If you're just joining, we are still letting some people filter in, so we'll be starting in just a minute. Thank you. So good afternoon. We still have some people joining. We'll be getting started in just a minute. Dustin, I see your question. Will the slides be available to download? Yes. You can return to the HCCI Learning Hub and the PDF of the slides will be posted there following this webinar. All right. Well, I want to thank you all for joining today's HCCI Intelligence webinar called Unlocking Revenue Streams, Navigating the 2024 Medicare Physician Fee Schedule for Home-Based Medical Care. This is by far the most popular webinar we do every year. So we're so thrilled to have such a large group joining us. And it really is important. It's really one of the value adds that HCCI brings is distilling these massive changes and so many pages and pages from CMS of critical information that will help you run your house call program. And so we kind of tap our experts and bring that to you in the most relevant pieces that you need to know going forward. So let me review just a few housekeeping items and logistics before we begin. So a recording of this presentation and the PowerPoint will be made available on our HCCI Learning Hub shortly following the webinar. Also, all questions will be addressed at the end of the presentation during the Q&A session. And that includes any questions that were submitted at the time of registration. So please feel free to add your comments or shout outs throughout the webinar. You can use the chat box on your screen, but you can also use the Q&A box to submit your questions. And we just ask that you hold off on expecting answers to those questions until the Q&A portion of the call. And at that time, we will go ahead and get those addressed. All right. So it is my absolute delight to introduce our presenters for today. We have Dr. Paul Chang, who is Medical Director of Home Care Physicians, which is a Northwestern medicine practice here in the Chicago area. We're also so happy that he works with HCCI a couple of days a week as our senior medical and practice advisor. And then Tammy Browning, who is also a consultant with us for education and practice development. And she was the founder of Grace at Home, which is a house call program that serves more than a dozen counties in central Illinois and provides primary care services for adults with chronic or acute health conditions or disabilities who are unable to safely or comfortably leave their home to receive medical care. Something of interest, as you learn from our presenters today, think about the fact that Grace at Home was a startup that grew to serve 2,500 patients with 20 providers. And Tammy recently retired from there, which allows her to work more with us at Home Centered Care Institute. We also have Dr. Kira Holmes, who is a certified professional coder. She is also our manager of practice development here at HCCI. I know you're going to learn a ton from her and from all our presenters. So thank you all for being part of our faculty today. In terms of our objectives for what we're going to accomplish, we will be reviewing the coding reimbursement and policy impacts that are specific to home-based medical care as a result of the 24 Medicare physician fee schedule final rule and how you all can best respond to these changes. We're going to discuss newly implemented reimbursement CPT codes for additional revenue in home-based medical care, and then also do some introduction to risk adjustment models, like the hierarchical condition category coding, the new model V28, which is so important in our transition to value-based care. All right. In our agenda for today, we're going to kind of do a lot of back and forth between our presenters and keep it very fresh. But as described in the objectives, reviewing the changes and impact, including the conversion factor change, we're going to go into newly implemented rules to offset that reduced conversion factor. Everything from SDOH, behavioral health services, preventive vaccine administration services, caregiver training, community health integration, telehealth, and of course that HCC coding. And we wrap it all up at the end with the ask the experts. All right. So at this point, I'm going to go ahead and turn it over to Dr. Cheng. Melissa, thank you. And thank you, everyone, for spending some time with us this afternoon. As Melissa said, this is by far, year after year, the most popular webinar that we do because we are all very interested in the impact of these rules. We have a lot of material and we want to get to questions and answers at the end. So let's get going without further delay. Melissa, next slide, please. As Melissa stated, I'll start with maybe some bad news first and then get to the good news later. Two not so happy news for 2024 is that the conversion factor has been reduced by about $1.15 compared to last year. Or roughly 3.4% reduction in terms of the conversion factor to the RVU. This is because of the budget neutrality requirement of federal programs, which includes Medicare. Now, you might be asking, where's this money going that they're reducing this conversion factor? So the money is used where? Well, the majority of the money is going to be anticipated, at least to fund the cost of implementing the G-2211 code. Now, people might be asking, what is the G-2211? The G-2211 is defined as the visit complexity inherent to the evaluation and management associated with medical care services that serve the continuing focal point for all healthcare needs and services. And for medical care services that are part of ongoing care related to a patient's single, serious condition or complex conditions. All right. In short, G-2211 is for the evaluation and management visits that are part of an ongoing longitudinal care relationship. It is an add-on code that can be billed separately in addition to the E&M visit. Now, you might be saying, well, this is great. Sounds like exactly what we do in phone-based primary care. But unfortunately, as of now, G-2211 is only available for billing for office E&M and not for household providers. So that's a little bit of a downer for us. But all is not lost. The House of Representatives did introduce a bill in middle December. For those of you who might be interested in following how the bill is going, what the prognosis of the bill is, and so forth, is H.R. 6683. It is called Preserving the Seniors' Access to Physician Act of 2023. It's got bipartisan support. And if passed, it will cancel the 3.4% pay reduction, as noted above. So keeping our fingers crossed there. On the G-2211 issue, HCCI, along with other organizations, such as the Academy of Family Medicine, the Academy of Home Care Medicine, are trying to lobby for a change which will allow us to bill for the G-2211 as well. So stay tuned. These are kind of sad news, but it may not be the end news as the year progresses. Now, we've got the bad news out of the way. We can go on to some good news regarding increasing reimbursement opportunities in 2024. And I'm going to turn it over to Tammy now, who is going to talk to us about social determinants of health. Thank you, Paul. Yes. So we are now going to have a reimbursable code that's available for the social determinants of health risk assessment that we're probably all already doing in our home-based primary care practices, or hopefully you're doing them. It does have to be a qualified risk assessment tool. We have some examples of those that we'll make available to you. But basically, it's a G-0136 code. It's going to reimburse $18.66 per time that's billed. It can be billed a maximum of twice a year. So once every six months. I'm going to encourage you to use this in all of your annual wellness exams, but it does have to be involved with an E&M visit. So E&M, annual wellness, and some cases behavioral health visits qualify as well for occasion when you could use the G-0136 code. Next slide, Melissa. So in this risk assessment, you need to be evaluating your patient's housing, food insecurities, transportation needs. And I imagine we are all doing that already. If you're seeing a patient in their home, you understand there's always transportation issues. Odds are, if you're making referrals at all, you're having to make special arrangements for your patient. do not need to certify, sorry, that the patient is homebound with Medicare, but you must document it in the patient's medical records, okay? So I wanted to point that out for that criteria. And then for the requirements for receiving the additional in-home payment is Medicare only pays the additional amount for administering the flu, hep B, or pneumococcal shots in the home if the sole purpose of the visit is to administer one or more Part B preventive vaccines, including the COVID-19 shot. Medicare will not pay the additional amount if you, the healthcare provider, provides another Medicare service in the home on the same date of service. In those situations, you will be reimbursed at the standard amount for administering those vaccinations, which is for flu, hep B, pneumococcal shot is the $30 per dose, and for the COVID-19 vaccine is $40 per, excuse me, per dose. Next slide. All right. Caregiver training, this one I'm really excited about because I know we have a lot of families that is a caregiver for their loved ones. I am too myself, so I'm really excited about this. And I know providers already assist a lot, so it's nice that you will now be able to be reimbursed for it. So reimbursement for practitioners who train and involve one or more caregivers to assist patients with certain diseases or illnesses such as dementia in carrying out treatment plans. CMS will reimburse for a caregiver training services when provided by the following providers, which are physicians, or as we know, NPPs are nurse practitioners, clinical nurse specialists, and assistants, and if you have on staff, of course, clinical psychologists. And then we also have our therapists, physical therapists, occupational, and speech language pathologists. All right. And before I get started on this slide, I do want to point out, because I know providers may wonder, who exactly is CMS considering a caregiver? How do we know the criteria of a caregiver? So we know billing, as defined by CMS, a caregiver is an adult, family member, or other individual who has a significant relationship with and who provides a broad range of assistance to an individual with a chronic or other health condition, disability, or functional limitation, and a family member, friend, or neighbor who provides unpaid assistance to a person with a chronic illness or disabling condition. So that's what CMS is defining as a caregiver, and, of course, that is very common in the home care industry, so I wanted to point that out because that's really important. For the caregiver training requirements, the following does apply. Consent is required from the patient or the patient's representative, especially because the patient may not be present for the trainings. The training should be directly relevant to the person-centered treatment plan for the services to be considered reasonable and necessary under the Medicare program. Also, frequency and volume of the training can be based on the patient's treatment plan, changes in conditions, their diagnosis or diagnoses, or change in caregivers, and caregiver training services codes are not included on the CMS telehealth list, so this service cannot be rendered via telehealth. This is the code set for caregiver training, so the first one is, as you can see, the 97550-552. These codes are a time, and the training session is for one or more caregivers for just one individual patient. The following set applies to the group. Group training for behavior management of patients with a mental health or physical diagnosis. It will include caregivers of multiple patients, and more than one caregiver for a patient can attend the training, and these codes are timed as well. Next slide. Thank you, Melissa. So, this is just a quick breakdown. I won't go through it all because it's so wordy and lengthy, but I just want to point out when you are rendering the caregiver training for a patient or multiple patients, how these apply. So, if you're wondering, okay, how do we build a group, and how do we build an individual if we're doing a group session? How do we build to each patient? There's a significant difference in the national payment amount for the group training, and as you can see for 97550, it's the 5206, and then the 97551 is the add-on code. And for 97552, the reimbursement national payment amount is 2194. Next slide, Melissa. All right, and then we have the 96202. This is the multiple family group behavior management. If you notice in the bowl, the initial time, I'm sorry if I didn't pick it out in the other one, but the initial timing is 60 minutes, and then the code underneath the 96203 is the add-on code for any time that's additional to the initial 60 minutes. All right, now I'm going to turn it over to Tami to discuss community health integration. Okay, so community health integration is a new CPT code, GOO19, and then the add-on code of GOO22 that can be utilized when patients need additional support and you're providing that through a community health worker or some other member of your team. It does not have to be the clinician itself. There's a lot of overlap between CHI and chronic care management. So if you're already doing chronic care management and you have a robust CCM program, you may not want to utilize this, but the difference specifically is that chronic care management has to be provided with a comprehensive care plan. It has to be provided in the situation of two or more chronic conditions, and all the work has to be provided by or overseen by a provider, a nurse practitioner, a physician assistant, or a physician. And so in the CHI services, it does not. So you can have a trained non-clinical staff member, as long as they've gone through an adequate training program that provides this. Note that it starts at a 60-minute threshold for services, but the reimbursement amount is good at $79.24 per. This does not require two chronic conditions, only one, and it does not require a written comprehensive care plan either. So that's some of the differences. I'm sure there'll be lots of questions on this one, but the big caveat is if you aren't currently doing chronic care management and you don't have MAs and nurses and social workers within your practice that are helping provide care, this may be a good tool for you to consider utilizing to capture some of the work that's required to support our patients. And I'm going to hand it back to Paul to discuss telehealth changes for 2024. Well, we went through a lot, and I see a lot of questions in the chat, and we'll try to get to them as quickly as we can get through our presentation here. I guess good news for telehealth, majority of telehealth, as we've known it through COVID, carries on until the end of this year. That's December 31st, 2024. Starting this year, you can see there have been some permanent changes related to telehealth services starting in 2024, and you can see them here on the slide. Most of these services that are permanent are related to behavioral mental health services. You can see whether you are at QAC or if you're doing this at home, any geographic restriction, is it audio only, and so forth. These changes are permanent. Next slide, please. As I stated before, what you see here on this slide, these are valid until the end of this year, and they include doing televisits with the patients in their homes, as we've been doing over the past four years now with COVID, without any geographic restriction, and we can do some services by audio only, and again, these services are provided by all eligible Medicare providers. The short of telehealth for 2024 is that stay tuned until the end of this year, and then we'll have to see what our government decides what to do in terms of coverage and reimbursement for 2025, whether these changes, whether these statements here on this particular slide will carry over in 2025, will become permanent, that is up or not, is to be determined. Next slide, please. A couple of things, just to highlight. When you bill for a telehealth visit, make sure you or your coder document or bill or log in as you submit the bill, the POS as 10, that will give you a higher reimbursement than the POS of 2, right? So the POS of 10 is the telehealth is provided to a patient in their homes, POS of 2 is other places other than the patient's home, right? Also remember to use a modifier 95 when you do a televisit, okay? And also document your time, your total time. I don't believe, and Kara, you can correct me, I don't believe a start and stop time is needed, just the total time for your televisit, okay? So POS of 10, document your time, and a modifier 95. And then stay tuned, check back with us later this year regarding changes for 2025, okay? Next slide, please. Now, we're going to switch gears maybe a little bit and step away just a little bit from this, the coding and the dollar amounts and so on. We're going to talk about ACC scoring, right? And how important this is going to be as we transition from fee-for-service as we know it to what I would call a fee-for-service plus, meaning tying to some kind of value or quality outcome as it relates to your care being delivered to these patients. So Tammy's going to give us a little bit of an introduction regarding ACC, what it is, and why it is so important as we move forward in healthcare. Thanks, Paul. Yeah, I hear so many clinicians and practice owners say, I work in fee-for-service. HCC coding doesn't affect me, and I don't need to know about that. And I just want to tell you that, in my opinion, humble as it may be, that is absolutely not true. And we are moving into an era of healthcare where this is more and more important. HCC coding basically, in any Medicare recipient, depicts the severity of illness of your particular patient. So not making sure that you are correctly coding and assigning all the appropriate HCC codes that is appropriate to the patient's diagnosis is not giving Medicare an adequate look at what should be expected for that patient's healthcare expenditures throughout the year. And then as you move from a fee-for-service practice, as my practice started out 100% fee-for-service, and in the last four years has integrated into part fee-for-service and part value-based care. But as you make that transition and change, your reimbursement becomes affected by what the patient's HCC codes are. So Medicare Allots, this is how much money we anticipate this patient is going to cost based on the HCC scores. And then if you perform under that budgeted amount, they're going to share some of that savings with you. And so that's why it becomes so important. And I think the sooner we can all conceptualize that this isn't just important if we're practicing in a value-based way, but it's important regardless of how we're practicing medicine, I think the better off we'll all be. So we're going to dive in a little deeper here, and I'll pass the baton back. I think, Paul, were you taking it from here or is this going back? Kira. Kira. OK, great. Kira. All right. Thanks, Tammy. Appreciate it. All right. So this is just a quick high-level review of HCC coding. So I'll just tap on each bullet point and then we'll talk about the transition in the following slide. But risk adjustment methodology used by the CMS and other programs to determine annual capitated payments for Medicare Advantage beneficiaries, the expected costs and ACOs and APMs. When it comes to HCC coding, it's important that the patient's risk score is calculated accurately. So you want to make sure that you are coding to the highest level of specificity to reflect an accurate risk score. Each diagnosis code is associated with a particular HCC weight that reflects expected medical costs and severity of the condition. So you definitely want to make sure that you are thoroughly reviewing the codes in their entirety to make sure that, once again, you're going to the highest level of specificity. Because even though we have like the general codes, you know, depression unspecified does not have an HCC weight. But, you know, depression with, you know, a manic episode does have an HCC score. So you want to make sure you are being as accurate and specific as possible with the codes. And then accurate coding can positively affect reimbursement rates, reflecting the actual complexity and health needs of the patient population. Next slide, Melissa. All right. So this is the transition. So we're now moving into a new model. We're moving in phases from Model V24 over to V28. And this transition is expected to take a total of three years. If you go and research yourself, you may find, you know, different variations in the time. But it started last year and it's kind of gone each year is a third. So it started last year in 2023. Now we're in 2024. We're hoping for it to pretty much be 66 to 67 percent on the V28 model. And then in 2025, we're hoping to be transitioning as we move into 2026, 100 percent away from V24 and into V28. And the difference in the two models, honestly, is the V28 model is now truly based and met with ICD-10 codes, whereas the previous model, which was V24, you had to crosswalk ICD-9 codes for ICD-10 codes. So that's like the biggest transition. And then things that were on the previous model, conditions, diagnosis are no longer on the newer model of V28. So definitely pay attention to that as well. And that's it for the ACC coding. Now I'm going to transition it back to Melissa for the Q&A. OK, so and I hope everybody picked up a lot of great information. I know we've got some questions. Carly Dennison on our team has been tracking all those questions and I'm going to ask her to kind of queue those up for us. All right, so I'm just going to drop everything into the chat. I was trying to add in the names of the folks that were asking them, but I ran out of time. So I'm just going to drop these into the chat really fast. It's going to be a pretty long message. OK, and then are you going to walk through each one like and ask those of the presenters? I can do I can do that if you'd like for me to. Oh, yeah, that's great. I'll just do that rather than dropping it into the chat. That sounds better. So one of the first questions that we have from the chat is, what diagnosis do you use on the SDOH assessment if the assessment is negative? Yeah, so that's a great question. Thank you for asking that. I would, obviously in the case where your SDOH is positive, which I'm going to suspect is the majority of our patients, you're going to use the Z codes that are appropriate for the identified issues or deficiencies, I'll call them. And then the original CMS guidance that came out didn't present any codes, any CPT codes. The most recent CPT suggestions by CMS is to use the 96160 and the 96161 CPT codes. I would say to continue to monitor that as I feel through first quarter, CMS will continue to update what they've sent out and I'll give a hats off to HCCI for getting this out to you by January the 10th. This is very early in the year. And so good job on everybody working together to get this information out as soon as possible. But there are some adjustments that I think will come. But right now it's 96160 and 96161. Great, thank you so much. All right, so the next question is, does the 99484 cover medication management and adherence for patient outcomes? Yes, it does. So much of what we do is medication management, right? Whether you're talking about heart failure, COPD or in this particular case about mental health condition, yes, we try different medications. We add, we augment medication to somebody who may be maxed out on an SSRI regarding their depression. So absolutely, yes. You should time your services and the time that you spend talking with patients and families about their mental health condition. Great, okay, so next we have, please repeat the caveat for in-home vaccine reimbursement when done on its own or with other services. Okay, so for CMS, per CMS, let me just get it one second, sorry, sorry. So for, in order to receive the add-on code or to fill the add-on code for administration, you have to be, the visit has to be strictly for that reason, to administer the vaccinations. If you are there providing your standard E&M code visit for the patient in the home, you cannot bill the add-on code. However, you can still bill for the standard vaccination administration for those vaccines to the patient, but you do not qualify for the add-on, the additional $38 that they would reimburse in addition to you providing those vaccinations if you're there for another E&M, if you're there for an E&M visit. Got it, okay. And for 99, yeah, 99484, are dementia-related behaviors excluded as a diagnosis or need to be coded in a specific way? Has that already been answered? No, Medicare said any mental, behavioral health or psychiatric conditions. So our patients with dementia, with behavioral disturbances, I would consider that being part of psychiatric behavioral health management and treatment. I don't, I had a point, but I escaped. Actually, I think it ties to the HCC about being specific. Tammy talked about being specific related to your coding as we transition from 24 to 28. So be specific related to your coding and also tying it to other comorbidities that will garner your higher HCC score, if you will. If you look at some of the articles that are written out there about HCC, overall, they're anticipating about a 3% reduction in your score compared to version 24, unless you're very, very careful about documenting specificity, as Tammy and Kara talked about. So documenting comorbidities that are related to a primary chronic severe illness. Okay, so for this next one, we might need a little bit more context. It says, is this assisted living staff? This is a huge need for the aging training, I believe. And this was from Radella Hedrick. Radella, if you can hear me, do you wanna drop in a little bit more context about the question that you were asking? And you can even unmute, I believe, and ask your question live. I think we have to give them the authority to unmute themselves. So let's see if we can do that. Was it Radella? Radella. I actually have two Radellas, so. Radella H. Hedrick or Hess? Oh. It's okay. Hedrick, I believe. It looks like Hedrick, okay. Yes, we hear you, Radella. Hey, the question was the training codes. Because I go to assisted livings, and I know now the place of care is the same as home for assisted livings, which took place last year at this time. I'm wondering, because I do a lot of education and the staff, it turns over so frequently, is that considered you would be able to bill for that code, I mean, for that training in the assisted living communities? Are you saying as far as training your staff? No, they're not my staff. I go in there to take care of the residents. And so I do a lot of education with, some families are in there, but also with all the turnover and the staff that are giving medications, turning, et cetera, just a lot of training, just like if they were in the homes. So that's a great question. And we talked as a group about that some. And so I'm gonna invite Kira and Paul to chime in here too. But our concern for that specific question is that you are billing this code to a specific patient. And so that education really needs to be specific to that patient. I'm gonna give you an example that might meet the criteria. And that would be if that assisted living facility staff is providing one-on-one care for this diabetic patient, and they don't understand how to administer the medications or test their blood sugars or do something like that, and you're doing education specific to how they would care for this patient, then I believe that's billable, but it needs to be specific to the patient that you're billing it to. Does that make sense? And Paul, Kira, speak up here. Yes, that makes sense. And actually that's what I do. So each patient, before I leave, I leave orders and then we go over those. And each one of these halls are assigned to staff. So lots of times I'm having to go directly to them and also the hands, those that do the personal care and those that pass the medications. And they're all individual patients that live in individual apartments at this assisted living. Rodella, I think that's a great question and a great example. Thank you for sharing. Thank you. Thank you. Awesome, thank you so much. So the next question, are CHI codes billable slash reimbursable for those of us participating in PCF? We are not eligible for CCM. Sorry, would you repeat that question one more time? Sure, so are CHI codes billable slash reimbursable for those of us participating in PCF? We are not eligible for CCM. And this was Sarah Raksa. Sarah, can you tell me what PCF is specifically? Primary Care First. Oh, Primary Care First. Yeah. I am not aware that it is excluding Primary Care First initiative. Paul, Kara, have you seen anything about that or read anything about it? I can, this is the first that I'm seeing this or PCF because I was going to ask the same question, Sammy. So I can look more into that. I can look more into that. It did not have any exceptions as to the type of provider, as long as you are a provider or a non-physician provider, you qualify to bill for that service. But I can definitely look more into that and give you a response. And shortly, Sarah, just give me some time. It's a great question, thanks for asking. All right, so next we have, can peer support fall under CHI? And I think we had asked for further context for that question as well. Did, wanted to have the context of what we are classifying as peer support. It was Renee Walton. Renee, do you want to give us a little bit more detail? And here I'll find her. Renee, you should be allowed to unmute if you want to ask your question. Yes, I was wanting to know if, I guess they're licensed mental health counselors. I was wanting to know, could I, like if they go out and see a client or a patient, could I bill for those services if they, you know, if they're with the client or if with the patient for 60 minutes or more? Because I already have pharmacists that do chronic care management with my patients who are eligible. So my understanding is that there, there is an element of community health integration there. If they're not billing Medicare, which what I would always caution you to be very, you know, suspect about is billing for something that someone else has already billed Medicare for, providing anything different or adding those services on or interpreting them as it relates to your patient, then I think that is definitely billable or could count towards the time. But if you said a provider outside of my practice is going out and providing 60 minutes of behavioral health services and they're billing Medicare for that, sending me a report, and I'm going to count full 60 minutes towards my CHI, I wouldn't do that. They don't bill Medicare, they bill Medicaid. Okay. Kara, do you have any suggestions on that? When I say peer support, there is actually another element that we did not include because it's very in-depth. So I don't want to touch on it too much. I can direct you to the CMS website. If you want to bill anything for peer support and the patient has a qualifying diagnosis or diagnoses, you can look into Principal Illness Navigation, which is PIN, and I'll drop the link in if I can. I'll drop it in there for you to kind of look that over. And it's very straight point, it's for peer support, peer navigator specialists. And that's more so where you would direct the billing for peer support within the community. Okay, thank you so much. You're welcome. All right, so the next question is for the behavioral health codes, does it need to be someone with a mental health specialty or can an FNP who is doing depression bill for it? For general behavioral health, the 994-84, and now the co-management, myself, my APPs can bill for services as long as the conditions are met. There's another question here I see in the Q&A, can you bill CCM with GBH? And the answer is yes, but you cannot double dip, meaning Medicare says they're distinct services, right? You're doing GBHs, they want you to spend 20 minutes on mental health and not count that as CCM. CCM should be related to other things that the patient has rather than the mental health component. So yes, you can bill both, but you cannot double dip and use time from both sides. Okay, great. Next we have, can you comment on differences on reimbursement for telehealth services using different modalities, video visits versus telephone visits? Yeah, sure. So there are different codes for video visit versus a telephone E&M. And then there are different reimbursement rates as you can imagine for each one of those codes. And Melissa can talk about this later on. ACCI has tools, a tip sheet, advanced coding opportunity resources that you can look through to see what type of services will best fit your patient's need and also will get you the reimbursement that you deserve. As we all know, many of our patients don't have video capabilities. They don't know how to click a link or whatnot. So Melissa, at the end of our session today, we can talk with you more about billing opportunities. So to answer your question, yes, there are different codes for telephone E&M versus a tele-video visit. I see another question there about any changes to home E&M regarding time. MDM, that was last year. We had a robust discussion about that. We went away from 95 or 97 criteria regarding all the 10 point review system. It is all MDM based as of last year. And regarding the question G031A prolonged services, there's been no change with that. For Medicare now, for Medicare, you have to exceed 140 minutes, okay? So that's a lot. I think it was a great disappointment last year. There was much moaning and groaning about that sadly, but that code is billable, but you still have to spend a lot of time. So we are running short on time. I'm gonna try to fit in just a few more questions, but if we're unable to get to your questions today, we're gonna try to send written responses to everyone after the webinar closes. So just keep your eye out on your email for that. The next question we have is, is there a limit on the frequency that caregiver training can be billed? So, no, there is not as long as it is deemed medically necessary according to the patients, the focused patient, right? Treatment plan or plan of care, as we know conditions can change in this industry, you know, health can be up and down. So based on the patient's treatment plan or plan of care, that's how you can bill. So there's no limit. CMS luckily did not put a limit on that and how frequently it could be billed. Great. Melissa, do we have time for any more questions or should I transfer back to you? Yeah, why don't we go ahead and transfer back to me cause I just have a few closing remarks. I wanna make sure everybody knows. We have developed a brand new bundle of HCC intelligence tools and tip sheets covering revenue cycle management. What you're seeing on your screen are the contents of that bundle. And one very exciting thing that we're really happy to bring to you is the very last bullet is we're going to provide to the purchasers of this bundle or the all access bundle, which includes this one and our other tools and tip sheets. But that very last bullet that says you will get exclusive access to an office hours series covering a range of revenue cycle management topics specific to house calls. So when you purchase this bundle at a special introductory price, you will get that office hours and have access to that. Nobody else can register for it. It's really exclusively for these bundle purchasers. So again, be watching your email for more information about that. And here's some more information about it. Again, it's exclusively available to the individuals who purchase those bundles and that it will cover key aspects of revenue cycle management and kick off next month. So here's some information about the HCC Intelligence Resource Center. Please feel free to stay in contact with us on the website that way. And then again, Carly is your go-to contact. She's our outreach and engagement specialist and she'll be following up with all of you to share written answers of these remaining questions. But I wanna thank our presenters. I wanna thank all of the attendees for investing your time in this today. And thank you for trusting HCCI to bring these answers to you. Everybody have a wonderful afternoon or evening and we'll talk to you again soon. All right, thank you. Bye. Bye-bye.

webinar

Medicare Physician Fee Schedule

home-based medical care

billing and coding

reimbursement

social determinants of health

telehealth visits

risk adjustment

hierarchical condition categories