Medical Billing FAQs
Below are some common medical billing FAQs regarding the Quality Payment Program (QPP), Chronic Care Management (CCM), Telemedicine, and changes in coding that can affect your practice in 2017.
Q: Can chronic care management be implemented in any medical field or specialty?
A: CCM is intended to be used by the provider that is managing the care for a patient with multiple chronic conditions. Although this is typically the primary care provider, there are cases where this may be a specialist.
Q: Can you bill Medicaid for CCM?
A: Maybe. CCM codes are just like any other CPT code, and can be sent to any payer. However, each payer, including every state Medicaid plan, is different. Some will cover CCM and others will not.
Q: Where can I find out more about billing for CPT codes 99487, 99489, and 99490?
A: The CPT Manual. This memo also provides some guidance but to date, CMS has yet to update this memo.
Q: Where can I find out more about measurements for QPP?
A: All measurements and improvement activities can be found here.
Q: For Pick Your Pace, is it just one quality measure for one patient at one visit?
A: To avoid the Medicare adjustment or penalty, CMS states that you can report one quality measure, one improvement activity or the four base Advancing Care Information measures.
Q: Are chiropractors eligible for the QPP and MIPS?
A: Chiropractors are included on the list of physicians that are covered for the QPP. More here on page 13.
Q: Are physical therapists required to participate in MIPS?
A: Although physical therapists are not required to participate in 2017, they will likely be added in year three of the program. Physical therapists can chose to participate now but they will be considered non-eligible clinicians, and will not receive a bonus or be subject to penalties. See page 13 of this document from CMS.
Q: Can mental health therapists bill for telemedicine services?
Q: Can a phone consultation be billed as telemedicine?
A: No. Telemedicine codes can only be used for telemedicine services which are defined as a combination of both audio and visual.
Q: Any CPT code changes that are related to the ICD-10 changes from October?
A: The ICD-10 changes do not impact CPT codes. However, the fall 2016 ICD-10 changes can be found here.