Coding Opportunities Summary
Bill for Developmental Screening
Bill for Postpartum Depression Screening
Apply Fluoride Varnish in Your Practice
Enroll in the Vaccines for Children (VFC) Program
NEW: 100 Patients + 1 Year = $18,000

Coding Opportunities Summary
Many Illinois providers are not taking advantage of the following opportunities for provide and bill for services and increase their revenue.

 

Bill for Developmental Screening
Developmental screening and referral services are vital to children's health. Therefore, practices should feel comfortable billing for provision of screening services.

For patients on public aid programs such as All Kids and Medicaid, IDHFS does reimburse providers for using any of 20 developmental screening tools. These tools include the Ages and Stages Questionnaire (ASQ), as well as others such as the Parents Evaluation of Developmental Status (PEDS) screen, the Battelle Developmental Inventory (BDI), the Bayley Infant Neurodevelopment Screener, and the Denver II. This also includes tools that screen for mental health or social/emotional issues, such as the Ages and Stages Questionnaire: Social/Emotional. ICAAP encourages all pediatric primary care providers to do both general developmental screening as well as social/emotional screening, setting a schedule for rotating screens at different well child visits.

For more information about the tools, please refer to the IDHFS Healthy Kids Handbook, or visit www.hfs.illinois.gov/handbooks/chapter200.html#hk200 and scroll to the bottom of the page to find a link to the Healthy Kids Handbook on-line. The list of reimbursable screening tools is found on page HK 203 (13) of the handbook. (CPT codes are found in Appendix 8 (1) to Chapter HK-200.)

To bill Medicaid for screening, providers must be implementing the screening consistently with all patients and billing all patients for the service. Practices should review their insurance contracts for the applicable developmental screening codes to see what private insurance carriers will reimburse. The Chapter recognizes that many private insurers will not reimburse for developmental screening. We hope that you will identify the carriers that are not currently reimbursing for your services, and then alert the Chapter.

The code for developmental screening or social/emotional screening is 96110 and providers are reimbursed $16.10 for each developmental or social/emotional screen.

If you are interested in reviewing related billing provider releases/informational memoranda, please visit www.hfs.illinois.gov/releases. For specific information about "unbundling" billing claims, including developmental screenings, please review the notice dated February 10, 2004, called “Billings for Screenings Under the Healthy Kids Program.” For more information, visit www.illinoisaap.org/socialemotional.htm or contact Sarah Baur at 312/733-1929 or sbaur@illinoisaap.net if you have any questions about billing procedures or would like to request training on developmental or social/emotional screening for your office.

Bill for Postpartum Depression Screening
IDHFS has announced that it will reimburse providers for screening mothers for perinatal depression. Please note that providers may bill for maternal depression screenings until the child is one year old. While there is no limit to the number of screenings conducted during the child's first year, experts affiliated with ICAAP recommend screening at well-child visits, and at least twice during the first year. In order to bill for these maternal depression screenings, either the mother or the child must receive Medicaid benefits. If the mother receives the benefits, providers should use her ID number when billing. If the child receives the benefits, use his member ID number.

Please remember that IDHFS will only reimburse for the use of an approved screening tool. At this time, the approved tools are: the Edinburgh Postnatal Depression Scale (EPDS); the Beck Depression Inventory (BDI); and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire (PRIME-MD/PHQ). Please keep in mind that IDHFS and ICAAP recommend developing a practice-wide policy and screening all mothers for depression consistently. However, insurance companies are not yet reimbursing separately for the screening, as they assume that the assessment of family status and risk is incorporated into the well child visit. The code for postpartum depression screening is 99420 and providers are reimbursed $14.60 for each developmental or social/emotional screen.

Visit www.hfs.illinois.gov/assets/112904pd.pdf for the IDHFS provider notice that explains the new billing procedure. For more information about billing Medicaid, please call IDHFS at 877/782-5565, or visit www.hfs.illinois.gov.

For more information about maternal depression, including the use of the above listed screening tools, or to schedule an in-office training session on maternal depression, please contact Sarah Baur, Project Director, at sbaur@illinoisaap.net or 312/733-1026, ext 203.

Apply Fluoride Varnish in Your Practice
Your practice can help address the shortage of dental care in Illinois by learning to provide better patient education, screen moms and young children for dental concerns, and apply fluoride varnish when necessary. ICAAP is partnering with the Illinois Department of Public Health, IDHFS and others to present an educational and technical assistance program called Bright Smiles from Birth. Participating practices will receive an in-office CME program on screening, referral and varnish application; patient education materials; referral resources; and varnish supplies.

Practices who participate will be enrolled in a pilot project and will receive Medicaid reimbursement for all varnish applications. Evaluation of the pilot project is being conducted by the University of Illinois at Chicago and Medicaid, and practices are only required to complete simple evaluation forms. Training will begin immediately, and only those who participate will be eligible for reimbursement.

Practices will be reimbursed $26.00 for each patient/varnish application. Please note that this pilot project is only available to practices in Cook County, IL (although it is expected to expand in late 2007 or early 2008) and that federally-qualified health centers (FQHCs) will not receive enhanced reimbursement because of the “encounter rate” arrangement. Please contact Paula Zajac at 312/733-1026, ext 212 or pzajac@illinoisaap.com to participate.

Enroll in the Vaccines for Children (VFC) Program
The Vaccines for Children (VFC) program is a federally funded, state administered program that provides free vaccines to eligible children ages 18 and younger. Vaccines are provided free at no cost to the provider or the patient, although providers may charge an administration fee. Eligible children include the following:

• Children who have or are eligible for Medicaid/All Kids
• Children with no health insurance
• American Indian or Alaska Native children
• Children who are Underinsured**

**Underinsured children are defined as those children who have private health insurance which does not include coverage of vaccines. A child whose health insurance covers only select vaccines or caps the vaccine cost at a certain limit is categorized as underinsured. Underinsured children in Illinois can receive all VFC vaccines through a private provider except for varicella, pneumococcal, meningococcal, and influenza; however, underinsured children can obtain these and all other vaccines at a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC).

For more information on the Illinois VFC program click here.

One Year in Your Practice
Taking into account rate increases and proper billing, a practice with only 100 Medicaid patients can see a total increase in reimbursement of $18,253 in one year! (Based on all recommended well child visits plus four sick visits and one code 99214.)

Interested in learning more? To request a presentation about Medicaid/All Kids in your office, contact ICAAP at info@illinoisaap.com.