Posts tagged with developmental screening

That's no typo in the title. The Commonwealth Fund has released a nifty on-line tool and manual to help pediatricians decide which developmental screening tools are appropriate. I played around with it and am impressed enough to spread the word.
To quote them:

Pediatric Developmental Screening: Understanding and Selecting Screening Instruments informs practitioners' selection and application of screening instruments in a range of practice settings. The Web-based manual, developed by the Commonwealth Fund, is based on a review of the scientific research on available developmental screening instruments. Part 1 is designed to facilitate the selection of screening instruments by helping practitioners define their practice needs. Part 2 presents guides designed to facilitate practitioners' abilities to compare developmental screening instruments with respect to clinical utility in practice settings and validity, or sensitivity and specificity, in different populations and at various ages. An interactive Web feature (flow chart) is also available to answer questions about screening needs and make instrument recommendations.

As promised, here's a followup to my 96110 data from the other day. It's interesting to see how 96110 usage has increased in pediatricians over the years, but what are folks getting paid? Here's the data:

I know it's hard to read, so click here or on the image to see the entire thing.

So, what do we learn? Back when the 96110 was rarely used by pediatricians, it was paid pretty well ($50+). However, in 2004, CMS first published RVUs for the code and the average reimbursement plummeted. Today (and 2008 projects the same), the average payment is often between $14 and $15...or right about 100% of Medicare for most folks. Given that this is a service many of you already perform - and all of you should! - it's nice to get reimbursed at all in today's climate. Frankly, 100% of Medicare is right in line with average pediatric reimbursement in general - sad, but true - so this looks like it should slip right into the daily expectation of your well visits, etc.

In order to see the total effect of 96110 income on a pediatric practice, compare this with the previous graph...if the average PCC client (who uses this code) recorded 1800+ of them in 2007, that's almost $30,000. Add to this Dr. Stoller's message (and, yes, you too, Dr. Cain!), and you're talking about lots of potential income. Enough to make the effort. What are you waiting for, agian?

I have some fascinating data about the after hours, etc., codes (9905x) coming, but I wanted to share these two followup tidbits before I forget:

• The Developmental Screening Toolkit For Primary Care Providers looks like an excellent site to add to the list I posted the other day. In particular, here's a great comparison chart of the more common screening tools, which includes costs, links, time it takes to complete, etc. As I've said before, why practices don't perform these services and bill for them is beyond me.
• Two more articles about personalized medicine, microcapitation, whatever we want to call it. The first is from northjersey.com and is the classic vignette-style article about docs dropping insurance. The second piece is from Medical Economics and, as one would expect, it offers more details about how a practice might go about dropping out of insurance. There are some insightful comments (for example, pointing out the challenges of dropping out one insurance company at a time vs. all-at-once), but their reference to a specific generic billing package is kinda' weird (why would they suggest people look at a billing system whose legal troubles are showcased on their own front page?). Any content about this subject with the "...skip the middleman.." in the title is good by me.

9905x coming next, I think. Interesting stuff.

I've written extensively about 96110 usage among practicing pediatricians in the past and wanted to provide an update for 2008/9.

The declining personal charges combined with the increasing insurance payments (increasing at a faster rate) imply that, indeed, more and more payers are picking up this code.

More telling?  That the number of PCC clients using this code increased by more than 50% (Q1 2008 vs. Q1 2009) and now nearly 1/2 of our clients are using this code regularly.  Why aren't you?

OK, I think I have written about the 96110 more than any other specific subject!

First, big thanks go out to Igor for getting this data for me. Sure, he deserves a raise...we all do.

The list below should not be considered a 100% accurate report of which payers, by state, cover the 96110 (or 96111, for that matter) for two reasons:

• First, as noted yesterday, these only reflect charges for which payments were made.  They could, conceivably, reflect payments made from patients on waivers, etc.  We can get the super-accurate data, but this is what we have on-hand today and it's pretty accurate, I suspect.  For example, how many Medicaid patients are on waivers?  Exactly.
• Second, it's quite conceivable that I counted a state when I shouldn't have because I am not aware of all the differences among "Blue Cross" vs. "Blue Shield" that exist in different parts of the country.  Most often, the follow each other identically.  But in places like PA, you can't just trust that the word "Blue" in the name means "BCBS."  I did my best.

Thanks again to Igor, we know that the states where BCBS appears to cover 96110 include: AL, AZ, CA, CO, CT, DE, FL, GA, IL, KS, MA, MD, MI, NC, NH, NJ, NY, OH, OK, PA, RI, TN, TX, UT, VA, VT, WV, WY. 28 states - not bad, considering the relatively low usage of this code and the fact that we don't have any clients in places like Alaska, Hawaii, North Dakota, etc.  Sure, we have clients in Maine, but I think it's more likely that they aren't billing and not that it isn't being paid.

As for Medicaid, the list is similar, though not identical: AL, AR, AZ, CO, CT, GA, KS, MA, MI, NC, NH, NJ, NY, OH, OK, PA, TN, TX, VA, VT, WA, OR, WV, MT, WY.  25, I believe. That means at least 1/2 of them (and quite likely many more).  

A request was made on SOAPM for a better understanding of the payment for developmental screening, namely the 96110 and 96111.  Here's the update for 1Q 2011, where we examined tens of thousands of 9611X CPT codes used by our clients.

•  The average charge for the 96110 was $42.02 with a low of $10 and a high of $200.  For the 96111, which is much less common, the average is $197 with a low of $150 and high of $250.

  I find this range of pricing a bit troubling. A 2000% spread?! I realize that the Medicare rate is something like $7-8, but I feel as though some practices are afraid to charge appropriately.

• The average payment for the 96110 was $13.29. The average total payment was $14.34...which indicates that personal money is still paying for about 8% of these "covered" services.

  For the 96111, the average insurance payment is $115 and average total payment is $145, or a 25% difference.

• A significant majority of the 96110s billed by our clients have modifiers on them, most often the -59, however the -25, -76, and -U1 or -U2 modifiers (?!?!) make an appearance, too. Perhaps our clients in the northeast can elighten me on the -U1/2 modifiers.
• Here's the biggie: we have only 4% of the codes submitted as being rejected by the inscos with no payment. However, what we don't capture here are all the times our practices don't bill for the code because they don't bother. You know how I feel about that - you'll NEVER get paid if you don't bill for it - but it still happens that way a lot.

To be clear about this sample: it's from the first 3 months of 2011. I have removed any 9611Xs with "no insurance" on them, so this is all for covered patients. There may be visits that are not yet paid, but given that it's August now, it'll amount to very little.

Meanwhile, I recommend checking out The Verden Group's Payer Policy Search, which just launched.  You can learn whether your payer covers the 96110 or not...at least, according to their own published policies...