To develop the prevention calculators, TMA combed through the CPT manual to identify the billing codes connected to each USPSTF guideline, says TMA Clini- cal Advocacy Director Joseph Gave. He calls the calculators “one-stop shopping” in that they include the billing codes for related clinical services, durable medical equipment, and lab tests. The Excel-based tools are free and downloadable from the TMA website at
www.texmed.org/ClinicalQualityTools/. TMA will update the calculators annu- ally through 2015, and practices should make sure they use the most current ver- sion for the corresponding billing year. Each calculator is customizable so physicians can enter the amount they re- ceive from insurers for each code listed. Medicare or Medicaid payment amounts already are included.
After choosing a calculator and input- ting contract fees, physicians can then enter the number of patients receiving or eligible for those services over a pe- riod of time to calculate their return on investment. TMA recognizes that providing these
services may not be financially sustain- able for all practices, Mr. Gave says. Still, the tool provides “a very practical look down to the nickels and pennies at how doctors stand to benefit from each guideline.” Mr. Gave warned that the calculators
are for use only by individual practices. Federal and state antitrust laws prohibit physicians from sharing contracted pay- ment information with other doctors and prevent TMA from collecting the data.
Fringe benefits
Some homework is involved, but simply entering the fees for each service can be an eye-opener and can help physicians’ negotiations with private health plans, says Keller family physician Gregory M. Fuller, MD, a member of the Council on Health Care Quality.
Getting familiar with the various codes can help physicians educate them- selves and their patients about the pre- vention recommendations and perform the documentation needed to get paid. For example, if a patient who smokes goes in for a hypertension check and has
bronchitis, his or her physician can take the opportunity to discuss tobacco cessa- tion, one of the guidelines. Dr. Fuller’s practice, North Hills Fam- ily Medicine, used its EMR system to identify more than 1,000 patients who could benefit from tobacco cessation counseling. “If we reach even 50 percent of them, that’s additional revenue.”
On the other hand, many primary
care physicians are used to listing gen- eral evaluation and management (E&M) codes when they actually do much more. “There are a lot of things physicians
are doing without realizing they can get some additional payment,” Dr. Fuller said. “If you are consulting with patients about their weight or about smoking ces-
Prevention calculators
TMA developed 36 interactive but simple calculators to help educate physicians on the requirements and billing codes as- sociated with preventive services recommended by the U.S. Preventive Services Task Force (USPSTF) and covered under the Patient Protection and Affordable Care Act (PPACA). Some of the calculators for adults include screenings, coun- seling, and interventions for abdominal aortic aneurysm, breast and cervical cancer, breastfeeding, depression, type 2 diabetes mellitus, obesity, osteoporosis, sexually transmitted infections, and tobacco use. Examples of calculators for child preventive services include major depressive disorder, hearing and vision loss, congenital hyperthyroidism, iron deficiency, obesity, and sickle cell disease. Download the free calculators at
www.texmed.org/Clinical
QualityTools/. Then follow a few easy steps to see the benefits of providing such care and evaluate the fiscal sustainability of offering these services.
• Choose a calculator. Start with something that fits your practice and patient population.
• Enter the contracted fee amounts for each of the codes listed. Medicare and Medicaid payment rates, if applicable, are included.
• Enter the number of patients for whom you provide or could provide this treatment over a specific time period, such as one month.
Details about the preventive services covered under PPACA
are available on the USPSTF website at
www.uspreventiveser
vicestaskforce.org/uspstf/uspsabrecs.htm.
June 2013 TEXAS MEDICINE 41
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