Rewriting WA State medical reimbursement to support new models of care..
From: Anderson, Nancy, Dr. (MAA) [mailto:ANDERNA@dshs.wa.gov]
Sent: Monday, May 13, 2002 10:49 AM
To: Kevin Little
Cc: 'James W. Stout'
Subject: RE: [asthma] FW: [btscollege] Re: Asthma group visits
Medical Assistance (the Washington State Medicaid Administration) is in the process of writing billing instructions for group clinical visits, led by an MD or ARNP, that are specific for diabetes and asthma.
We've written various drafts of the instructions, but all include:
1. review of records/labs/etc by the clinician prior to the visit;
2. Group discussion devoted to a clinical issue;
3. Some question/answer time;
4. Routine review for all (most can be done in a group setting) and short individual visits as necessary
We will allow four one hour modules per year, which can be grouped together and billed as more than one module at one time. We will not allow billing for another e/m code the same day for the same diagnosis. We will allow those clients who have both diabetes and asthma to get clinical visits for each diagnosis (ie 8 one-hour visits a year, 4 for each disease). I'm hoping that we'll begin reimbursement June 1 (but with various bureaucratic issues, probably wouldn't make a bet). We also have a separate pilot project for asthma education with one clinical site, which is an individual contract. These visits are let by an asthma educator and are modeled after the diabetes education that we already reimburse.
Nancy Anderson MD MPH
Medical Epidemiologist
PO Box 45506
Olympia WA 98504-5506
360-725-1567 (v) 360-664-3884
8:19:05 AM 
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