CDP Coding and Billing

1. CDP Coding and Billing Family Planning Program January 25, 2012

2. Importance of accurate coding • Maximize reimbursement from third party insurers, including public (Medicaid) and private (Humana, Blue Cross, etc) • Maximize fee collection • Donations • Mandated Office of Population Affair's Family Planning Annual Report (FPAR) • Annual Title X 802 allocation to LHD

3. 3rd Party Insurers Reimbursement Maximize revenue for your family planning services by assuring all services are coded accurately and to the highest level provided. • Medicaid – MCO’s!!! Use right ICD code for CPT codes!! Check denials and FIX! • Private insurers – Ditto above!! • 4 Districts/11 LHD do not bill private insurers. Statewide over $400,000 in revenue were collected from private insurers for FPP.

4. Private Insurers • Typically pay higher rates than Medicaid • Lost revenue to support clinical services • Required by KAR to bill 3rd party payers SUGGESTIONS: • Pick largest insurers in county that patients seek services - negotiate a contract • Reach out to others to learn how to bill private insurers • BE PREPARED FOR 2014 – Potential for noninsured to be insured

5. Maximize Fee Collection • Assure accurate documentation of income into PSRS system for assessing sliding fee and self pay • Income is to be assessed every 6 months - AR. Title X allows verification of income - AR • Assure complete and accurate coding of all services to assure highest level of fee collection from sliding fee schedule

6. Maximize Fee Collection • Always give patients a copy of their bill showing the full charge for services, minus any discounts based on their income. EVEN IF THE BILL IS ZERO!! EVEN IF 3RD PARTY PAYER • Assure effective fee collection system/process, i.e. payment plans, financial counseling to encourage payment of fees

7. Donations • Post signs that donations are accepted to assist with the cost of family planning services for citizens of the county. • Upon check out, ask each patient, regardless of payer source, to consider making a donation to the family planning program to assist the LHD to provide services to others in the community • Title X requires donations to be voluntary and without coercion

8. Family Planning Annual Report • Family Planning Annual Report (FPAR) - total number of unduplicated FP users served in the calendar year - Title X allocations based on number served at state, regional, and federal levels - CDP runs the FPAR Mid Year and Final Calendar year based on the information entered on each patient’s registration and PEF

9. FPAR Demographic Information • Table 1 FP Users by Age and Gender • Table 2 Female FP Users by Ethnicity and Race • Table 3 Male FP Users by Ethnicity and Race • Table 4 FP Users by Income Level

10. FPAR DEMO/PEF Information • Table 5 FP Users by Principal Health Insurance Coverage Status • Table 6 FP Users with Limited English Proficiency (LEP) • Table 7 Female FP Users by Primary Method and Age • Table 8 Male FP Users by Primary Method and Age

11. FPAR PEF Information • Table 9 Cervical Cancer Screening Activities • Table 10 Clinical Breast Exams and Referrals • Table 11 FP Users Tested for Chlamydia by Age and Gender • Table 12 FP Users Tested for Gonorrhea, Syphilis, and HIV

12. AR, PSRS, Page 32 • Must enter methods dispensed day of service and quantity amount): CONTRACEPTIVES, QUANTITY ISSUED and LOT#: All contraceptive methods being administered during a Family Planning Visit must be reported as an “S”, “J” or CPT code. PEF entry for methods dispensed must be put in CHG/QTY field! DO NOT USE UNIT FIELD

13. Accurate data for FPAR • There are many methods of contraceptives other than prescriptive birth control, including withdrawal, natural fertility awareness (rhythm method), pregnant or seeking pregnancy, sterilization (female or male) and infertility services for Title X “methods of fertility” • It is essential to identify the primary method used at each FP visit type, including pregnancy test visits and ECP visits, and other program visits

14. AR, PSRS, Page 32, Primary Method VERY IMPORTANT Use when V25 ICD-9 is coded in any position (STD, Adult/Child, Cancer visits) and NO method is dispensed at visit, OR a prescription is written for a method • MUST document on PEF in 2 digit code section to capture the primary method!!!! PRIMARY METHOD PATIENT IS USING IF NO METHOD GIVEN TODAY: The “2” digit codes are used only for Family Planning Visits where no contraceptive method is given to the patient. For reporting purposes only, these “2” digit codes are used to identify what contraceptive method the patient is using. Place a check in the box preceding the appropriate method.

15. Primary Method Patient is Using Revised PEF • 07 Natural Fertility Awareness • 03 Male Condom • 13 Foam/Spermicide/Gel • 24 Pregnant or seeking pregnancy • 10 Withdrawal • 05 Female sterilization

16. Primary Method Patient is Using Added • Abstinence • Rely on female method • Vasectomy • Sterile, Non Surgical

17. Pregnancy Test & ECP Visits It is recommended to enter a V25 code to cover family planning counseling or method provided Assure level of visit is equal to amount of service provided as required in PHPR, FP Matrix for pregnancy test and ECP visits

18. Essential FPAR data • WHEN PROVIDED, be sure to enter codes for cervical cancer screening and breast exam during family planning initial and annual visits • Follow cancer guidelines to start routine screening at age 21!!!! Unless problem identified!

19. LHD Title X Allocation • Each LHD/Districts Title X allocation is based on the total number of unduplicated users reported on the previous FPAR. • It is essential you get credit for the pregnancy prevention and pregnancy planning services you provide - CODE IT!!

20. ICD 9 Codes for Family Planning AR, PSRS, Page 137 Primary V25 codes with edit to 802 Family planning. If you provide pregnancy prevention counseling or assess for pregnancy risk at a STD, child or adult preventive exam, code a V25 in the secondary position (so you get credit for it on FPAR)!!

21. FP ICD-9 AR PSRS Section Page 31 • Family planning ICD-9 (V25) codes may be in the primary, secondary, etc code: Examples of secondary coding adult/child preventive, STD, Post Partum visits V2509 Family Planning Advice/Counseling “Pregnancy prevention” • Males, Males, Males

22. IT is essential to enter COMPLETE and ACCURATE • DEMOGRAPHIC INFO, • INSURANCE INFO, • INCOME INFO, and • CODING/Billing OF ALL SERVICES PROVIDED at the HIGHEST LEVEL

23. Cost of Contraceptives • 340B Prime Vendor Program – Compare prices to obtain best price on new website: https://www.340bpvp.com/controller.html. • Use 340B number to register for access to the Title X Price List for comparisons • Prescriptions allowed for insured FP patients.

24. Questions • Maximize reimbursement from third party insurers, including public (Medicaid) and private (Humana, Blue Cross, etc) • Maximize fee collection • Donations • Mandated Office of Population Affair's Family Planning Annual Report (FPAR) • Annual Title X 802 allocation to LHD

25. Contact Information Debra Israel, RN Nurse Consultant Director Family Planning Program Division for Women’s Health (502) 564-3236, Ext: 4590 Fax:  (502) 564-1552 email:  debra.israel@ky.gov