Advanced Applications of Home-Based Primary Care-Virtual Workshop-Workshop PowerPoint Slides-Day 2

Workshop PowerPoint Slides-Day 2
Pdf Summary
The document is a comprehensive guide focusing on the intricacies of managed healthcare practice for clinicians. It provides crucial information on quantifying the value of healthcare practices, risk management, relationship-building with payers, and detailed coding and billing procedures for various medical services.<br /><br />Key sections of the document include:<br /><br />1. **Quantifying Practice Value**:<br />   - Emphasizes evaluating expenses against reimbursements to maximize capitated payments.<br />   - Encourages assessing the clinical model’s readiness for risk contracts and building strong payer relationships.<br />   - Reviews types of value-based contracts and their implications.<br /><br />2. **Case Study - Minerva**:<br />   - Illustrates the clinical and financial challenges faced by a high-utilizer patient.<br />   - Discusses strategies for impactful clinical interventions and payment models under different contracts.<br /><br />3. **Clinical Model Foundations**:<br />   - Highlights the importance of having a robust clinical model before entering risk contracts.<br />   - Stresses honest evaluation of strengths, weaknesses, and readiness.<br /><br />4. **Building Relationships with Payers**:<br />   - Suggests time-intensive relationship-building with payers.<br />   - Outlines key concerns like demonstrating value propositions, understanding partner goals, and creating transparent performance metrics.<br /><br />5. **Types of Value Contracts**:<br />   - Describes various contract types such as full risk, shared risk, quality bonuses, bundled payments, and capitated payments.<br /><br />6. **Hierarchical Condition Category (HCC) Scoring**:<br />   - Explains HCC risk adjustment models and their importance in Medicare payments.<br />   - Provides examples and coding practices to enhance accurate risk stratification and better payment models.<br /><br />7. **Documentation and Procedural Codes**:<br />   - Discusses proper coding for procedures like gastrostomy tube replacement, tracheostomy tube exchange, knee joint aspirations, and wound care.<br />   - Highlights the financial impact and reimbursement details associated with these procedures.<br /><br />8. **Chronic Care Management (CCM)**:<br />   - Defines CCM and its requirements, including comprehensive care plans and necessary documentation.<br />   - Details billing codes and revenue potential from CCM services.<br /><br />9. **Care Plan Oversight (CPO)**:<br />   - Describes CPO services for patients receiving home health or hospice care and the billable activities involved.<br />   - Covers coding and documentation requirements to support billing for CPO services.<br /><br />10. **Transitional Care Management (TCM)**:<br />   - Outlines requirements for managing patient transitions from hospital to home or other settings.<br />   - Details interactive contact, non-face-to-face services, and face-to-face visits.<br /><br />11. **Advance Care Planning (ACP)**:<br />   - Discusses reimbursement and time-based requirements for ACP services.<br />   - Emphasizes accurate documentation and patient consent.<br /><br />12. **Prolonged Services Without Direct Patient Contact**:<br />   - Covers billing codes for non-face-to-face prolonged services that extend beyond the typical E/M services.<br />   - Lists documentation requirements for these services.<br /><br />13. **Anticoagulation Management Services**:<br />   - Details initial setup and management codes for home INR monitoring.<br />   - Provides reimbursement amounts and documentation needs for anticoagulation management.<br /><br />The document serves as an essential resource for healthcare providers to navigate the complexities of financial management, coding, billing, and relationship-building with payers, aimed at optimizing practice profitability and improving patient outcomes.
Keywords
managed healthcare practice
quantifying practice value
risk management
payer relationships
coding and billing
value-based contracts
Hierarchical Condition Category
Chronic Care Management
Transitional Care Management
Advance Care Planning