Controversies in Billing for Clinical Services - American Society of ...

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Outpatient Diabetes Self- Self Management Training (ODSMT) The training must be ordered by the physician or qualified nonphysician provider. Services must be provided by an ADA certified multidisciplinary team. – Must include a dietitian and certified diabetes educator (may be a pharmacist). Medicare beneficiaries; paid by Medicare Part B. Payment to employer/facility. “Allows the pharmacist to become a revenue stream for the hospital.” Covers up to 10 hours of training – HCPCS code G0108 – individual and G0109 – group training – Coverage through Medicaid and private insurance varies
MTMS: New Advances in DIRECT Billing for Pharmacy Services CPT-III CPT III is a set of temporary codes for emerging technology, services, and procedures. Allows for data collection and reporting. Medication Therapy Management – 0115T - Medication therapy management service(s) service(s) provided by a pharmacist, individual, face-to face to-face face with patient, initial 15 minutes, with assessment, and intervention if provided; initial encounter – 0116T - subsequent encounter – +0117T - each additional 15 minutes http://www.ama-assn.org/ama/pub/category/3885.html
Page 1 and 2: Controversies in Billing for Clinic
Page 3 and 4: Recent Milestones Affecting Billing
Page 5 and 6: Recent Milestones Affecting Billing
Page 7 and 8: Clinical Pharmacy Services & MTMS E
Page 9 and 10: Justification for Clinical Services
Page 11 and 12: Justification for Clinical Services
Page 13 and 14: Methods for Reimbursement Methods f
Page 15 and 16: Methods for Reimbursement Medicare
Page 17: DME (durable medical equipment) Med
Page 21 and 22: Methods for Reimbursement Incident
Page 23 and 24: Methods for Reimbursement Outpatien
Page 25 and 26: Sample UB-92 UB 92 Form 42 Rev CD 4
Page 27 and 28: “Superbills Superbills” Superbi
Page 29 and 30: Methods for Reimbursement CLIA-waiv
Page 31 and 32: Methods for Reimbursement Medicaid
Page 33 and 34: Methods for Reimbursement Third Par
Page 35 and 36: Methods for Reimbursement Payer - M
Page 37 and 38: Methods for Reimbursement Methods f
Page 39 and 40: Billing in Hospital-Based Hospital
Page 41 and 42: Billing in Hospital-Based Hospital
Page 43 and 44: Billing in Physician Clinics Bill f
Page 45 and 46: Methods for Reimbursement Community
Page 47 and 48: Reimbursement Controversies Pharmac
Page 49 and 50: Where are we headed? �� Direct
Page 51 and 52: Billing Scenarios: Medicare MD Offi
Page 53 and 54: Billing Scenarios: Medicare R.Ph. s
Page 55: Billing Scenarios: Medicare If the

Controversies in Billing for Clinical Services - American Society of ...

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