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Billing and Coding for Patient Education Services

The climate of medical practice is changing. With the advent of Internet communication, patients have become exposed to an enormous amount of health information. Today’s health consumers want, and expect, to be a partner in their health care decision making. Providing evidence-based information that is easily understood and utilized is the challenge facing many physicians and medical practices today.

In 2005, the NIWH model became the mandate for “the practice of medicine in all settings”. Both the Joint Commission on Accreditation of Health Care Organizations (JCAHO) and hospitals and the Institute of Medicine (IOM) identified these key guidelines which include:

  • Placing the patients at the center of their health care decision making
  • Treating the patient as a whole person
  • Evidenced-based health education for prevention and disease management
  • Medicaid/Medicare initiatives, currently voluntary but soon to be mandatory, include patient education, prevention of disease states and “Pay for Performance” reimbursement guidelines for medical practices. “Pay for Performance” reimbursements are based on a physician’s documentation of patient education methods and disease prevention outcomes data

In addition, the current voluntary “Pay for Performance” insurance guidelines are expected to be made mandatory, following in HIPPA’s footsteps, by the year 2012. Pay for Performance will require all medical practices to demonstrate and document their patient education procedures to receive optimal insurance reimbursement payment. Electronic medical records and patient health education are rapidly becoming two of the fastest growing areas within the health industry.

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Medicare Begins Pay-for-Performance
Initiative
April 15, 2005

The New York Times on Friday looked at how Medicare for the first time has begun giving providers financial incentives to meet quality goals. More than 600,000 Medicare beneficiaries by the end of this year will be participating in pilot projects that give physicians and hospitals bonuses for improving medical care. Physicians will get bonuses for demonstrated improvements in care for patients with common chronic diseases such as congestive heart failure, coronary disease, diabetes and high blood pressure. The program involves 10 large groups covering approximately 200,000 patients, the Times reports. Medicare likely will pay $21 million in bonuses to hospitals during the three-year program.

Medicare already has launched a similar pay-for-performance program involving 280 hospitals, and later this spring Medicare will publish on its Web site results on 34 quality measures for those hospitals, the Times reports. A third test project scheduled for later this year will deal with chronic-care management companies that help patients manage diabetes and other chronic illnesses (Kolata/Abelson, New York Times, 4/15).

As a medical provider, you can serve your patients, comply with current and upcoming mandated guidelines and generate the necessary “pay for performance” data relating to patient education and disease management, through the services of a certified health educator. These services are consistently reimbursed when using standard procedure codes designated for patient education.

You will provide greater service to your patients, increasing self-selected compliance which result in improved clinical and quality of life outcomes, and in addition generate additional income for practice overhead. The following is a excerpt from a Family Physicians Journal article, which discusses how simple and beneficial incorporating patient health education into your current billing practice is.

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“Most practices already provide a number of billable services [such as patient education] but fail to capture those charges. Reporting [these services] can bring additional, easy revenue to your practice.”

— Quoted from the American Academy of Family Physicians Journal

By using established procedure coding designated for patient education services you can simply and appropriately integrate patient education into your current practice with no additional staff training or expense. This added benefit to your patients and practice is a “drop-in component” to your current billing procedures.

Since 1997 NIWH has provided, free of charge to physician practices, hospital and clinics participating in NIWH Pilot Programs, this outstanding billing and coding manual.  To learn more about the NIWH Physician’s Billing Manual contact Paul Bergeron, MD, Director of NIWH Pilot Programs, NIWH Administrative Office – 888-354-HEAL (4325)