Open Forum

Good morning! 

I ran into this exact question at our organization recently. We worked closely with our revenue cycle team & were able to develop a clear process around nurse visits, documentation expectations, and when/how 99211 can be used appropriately.

I'm happy to share what we put together and the resources we used if that would be helpful.

I'd love to see any of those resources, Bassem! Feel free to email them to me at ashley.martin@llchc.org. Thank you!

Good morning! 

I ran into this exact question at our organization recently. We worked closely with our revenue cycle team & were able to develop a clear process around nurse visits, documentation expectations, and when/how 99211 can be used appropriately.

I'm happy to share what we put together and the resources we used if that would be helpful.

I'd love to see any of those resources, Bassem! Feel free to email them to me at ashley.martin@llchc.org. Thank you!

Good morning! 

I ran into this exact question at our organization recently. We worked closely with our revenue cycle team & were able to develop a clear process around nurse visits, documentation expectations, and when/how 99211 can be used appropriately.

I'm happy to share what we put together and the resources we used if that would be helpful.

Good morning! 

I ran into this exact question at our organization recently. We worked closely with our revenue cycle team & were able to develop a clear process around nurse visits, documentation expectations, and when/how 99211 can be used appropriately.

I'm happy to share what we put together and the resources we used if that would be helpful.

Hi Bassem - would love to see what your team has put together. Please feel free to email me at samantha_colontuono@rush.edu

Thank you!

Good morning! 

I ran into this exact question at our organization recently. We worked closely with our revenue cycle team & were able to develop a clear process around nurse visits, documentation expectations, and when/how 99211 can be used appropriately.

I'm happy to share what we put together and the resources we used if that would be helpful.

Good morning! 

I ran into this exact question at our organization recently. We worked closely with our revenue cycle team & were able to develop a clear process around nurse visits, documentation expectations, and when/how 99211 can be used appropriately.

I'm happy to share what we put together and the resources we used if that would be helpful.

Good morning! 

I ran into this exact question at our organization recently. We worked closely with our revenue cycle team & were able to develop a clear process around nurse visits, documentation expectations, and when/how 99211 can be used appropriately.

I'm happy to share what we put together and the resources we used if that would be helpful.

Hi Toni--(and others on the thread identifying as FQHC nurses)--you should also join our FQHC community as we talk about these things specific to FQHCs--because. as was pointed out on this thread--we cannot bill AWVs as nurse visits--but only as provider visits--this is one example of an FQHC only rule. All other practices can do it with an RN and bill...

Our clinic does 99211 as our state medicaid in CT does reimburse for these visits. Not every state reimburses--but it is important to look at those regs as there are MANY types of visits that can be done this way. We have a whole host of standing orders for chronic disease care, acute issues, etc. 

Our system does somewhere between 28,000-32,000 nursing visits per year, depending on staffing, etc.

LPNs/LVNs can only bill vaccine visits in our state and be paid given the lack of scope of practice to "assess." We use LPNs for in-visit provider support. RNs have their own schedules.

Hope that helps--but maybe we can use one of our networking calls in the FQHC SIG for this topic!

Hope to see you there!

Mary

Mary Blankson, DNP, APRN, FNP-C, FAAN

Chief Nursing Officer

Community Health Center, Inc.

675 Main Street,

Middletown, CT, 06457

Cell: (860)227-5432

mary@chc1.com

Executive Director

National Institute for Medical Assistant Advancement (NIMAA)

1525 N Raleigh Street

Denver, CO 80204

mary.blankson@nimaa.edu

How might I listen in on or participate in the network call - if that's possible, I would LOVE to hear more about the possibilities, as the 99211 code isn't really sufficient to cover some of the complex care we nurses provide. 

Thank you, and I'm so glad we're discussing this.

Ingrid 

Hi Toni--(and others on the thread identifying as FQHC nurses)--you should also join our FQHC community as we talk about these things specific to FQHCs--because. as was pointed out on this thread--we cannot bill AWVs as nurse visits--but only as provider visits--this is one example of an FQHC only rule. All other practices can do it with an RN and bill...

Our clinic does 99211 as our state medicaid in CT does reimburse for these visits. Not every state reimburses--but it is important to look at those regs as there are MANY types of visits that can be done this way. We have a whole host of standing orders for chronic disease care, acute issues, etc. 

Our system does somewhere between 28,000-32,000 nursing visits per year, depending on staffing, etc.

LPNs/LVNs can only bill vaccine visits in our state and be paid given the lack of scope of practice to "assess." We use LPNs for in-visit provider support. RNs have their own schedules.

Hope that helps--but maybe we can use one of our networking calls in the FQHC SIG for this topic!

Hope to see you there!

Mary

Mary Blankson, DNP, APRN, FNP-C, FAAN

Chief Nursing Officer

Community Health Center, Inc.

675 Main Street,

Middletown, CT, 06457

Cell: (860)227-5432

mary@chc1.com

Executive Director

National Institute for Medical Assistant Advancement (NIMAA)

1525 N Raleigh Street

Denver, CO 80204

mary.blankson@nimaa.edu

Hi Toni--(and others on the thread identifying as FQHC nurses)--you should also join our FQHC community as we talk about these things specific to FQHCs--because. as was pointed out on this thread--we cannot bill AWVs as nurse visits--but only as provider visits--this is one example of an FQHC only rule. All other practices can do it with an RN and bill...

Our clinic does 99211 as our state medicaid in CT does reimburse for these visits. Not every state reimburses--but it is important to look at those regs as there are MANY types of visits that can be done this way. We have a whole host of standing orders for chronic disease care, acute issues, etc. 

Our system does somewhere between 28,000-32,000 nursing visits per year, depending on staffing, etc.

LPNs/LVNs can only bill vaccine visits in our state and be paid given the lack of scope of practice to "assess." We use LPNs for in-visit provider support. RNs have their own schedules.

Hope that helps--but maybe we can use one of our networking calls in the FQHC SIG for this topic!

Hope to see you there!

Mary

Mary Blankson, DNP, APRN, FNP-C, FAAN

Chief Nursing Officer

Community Health Center, Inc.

675 Main Street,

Middletown, CT, 06457

Cell: (860)227-5432

mary@chc1.com

Executive Director

National Institute for Medical Assistant Advancement (NIMAA)

1525 N Raleigh Street

Denver, CO 80204

mary.blankson@nimaa.edu

Hi Toni--(and others on the thread identifying as FQHC nurses)--you should also join our FQHC community as we talk about these things specific to FQHCs--because. as was pointed out on this thread--we cannot bill AWVs as nurse visits--but only as provider visits--this is one example of an FQHC only rule. All other practices can do it with an RN and bill...

Our clinic does 99211 as our state medicaid in CT does reimburse for these visits. Not every state reimburses--but it is important to look at those regs as there are MANY types of visits that can be done this way. We have a whole host of standing orders for chronic disease care, acute issues, etc. 

Our system does somewhere between 28,000-32,000 nursing visits per year, depending on staffing, etc.

LPNs/LVNs can only bill vaccine visits in our state and be paid given the lack of scope of practice to "assess." We use LPNs for in-visit provider support. RNs have their own schedules.

Hope that helps--but maybe we can use one of our networking calls in the FQHC SIG for this topic!

Hope to see you there!

Mary

Mary Blankson, DNP, APRN, FNP-C, FAAN

Chief Nursing Officer

Community Health Center, Inc.

675 Main Street,

Middletown, CT, 06457

Cell: (860)227-5432

mary@chc1.com

Executive Director

National Institute for Medical Assistant Advancement (NIMAA)

1525 N Raleigh Street

Denver, CO 80204

mary.blankson@nimaa.edu

Great topic and relevant to some of the work we are doing right now in our clinics. Tacking onto this thread...With regard to the nurse visit itself, we are getting some pushback from providers asking if nurse visits can be done without a provider in office. As a rule, we have never allowed this in the past, but one of our Lead Physicians wants to see the regulations that require this, and I have not been able to find anything explicitly stating that they cannot complete without a provider. For context, we are located in Massachusetts. Provider-based billing site that provides primary care and OBGYN services. Many of our practices existed in the past as privately owned and now being part of a larger health system, our interpretation of risk is not always the same. Any insight or policies you can share are appreciated. Thanks!  

Good Morning Bryony,

I work for an FQHC in California and we are highly restricted here.  Our clinics finance department developed a billing policy for us which I have included for your review and I hope you find some of the information helpful to your particular setting.

1.  How does your organization define nurse visits and the documentation required for compliance and reimbursement purposes?  Our (billable) nurse visits are defined as an in-person visit that occurs on a day where a patient does not see a clinician (NP, PA, MD).  We created a separate RN template where the nurses document a comprehensive assessment which meets the needed criteria.  We also check vital signs even at our educational appointments, even though we aren't necessarily doing a comprehensive assessment.  (refer to attached documents for billing criteria)

·    2.    Recommended approaches for charging nursing services, including any applicable CPT codes or billing guidelines.    We can put in an administrative code when providing series injections in addition to the 99211

·   3. ·   How are organizations handling charges for patient education, nurse navigator services, and annual wellness visits?  As an FQHC we cannot bill for the annual wellness visits.  The RN does see the patient and completes a majority of the work for the clinician but the billing is coded by the clinician not the RN. That's how we are required to manage those visits here. A different State or a non-FQHC might be allowed something different.  

·      Please feel free to reach out to me if you have any questions about the resources I've included.

Good Morning Bryony,

I work for an FQHC in California and we are highly restricted here.  Our clinics finance department developed a billing policy for us which I have included for your review and I hope you find some of the information helpful to your particular setting.

1.  How does your organization define nurse visits and the documentation required for compliance and reimbursement purposes?  Our (billable) nurse visits are defined as an in-person visit that occurs on a day where a patient does not see a clinician (NP, PA, MD).  We created a separate RN template where the nurses document a comprehensive assessment which meets the needed criteria.  We also check vital signs even at our educational appointments, even though we aren't necessarily doing a comprehensive assessment.  (refer to attached documents for billing criteria)

·    2.    Recommended approaches for charging nursing services, including any applicable CPT codes or billing guidelines.    We can put in an administrative code when providing series injections in addition to the 99211

·   3. ·   How are organizations handling charges for patient education, nurse navigator services, and annual wellness visits?  As an FQHC we cannot bill for the annual wellness visits.  The RN does see the patient and completes a majority of the work for the clinician but the billing is coded by the clinician not the RN. That's how we are required to manage those visits here. A different State or a non-FQHC might be allowed something different.  

·      Please feel free to reach out to me if you have any questions about the resources I've included.

Wow thank you-- This has been very helpful!