Optimizing CPT Coding For New, CalAIM-Driven Service-Based Care Models
Gettysburg, Pa. (July 23, 2023)— A big change to California’s Medicaid program, payer reform under California Advancing and Innovating Medi-Cal (CalAIM), is the shift to one model for payment and documentation of services. The goal is to decrease administrative burden for providers of care and to focus on a whole person’s care needs. One important step in achieving this goal is to use the national standard coding systems, Current Procedure Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and International Classification of Disease, version 10 (ICD-10) for all coding and care definitions. In addition to the code sets, California is also seeking to reduce administrative burden by making documentation fall in line with regular physical health practice.
The first step in achieving this goal is to use the national standard coding systems. To help executive teams with this transition, OPEN MINDS is hosting an Executive Roundtable, CalAIM & CPT Code Best Practices: Developing A New Model For Service-Based Care. The session, being held virtually on August 3 at 1:00 pm ET, will be moderated by Richard Louis, III, OPEN MINDS Vice President West Region, and will also feature OPEN MINDS Senior Associate Sharon Hicks and Dee DeWitt.
In this session our panel will discuss the best practices for optimizing CPT code billing, familiarity with the Medi-Cal code set for behavioral health including evaluation and management (E&M) codes, standard service codes, and providing services under new models for service-based care.
“With the implementation of new CPT codes for billing Medi-Cal reimbursable services, part of the payer reform system transition under the CalAIM initiative, managed care program coding and documentation take on greater importance. Provider organizations will need to learn a new scope of practice and the implications of related risk management and compliance issues using these new codes”, said Mr. Louis, Vice President West Region, OPEN MINDS.
To register for the August 3 roundtable, visit https://attendee.gotowebinar.com/register/127696613475562845. There is no cost to register, but a free membership in the OPEN MINDS Circle is required.
This roundtable is part of the OPEN MINDS quarterly CalAIM series and OPEN MINDS Circle Elite Executive Roundtable sessions, designed to help executive teams navigate the business, organizational, operational, and cultural changes of a market in turbulence. Each one-hour briefing outlines a field-tested approach for recovering from a crisis and developing a plan for organizational sustainability.
Richard Louis, III, Vice President, Western Region for OPEN MINDS, brings extensive experience as a behavioral health care administrator, business development specialist, and innovator of new service lines for behavioral health care organizations. His expertise in population health management program development, strategic planning, and payer mix diversification helped create programs that target high-cost and complex behavioral health populations.
Sharon Hick, Senior Associate for OPEN MINDS, has more than 30 years of experience in the health and human service field. She has extensive experience and a wide range of expertise in health plan management, clinical operations management, and technology. Prior to joining OPEN MINDS, Ms. Hicks spent two decades in a number of executive positions within the University of Pittsburgh Medical Center (UPMC) system and within its health plan division.
Dee DeWitt, Senior Associate for OPEN MINDS, offers extensive experience as a consultant and corporate leader in the healthcare field. Mr. DeWitt brings over 28 years of experience in healthcare finance and operations, M&A, the use of technology, strategic planning, and change management in healthcare organizations to OPEN MINDS as a Senior Associate. Previously, Mr. DeWitt was the Chief Financial Officer and Chief Operating Officer of Momentum for Health in San Jose, California.
About OPEN MINDS
OPEN MINDS is a national market Intelligence, management consulting, and marketing services firm specializing exclusively in the markets of the health and human service field that serve consumers with chronic conditions and complex support needs. OPEN MINDS mission is to provide payers, service provider organizations, and technology and scientific firms that serve these consumers with the market and management knowledge needed to improve their organizational efficiency and effectiveness. Learn more at www.openminds.com.