July 2021 Client Newsletter

Cognitive Assessment: What’s in the Written Care Plan?

 

From CMS in MLN Matters on June 15, 2021:

 

“Do you have a patient with a cognitive impairment? Medicare covers a separate visit for a cognitive assessment so you can more thoroughly evaluate cognitive function and help with care planning. Any clinician eligible to report evaluation and management services can offer this service, including physicians (MD and DO), nurse practitioners, clinical nurse specialists, and physician assistants.

 

The Cognitive Assessment & Care Plan Services (CPT code 99483) typically start with a 50-minute face-to-face visit that includes a detailed history and patient exam. Use information you gather from the exam to create a written care plan.

 

The resulting written care plan includes initial plans to address:

• Neuropsychiatric symptoms

• Neurocognitive symptoms

• Functional limitations

• Patient or caregiver referrals to community resources, as needed, with initial education and support

 

Effective January 1, 2021, Medicare increased payment for these services to $282 (may be geographically adjusted) when provided in an office setting, added these services to the definition of primary care services in the Medicare Shared Savings Program, and permanently covers these services via telehealth.

 

Get details on Medicare coverage requirements and proper billing at www.cms.gov/cognitive .”

 

Reading between the lines: For the fee above, CMS is expecting the provider themselves to be providing all of most of this service. You can expect there WILL be medical record audits to make sure all documentation is present for payment, just as we are seeing audits for Telemedicine services provided since last Spring. Better to “over-document” than not enough.

 

If ALL requirements are not met for payment, you will be required to repay for those services. It is strongly recommended that you take the time on the day of service to complete your charts properly & completely. If you are not sure what is needed, send me the CPT/HCPCS billing codes & we will send you the information.