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Group: Forum Members
Last Login: Monday, November 30, 2009 6:28 PM
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Dear national colleagues: At Multnomah County Health Department in Portland, Oregon, our Environmental Health Services Healthy Homes team has been working persistently to seek Medicaid and Managed Care Plan reimbursement for several aspects of its asthma program. We have been working for almost two years with legislators, the State Public Health Division, the State Department of Medical Assistance Programs, and other organizations and agencies to advocate for reimbursement by educating individuals on the cost effectiveness of our Healthy Homes Program. We are making progress, and would love to gather some information from other asthma programs nationally that are successfully being reimbursed for their services and disciplines. Optimally, we would like reimbursement for home visits by our asthma educator, and the behavioral and environmental interventions and assessments that are implemented by our community health workers, as well as devices or supplies. We are indebted to Health Resources in Action for their invaluable report about a business case model for asthma reimbursement, and would love to personally hear from you. It would be greatly appreciated if you could provide us with the following information within the next week: - Please describe how your asthma program is currently funded.
- What percentage of your program is funded by local general funds, state health department, foundations, reimbursement and other sources?
- If you are being reimbursed by Medicaid or Managed Care Plans, what state or national codes are you using to bill for reimbursement?
- What is the rate for which you are billing? Do you receive that much in reimbursement or do you incur a debt? If so, what is it?
- Please describe, in detail, the process you used to advocate with Managed Care Plans and Medicaid to gain support for reimbursement.
- What advice would you pass along to us to help advise our process?
Please respond to lyonsk@co.multnomah.or.us or via this discussion forum. Many thanks, Rosa Klein on behalf of Kari Lyons Environmental Health Policy Analyst Multnomah County Health Department
Rosa Klein,
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Group: Forum Members
Last Login: Tuesday, December 08, 2009 1:05 PM
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| Our asthma program (Asthma Safe Kids Expansion program)is funded through a grant provided by a medicaid insurance company in Pennsylvania. The insurance company had grant money to provide asthma education services to it's most at-risk population of asthmatic children with the purpose of reducing hospitalizations and emergency room visits and therefore reducing the costs associated with each. We were able to use this money to expand upon our exisiting asthma program as a Pilot, with the hopes of receiving future funding from the insurance company. So instead of recieving reimbursements from the insurance company we recieve our funding in grant form. I spoke with our Third Party Reimbursement Manager here at my company and he had a list of asthma reimbursement codes that he pulled from Navinet (Independence Blue Cross). See the following: Procedure Code | Description | Effective Date | End Date |
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| 1005F | ASTHMA SYMPTOMS EVALUATED (INCLUDES PHYSICIAN DOCUMENTATION OF NUMERIC FREQUENCY OF SYMPTOMS OR PATIENT COMPLETION OF AN ASTHMA ASSESSMENT TOOL/SURVEY/QUESTIONNAIRE) | 01/01/2006 | | | 1026F | CO-MORBID CONDITIONS ASSESSED (EG, INCLUDES ASSESSMENT FOR PRESENCE OR ABSENCE OF: MALIGNANCY, LIVER DISEASE, CONGESTIVE HEART FAILURE, CEREBROVASCULAR DISEASE, RENAL DISEASE, CHRONIC OBSTRUCTIVE PULMONARY DISEASE, ASTHMA, DIABETES, OTHER CO-MORBID CONDITIONS) (CAP) | 01/01/2007 | | | 1038F | PERSISTENT ASTHMA (MILD, MODERATE OR SEVERE) | 01/01/2007 | | | 1039F | INTERMITTENT ASTHMA | 01/01/2007 | | | 4015F | PERSISTENT ASTHMA, PREFERRED LONG TERM CONTROL MEDICATION OR ACCEPTABLE ALTERNATIVE TREATMENT, PRESCRIBED (ASTHMA) | 01/01/2006 | | | G0244 | OBSERVATION CARE PROVIDED BY A FACILITY TO A PATIENT WITH CHF, CHEST PAIN, OR ASTHMA, MINIMUM EIGHT HOURS | 01/01/2002 | 01/01/2006 | | G0263 | DIRECT ADMISSION OF PATIENT WITH DIAGNOSIS OF CONGESTIVE HEART FAILURE, CHEST PAIN OR ASTHMA FOR OBSERVATION SERVICES THAT MEET ALL CRITERIA FOR G0244 | 01/01/2003 | 01/01/2006 | | G0264 | INITIAL NURSING ASSESSMENT OF PATIENT DIRECTLY ADMITTED TO OBSERVATION WITH DIAGNOSIS OTHER THAN CHF, CHEST PAIN OR ASTHMA OR PATIENT DIRECTLY ADMITTED TO OBSERVATION WITH DIAGNOSIS OF CHF, CHEST PAIN OR ASTHMA WHEN THE OBSERVATION STAY DOES NOT QUALIFY FOR G0244 | 01/01/2003 | 01/01/2006 | | G8370 | ASTHMA PATIENTS WITH NUMERIC FREQUENCY OF SYMPTOMS OR PATIENT COMPLETION OF AN ASTHMA ASSESSMENT TOOL/SURVEY/QUESTIONNAIRE NOT DOCUMENTED ASTHMA ASSESSMENT TOOL/SURVEY/QUESTIONNAIRE NOT DOCUMENTED | 07/01/2007 | | | G8391 | PATIENTS WITH PERSISTENT ASTHMA, NO DOCUMENTATION OF PREFERRED LONG TERM CONTROL MEDICATION OR ACCEPTABLE ALTERNATIVE TREATMENT PRESCRIBED | 07/01/2007 | | | S8097 | ASTHMA KIT (INCLUDING BUT NOT LIMITED TO PORTABLE PEAK EXPIRATORY FLOW METER, INSTRUCTIONAL VIDEO, BROCHURE, AND/OR SPACER) | 01/01/2002 | | | S9441 | ASTHMA EDUCATION, NONPHYSICIAN PROVIDER, PER SESSION | 01/01/2002 | |
Tameka Wall, Program Coordinator
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