This is a very specific question, it's been difficult for me to find the answers I'm looking for. Our clinic was just certified as a Health Home Demonstrator for the MAPCP program by Medicare. We are in Minnesota, which has slightly different rules about this than the rest of the states with the program. We are brand new to the coding requirements for this. Our clinic does not have a coder. The doctors do their own coding and if there's a problem it comes to me or the other lady in billing. So we're the ones who need to know this. Hopefully someone can help me with this! Here are my questions:
- Do the chronic conditions for patients need to be listed in every claim submitted to qualify for the tier level on the claim? I know about the modifiers for mental illness and non-English speakers, I'm more curious about if the chronic conditions need to be listed in the ICD section.
- I am putting the “P4” reference ID qualifier in the paperwork loop (pathology report) with document ID type “AA”; and the “58” demonstration code in box 19 of the HCFA (“reserved for local use”) – is this correct? I've had a rough time getting information on this.
- Is there any other field that must be filled out in the header or data info for the claim that I haven't already mentioned?
- Is the “place of service” still considered the office for phone calls to patients for care management?
Thanks so much to anyone who can help me out with this! Google was a bust, the Medicare people were unhelpful, and I even called the support center for our claims software and they were able to help me but they're not very familiar with this specific set of coding requirements. I just need to find someone who does this regularly I think.