedistoseeacopyoftheUB- garvey@dochs.orglana.hilling@johnmuirhealth.com8
E:Physician’sCurrentProceduralTerminology(CPT )codes,descriptions,andnumericmodifiersare ved].1. e.breathingretraining),facetoface,one- ‐on- eeds.UsedinthePRsetting,thisincludespre- ‐andpost- isincludespre- ‐andpost- rking9
red- on,follow- tervention,each15minutes,face- ‐to- tion,each15minutes,face- ‐to- ‐face;group.99211- planning.10
intervention,individual,face- ‐to- mentofcachexia,obesity,follow- ,reassessmentandintervention,individual,face- ‐to- mentofcachexia,obesity,follow- esity,follow- patientself- ‐management,face- ‐to- patientself- ‐management,2- anagementofexacerbations,actionplan,diseaseself- ientself- ‐management5- anagementofexacerbations,actionplan,diseaseself- o- rescriptionincollaborationwithmedicaldirector.11
runderstandingofself- ouse. ques,needforongoingmedicalfollow- SevereCOPD:GOLDStageIII(moderatelycomplex,co- 12
edduetosocialisolation.Moderateinsomniafor6months. ques,needforongoingmedicalfollow- tionstatus- focusedtrainingandfollow- co- Natrest.SpO290%on13
rwith100 m. ques,needforongoingmedicalfollow- ingcessationcounselingwithon- seofarollator.Assessnutritionstatus- focusedtrainingandfollow- provideexamplesforyourconsideration.14
Exerciseequipment ask,non- Pvalves/Vestdevice15
Sani- ‐wipesGlovesmountedonwallFirst- ‐aidsuppliesAudiosystemSoftware KramesondemandEpocrates seBooks sories rciseroomPrinterCopier/fax16
Secretaryandreceptiondesk Coffeemakerandcabinet Sinkforpatientsandstafftowashtheirhands Bottledwater Clockswithsecondhands 5. Addupallofthecharges.Divid
PULMONARY REHABILITATION TOOLKIT Guidance to Calculating Appropriate Charges for G0424 Developed by and in Cooperation With The American Association of Cardiovascular & Pulmonary
