Practice Management

  • The AAO Board of Trustees created the Osteopathic Medical Economics Committee to form as an informational resource for members dealing with
    difficulties regarding coding reimbursement for OMT. The Committee also reviews documents and audiovisual materials peftaining to medical
    economics issues, which can be used to influence coverage and reimbursement policies of third pa¡ty carriers and legislators alike. The Committee serves as a resource for members, insurance companies and attorneys who need access to OMM expefts for medical opinions, depositions
    and court testimony.

The American Osteopathic Association has many valuable resources available via the Internet to facilitate appropriate physician reimbursement for
uniquely osteopathic services provided to their patients. For example, you can download as .pdf files the following documents:

  1. Documentation Guidelines for Evaluation and Management Services which explains when it is appropriate for the DO to bill for delivery of
    osteopathic manipulative treatment in conjunction with an evaluation and management service (office visit.)
  2. Protocols for Osteopathic Manipulative Treatment which explains the rationale for utilization of OMT in patient care.
  3. Osteopathic Coding 2002 provides updated information on appropriate policies for coding and reimbursement

To access these and other resources, log onto www.doonline.org and click on Practice Management on the top toolbar.

Other resources
www.ama-assn.org (click on professional resources)
www.cms.hhs.gov/
www.aoa-net.org 

Accurate coding is a skill learned to maximize reimbursement.

Requirements of Current Procedural Terminology (CPT) and the Centers for Medicare and Medicaid Services (CMS) are accepted throughout the US, but Medicare contractors and insurers may have varying interpretations of some of the requirements.

Definitions:

New patient: a patient who has not received care from you or members of your group in any service location in the past 3 years. Therefore, if an established patient has not received care from you or your group in the past 3 years, patient can be billed as a NEW PATIENT.

Group Practice: are physicians belonging to the same Medicare billing group identification in the same specialty.

What are the Criteria for E&M Visits?

History

  • Chief complaint (CC)
  • History of Present Illness (HPI) 
  • Review of Systems 
  • Past History, Family History, Social History

Other impoftant information to help with grading your medical decision making should included: Source of Information-ex. Patient, chart or other,

Miscellaneous information important to physicians: Allergies, Prior Infectious Diseases (ex: clostridium difficile, skin infectious (MRSA).

Exam: number of organ systems

Medical Decision Making (MDM)

  • List of diagnosis and management provided
  • Studies reviewed and new studies ordered if needed 
  • Cornplexity (straightfonruard, moderate, high) 
  • Risk level to patient

Time spent Counseling, etc.

To establish how many systems are needed to determine a level of Billing, please refer to www.acp.orq, www.cms.hhs.gov, www.acofp.org.

Acceptable Tips on Documentation:

  • All other review of systems are negative.
  • Family history unchanged since last visit or give a date.

List of CPT Codes:

  • Office*NEW' codes: 9920L-99205
  • Office "ESTABLISHED" codes: 992L1-99215
  • Hospital "INITIAL" Consultation codes: 99251-99254
  • Hospital "FOLLOW- UP'Consultation codes: 9923L-99233
  • Outpatient/Office Consultation codes: 9934L-99245

Available to members of the AAO will be upcoming lectures on the Basic Approach to Billing and Coding OMT and Tips on Optimizing Your Reimbursement.

Practice Management and EMR:

More to come for AAO members