Sam Wiley, vice president of programs for the Alzheimer’s Association South Carolina Chapter, contributes some information relating to care planning for people with cognitive impairment and some of the latest information on local programs in this week’s column.
What is an example of cognitive impairment?
Cognitive impairment causes problems with a person’s thinking, communication, understanding or memory. It might be a short-term problem or a permanent condition. Alzheimer’s disease would be an example of a permanent cognitive impairment.
What information is there about Medicare planning for individuals with cognitive impairment and what services does Medicare provide beneficiaries?
Beginning Jan. 1, 2017 of this year Medicare created a new billing code known as G0505. Under this new billing code, Medicare provides reimbursement to physicians and other clinicians for care planning services provided to individuals with cognitive impairment, including Alzheimer’s disease.
All Medicare beneficiaries who are cognitively impaired are eligible to receive the services under the new code. This includes those who have been diagnosed with Alzheimer’s, other dementias, or mild cognitive impairment.
It also includes those individuals without a clinical diagnosis who, in the judgment of the medical provider, are cognitively impaired.
Why is there a need for cognitive impairment care planning?
Care planning allows newly-diagnosed individuals and their caregivers to learn about medical and non-medical treatments.
Particularly for those individuals that have been diagnosed with Alzheimer’s disease or a related dementia.
Care planning also provides information for individuals and their families on the availability of clinical trials, and support services, in the community.
For individuals with dementia or Alzheimer’s disease, what is important?
I believe it is important for individuals living with Alzheimer’s disease or related dementia, to have a proper care plan in place, which will most likely result in a higher quality of life. We also know that for individuals receiving care planning, specifically geared toward those with dementia, studies have shown fewer hospitalizations, fewer emergency room visits, and better medication management.
Who can be reimbursed under this new code?
Medical providers that are able to bill under this code are physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified nurse midwives.
What services are covered under this code?
An evaluation of cognition and function is involved. The service also includes measuring neuropsychiatric symptoms; we see that an evaluation of safety (including driving ability) is included. We also see the service identifying and assessing primary caregivers, the service includes helping to develop advance care directives, as well as planning for palliative care needs.
With all these services, it will allow medical providers to have time and resources to provide a set of care planning services, to people with cognitive impairment and their caregivers.
Has Medicare set up the billing code that will allow medical providers to have the time and resources to provide a comprehensive set of care planning services to people with cognitive impairment and caregivers?
Yes, with the way Medicare has set-up the billing code for this service, it will allow medical providers to have the time and resources to provide a comprehensive set of care planning services, to people with cognitive impairment and their caregivers.
Medicare has set up the billing code for service for medical providers. Will you explain that and the amount of reimbursement rate for GO505 when billed by a physician would be $238. Is that a good rate for physicians?
Keep in mind that Medicare reimbursement rates can vary slightly based on the setting, in which the service is provided and one’s geographic location. Given those caveats, it has been estimated that the reimbursement rate for G0505 (which is the care planning code we are speaking about), when billed by a physician, in a non-facility setting, would be about $238.
And regarding your question of, is this a good rate for reimbursement. All the information that I have gathered so far, this does seem to generate interest when I mention it to physicians and other medical providers. It does seem to be a good reimbursement rate for physicians.
How are caretakers included in the care planning services?
The care planning includes specific identification of the caregiver. It includes an assessment of that caregiver’s knowledge, their needs and their ability to provide care. Caregivers may also be included throughout each of the required elements of the care plan, which include the creation of a detailed care plan for the person with cognitive impairment.
How often can care planning be provided for individuals with cognitive impairment?
The care planning code has no restrictions on how often medical providers can provide and bill for care planning services. Experts have noted that care planning for individuals with dementia is an ongoing process and that a formal update to a care plan, should occur at least once per year.
However, I would encourage medical providers to review their local Medicare coverage policies, with respect to this new code, for any billing limitations.
What is the take home message regarding a proper medical care plan?
I believe that the first thing to remember is if someone is struggling with memory lost or confusion, its best to go to speak with your doctor or medical provider about your concerns. Chances are it’s something that can be treatable and your mind will become clear again. But perhaps it might be something more. And if so, speaking to your doctor about the new Medicare code, Cognitive impairment care planning would be a good start.
Program Director Elizabeth Brantley will be providing a series of educational programs at Newberry County Memorial Hospital in the dining room.
• Oct. 17: Effective Communication Strategies, 5:30 p.m. to 6:30 p.m.
• Nov. 14: Understanding and Responding to Dementia-Related Behaviors, begins at 5:30 p.m.
• Dec. 12: Legal and Financial Planning for Alzheimer’s Disease, begins at 5:30 p.m.
Call 1-800-272-3900 or visit www.alz.org/sc for more information.