Home Forums Discussions General Discussion Getting Paid For Care Management

The Commonwealth Fund released a report regarding oprions for improving the value of health care dollars being spent. Here is an excerpt:
Change reimbursement to primary care physician practices to support enhanced primary care services, such as care coordination, care management, and easy access to appropriate care. Under this option, Medicare fee-for-service beneficiaries would be enrolled in "medical homes" that have this enhanced capacity. Mandatory enrollment could result in net health system savings of $194 billion over 10 years, with savings accruing to all payers. Estimated savings would be larger if this approach were adopted by all payers.

I have rarely billed and even rarer received any monies for care management. Yet,I do this sort of thing all day long.

Anyone have success doing this?

Here is the full report....lots of interesting ideas.

Commonwealth Report

Lowell

My definition of "Care Management Programs" in the Medicaid environment: (noun) 1. Mucky-Muck Corporations who get between the doctor and patient and introduce a bunch of useless/brainless suggestions to confuse both patients and physicians, while really imparting no improvement of care. (verb)1. Yet, another way to take more health care dollars away from those really delivering medical care.

Feel free to add your definition of "Care Management Programs." Hey this could become our own Wikipedia!

I met with my biller this morning to talk about means of getting paid for the work I do coordinating Home Health Nurses at a local Independent Living Facility.

Basically, I have to:

Document time spent in doing each activity.

Make sure that activity does not occur 24 hours before, or after, I see the patient, or it doesn't count.

At the end of the month, count up the time spent on each patient.

If it amounts to more than 15 minutes, I can bill for it, if I can produce some kind of documentation that supports my "alleged" story that I was "allegedly" helping someone.

She wanted a little note for each superbill I turned in, summarizing my activities, plus an ICD-9 code or two, if possible, in case I got audited.

She suggested making myself a little Excel file to keep track of my time, but I think I can coerce Amazing Charts into keeping track of this for me.

My comment was, "You can tell that they don't want to pay me for doing this."