Primary Care Revenue Opportunities

The Center for Medicare and Medicaid Services (CMS) is committed to increasing payment to primary care through coding. In past years they have added services with high relative value units for wellness visits and transitional care management. They have also begun paying for chronic care management (CCM). Although many of these services are not limited to primary care practices, primary care practices perform these services most frequently. However, primary care physicians and other practitioners have not uniformly embraced all of these services. CMS has developed these services to recognize work done by primary care physicians that has not received payment in the past. 
2017 brings exciting changes for primary care physicians. First, CMS is now recognizing an existing CPT Service that will be used by primary care and specialty physicians alike, non-face-to-face prolonged services codes 99358 and 99359. Not only are they recognizing them, they are following CPT rules for the codes.  These services allow a provider to be paid for extensive record review or other management activities when the patient is not present. They must be done in relation to an Evaluation and Management (E/M) service, but may be performed on the date of an E/M or on a day before or after that service. 99358 is for the first hour of this work and, following CPT rules, may be billed after 31 minutes.
CMS has also developed an HCPCS code, G0505, for the cognitive evaluation of a patient with dementia or Alzheimer’s disease. This service may only be performed by a clinician, who may also perform an E/M service. This is a detailed structured assessment and may not be done on the same day as an office visit. It will most likely be performed by primary care providers, psychiatrists and neurologists.  It may not be reported by social workers or psychologists.
Additionally in 2017, CMS removed some of the burdens of reporting chronic care management (CCM). CMS believes that many more patients are eligible and would benefit from receiving these services. In addition to a slight easing of the rules related to CCM, CMS has developed an HCPCS code, G0506, which may be used once at the initiation of CCM. This is an add-on code that is reported in addition to the visit at which CCM is discussed and initiated.
Finally, there are new HCPCS codes for collaboration of care management/behavioral health integration (CoCM/BHI).  The first three - G050,GO503 and G0504 - require that the practice use a better work like procure or acquire the services of a behavioral health manager and a consulting psychiatrist. These professionals must work with the primary care practice, although they may be leased or contracted to provide the service. Most primary care practices will find the requirements related to these services difficult to perform.  A fourth behavioral health collaboration code, G0507, pays significantly less than the other two and requires case coordination by clinical staff. For these four services, the patient must complete a behavioral health diagnosis.
Some HCPCS codes will be replaced by CPT codes in 2018. Until that time, practices will need to learn HCPCS codes and understand the rules related to them in order to perform and bill for services.

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