Welcome! Your microphone is muted. Special Care We will begin shortly… Home Management Fee Codes Family Practice Webinar for Physicians & Staff Dr. Stan Oleksinski FP Board; President March 30, 2020 1
Welcome – Your Participation • All participant microphones are muted • Please send your questions to Dr. Stan Oleksinski anytime during the presentation: Email: modernization@sma.sk.ca, or Use the chat box: Stan will answer questions at the end of the presentation 2
Where is the chat box? Computers: 3
Where is the chat box? Computers: Phones/iPads: Step 1) Step 2) 4
Your Participation • Please send your questions to Dr. Stan Oleksinski anytime during the presentation: Email: modernization@sma.sk.ca, or Use the chat box: Stan will answer questions at the end of the presentation 5
Special Care Home Management Fee Codes Outline • Context • Special Care Home Management (SCHM) • Pandemic Temporary Care Codes • Operational Discussions & Resources • FP Savings Reinvestment • (FAQ’s) Frequently Asked Questions • Questions and Answers with Dr. Oleksinski • Close 6
Context • Work has been underway for over a year to modernize how fee-for-service family physicians are paid for providing care to patients in Special Care Homes. • This was not a cost-savings initiative. The fee code description was broad and the services provided varied. • The Ministry of Health, the SMA, and the Section of Family Practice and FP Working Group dedicated time to updating the fee code to bring the services in line with current medical practices, to keep the changes cost neutral, and to align the work with three principles, Patient-Centered Care, Appropriateness, and Fairness. 7
Special Care Home Management (SCHM) Overview 8
SCHM Overview Special Care Home Management (SCHM) fees • For continuous management of care for patients in special care homes. All non-urgent medical interventions are performed during regular business hours. • The fees have two components: 1) Indirect patient care, and 2) Direct patient care. • Implementation will be April 1, 2020 in the new Payment Schedule Resource : Key Messages (included in webinar invitation) 9
SCHM: Indirect Patient Care (627A) Indirect Care: $24 • It is the bi-weekly continuous management of non- urgent indirect patient care. • The physician is the most responsible physician. • A facility site visit is not required for billing. • Service is provided during regular business hours. It includes: Medication refills; • Routine ordering and/or reviewing test results; • Routine advice to family members/caregivers; • Monitoring Anticoagulant Therapy (763A); • All discussions with the staff of the facility; • All telephone calls related to the patient’s routine care. • 10
SCHM: Direct Care (628A) Direct Care: $60 • This fee is for a non-urgent medically necessary visit to evaluate the patient's condition and to provide advice as necessary to the patient and/or the nursing/facility staff concerning the routine management of the patient. • A face-to-face patient/physician encounter must be made and the medical necessity for this visit must be fully documented. • Direct patient care also includes indirect patient care. • A minimum of one direct patient care visit is required per patient per calendar year. 11
SCHM Urgent/Emergent Care • There will be no change if residents require medically urgent care. This change is for non-urgent medical care performed during regular business hours. 12
COVID-19 Pandemic Codes 13
Pandemic Codes for Virtual Care Two virtual care temporary codes can be used by physicians for resident care in Special Care Homes, instead of (5B). • Pandemic Telephone Assessment (510A): $35.00 Direct patient care via telephone in real time (i.e., not text). Max. 2 per patient per day, with documentation. • Pandemic Video Assessment (515A): $35.00 Patient care via secure healthcare appropriate virtual visit technology (not FaceTime or WhatsApp). Max. 2 per patient per day, with documentation. 14
Summary: When to Bill Codes in SCH $24 every 2 weeks for Indirect care for non-urgent continuous (627A) management for phone, fax, email, med refills, etc. $60 for Direct care, a non-urgent and medically necessary visit, (628A) during regular business hours, up to a max of every 2 weeks. Bill when you visit, and document. (5B) $35 for Partial Assessment for urgent or medically necessary care. (790A) $12.50 for Telephone calls for urgent care after-hours/stats, in rare circumstances, billed by report. Or virtual care instead of (5B): Pandemic Telephone Assessment for direct patient care (510A) provided by telephone in real time (not text), and document. (515A) Pandemic Video Assessment (not FaceTime/WhatsApp), and document. 15
Operational Discussions with Facilities Vacation/Time Off Plan for continuous care while away . • Establish a system of communication for Indirect care • Create a time for non-urgent phone calls during regular business hours at least disruptive times. • Explore if emails/faxes can be batched with highest priority first. Arranging Direct visits • Plan a time when you would like to conduct medically necessary visits. • Could a list of people who need visits be prepared in advance? • Plan to do Medication reviews during the direct visits. Coordinating Case conferences Formally scheduled, multi-disciplinary conference (2x/yr.) • 16
Resources Physician Resources: • Documents: Key Messages, FAQ’s • 2 webinars for physicians + staff (Fri, March 26 th and Monday, Mar 30 th , 12pm) Facility Resources: • Communication to SHA, Provincial Affiliates Resource Group (PARG), Directors of Care, and Special Care Home Facilities • Documents: Key Messages, FAQ’s • Webinar for Facilities (Tuesday, Mar 31 st , 10:30am) Residents and Families: • Handout 17
FP: Savings Reinvested 18
Family Practice: Savings Reinvestment Reallocation of funds: • Age Premiums Increased • Remaining savings reinvested to 5B ($0.40) Current Age Premiums New Age Premiums 55-64 15% 55-64 15% 65-74 25% 65-74 30% 75+ 35% 75-84 40% 85+ 50% 19
SCHM Frequently Asked Questions 20
FAQ’s: TOPICS • Getting Started: How to Bill • Understanding the Codes • Covering for a Physician • Documentation • Medical Necessity for Direct Care • Urgent/Emergent Care • What Else is Included/Excluded? • Facilities • Operational Considerations Resource : FAQ handout (included in webinar invitation) 21
FAQ’s: Getting Started: How to Bill 1. How do I start billing as the Most Responsible Physician (MRP)? • Must include the comment: “will be providing continuous care”, identifying yourself as the MRP. • Bill every 2 weeks, no further comments are required. • Either Indirect/Direct code can initiate billing. Resource : FAQ handout 22
FAQ’s 2. When do I use each code? $24 every 2 weeks for Indirect care for non-urgent continuous (627A) management for phone, fax, email, med refills, etc. $60 for Direct care, a non-urgent and medically necessary visit, (628A) during regular business hours, up to a max of every 2 weeks. Bill when you visit, and document. (5B) $35 for Partial Assessment for urgent or medically necessary care. (790A) $12.50 for Telephone calls for urgent care after-hours/stats, in rare circumstances, billed by report. Or virtual care instead of (5B): Pandemic Telephone Assessment for direct patient care (510A) provided by telephone in real time (not text), and document. (515A) Pandemic Video Assessment (not FaceTime/WhatsApp), and document. 23
FAQ’s: Understanding the Codes 3. Can I bill both (627A) Indirect care and (628A) Direct care fee code for a patient in a two-week time period? • Yes, but only one code will process. • If you bill Indirect care (627A), and then visit the patient in the same 14 day billing period and bill the Direct care code (628A), the system automatically converts the fee to the Direct care fee (higher amount) for those 2wks. Resource : FAQ handout 24
FAQ’s: Understanding the Codes 4. Can I bill the Pandemic codes (510A/515A) in the same two-week time period as Indirect or Direct care? • Yes, as long as it is medically necessary, it is not for routine care (627A/628A), and it occurs at a different time of patient contact. Resource : FAQ handout 25
FAQ’s: Understanding the Codes 5. I have a palliative care patient in a Special Care Home and their condition is worsening. How do I bill in this situation? • Continue to bill an Indirect care or a Direct care code every 2 weeks as usual. • If you need to see that patient more frequently because of their condition, the extra visits should be billed as partial assessment (5B) codes. Resource : FAQ handout 26
FAQ’s: Understanding the Codes 6. I have a palliative care patient in a Special Care Home and am getting very frequent phone calls and faxes about their worsening condition. How do I bill in this situation? • Telephone calls/facsimile/email for palliative care patients are not included in Indirect/Direct care. • Billed separately up to a maximum of three times in a day if needed, using the (793A) fee code. Resource : FAQ handout 27
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