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.

The following content is intended as potential billable opportunities. Each provider is responsible for assuring the accuracy of billing codes for services provided.)

HCS helps providers meet the documentary and interventional requirements for chronic disease management, screening, preventive care, intensive behavioral therapy for diabetes and cardiovascular disease with the goal of maximizing what your entire patient-facing team can bill for.

What codes are compatible for use by MDs, DOs, PAs, and NPs?

In the following scenarios prevention and chronic disease counseling can be supported by using the HCS benchmark education at the top of the script and the action steps chosen by the patient to document appropriately.

• During Annual Wellness Visits (AWVs): You can use standard E/M codes like G0438/9 or G0468.

• Once per Lifetime: For initial preventive physical exams (IPPE), you can use G0402 or G0468.

• Once a patient picks a "script" area, you can add on these specific codes:

  • Tobacco Cessation Counseling: 99406/7

  • Alcohol Misuse Screening and Counseling: G0442/3

  • Depression Screening: G0444

  • Diabetes Screening: 82947, 82950/1, 83036

  • Prolonged Preventive Services: G0513/4

What other codes are compatible with HCS for Evaluation and Management (E/M)?

The two levels of Physical Activity Scripts, The Body System Reboot, Stress Management, WeightLoss 2.0 and the Sleep Well Script all help providers meet portions of the lifestyle behaviors in the Intensive Behavioral Therapy for Diabetes and Cardiovascular Disease. All of the scripts provide supportive documentation on interventions to qualify the use of Preventive Medicine Planning.

• 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 Cardiovascular Disease (CVD): G0466

• Behavioral Health Integration: 99484, G0323

What other providers can use HCS for billable services ?

With provider oversight once the visit has been initiated, Medical Assistants can help with these Care Management codes:

• Principal Care Management: 99424-27

• Transitional Care Management: 99495-6

• Chronic Care Management: 99487-99401, 99490, 99491

What codes can be used by an RN utilizing HCS?

An RN can use code 99211 for existing patients. This saves the MD, PA, or NP time and gets patients more involved in their health.

How can HCS be used with a Fee For Service model?

Practices can get around $40 for every 20 minutes spent on CCM per patient. It's one of the few ways the fee-for-service system actually pays for lifestyle and behavior change –HCS provides the ‘script’ and script providers and patients can use to meet the criteria for CCM.

• Who can do it? Medical assistants, health coaches, dietitians, nurses, and even providers can perform CCM. MAs, in particular, can make it a significant revenue generator for the practice.

• What does it cover? CCM covers non-face-to-face tasks like referrals, prescriptions, and monthly reviews for patients who have two or more chronic conditions. The script can be read and reviewed during phone follow-ups or portal interactions with documentation language pulled from the education and action step portion of the script as well as with provider patient review of the goal tracking sheets.

• CCM Codes to Know:

  • CCM by clinical staff to establish or revise a plan (first 60 min): 99487

  • Additional 30 min: 99489

  • Monthly CCM by clinical staff (first 20 min): 99490

  • Additional 20 min: 99439

  • Monthly CCM by physician (first 20 min): 99491, additional 20 min: 994337

Can HCS be used to guide a Shared Medical Appointment (SMA)?

Yes, the scripts are effective in a group setting with the education piece used to guide the topic and group members sharing effective strategies for success, providing support and accountability, and brainstorming ideas for action steps.

For those unfamiliar with SMA’s, here is a brief description:

• How it works: Providers can see several patients at the same time, as long as each patient gets individual care, and the group visit happens at your NPI location.

• Who leads it? An MD can kick off the session, and other medical staff can lead discussions on specific health topics. Existing individual E/M codes can still apply.

• Other team members can bill too! Dietitians, physical/occupational therapists, nurses, and social workers can also get reimbursed for group visits on the same day:

  • Group dietitian visits (for 2+ people, 30 mins): 97804

  • Group psychotherapy: 90853 or the Health and Behavior Code: 96153

  • Physical Therapist (for therapeutic exercise, etc.): 97110, 97530, 97535, 97750

  • Occupational Therapist: 97110, 97530, 97535

• HCS workbooks and "prescriptions" can also help meet CMS payment requirements for structured group appointments like Cardiac Rehabilitation, DPP, and IBT for Obesity and CVD.

How can HCS be used in an Advanced Primary Care Model?

Scripts could be useful to help meet requirements of Advance Primary Care Management billing through CMS by billing providers. APCM services combine elements of several existing care management and communication technology-based services you may have already been billing for your patients. This payment bundle reflects the essential elements of advanced primary care, including:

• Principal care management (PCM) – disease-specific services to help manage a patient’s care for a single, complex chronic condition that puts them at risk of hospitalization, physical or cognitive decline, or death

• Transitional care management (TCM)

• Chronic care management (CCM)

Communication technology-based services include:

• Virtual check-ins

• Remote evaluations of pre-recorded patient information

• Interprofessional consultations

APCM services allow you to:

• Provide patients with a wide range of services to meet their individual needs based on complexity

• Bill for these services using a monthly bundle (instead of billing for each individual service or recording minute by minute)

These services help simplify your billing and documentation requirements while ensuring that your patients have access to high-quality primary care services.

Prepare

The patient will either read or listen/watch an introduction about the move to add Lifestyle changes for their health. 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 "Are You Ready?" 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 several Tips for Success and a QR code that takes them on a list to relevant public websites to support them on their journey. They are also encouraged to contact the provider's office should they experience concerning symptoms or have difficulty following through with the change and need help from a Health Coach, Mental or Behavioral Health provider, Nutritionist/Dietician, Personal Trainer.

Closing the Visit

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 offered 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.

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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 for habit formation, finding accountability partners and developing a reset plan if and when there is a lapse in performance.

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.

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Document

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. A short customized templet can be added to the EMR to document their goal and any important details. 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.

Follow-Up

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. Research shows that people can improve their healthy behaviors when involved in a group session. Following through with a Shared Medical Appointment or having Group Health Coaching are options.

Ideally, these were designed to be used by the patient’s provider to enrich the patient-provider relationship and maximize the accountability that relationship has for change. It can be however utilized by other people in the organization that are familiar with or interested in assisting people with behavior change which might include Health Coaches, Nutritionists/Dieticians, or Chronic Care Managers.

As certified Health and Well-being Coaches, we know the benefit that trained certified coaches can bring to lifestyle behavior change. We are also aware that people will likely have more success following through with the changes they have chosen with more regular assistance/support from the MD office or Health Coach versus waiting for the next office visit that might be months away.

Ideally, a Health Coach would be working alongside an MD in the office either as an employee or consultant to maximize the buy-in by the patient. Having a referral list of Health Coaches could also be an option. Group coaching could be offered (in person or online) per diem for patients and led by Health Coaches, Dieticians/Nutritionists, Mental and Behavioral Health Professionals or Personal Trainers depending on the Lifestyle Pillar focus. This is also an excellent tool to utilize in a Shared Medical Appointment where the patient could be prompted to fill it out with the group.

Health Coaches, if employed by the practice, could bill Chronic Care Management Codes for providing subsequent coaching visits for Medicare patients.

Scripts could be useful to help meet requirements of Advance Primary Care Management billing through CMS by billing providers.

We developed a coaching script for providers to use when creating a plan and setting goals for implementing the change into their own daily routine or into an entire practice. It can be printed from the member portal.

Transform your practice and empower yourself and staff with this self-coaching tool. "Converting Talk to Action" provides the framework and guidance you need to confidently implement meaningful and lasting change.

Key Features:

• Readiness Assessment: Evaluate your current readiness for change with a simple 1-10 scale and gain insights into your motivations.

• Discover Your "Why": Connect with your internal motivations and values to fuel your journey towards a healthier practice.

• Craft a Vision: Envision your practice one year from now, successfully embracing Lifestyle Medicine and experiencing profound positive changes.

• Identify Strengths: Leverage existing strengths, skills, and resources to bring your vision to life.

• Comprehensive Action Plan (Mind Mapping): Utilize a visual tool to outline new behaviors, anticipate challenges, and brainstorm specific actions across key impact areas:

  • Patient Care

  • Office Workflow/Operations

  • Team Engagement

  • Personal Growth/Well-being

  • Specific Lifestyle Behavior Interventions and HealthyChange Scripts

• Develop SMART Goals: Create specific, measurable, action-oriented, realistic, and time-bound goals for effective implementation.

• Anticipate Obstacles & Strategies: Proactively identify potential challenges and develop strategies to overcome them, including identifying support systems.

• Connect to Positive Emotion: Harness the power of positive emotions to motivate and sustain your commitment to change.

• Confidence Scale: Assess your confidence in achieving your goals and refine your approach for greater success.

• Tips for Success: Benefit from practical advice, including finding accountability partners, adjusting goals, and celebrating milestones.

Yes, refills for all the components are available for purchase. The pads are sold in a package of 5 of the same pad with price discounts when purchasing amounts of 10 or more. Workbooks, Weight Loss 2.0 mini-book and Optimizing Your Health and Well-Being flyer are sold in packages of 25 with price discounts when purchasing 50 or more.

No, the Scripts, workbooks and flyer material is copyrighted and any duplication of this material would be a violation of copyright and intellectual property laws. Of course, completed scripts can be copied, scanned and uploaded to the EMR and printed from the EMR.

All content provided by HealthyChange Scripts, including but not limited to script

pads, workbooks, website content, and downloadable resources, is or may be

protected by copyright, trademark, patent, trade secret, or other intellectual

property laws. You may not reproduce, distribute, modify, or create derivative

works from our content without express written permission.

The Self-Coaching Script for providers called Converting Talk to Action can be printed for provider use. Goal Tracking Sheets PDF can be downloaded and reproduced for patients and uploaded to the patient medical portal. The patient invitation written document called Adding Years to your Life and Life to your Years PDF can be printed for use in the office or downloaded for patients to review in the patient portal prior to their visit.

Yes, this might be advantageous for the practice as profit from the sale could offset the cost of the HealthyChange Script products.

For example: if the Creating Your Healthy Self: A Workbook was purchased at $1.50 and sold for $3.99 plus tax (less than a typical cup of coffee!), the profit for each book would be $2.49. If during a year, if just 300 workbooks were sold, this would generate $747 for the practice.

We are in the process of developing our digital material which we anticipate will be purchased on a subscription basis. Please fill out our Contact Us form to let us know that you may be interested in this option.

We have a video presentation that Provider User Guide Training Video: A Comprehensive Guide to Healthy Change Scripts. This training video offers a comprehensive demonstration of how to effectively integrate Healthy Change Scripts into office visits. It covers:

• Introduction to Behavior Change: Understanding the science behind behavior change and habit development.

• Script Components & Purpose: A detailed breakdown of each script component, its purpose, and helpful phrases and strategies for various patient responses.

• Supporting Materials: An overview and summary of the three accompanying workbooks and the "Optimizing Your Health and Well-Being" brochure.

• Script Level Guidance: Assistance in determining the most appropriate script level for each patient's starting point.

• Material Presentation: Recommendations on how to effectively present the materials to patients.

• Goal Setting & Tracking: Instructions on developing SMART goals and utilizing the provided Goal Tracking Sheet in the "Creating Your Healthy Self" workbook.

• Motivational Interviewing & Coaching: Techniques for motivational interviewing and types of coaching reflections for effective patient conversations.

• Follow-Up Strategies: Suggestions for productive follow-up visit conversations.

• Role Play Video Example Sessions: Video sessions that will help visualize an actual conversation that is guided by the script questions.

It is currently only available in English. We are planning on adding a printable version in Spanish in the future.

We are excited to launch our first version of the product at the ACLM Conference 2025 on November 15-19, 2025. We are looking forward to getting feedback from participants interested and those that ended up purchasing the product.