Telehealth Medicare Visit Scheduling Front Desk Workflow...E. Go to NGSConnex and verify date of...

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Date Last Revised: 4/8/2020 12:53:00 PM 1 Telehealth Medicare Visit Scheduling Front Desk Workflow Medicare Visit Type Overview & Which Types Qualify for Telehealth Visits ........................ 2 New Telehealth Visit Types ...................................................................................................... 2 Telehealth MWV – Initial Workflow ........................................................................................ 3 Telehealth MWV – Subsequent Workflow .............................................................................. 4 Identifying Patients Due for Medicare Wellness – Subsequent Visit ..................................... 6 Denial of Medicare Visit Type Scheduling ............................................................................... 7 Proactive Review of Daily Provider Schedule.......................................................................... 8 Check-In of Telehealth Medicare Visits ................................................................................... 9 Check-Out of Telehealth Medicare Visits ................................................................................ 9 APPENDIX .................................................................................................................................................. 11 A. NGSConnex ................................................................................................................................................. 11 Registration ............................................................................................................................. 11 Login & Eligibility Information ................................................................................................. 13 Medicare Beneficiary Identifier (MBI) Tool............................................................................. 17

Transcript of Telehealth Medicare Visit Scheduling Front Desk Workflow...E. Go to NGSConnex and verify date of...

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Telehealth Medicare Visit Scheduling Front Desk

Workflow Medicare Visit Type Overview & Which Types Qualify for Telehealth Visits ........................ 2

New Telehealth Visit Types ...................................................................................................... 2

Telehealth MWV – Initial Workflow ........................................................................................ 3

Telehealth MWV – Subsequent Workflow .............................................................................. 4

Identifying Patients Due for Medicare Wellness – Subsequent Visit ..................................... 6

Denial of Medicare Visit Type Scheduling ............................................................................... 7

Proactive Review of Daily Provider Schedule .......................................................................... 8

Check-In of Telehealth Medicare Visits ................................................................................... 9

Check-Out of Telehealth Medicare Visits ................................................................................ 9

APPENDIX .................................................................................................................................................. 11

A. NGSConnex ................................................................................................................................................. 11

Registration ............................................................................................................................. 11

Login & Eligibility Information ................................................................................................. 13

Medicare Beneficiary Identifier (MBI) Tool ............................................................................. 17

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Medicare Visit Type Overview & Which Types Qualify for Telehealth Visits Medicare now allows patients to complete two of the three Medicare Wellness Visits (MWV) via Telehealth visits.

Welcome to Medicare IPPE Visit DOES NOT QUALIFY FOR TELEHEALTH!!!

• This is a new visit type that did not previously exist in Epic.

• Must schedule within the first 12 months that a patient is eligible for Medicare Part B

• There is no charge to the patient for this visit; it is covered completely by Medicare.

• This visit includes a review of the patients medical and social history related to their health and education

and counseling about preventative services.

Medicare Wellness - Initial Visit

• If the patient does NOT schedule the Welcome to Medicare Visit during the first 12 months of Medicare Part

B eligibility, schedule a Medicare Initial Visit instead.

• There is no charge to the patient for this visit; it is covered completely by Medicare.

• This visit includes a review of the patients medical and social history related to their health and education

and counseling about preventative services.

Once per lifetime, patients may have EITHER a Welcome to Medicare Visit OR a Medicare Initial Visit.

Medicare Wellness - Subsequent (Annual) Visit

• Schedule annually after EITHER the Welcome to Medicare Visit OR the Medicare Wellness - Initial Visit

has been completed.

• This appointment is for patients to discuss their plan of preventative care in the coming year.

These Medicare visits are NOT:

• A routine visit

• A follow up

• A check up

• A time to assess and manage acute or chronic medical conditions

New Telehealth Visit Types The new visit types available for scheduling are:

• Telehealth MWV - Initial

• Telehealth MWV – Subsequent

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NOTE: The Welcome to Medicare Visit IPPE does NOT qualify for Telehealth visits.

To ensure that the correct Telehealth Medicare Visit type is selected during scheduling, whenever any of the

Medicare visit types are selected:

… a decision tree appears which guides the user through which Medicare Visit type to schedule. NGSConnex

must be utilized to verify eligibility dates for Medicare Part B and the different Medicare visit types by “G” code:

▪ G0438 = Medicare Wellness - Initial Visit

▪ G0439 = Medicare Wellness - Subsequent (Annual) Visit

(Refer to “NGSConnex” in the appendix of this tip sheet.)

This decision tree is based upon the definitions outlined for Medicare Visit Types and the eligibility dates indicated

in NGSConnex. If the user initially chooses the incorrect Medicare visit type, the system will correct (or deny)

the visit type being scheduled based upon the decision tree responses.

Telehealth MWV – Initial Workflow When the decision tree is answered as follows, the Telehealth MWV – Initial will be scheduled. Note that

the decision tree has an additional last question to indicate whether the visit will be in the office or a

telehealth visit:

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Telehealth MWV – Subsequent Workflow

When the decision tree is answered as follows, the Telehealth MWV - Subsequent visit will be scheduled.

Note that the decision tree has an additional last question to indicate whether the visit will be in the office

or a telehealth visit:

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When scheduling a Telehealth MWV – Subsequent, be sure to:

• Confirm reason for visit and educate patient on scope of this visit, utilizing the scripting: “During this visit

your provider will address any preventative services and complete a health risk assessment to better fit your needs.

If you are a MyChart user, you will receive the health risk assessment via MyChart to complete online prior to the

visit.”

NOTE: Reference the Medicare HRA Via MyChart Tip Sheet for more information.

• Instruct patient to have available at the time of the visit a list of all medications & supplements and any

specialists they see, as well as their Medicare card for coverage verification.

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Identifying Patients Due for Medicare Wellness – Subsequent Visit A. To determine when a patient is due for a Medicare Wellness - Subsequent Visit in Epic, run the

“Medicare Wellness Visit” report. This is accessed through the following link:

http://rhbidb01.riversidehealthcare.net/Reports/report/Ambulatory%20Reports/Medicare%20Wellness%20Visits%202018

B. Select the provider for whom you want to pull the report.

C. Enter Last Visit on or Before Date.

D. Look for the patient’s last “G” code billed- if over 1 year or never.

▪ G0438 = Medicare Wellness - Initial Visit

▪ G0439 = Medicare Wellness – Subsequent Visit

E. Go to NGSConnex and verify date of last billed Gcode. (Refer to “NGSConnex” in appendix of this

tip sheet.)

F. In Epic, check the patient’s future appointment desk for visits with your provider.

1. If an appointment (e.g. Office Visit) is scheduled- check to see if it should be a Medicare Wellness-

Subsequent Visit.

i. If Yes: Change appointment type and notify patient of this change at Check-In. Utilize the

following scripting:

• “Your appointment for today has been changed from an Office Visit to a Telehealth Medicare

Wellness Visit, as our records indicate you are due for this Medicare visit. During this visit the

provider will address any preventative services and complete a health risk assessment to better fit

your needs. If you are a MyChart user, you will receive the health risk assessment via MyChart to

complete online prior to the visit. Should you have other concerns or complaints, they will be

addressed separately during this visit.”

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ii. If No: Notate in existing appointment note to schedule Medicare Wellness – Subsequent

Visit at Check-Out; indicate the due date for this visit type in the appointment note as well.

2. If a Telehealth MWV – Subsequent Visit shows as a future appointment on a date BEFORE the

patient’s eligibility date, call the patient utilizing this scripting:

Outgoing call if patient is not eligible for Medicare Wellness - Subsequent Visit

“Hello, this is [your name] calling from Riverside Medical Group [insert your clinic name here]. May I

please speak with [patient name]? You are scheduled for a Telehealth Medicare Annual Wellness Visit with

Dr. [name] on [date]. It appears that you have already received this service on [date]. This benefit is only

eligible for reimbursement once every 12 months. Is there any other concern that you would like to address

at this time? If so, you may keep this appointment and I’ll just change the visit type to an Office Visit.

Otherwise, I will need to reschedule this appointment for when you are eligible.”

3. If no future appointment exists, call the patient to schedule one, utilizing this scripting:

Outgoing call if patient is eligible for Medicare Wellness - Subsequent Visit.

“Hello, this is [your name} calling from Riverside Medical Group [insert your clinic name here]. May I

please speak with [patient name]? Our records indicate that you are due for your free Annual Medicare

Wellness Visit with Dr. [name], which we can scheduled as a Telehealth visit. During this visit he/she will

address any preventative services and complete a health risk assessment to better fit your needs. May I go

ahead and schedule this appointment for you?”

Denial of Medicare Visit Type Scheduling

If a scheduler answers “NO” to “Will this appointment be on or after the Next (NGSConnex) Eligibility

Date”, a “Results – Deny” error message will appear and the system will not allow scheduling:

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Proactive Review of Daily Provider Schedule Depending on the clinic, this work may be performed by a CA or a CT.

A. Review any Follow Up appointments

1. Check to see if patient is following up on a problem visit.

a. Verify follow-up recommendations in provider’s last Office Visit notes.

b. Verify if patient has already followed up on problem visit.

c. If any problems need to be addressed, leave as a follow up visit.

2. Check encounters to confirm last date of Medicare Wellness – Subsequent visit.

a. Confirm in Office Visit notes for that encounter that physical exam (PE) was completed.

b. Confirm that Health Risk Assessment (HRA) form in Media Manager matches the Medicare PE

date of service.

B. Review any Medicare Wellness – Subsequent appointments

1. Check encounters to confirm last date of Medicare Wellness – Subsequent visit.

2. Confirm in Office Visit notes for that encounter date of service that a PE was completed.

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Additionally:

• Indicate last Medicare Wellness PE date of service on “My Sticky Note” for reference only (Care

Associates do not have access to “My Sticky Note”: only the clinical staff do).

• Run eligibility in NGSConnex to see if patient is eligible for Medicare Wellness – Initial or Subsequent

visit.

• Update visit type on appointment desk.

• Communicate with provider which patient was changed to Medicare PE so they know why it is

scheduled as a 15 minute visit.

Check-In of Telehealth Medicare Visits 1. Verify with the patient that the reason for the visit is for their respective Medicare visit.

2. Inform patient that this is their free Annual Medicare Wellness Visit. If the patient has NOT completed

the required Health Risk Assessment (HRA) form via MyChart, the clinical staff will complete this form

verbally with the patient during the rooming process BEFORE the patient is seen by the provider.

NOTE: Reference the Medicare HRA Via MyChart Tip Sheet for more information.

3. If the patient has additional concerns to be addressed outside of the Medicare visit, these may be

addressed and handled by the provider.

4. Be sure to update list of specialty providers in patient’s Care Team.

Check-Out of Telehealth Medicare Visits 1. When the Telehealth MWV is complete, go to the DAR and check the patient out.

2. At check out, look for “Follow-up Disposition”. If a follow-up appointment is indicated by the provider, call the patient back in a timely manner to schedule (immediately following initial appointment or same day preferred) .

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APPENDIX

A. NGSConnex

Registration 1. Go to

https://connex.ngsmedicare.com/home/start.swe?SWECmd=Start&SWEHo=connex.ngsmedicare.com

2. Read and agree to the standard Disclaimer

3. Click “new user”

4. Read and agree to the Online Services & Web Confidentiality Agreement

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5. Create User Name (must contain 4 alpha and 3 numeric)

6. Create Password (must contain 1 alpha, 1 numeric, 1 special character, 1 uppercase, 8-30 characters long)

7. Enter personal Information

8. Enter Organization Information

a. NPI :1417061193

b. PTAN: 356254

c. Last 5 digits of TIN: 67726

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d. Line of Business- Part B

e. State- Illinois

9. When users initially register through Connex, an approval notification request is automatically emailed to

the current Connex administrator and should not need further action/email from you once you complete

the registration process. Users do NOT need to reach out to the administrator to inform them that they

have registered.

10. If you have any problems with this process, please submit a ticket via the Riverside IS Help Desk portal.

The tickets will be worked in the order they are received and will be resolved within 24 hours (except

weekends). Please do not e-mail, call, or jabber the administrator directly.

Login & Eligibility Information

1. Go to

https://connex.ngsmedicare.com/home/start.swe?SWECmd=Start&SWEHo=connex.ngsmedicare.com

2. Read and agree to the standard Disclaimer

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3. Enter your Username and Password; Click OK.

4. Choose Delivery Method to Multi-Factor Authentication by selecting email or text option. Click “Send

Security Code”

5. Enter Security Code once you receive it- The Security Code is good for 24 hours even with multiple

logins.

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6. Click Eligibility Tab

7. Hit Select- For RMG- Everyone reflects as “Willmington” (Yes, it is misspelled with 2 “l’s!)

8. Enter Beneficiary’s Information and select

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9. Check “Current Part B Entitlement Date”

10. Under Preventive Services, look for patient’s next eligibility date to determine when he/she is eligible for

an AWV. If “Current Part B Entitlement” and the “Next Eligibility Date” Are the same- Patient

should have a Welcome to Medicare Visit.

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Medicare Beneficiary Identifier (MBI) Tool

The MBI look up tool will help you look up the patient’s new MBI if the patient does not have their new card

available when you are speaking with them.

1. Login to NGS Connex

2. Select MBI Lookup link in the top right-hand corner

3. Select “reCAPTHA” checkbox and select the appropriate images to validate

4. Enter at least the first 6 letters of the last name and the first letter of the patients first name, DOB, SSN,

and Group NPI

5. Select “Done”