FAQ

The scripted format of HCS enables any provider to use the product to lead an Individual or Shared Medical Appointment to confidently assist the patient(s) in evidence-based practices to improve their health with a coaching approach designed to capitalize on intrinsic motivation and self determination. The two models below can be used by individual providers or large practices with existing staff by maximizing the billing capabilities of all members of the patient-facing team. 

 

Chronic Care Management (CCM) rewards practices for proactively caring for chronic conditions.  CCM enables any clinical staff of the practice to recoup about $40 per 20 minutes spent in the management of chronic conditions for patients. Since it is one of the few ways that the fee-for-service system will pay practices to work with patients on lifestyle and behavior change it can be a big win for the patient’s health and customer experience as

well. CCM can be performed by medical assistants,health coaches, dietitians, nurses, providers, or any other clinical staff. When performed by talented medical assistants, it can be sufficiently lucrative to incentivize the practice to expand its CCM services as a revenue generator. Chronic CCM includes non-face to face management of 2+ chronic conditions outside of clinic visits including referrals, prescription and ongoing review time spent each month. The codes are as follows:

• CCM by clinical staff to establish or revise a plan 1st 60 min: 99487

• Additional 30 min: 99489

• Monthly CCM by clinical staff Per month 1st 20 min:99490

• Additional 20 min: 99439

• Monthly CCM by physician per month 1st 20 min: 99491, additional 20 min: 994337

 

Shared Medical Appointments (SMA’s)99213-5

Shared Medical Appointments enable providers to see multiple patients with the same complexity of diagnosis at the same time, on the same day with the stipulation that each patient receives some individual care during the encounter and that the group encounter take place in the NPI location. The group can be initiated by the MD with auxiliary medical staff conducting topic specific disease education. Existing individual E/M codes can apply to the shared medical appointment.

 

 Non-primary provider team members such as registered dietitians, physical and occupational therapists, nurses and social workers often have the ability to bill and get reimbursed for group visits on the same day:. 

• Group dietician visits for two or more individuals for 30 minutes : 97804

• Group psychotherapy can use codes: 90853 or The Health and Behavior Code: 96153

• Physical Therapist: 97110, 97530, 97535, 97750 (therapeutic exercise, therapeutic activities, self-care/home management training, physical performance test of measurement)

• Occupational Therapist : 97110, 97530, 97535

 

Traditional Cardiac Rehabilitation, DPP, and IBT for Obesity and CVD are more structured group appointment models that HCS workbooks and blood sugar prescription would assist in attaining the outcomes required for CMS payment.

Prepare

The patient will either read or listen/watch an introduction about the move to add Lifestyle 

changes/Medicine to their care.  This can be done through the patient portal prior to their visit or while waiting in the office prior to their appointment time. 

 

The introduction material outlines the problem with our current “sick care” health system and the role our lifestyle choices play in our health. Common chronic diseases are listed as mostly preventable and lifestyle related.  It lists the lifestyle behaviors that have been proven to reduce all cause mortality, reduce onset of preventable chronic diseases and when a majority of them are completed, reverse chronic disease.

 

It prompts the reader to think about their health over the future, not just in the present.  It creates an expectation that they play a significant role in their health and the time is now to begin collaborating with their healthcare team. It lists 11 behaviors with optimal parameters so that they can self-assess their current level of achievement. It then asks the question,  Which of these areas that need some work do YOU feel might be EASIEST to start making changes? This ability for the patient to choose will improve intrinsic motivation and self-confidence to create greater success. They are invited to discuss this with their practitioner or feel free to consult with them regarding the best place to start if they are unsure.

 

Discuss

During the visit the practitioner  can reference the introduction materials and inquire about the patient’s readiness for change along with the specific area that they may feel most confident about addressing.  Should the patient share that they “can’t or won’t change, there is a specific Script Pad called the Pros and Cons of Change that can be completed with the patient or just given to the patient to consider these questions at home. The practitioner can then choose the appropriate Script Pad and begin the scripted 6 question mini-coaching conversation.  This can take as little as 5-6 min or longer if there is time. Legible answers can be written on the script by the practitioner rather than the patient which may speed up the process. 

 

At the end of the page, there are encouraging phrases and information to contact the MDs office should they experience concerning symptoms or have difficulty following through with the change and need help from a Health Coach, mental health provider, nutritionist or personal trainer. 

 

Follow Through

Because the Script is only designed to be an introduction and provide a quick mini-coaching conversation, it leads to identifying one short term goal (the prescription).  There is an accompanying Self-Coaching Workbook that should be given to the patient.  This mini-workbook guides them through questions that will better define their Wellness Vision, values and strengths.  It also explores past successes or vicarious experiences of others that may ignite and inspire change. If there is still some hesitation about change or a feeling that they “won’t or can’t change; a Motivational Interviewing exercise is provided that helps them contemplate the pros and cons of change. 

 

In the office together, only one or two short term goals are identified which is well short of an initial typical coaching session.  The workbook walks patients through setting up 3 month goals and related 1-3 week goals encouraging patients to increase the challenge of their existing goal or add new goals from the Script list using a SMART format. It also provides a tracking sheet to help with accountability. At the end of the workbook, it gives recommendations to increase the chance for success. This includes ideas to add rewards, accountability partners and developing a reset plan if and when there is a lapse in performance. 

 

The practitioner can scan/copy the completed script so that it can be uploaded to the chart/EMR for reference at the next encounter to improve accountability. It will be important to leave the patient with the idea that you will be asking about their progress at their next visit. Possibly, encourage them to bring in the Workbook to show you their progress. An electronic version of the Goal Tracking Sheet could be available through the portal for the patient to update their goals and provide easier access.  

 

We encourage a Health Coach, Case manager or trained staff member in the office to follow-up with the patient in 2 weeks through a phone call or portal message. This will convey to the patient that you are rooting for their success and can provide support through referral should they need assistance.  

There are multiple pathways to be reimbursed for the time spent using the HCS tool in our current fee for service model. The product itself provides the ‘script’ for the provider and effective first steps and accountability pieces that fit within CMS guidelines. 

 

During an initial or existing AWV an MD, DO, PA, NP can maximize billable services for lifestyle interventions by using standard E/M codes G0438/9, G0468. Once per lifetime IPPE coding can be utilized by the above providers as well G0402/G0468. ?? Once a patient has chosen a script area the provider can use the appropriate add on codes which include:

• Counseling to Prevent Tobacco Use    99406/7

• Alcohol Misuse Screening and Counseling G0442/3

• Depression Screening G0444

• Diabetes Screening 82947,82950/1, 83036

• Prolonged Preventive Services G0513/4

 

For Evaluation and Management the following codes are compatible with HCS use:

• The NEW add on code for complex Medicare patient visits G2211

• Shared medical appointments 99213-5

• Traditional and Intensive Cardiac Rehabilitation* 93798,93797 or G0422, G0423

• Collaborative Care Management  99492-4, G2214

• Preventive Medicine Planning 99401-99404, 99411-99412

• Remote Patient Monitoring (initiating visit and oversight) 99091,99453/4, 99457/8

• Intensive Behavioral Therapy for CVD G0466

• Behavioral Health Integration 99484,G0323

 

Once the visit has been initiated and with provider oversight a Medical Assistant can use HCS for the following Care Management Codes:

• Principal Care Management 99424-27

• Transitional Care Management 99495-6

• Chronic Care Management 99487-99401,99490, 99491

 

An RN can also use code 99211 for existing patients, saving the MD, PA, or NP even more time while maximizing patient participation in his or her health.