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5/15/2017Home NursePractitionerProgramPorchlight VNA/Home CareAugust 2016Shannon SmithBilling ManagerGetting Started OverviewAgency Requirements Collaborative AgreementNursing GuidelinesApply for NPI with localintermediary for Part BservicesComplete form 855BComplete MedicaidapplicationApply for access to yourlocal intermediary’scustomer service portalPractitioner Requirements Apply for NPI with localintermediaryComplete form 855IComplete form 855RComplete MedicaidapplicationCollaborative Agreements Findlocal MD(s) to sign a collaborativeagreement Your collaborating physician must belicensed to practice in your state Your collaborating physician must be ofthe same area of practice as your NP1

5/15/2017Nursing Guidelines Your agency must create nursing guidelines that willdesignate a physician who will sign off on them aswell as provide medical direction to the NP includingchart review for prescriptive practices at least every3 monthsThe guidelines must: describe the scope of the nurse’s practice,describe the scope of the nurse’s prescriptive practices,describe circumstances where a physician consultationor referral is required,describe established procedures for common medicalconditions andinclude emergency planningNursing Guidelines cont’d YourNursing Guidelines must be kept onfile in case DPH or BORN want to review. Nursing Guidelines are a public documentand must be made available to anyperson upon request. In Massachusetts go to www.mass.govand reference 244 CMR 4.22-25 for furtherinformationPrescriptive Practices As of March 2016 to following changes have beenimplemented:Patients have the right to request less than theprescribed amount of opioid substancePrescribers MUST include a notation on theprescription that the patient may request anamount less than the full quantity prescribed“Partial fill upon patient request” is therecommended phrase to use.If this occurs the remaining quantities will be voidThis notation is required on any Schedule II opioidprescriptions and pharmacists are required to callthe prescriber if this notation is missing.2

5/15/2017Prescriptive Practices Cont’d By January 1, 2018Prescribers must ensure that their EMR software orprescriptive forms for Schedule II opioids including therequired notation, or the prescriber MUST write thenotation on ALL Schedule II opioid prescriptions theyissue-until then the below may happenPrescribers may elect to staple or otherwise attach asecond piece of paper with the required notationpre-printed on it or they may write the notation on allSchedule II opioid prescriptions issued.Pharmacists receiving a prescription for a Schedule IIopioid without the required notation must contactthe prescriber for confirmation and document therequired notation on the prescription.Agency Requirements Youragency must have an NPI whichneeds to be enrolled with your localintermediary To obtain an NPI go to https://nppes.cms.hhs.gov/NPPES/Welcome.doAs seen in slide 5, you will click on NationalProvider Identifier (NPI) seen in blue and thenfollow the instructions from there. You are given alist of information you will need to complete theapplication.Click here3

5/15/2017Form 855B Form855B is for suppliers who will billMedicare This is your application to obtain the rightto bill for your practitioners’ visits andreceive reimbursement for them.Form 855B continuedThis application can be obtained on thefollowing websites www.cms.gov For NGS users go towww.ngsmedicare.comMedicaid Application Theagency must fill out a MedicaidProvider application This application cannot be completeduntil at least one practitioner has beenenrolled as a Medicaid Provider so theycan be attached to the agency This application is obtained by contactingthe MassHealth Provider Enrollment andCredentialing at 1-800-841-29004

5/15/2017Provider Services Portal Access ForNGS users go towww.ngsmedicare.com, under webservices on the left click Connex OnlineInquiry Each individual who will need access willhave to enroll as a new userPSP Continued Oncegranted access, the followingwebsites will allow your staff to findbeneficiary eligibility and entitlementinformation, check on the status ofsubmitted claims and query for financialdata. https://connex.ngsmedicare.comPractitioner Requirements Eachpractitioner must have an NPI whichneeds to be enrolled with your localintermediary To obtain an NPI each practitioner mustgo tohttps://nppes.cms.hhs.gov/NPPES/Welcome.do5

5/15/2017Practitioner RequirementsContinued CompleteForm 855Iis the Medicare Enrollmentapplication for Individual Practitionersand Non-Physician Practitioners This application will need to be filled outfor each Nurse Practitioner enrolling withMedicare www.ngsmedicare.com ThisPractitioner RequirementsContinued CompleteForm 855Ris the Medicare enrollmentapplication for Reassignment of MedicareBenefits This application tells Medicare yourpractitioners are giving permission for youragency to bill and receive payment fortheir services www.ngsmedicare.com ThisPractitioner RequirementsContinued Eachpractitioner will need to complete aNurse Practitioner application withMedicaid You must contact MassHealth ProviderEnrollment and Credentialing at 1-800841-2900 and request an applicationpacket. Each practitioner will be assigned atracking number for their application6

5/15/2017Documentation and Billing Youragency will need to choose aMedical Records software (EMR); PracticeFusion is a free EMR which can be viewedat www.practicefusion.com (use ofchrome browser is necessary) You will need to set up SOAP notetemplates or choose the ones you wantto use for your practiceDocumentation and Billing Youragency will need to choose billingsoftware; Kareo is a low cost billingsoftware option which integrates withPractice Fusion (www.kareo.com)Documentation and Billing Whicheversoftware you choose you willneed to set up your practice, including alist of referring doctors, primary caredoctors, referral sources, place of servicelocations, etc. You will need to create a Part B treatmentconsent form7

5/15/2017Documentation and Billing Yourstaff will need to create an intakeform and superbill or one form that servesas both as seen in the next slide The form(s) need to include: patientname, address, phone number, primaryand secondary insurance names and IDnumbers, PCP name, phone and faxnumbers, referral source name, contactand phone number as well as billingcodes.Documentation and Billing BillingStaff will want to download andreview the Part B Billing Guidelines; E&MServices Billing Guide, Non-PhysicianPractitioners Billing Guide, PreventiveServices Billing Guide They are located on your localintermediary’s website www.ngsmedicare.com8

5/15/2017Documentation and Billing Yourbilling staff will need to obtain acoding book (eg: ICD-10-CM Expert forPhysicians) This contains the diagnosis codes for yourclaims Your billing staff will need a CPTProfessional Edition manual as well This contains the billing codes andmodifiers for your claimsDocumentation and Billing Your practitioner’s charges will be basedupon the Medicare Physician Fee Schedulewhich can be found on the CMS websitewww.cms.gov , search physician feeschedule 2016 this updates every JanuaryYou will want reimbursement codes for Homevisits, Assisted Living visits and Nursing HomevisitsDocumentation and Billing Therates are based upon the Physicianreimbursement which is given a 15% NPreduction 20% of the remaining amount is puttoward the coinsurance for the serviceand will either be the patient’sresponsibility or be forwarded to thepatient’s secondary insurance plan. There is an annual deductible for Part B9

5/15/2017Documentation and Billing Your agency will need to create a referral processand admit packetSince most of your patient’s will already have aPCP in place you will want to create relationshipswith these offices.Contacting the office ahead of time to alert themof the NP referral helps with this.During this call requesting clinical information anda current medication list is helpful for the NP.Let the PCP’s office know that the clinical findingsfrom the NP visit will be faxed over for the patient’smedical record.Documentation and BillingReferral Process: Gather information: patient name, address,dob, insurance information, PCP information,referral source information, reason for visit Verify eligibilityMed B benefits activeDeductible amount remaining Homecare episode open Hospice episode open Documentation and BillingYour admit packet should include: A superbill with patient, PCP and referralsource information filled out. A consent form Information Sheet, explaining reason forthe visit Clinical note from last nurse or MD visit Medication list10

5/15/2017Documentation and BillingReferral Process: If a home care or hospice episode is openyour agency will need to find out with whomand coordinate care so the patient does notreceive a nursing visit the same day as the NPvisit. Contact PCP’s office to alert of the visit (youdo not need their permission, this is just acourtesy to create relationships and facilitateobtaining patient information) and requestcurrent clinical information and medicationlistDocumentation and BillingOnce the paperwork for the visit is returnedto the office: Fax visit note to PCP’s office Fax visit note to home care agency orhospiceDocumentation and Billing Whenready to bill, use the audit tool onthe NGS website to assure the proper CPTcode is chosen by NP Check diagnosis codes for accuracy Add appropriate modifiers as needed11

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5/15/2017Documentation and Billing Whenreviewing the NP note remember isit is not documented it did not happen. The clinician can only get credit towardreimbursement for the care that is clearlydocumented happened during the visit Always assume the chart will be auditedand the clinician will not be present toexplain what is writtenDocumentation and Billing Oncethe visit has been reviewed foraccuracy enter it in your billing softwareand send over your claims. Keep a copy of the visit note, super billand audit tool together in the patient’sbilling file for future reference if neededQuestions?Call or email us Porchlight VNA/Home Care413-243-1212Holly hchaffee@porchlighthomecare.orgShannon ssmith@porchlighthomecare.org13

Medical Records software (EMR); Practice Fusion is a free EMR which can be viewed at www.practicefusion.com (use of chrome browser is necessary) . A superbill with