July 14, 2025 • 33 mins
In this episode of Compliance Conversations, CJ Wolf welcomes back Maya Turner, a nationally recognized expert in medical coding and consulting. Together, they explore how value-based care and ancillary services are transforming provider reimbursement, especially in a telehealth-enabled world.
You'll learn:
- What value-based care really means (and why it matters)
- The billing codes you may be overlooking
- How to streamline documentation and consent
- Why ancillary staff and virtual care models are key to success
- What telehealth's future means for your billing strategy
Whether you're already billing for chronic care or just starting to explore value-based models, this episode will help you uncover new revenue opportunities—without adding more hours to your day.
Thank you for listening! Please share, like, and subscribe.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
SPEAKER_02 (00:00):
Hello, everybody.
Welcome to another episode ofCompliance Conversations.
My name is CJ Wolff withHealthicity, and today's guest
is a return guest.
It is Maya Turner.
Maya, welcome back.
SPEAKER_00 (00:15):
Hey, everybody.
Hi, CJ.
I'm so glad to be back.
Hello, hello, hello.
SPEAKER_02 (00:20):
Yes, we're so glad to have you back.
And we know you're doing lots ofgood things.
We were talking before westarted how we're kind of like
always passing each other atconferences and this and that.
And now we actually have achance to sit down and talk a
little bit about somesubstantive things.
So I'm so glad that you're here.
SPEAKER_00 (00:39):
Yeah, absolutely.
It's been a lot.
It's been a whirlwind.
So much has changed since thelast time I've been here.
Goodness
SPEAKER_02 (00:45):
gracious.
SPEAKER_00 (01:09):
to the National Advisory Board.
I also work as a virtualinstructor-led training, which
is through AAPC.
And I have gone off on my own.
I am now an independentconsulting company.
The last time I was on, I wasworking for my prior employer.
Now I am flying solo.
And it's been a...
(01:29):
A different experience, but avery rewarding experience.
And it's all about stepping outand doing something and being
brave.
And now I get to explore thesewonderful topics, especially the
one that we're going to betalking about today, to provide
some insight and maybe someclarity for folks who may not
understand about it.
SPEAKER_02 (01:47):
Yeah.
Well, good, good.
And it's good to know thatyou're kind of on your own, your
own consulting services.
We'll make sure that in the shownotes that you get us a link to
that so that if people areinterested in contacting you,
they have a way to reach out andask you questions about what you
do.
Oh, I would love that.
Hello.
Good.
Okay.
Well, awesome.
(02:08):
Well, so we'll do all thatbehind the scenes and show notes
and that sort of thing.
But today we wanted to talkabout...
value-based care and a littlebit about telehealth, maybe how
those go together.
And maybe just to set the stage,you could tell us a little bit,
just in your own words or yourunderstanding, what is
(02:28):
value-based care and why shouldsomeone even need to know what
it is?
Like, why is this evenimportant?
SPEAKER_00 (02:34):
You know what?
There's a lot of things that Ican say about value-based care.
And I think there's many termsthat people use But it really is
peripheral care outside of theoffice, whether it's ongoing or
if it's starting from.
Thank you so much.
(03:20):
things are types of value-basedcare and the list goes on and
on.
But I think the biggest takeawayfor me is that the providers who
are managing these patients cannow create value for the
services that they're alreadydoing, um, post-hospitalization.
(03:43):
And you would be so surprisedabout how many providers who are
actually doing these servicesdon't even know that they can
build them.
So, you know, I'm standing on mysoapbox, uh, to say, get paid
for the work that you do.
And there are people who canhelp you navigate this process.
And I, and it's just, um, areally good thing because the
value of the dollar for thephysician is going lower and
(04:05):
lower, but they're adding moreservices as the dollar goes
lower for the physician tocapture these types of services
to enhance the revenue in theiroffice.
SPEAKER_02 (04:15):
That's a great kind of summary.
I deal with clients all the timein these spaces as well as you
are.
And we've been doing this a longtime.
So let's just kind of as painfulof it as it is, let's go back to
when I were 12 years old orwhatever.
So let's look back 20 years.
A lot of codes, a lot of thoseservices that you mentioned,
(04:35):
there were no codes, chroniccare management, et cetera.
And Providers just did thoseservices because it was good
care and it kind of got lumpedinto an E&M code that they did a
week ago or that they're goingto do in two weeks.
And, you know, in the last 10years or so, like, you know, I
think it was 2015 when thechronic care management program.
(04:56):
final rule came out fromMedicare.
And then all of these otherservices that you started to
mention, they're now recognizedwith codes, they're being paid.
And these, and like you said,some physicians and practices
might not even know that you getpaid separately for these,
because if you're like us thathave been around 30 years and
you're just basing yourknowledge off of what we did 20
(05:18):
years ago, you'd think, yeah,there are no codes, but there
are codes and that list isgrowing.
Yeah.
Yeah.
So, Yeah, I think you're spoton.
Another one, I don't know ifyou'd put it in this same
category, but the advanced careplanning code.
Oh, yes.
Right, where as you get olderadults and doctors are trying to
(05:40):
do good by them and making surethat they have advanced care
planning, meaning they havepower of attorney or they've
thought through will or those,not that the doctor just makes
those decisions, but he offersthe conversation and there are
codes for that now too.
Yeah.
SPEAKER_00 (05:55):
Absolutely.
And the advanced care planningcame out in 2017 finals, 2017's
final rule.
And then there were, I mean, andto be quite honest with you,
there are a lot of codes thathave been around forever, right?
I mean, and it's just now beingtagged this value-based care,
but it kind of coincides againwith the care that's outside of
(06:16):
the office or outside of thevisit.
So think about transitional carethat came out in 2013, you know,
so we think about all thesedifferent things that are kind
of tie it together.
And then we think about how thiscan add value, like you say, to
the office.
But physicians are just like,well, well, well.
And they don't think about thereturn on investment for
(06:36):
consultants like us to say,well, let's optimize your
revenue.
Well, I do that all the time.
Well, duh, you should be billingfor it, you know.
And then they get concernedabout the patient's
out-of-pocket expense.
But is the out-of-pocket expensefor the patient going to
outweigh the quality of lifethat you're providing?
And the answer is no.
(06:57):
So you should be able to billfor these services confidently
with the patient's consent,wink, you need patient consent
for some of these, to providethese services and make it so
that it's a collaborative effortof patient care and the quality
of life that's surrounding thatcare that the patients are
receiving.
SPEAKER_02 (07:18):
Yeah.
Like when I talk to people aboutchronic care management, they
see all the things they have todo.
And to your point, kind of thatconsent is one of those first
things, right?
Where you might have aninitiating visit of some sort.
That's a good opportunity toalso get the patient's consent.
It can be verbal, right?
It doesn't have to be inwriting, but you have to
(07:40):
document somehow that you didget consent and you let the
patient know that, look, therecould be cost-sharing
responsibilities on your part,um, and, um, only one
practitioner can build chroniccare management at a time.
And, you know, so kind of allthese kinds of disclaimers, um,
have you been like successful inhelping people get over that
(08:02):
fear of, of that consentdiscussion?
SPEAKER_00 (08:05):
You know what?
I mean, and I'm gonna be honestwith you.
I, um, I definitely have beenable to, um, to provide some
insight.
And I actually helped design acouple of programs through my
former organization in regardsto that.
I helped design their ACOprogram to help them implement
this process.
And technically, what typicallyhappens is that they are...
(08:30):
able to do a lot more once it'sstructuralized for the ancillary
staff to help assist with thatprocess.
They have to explain, and thevendors that are out there, it
has to be the ancillary staffthat's educated, but the vendors
who are assisting with that,there has to be some
collaborative communication.
(08:52):
There has to be thedocumentation.
There has to be a a processthat's involved.
And once you get that process inplace and everybody, quote
unquote, is educated like we do,CJ, you know, then it becomes a
more streamlined process andpatients aren't afraid.
They're not forced to dosomething that you can't explain
(09:12):
well because you have people whoare assisting with that process.
So, you know, all of thosethings need to come into play
when it comes to that.
Yeah.
UNKNOWN (09:21):
Yeah.
SPEAKER_02 (09:22):
Yeah, good point.
And I think that you hit on areally important point that,
well, let's just kind of stickwith chronic care management for
a second.
Like most of those services aredone by the ancillary staff,
right?
They're done by clinical staff,like maybe a nurse or somebody
who is probably already doingthat management, right?
Like they're reconcilingmedications and they're, oh, did
(09:43):
home health come by yet?
No, they didn't.
And, you know, all these phonecalls and all of this kind of
coordination, right?
the doctor's not necessarilydoing it, but it's under his or
her direction.
And there's appropriate ways tomake that work.
And, you know, once, like yousaid, once the process is set
(10:04):
up, the doc's involvement stillneeds to be there, but a lot of
the work is done by the clinicalstaff.
SPEAKER_00 (10:13):
Yeah.
I mean, and, and again, I, I'm afirm believer, and we all know
this, that the ancillary staff,the front desk staff outside of
the physician's encounter isreally the strength of the
provider.
Because at the end of the day,they're going to remember the
care that they received whenthey were in the room, but
(10:33):
they're also going to beremembered how the way that they
were treated.
So the patient feels that theyhave been paid attention to and
their health is catered to them.
They feel like they're beingtreated like royalty.
Right.
But then when you think abouthow, you know, it's kind of
somebody kind of dropped theball and then they're looking
like there's no empathy orempathetic approach of them
(10:53):
dropping the ball or even noapology, then it becomes
difficult.
a lost cause, to say the least.
And so we need to also placevalue on the ancillary staff,
the ancillary care and thecollaboration for any type of
vendor who's working with themso that, you know, the end of
the day, the patient feelsvalued and feels that it's worth
paying for, you know, becausethere is going to be some sort
(11:15):
of out of pocket expense.
But you have to make the patientwant to know that it's worth it
so that they'll be willing topay for it.
SPEAKER_02 (11:21):
Yeah, no, good point.
So tell me how telehealthintegrates into all of this.
SPEAKER_00 (11:29):
OMG.
Okay.
I'm trying not to, I mean, I'mtrying not to get excited
because I think, you know, withall this stuff that's happening
with Congress spoon feeding us,oh, it's going to be for
September 30th, but now it'sMarch 30th.
You're just like, seriously, canwe just get something that's
just going to be forever and notjust spoon feed us?
And it's all about funding, butI won't even go into there.
(11:52):
I'll get off my soapbox there,CJ, I promise.
And I said I would behave today,so I'm sorry.
I'd rather ask for forgivenessrather than for permission.
Totally understand.
Yeah, so- I think telehealthcomes into a big play because,
you know, a lot of thisvalue-based care is not, it's
always driven by the initialvisit, but it doesn't always
(12:13):
have to happen in the office.
And that's what's important.
Like we talked about theancillary staff.
We talked about transitionalcare management.
We talked about remote patientmanagement.
We also talked about, you know,these, you know, advanced care
planning.
Based upon the current rules,they can be performed up to
September 30th, some of them.
(12:34):
But advanced primary caremanagement, remote care
monitoring, chronic caremanagement, all of these
services are not consideredtelehealth.
They are considered servicesthat are generated by phone
calls, not necessary audio videovisits, and they still are
payable without telehealth carestatus.
SPEAKER_01 (12:56):
Exactly.
SPEAKER_00 (12:57):
And that's important for people to realize because
it's not contingent upon thetelehealth rules.
They can take advantage of thisright now and not be limited to
originating and distant sites.
This is all contingent aboutconsent for treatment.
That's it.
SPEAKER_02 (13:17):
Yeah, exactly.
Because a lot of like withchronic care management, the
majority of those services arelike phone calls and emails and
communication, right?
So, and it's not always with thepatient.
It could be, I'm trying tocoordinate that your home health
does come by your house thisweek.
Absolutely.
These drug interactions aretaken care of or, right?
(13:38):
And so it's people callingaround, it's people emailing
around, it's communicating.
And you're right.
It's not, in that case, it's notwhat we think of as falling
under, you know, telehealthcoverage.
These are activities that are apart of the codes, irrespective
of health.
SPEAKER_00 (13:55):
Right.
Irrespective.
I mean, online minutes, phonecalls.
I mean, and if they're audiovideo, then so be it.
But they are not consideredtelehealth codes.
Some of the codes that are E&M,like the advanced care
management, that is not advancedcare, advanced care planning, I
(14:18):
should say, that is telehealththat can be done.
But there's also a contingencyfor those advanced care planning
codes where you don't have to,this could be something that
could be done with the caregiverand it doesn't have to be over
the phone.
I mean, it doesn't have to beaudio video.
So I take that back.
It's not a telehealth drivencode.
(14:39):
It can be, but it can beservices that could be done on
over the phone with thecaregiver and or the patient
themselves.
So, you know, there's just somany opportunities that people
are failing to understand whenit comes to these types of
services that can be providedfor the quality of life for the
patient.
SPEAKER_02 (14:56):
Yeah, yeah, great point.
Let's take a quick break,everybody, and we'll be right
back and we'll be asking somemore questions.
Welcome back from the break,everybody.
We're talking to Maya Turnerabout some of these services
that providers you know,historically have done just kind
(15:17):
of without payment, separatepayment.
And for many years now, there'sbeen recognized separate payment
and codes for a lot of thesekind of ancillary staff
services, kind of coordinatingcare and management and those
sorts of things.
And we were talking abouttelehealth a little bit before
the break.
I wanna ask a little bit, Maya,about, is there risk?
(15:37):
So like if you're a provider ora practice that hasn't been
doing these, types of services,or I should say billing for
these types of services, isthere risk in becoming heavily
involved in this?
And then what are the benefits?
SPEAKER_00 (15:50):
Well, the benefit, well, let's first answer the
first question, because again,I'm like, I'm so excited about
this because I really do thinkthat, uh, providers really need
to understand that this is anopportunity.
This is a high-level opportunityto create value.
The first thing is making surethat you're documenting
appropriately.
The risk of compliance anddocumenting consent is
(16:13):
important.
And then, you know, once theconsent is made, you know, there
should be some clarity about thescope of the services.
Someone would be calling andthat kind of thing, or to check
on your care.
That's the first thing.
The risk that's involved ismaking sure that the
documentation supports the levelof services provided.
So if you're billing and thatthe code requires 30 minutes or
(16:36):
the code requires 20 minutes andyou're going over that, make
sure that each encounter that'srelated to this value-based
care, whatever type of serviceit is that we discussed, the
categories of service it is,that it's documented, right?
So if you're monitoring apatient for a chronic condition
and the only documentation isfor a non- chronic condition.
SPEAKER_01 (16:59):
then
SPEAKER_00 (17:01):
you gotta be really careful about how that's being
monitored and for the servicesthat you're monitoring them for.
Because in most instances, thesevalue-based codes are based upon
chronic conditions that requireadditional management.
If you're not addressing achronic condition, then you need
to be billing the G20 to 11 thatindicates longitudinal care,
(17:23):
which is ongoing.
But if there are chronicconditions for advanced primary
care, remote patient monitoring,then it becomes chronic, then
you need additional consent,then you should be billing as
well as documenting theappropriate diagnoses to negate
the kind of care that you'reproviding for the patient.
SPEAKER_02 (17:44):
Yeah, that's such a great point.
And like with chronic caremanagement, you have to have two
diagnosed chronic conditions,right, that are anticipated to
last 12 months or longer oruntil the patient, you know,
Right, right.
Yes.
(18:13):
has to be met as well, right?
SPEAKER_00 (18:15):
Yeah, and then there's also principal care
management services, which isthree months or more.
So, you know, and when you thinkabout, you know, these types of
services, and if there'seducation, hint, hint, wink,
wink, me and CJ, hello, toprovide this kind of advice for
you to take advantage of thesetypes of care, then I really do
(18:38):
believe that there is anopportunity for providers to
really capture that, especiallywhen you're dealing with
post-hospitalizations.
Post-hospitalizations and theannual Medicare preventive
visits, those are the mostopportune times to capture those
types of care because you aretypically monitoring a moderate
(19:00):
to high severity level of care.
based upon apost-hospitalization.
And then, and with the Medicarevisit, unless you're some 70
year old bodybuilder with zerobody fat, you're going to have
some sort of chronic conditionsthat are being managed.
So in those particularinstances, you need to take
advantage of these types ofcare, not to mention social
(19:23):
determinants of health.
We haven't even talked aboutthat, you know, about how, I
mean, and there's so, like Isaid, there's so many
opportunities, you know, inregards to this and, you know,
the community healthintegration.
I mean, there's, I can't talkabout all of this in one
setting.
It's just so many.
And I just think that ifproviders were aware of the
(19:46):
amount of missed opportunity, Ithink that there would be such a
turnaround in the usage of thesecodes.
It's just that a lot ofproviders are just failing to
realize the return on investmentto have somebody come in to tell
them about all of this stuff.
SPEAKER_02 (20:00):
Yeah.
And I think some of them feartoo, like, do they have the
internal structure and resourcesto kind of do everything that's
required of that code?
So like, again, sorry, I keepgoing back to chronic care
management because that's oneI'm very familiar with recently.
And there's this requirement ofthe patient has to have 24-7
access, right?
(20:20):
So that means they can come andsee you 24 seven, but they
should be able to have a phonenumber or some sort of way of
contacting 24 seven access.
And so that throws a lot ofproviders like, whoa, wait, I
don't know if I can providethat.
And so some feel like they havethe infrastructure to do it.
Any thoughts on those kinds ofrequirements if providers are a
(20:44):
little bit afraid of those?
SPEAKER_00 (20:46):
Oh, yes, CJ.
And you know, what's reallyinteresting is that even with
those chronic care managementcodes, you have to be available
for 24-7, but the max time forthose codes to bill it is 20
minutes.
So it's a time-based code.
And so when you have theprincipal care management,
(21:09):
that's 30 minutes, the chroniccare management is 20 minutes.
So you really have to keep inmind that So, yeah.
(21:38):
You know, the advanced primarycare codes that came out in
2025, those codes are nottime-based, but they do bundle a
lot of the services that wouldtraditionally be unbundled.
Like it bundles traditionaltransitional care management,
and I believe it bundles withchronic care management
services.
But in the same breath, you'regoing to build one or the other,
(21:59):
but you still...
think about the amount of timeyou're spending and then think
about the time that you're usingto manage.
So what's going to takeprecedence?
You got to make some decisions.
That's why consultants like uscan advise you on how to do
that.
So, you know, there's just somuch, so
SPEAKER_02 (22:14):
much
SPEAKER_00 (22:14):
going
SPEAKER_02 (22:14):
on.
SPEAKER_00 (22:15):
Yeah.
SPEAKER_02 (22:15):
So are these, these services we've been discussing,
are they only for primary careproviders?
What about specialists?
What are your thoughts on those?
SPEAKER_00 (22:24):
Well, Transitional care is for everybody.
Principal care management is foreverybody, but only one provider
can bill it a month.
So it's kind of like thepreventive care visits, you
know, like first come, firstserve.
Oh, sorry, I can't do it.
Oh, so you're mad.
But I mean, some of them areprimary care.
Some of them are just oneprovider base.
(22:47):
And a lot of times you just haveto check your edits to make sure
who's gonna be billing to see,or your eligibility to see if
you're able to bill for theirservices.
But the most important thing isthat to know that they are
available and to get consentwhere it's needed and to make
sure that if they do overlap,that you make sure that you can
(23:08):
unbundle what isn't so you canget paid appropriately.
Because some of these codesdon't overlap and you are able
to get paid for both, but youjust got to watch because
there's a lot of edits that mayhit if you try to build them on
the same day.
So you got to watch all of that.
SPEAKER_02 (23:24):
Gotcha.
Makes a lot of sense.
So, so you may have already kindof addressed this.
I think we probably have that,you know, if telehealth has the
possibility of ending, canproviders still perform these
and get paid?
I think the answer to that isyes, but let me just confirm.
Does anything change if, youknow, and who knows what will
(23:45):
happen, right?
Yeah.
You know, we get closer toSeptember.
They always wait to the lastsecond to pass some, law or
extension, but let's say it wereto end, the extension that we
have through September were toend, does that affect any of
this?
SPEAKER_00 (24:02):
It doesn't.
That's what I love about this.
It does not.
It doesn't.
You know, it's such a platformthat is undervalued.
I mean, and just remember thattransitional care management
services can be performed.
It's an E&M service, so it canbe performed audio-video, but
(24:22):
it's not contingent uponaudio-video.
If they come to the office andyou bill for it, you know, it
still meets it.
But all of the categories ofservice that relate to
value-based care are notcontingent upon telehealth
services.
They can be performed viatelehealth, but it's not
(24:42):
contingent upon telehealthservices.
So it will be ongoing and thelist will continue to expand.
It will continue forever.
Yeah, exactly.
SPEAKER_02 (24:51):
As more and more medical studies are done to show
that, look, when you have thiscare program, that kind of helps
bridge gaps, right?
Somebody gets discharged fromthe hospital.
What do you want to do?
You want to prevent them frombeing readmitted.
So it's like, you can't justwish for the best upon
(25:12):
discharge.
There are actual things that youcan do.
And that's what these servicesare, right?
These are the services that youcan, that you as a provider can
do to try.
So number one, you're providingbetter care when you do this
stuff to begin with.
And number two, you get paid forit.
So, I think that's really kindof the take-home message that I
(25:32):
get from what I'm hearing yousay.
SPEAKER_00 (25:35):
Yeah, I mean, there's so...
Like I said, I mean...
Providers are afraid becausethey feel like they don't have
the bandwidth.
But remember, these are timebased codes.
So and based upon the codedescriptors, you have to meet
the timeline based upon it's notlike a half type of deal, you
need to meet the all of theminutes.
But the max per month is like 20to 30 minutes.
(25:55):
And then anything that you goover that you have to meet the
next interval.
But I mean, how much of this areyou doing already that you're
not getting paid for?
Exactly.
You're already doing the
SPEAKER_01 (26:06):
work.
SPEAKER_00 (26:07):
Exactly.
You're doing the work, so whynot?
So start thinking about thereturn on investment.
Start thinking about, okay,well, I'm not getting my money
here.
Maybe I can start doing this tomake the work that I'm already
doing worth it and that thepatient is aware and I'm getting
reimbursed for all of the timeand effort that I'm spending
behind it.
SPEAKER_02 (26:27):
Yeah.
Such good advice.
And I think...
I think this is a really, reallyimportant topic because I think
you are spot on.
A lot of providers don't realizethe opportunities here.
And as you mentioned, there'snew codes, right?
And these things have beenbuilding over the years.
(26:48):
And so if you haven't reallybeen paying attention, you're
probably going to miss out onthose opportunities.
SPEAKER_00 (26:55):
Oh, and I can't stress enough that, especially
with the...
the advanced primary caremanagement codes because the
primary care has always been thelesser of the providers who
aren't specialists to see thedecline in the dollar and not
realizing that they can getmore.
And the more offices that Iconsult with, the more I realize
(27:18):
that they are in a bubblebecause they simply feel that
they can't afford it.
But when you, you know, youknow, solicit or not solicit,
but when you, you know, engagewith a consultant, you know, you
get a whole new world, right?
But you don't realize that it'sa return on investment to engage
the consultant so you could beaware of what's happening.
(27:38):
I had one doctor's office whowas getting ready to spend an
entire EMR system because theygot another tax ID number
because that's what they thoughtthey needed to do.
And I was just like, Are youusing the same system?
And I'm like, well, you don'tneed to do that.
Oh, we don't.
You just saved us so much money.
I was like, well, hello.
You don't need to do that.
(27:58):
So it's just, you know, selfself-awareness.
But then there also has to besome transparency from the
offices to be, you know, to beable to engage in a consultant,
because that's the only way thatthey're going to really
understand all of this.
SPEAKER_02 (28:16):
Yeah, I agree with you.
So Maya, I could talk all daywith you about all this stuff.
We are unfortunately kind ofrunning towards the end of time.
So I want to give you, if youhave any last minute thoughts
about this topic or maybe adifferent topic, anything kind
of parting words that you mightshare with the audience before
we wrap up today.
SPEAKER_00 (28:36):
I know I'm so sad, but I'll say this.
Offices need to be aware thatoffice visits or E&M visits are
not the only means of incomewhen you're primary care or when
you're a non-procedural office.
There's just a lot of valuebased upon exploring, right?
(29:00):
But once you explore, don't beafraid to explore more because
more than likely, you're missingout on more than what you think
you are if you're only billingfor E&M services if you're a
primary care office.
Yes.
And I think that that's just thebiggest takeaway.
And it's not contingent upontelehealth.
(29:21):
It's contingent upon value-basedcare equaling the quality of
life for your patients, nomatter what age they are.
So you have to really be mindfulof the care that you're
providing and the codes thatyou're billing to get the
revenue that you want or thatyou're expecting.
Don't expect for...
(29:44):
your staff to, or, you know,pressuring your staff for, you
know, revenue cycle managementwhen you're only doing 10 E&M
codes a day, when you could bebilling 20 E&M codes based upon
the value-based care alone.
So think about that and engagethem with a consultant.
SPEAKER_02 (30:01):
Yeah.
I think that's such a goodpoint.
And that's kind of how westarted was, you know, I was
saying, look, 20 years ago, itwas just those E&M codes, you
know, you're your office visitcodes.
And so I think people can getstuck in that paradigm.
And what you just described isspot on.
In addition to what those, whatyou're doing, you're doing all
this other stuff already.
(30:22):
And you might need to, you know,you might need to boost the way
you document it or this or that,but you're doing that kind of
care.
And so take advantage of thosecodes.
SPEAKER_00 (30:32):
Absolutely.
And I think, you know, don't beafraid or don't think that it's
the physician practice does notalways weigh on just what the
physician does.
If you have an ancillary staffthat is capable with your
oversight, because it's generalsupervision for most of these,
you're able to perform thesewith general supervision and
(30:53):
still be paid because generalsupervision means that you are
supervising the service, but thebill goes out in your name and
you are certifying that theservice was performed under your
supervision.
So that's extremely important.
And it's just a lot ofopportunity.
And if you haven't done soalready, take a look at it and
see how it benefits you.
SPEAKER_02 (31:12):
Thank you so much, Maya.
And we are going to include yourcontact information in the show
notes because I'm sure there arepeople out there listening that
this will resonate with andthey'll want to know how they
can do it in their ownpractices.
And so I highly recommend youreach out to Maya and get some
more information on this.
(31:32):
So thank you, Maya, for beinghere today.
SPEAKER_00 (31:34):
Thank you, CJ.
So good to talk to you.
Yes.
SPEAKER_02 (31:38):
And thank you to all of our listeners for listening
to another episode.
As always, we welcome yourfeedback on topics.
What other topics would you liketo hear about?
And if you know great speakerslike Maya or guests that we
should have on, please feel freeto recommend those to us.
Until next time, everybody, takecare.
Hello, everybody.
Welcome to another episode ofCompliance Conversations.
My name is CJ Wolff withHealthicity, and today's guest
is a return guest.
It is Maya Turner.
Maya, welcome back.
SPEAKER_00 (00:15):
Hey, everybody.
Hi, CJ.
I'm so glad to be back.
Hello, hello, hello.
SPEAKER_02 (00:20):
Yes, we're so glad to have you back.
And we know you're doing lots ofgood things.
We were talking before westarted how we're kind of like
always passing each other atconferences and this and that.
And now we actually have achance to sit down and talk a
little bit about somesubstantive things.
So I'm so glad that you're here.
SPEAKER_00 (00:39):
Yeah, absolutely.
It's been a lot.
It's been a whirlwind.
So much has changed since thelast time I've been here.
Goodness
SPEAKER_02 (00:45):
gracious.
SPEAKER_00 (01:09):
to the National Advisory Board.
I also work as a virtualinstructor-led training, which
is through AAPC.
And I have gone off on my own.
I am now an independentconsulting company.
The last time I was on, I wasworking for my prior employer.
Now I am flying solo.
And it's been a...
(01:29):
A different experience, but avery rewarding experience.
And it's all about stepping outand doing something and being
brave.
And now I get to explore thesewonderful topics, especially the
one that we're going to betalking about today, to provide
some insight and maybe someclarity for folks who may not
understand about it.
SPEAKER_02 (01:47):
Yeah.
Well, good, good.
And it's good to know thatyou're kind of on your own, your
own consulting services.
We'll make sure that in the shownotes that you get us a link to
that so that if people areinterested in contacting you,
they have a way to reach out andask you questions about what you
do.
Oh, I would love that.
Hello.
Good.
Okay.
Well, awesome.
(02:08):
Well, so we'll do all thatbehind the scenes and show notes
and that sort of thing.
But today we wanted to talkabout...
value-based care and a littlebit about telehealth, maybe how
those go together.
And maybe just to set the stage,you could tell us a little bit,
just in your own words or yourunderstanding, what is
(02:28):
value-based care and why shouldsomeone even need to know what
it is?
Like, why is this evenimportant?
SPEAKER_00 (02:34):
You know what?
There's a lot of things that Ican say about value-based care.
And I think there's many termsthat people use But it really is
peripheral care outside of theoffice, whether it's ongoing or
if it's starting from.
Thank you so much.
(03:20):
things are types of value-basedcare and the list goes on and
on.
But I think the biggest takeawayfor me is that the providers who
are managing these patients cannow create value for the
services that they're alreadydoing, um, post-hospitalization.
(03:43):
And you would be so surprisedabout how many providers who are
actually doing these servicesdon't even know that they can
build them.
So, you know, I'm standing on mysoapbox, uh, to say, get paid
for the work that you do.
And there are people who canhelp you navigate this process.
And I, and it's just, um, areally good thing because the
value of the dollar for thephysician is going lower and
(04:05):
lower, but they're adding moreservices as the dollar goes
lower for the physician tocapture these types of services
to enhance the revenue in theiroffice.
SPEAKER_02 (04:15):
That's a great kind of summary.
I deal with clients all the timein these spaces as well as you
are.
And we've been doing this a longtime.
So let's just kind of as painfulof it as it is, let's go back to
when I were 12 years old orwhatever.
So let's look back 20 years.
A lot of codes, a lot of thoseservices that you mentioned,
(04:35):
there were no codes, chroniccare management, et cetera.
And Providers just did thoseservices because it was good
care and it kind of got lumpedinto an E&M code that they did a
week ago or that they're goingto do in two weeks.
And, you know, in the last 10years or so, like, you know, I
think it was 2015 when thechronic care management program.
(04:56):
final rule came out fromMedicare.
And then all of these otherservices that you started to
mention, they're now recognizedwith codes, they're being paid.
And these, and like you said,some physicians and practices
might not even know that you getpaid separately for these,
because if you're like us thathave been around 30 years and
you're just basing yourknowledge off of what we did 20
(05:18):
years ago, you'd think, yeah,there are no codes, but there
are codes and that list isgrowing.
Yeah.
Yeah.
So, Yeah, I think you're spoton.
Another one, I don't know ifyou'd put it in this same
category, but the advanced careplanning code.
Oh, yes.
Right, where as you get olderadults and doctors are trying to
(05:40):
do good by them and making surethat they have advanced care
planning, meaning they havepower of attorney or they've
thought through will or those,not that the doctor just makes
those decisions, but he offersthe conversation and there are
codes for that now too.
Yeah.
SPEAKER_00 (05:55):
Absolutely.
And the advanced care planningcame out in 2017 finals, 2017's
final rule.
And then there were, I mean, andto be quite honest with you,
there are a lot of codes thathave been around forever, right?
I mean, and it's just now beingtagged this value-based care,
but it kind of coincides againwith the care that's outside of
(06:16):
the office or outside of thevisit.
So think about transitional carethat came out in 2013, you know,
so we think about all thesedifferent things that are kind
of tie it together.
And then we think about how thiscan add value, like you say, to
the office.
But physicians are just like,well, well, well.
And they don't think about thereturn on investment for
(06:36):
consultants like us to say,well, let's optimize your
revenue.
Well, I do that all the time.
Well, duh, you should be billingfor it, you know.
And then they get concernedabout the patient's
out-of-pocket expense.
But is the out-of-pocket expensefor the patient going to
outweigh the quality of lifethat you're providing?
And the answer is no.
(06:57):
So you should be able to billfor these services confidently
with the patient's consent,wink, you need patient consent
for some of these, to providethese services and make it so
that it's a collaborative effortof patient care and the quality
of life that's surrounding thatcare that the patients are
receiving.
SPEAKER_02 (07:18):
Yeah.
Like when I talk to people aboutchronic care management, they
see all the things they have todo.
And to your point, kind of thatconsent is one of those first
things, right?
Where you might have aninitiating visit of some sort.
That's a good opportunity toalso get the patient's consent.
It can be verbal, right?
It doesn't have to be inwriting, but you have to
(07:40):
document somehow that you didget consent and you let the
patient know that, look, therecould be cost-sharing
responsibilities on your part,um, and, um, only one
practitioner can build chroniccare management at a time.
And, you know, so kind of allthese kinds of disclaimers, um,
have you been like successful inhelping people get over that
(08:02):
fear of, of that consentdiscussion?
SPEAKER_00 (08:05):
You know what?
I mean, and I'm gonna be honestwith you.
I, um, I definitely have beenable to, um, to provide some
insight.
And I actually helped design acouple of programs through my
former organization in regardsto that.
I helped design their ACOprogram to help them implement
this process.
And technically, what typicallyhappens is that they are...
(08:30):
able to do a lot more once it'sstructuralized for the ancillary
staff to help assist with thatprocess.
They have to explain, and thevendors that are out there, it
has to be the ancillary staffthat's educated, but the vendors
who are assisting with that,there has to be some
collaborative communication.
(08:52):
There has to be thedocumentation.
There has to be a a processthat's involved.
And once you get that process inplace and everybody, quote
unquote, is educated like we do,CJ, you know, then it becomes a
more streamlined process andpatients aren't afraid.
They're not forced to dosomething that you can't explain
(09:12):
well because you have people whoare assisting with that process.
So, you know, all of thosethings need to come into play
when it comes to that.
Yeah.
UNKNOWN (09:21):
Yeah.
SPEAKER_02 (09:22):
Yeah, good point.
And I think that you hit on areally important point that,
well, let's just kind of stickwith chronic care management for
a second.
Like most of those services aredone by the ancillary staff,
right?
They're done by clinical staff,like maybe a nurse or somebody
who is probably already doingthat management, right?
Like they're reconcilingmedications and they're, oh, did
(09:43):
home health come by yet?
No, they didn't.
And, you know, all these phonecalls and all of this kind of
coordination, right?
the doctor's not necessarilydoing it, but it's under his or
her direction.
And there's appropriate ways tomake that work.
And, you know, once, like yousaid, once the process is set
(10:04):
up, the doc's involvement stillneeds to be there, but a lot of
the work is done by the clinicalstaff.
SPEAKER_00 (10:13):
Yeah.
I mean, and, and again, I, I'm afirm believer, and we all know
this, that the ancillary staff,the front desk staff outside of
the physician's encounter isreally the strength of the
provider.
Because at the end of the day,they're going to remember the
care that they received whenthey were in the room, but
(10:33):
they're also going to beremembered how the way that they
were treated.
So the patient feels that theyhave been paid attention to and
their health is catered to them.
They feel like they're beingtreated like royalty.
Right.
But then when you think abouthow, you know, it's kind of
somebody kind of dropped theball and then they're looking
like there's no empathy orempathetic approach of them
(10:53):
dropping the ball or even noapology, then it becomes
difficult.
a lost cause, to say the least.
And so we need to also placevalue on the ancillary staff,
the ancillary care and thecollaboration for any type of
vendor who's working with themso that, you know, the end of
the day, the patient feelsvalued and feels that it's worth
paying for, you know, becausethere is going to be some sort
(11:15):
of out of pocket expense.
But you have to make the patientwant to know that it's worth it
so that they'll be willing topay for it.
SPEAKER_02 (11:21):
Yeah, no, good point.
So tell me how telehealthintegrates into all of this.
SPEAKER_00 (11:29):
OMG.
Okay.
I'm trying not to, I mean, I'mtrying not to get excited
because I think, you know, withall this stuff that's happening
with Congress spoon feeding us,oh, it's going to be for
September 30th, but now it'sMarch 30th.
You're just like, seriously, canwe just get something that's
just going to be forever and notjust spoon feed us?
And it's all about funding, butI won't even go into there.
(11:52):
I'll get off my soapbox there,CJ, I promise.
And I said I would behave today,so I'm sorry.
I'd rather ask for forgivenessrather than for permission.
Totally understand.
Yeah, so- I think telehealthcomes into a big play because,
you know, a lot of thisvalue-based care is not, it's
always driven by the initialvisit, but it doesn't always
(12:13):
have to happen in the office.
And that's what's important.
Like we talked about theancillary staff.
We talked about transitionalcare management.
We talked about remote patientmanagement.
We also talked about, you know,these, you know, advanced care
planning.
Based upon the current rules,they can be performed up to
September 30th, some of them.
(12:34):
But advanced primary caremanagement, remote care
monitoring, chronic caremanagement, all of these
services are not consideredtelehealth.
They are considered servicesthat are generated by phone
calls, not necessary audio videovisits, and they still are
payable without telehealth carestatus.
SPEAKER_01 (12:56):
Exactly.
SPEAKER_00 (12:57):
And that's important for people to realize because
it's not contingent upon thetelehealth rules.
They can take advantage of thisright now and not be limited to
originating and distant sites.
This is all contingent aboutconsent for treatment.
That's it.
SPEAKER_02 (13:17):
Yeah, exactly.
Because a lot of like withchronic care management, the
majority of those services arelike phone calls and emails and
communication, right?
So, and it's not always with thepatient.
It could be, I'm trying tocoordinate that your home health
does come by your house thisweek.
Absolutely.
These drug interactions aretaken care of or, right?
(13:38):
And so it's people callingaround, it's people emailing
around, it's communicating.
And you're right.
It's not, in that case, it's notwhat we think of as falling
under, you know, telehealthcoverage.
These are activities that are apart of the codes, irrespective
of health.
SPEAKER_00 (13:55):
Right.
Irrespective.
I mean, online minutes, phonecalls.
I mean, and if they're audiovideo, then so be it.
But they are not consideredtelehealth codes.
Some of the codes that are E&M,like the advanced care
management, that is not advancedcare, advanced care planning, I
(14:18):
should say, that is telehealththat can be done.
But there's also a contingencyfor those advanced care planning
codes where you don't have to,this could be something that
could be done with the caregiverand it doesn't have to be over
the phone.
I mean, it doesn't have to beaudio video.
So I take that back.
It's not a telehealth drivencode.
(14:39):
It can be, but it can beservices that could be done on
over the phone with thecaregiver and or the patient
themselves.
So, you know, there's just somany opportunities that people
are failing to understand whenit comes to these types of
services that can be providedfor the quality of life for the
patient.
SPEAKER_02 (14:56):
Yeah, yeah, great point.
Let's take a quick break,everybody, and we'll be right
back and we'll be asking somemore questions.
Welcome back from the break,everybody.
We're talking to Maya Turnerabout some of these services
that providers you know,historically have done just kind
(15:17):
of without payment, separatepayment.
And for many years now, there'sbeen recognized separate payment
and codes for a lot of thesekind of ancillary staff
services, kind of coordinatingcare and management and those
sorts of things.
And we were talking abouttelehealth a little bit before
the break.
I wanna ask a little bit, Maya,about, is there risk?
(15:37):
So like if you're a provider ora practice that hasn't been
doing these, types of services,or I should say billing for
these types of services, isthere risk in becoming heavily
involved in this?
And then what are the benefits?
SPEAKER_00 (15:50):
Well, the benefit, well, let's first answer the
first question, because again,I'm like, I'm so excited about
this because I really do thinkthat, uh, providers really need
to understand that this is anopportunity.
This is a high-level opportunityto create value.
The first thing is making surethat you're documenting
appropriately.
The risk of compliance anddocumenting consent is
(16:13):
important.
And then, you know, once theconsent is made, you know, there
should be some clarity about thescope of the services.
Someone would be calling andthat kind of thing, or to check
on your care.
That's the first thing.
The risk that's involved ismaking sure that the
documentation supports the levelof services provided.
So if you're billing and thatthe code requires 30 minutes or
(16:36):
the code requires 20 minutes andyou're going over that, make
sure that each encounter that'srelated to this value-based
care, whatever type of serviceit is that we discussed, the
categories of service it is,that it's documented, right?
So if you're monitoring apatient for a chronic condition
and the only documentation isfor a non- chronic condition.
SPEAKER_01 (16:59):
then
SPEAKER_00 (17:01):
you gotta be really careful about how that's being
monitored and for the servicesthat you're monitoring them for.
Because in most instances, thesevalue-based codes are based upon
chronic conditions that requireadditional management.
If you're not addressing achronic condition, then you need
to be billing the G20 to 11 thatindicates longitudinal care,
(17:23):
which is ongoing.
But if there are chronicconditions for advanced primary
care, remote patient monitoring,then it becomes chronic, then
you need additional consent,then you should be billing as
well as documenting theappropriate diagnoses to negate
the kind of care that you'reproviding for the patient.
SPEAKER_02 (17:44):
Yeah, that's such a great point.
And like with chronic caremanagement, you have to have two
diagnosed chronic conditions,right, that are anticipated to
last 12 months or longer oruntil the patient, you know,
Right, right.
Yes.
(18:13):
has to be met as well, right?
SPEAKER_00 (18:15):
Yeah, and then there's also principal care
management services, which isthree months or more.
So, you know, and when you thinkabout, you know, these types of
services, and if there'seducation, hint, hint, wink,
wink, me and CJ, hello, toprovide this kind of advice for
you to take advantage of thesetypes of care, then I really do
(18:38):
believe that there is anopportunity for providers to
really capture that, especiallywhen you're dealing with
post-hospitalizations.
Post-hospitalizations and theannual Medicare preventive
visits, those are the mostopportune times to capture those
types of care because you aretypically monitoring a moderate
(19:00):
to high severity level of care.
based upon apost-hospitalization.
And then, and with the Medicarevisit, unless you're some 70
year old bodybuilder with zerobody fat, you're going to have
some sort of chronic conditionsthat are being managed.
So in those particularinstances, you need to take
advantage of these types ofcare, not to mention social
(19:23):
determinants of health.
We haven't even talked aboutthat, you know, about how, I
mean, and there's so, like Isaid, there's so many
opportunities, you know, inregards to this and, you know,
the community healthintegration.
I mean, there's, I can't talkabout all of this in one
setting.
It's just so many.
And I just think that ifproviders were aware of the
(19:46):
amount of missed opportunity, Ithink that there would be such a
turnaround in the usage of thesecodes.
It's just that a lot ofproviders are just failing to
realize the return on investmentto have somebody come in to tell
them about all of this stuff.
SPEAKER_02 (20:00):
Yeah.
And I think some of them feartoo, like, do they have the
internal structure and resourcesto kind of do everything that's
required of that code?
So like, again, sorry, I keepgoing back to chronic care
management because that's oneI'm very familiar with recently.
And there's this requirement ofthe patient has to have 24-7
access, right?
(20:20):
So that means they can come andsee you 24 seven, but they
should be able to have a phonenumber or some sort of way of
contacting 24 seven access.
And so that throws a lot ofproviders like, whoa, wait, I
don't know if I can providethat.
And so some feel like they havethe infrastructure to do it.
Any thoughts on those kinds ofrequirements if providers are a
(20:44):
little bit afraid of those?
SPEAKER_00 (20:46):
Oh, yes, CJ.
And you know, what's reallyinteresting is that even with
those chronic care managementcodes, you have to be available
for 24-7, but the max time forthose codes to bill it is 20
minutes.
So it's a time-based code.
And so when you have theprincipal care management,
(21:09):
that's 30 minutes, the chroniccare management is 20 minutes.
So you really have to keep inmind that So, yeah.
(21:38):
You know, the advanced primarycare codes that came out in
2025, those codes are nottime-based, but they do bundle a
lot of the services that wouldtraditionally be unbundled.
Like it bundles traditionaltransitional care management,
and I believe it bundles withchronic care management
services.
But in the same breath, you'regoing to build one or the other,
(21:59):
but you still...
think about the amount of timeyou're spending and then think
about the time that you're usingto manage.
So what's going to takeprecedence?
You got to make some decisions.
That's why consultants like uscan advise you on how to do
that.
So, you know, there's just somuch, so
SPEAKER_02 (22:14):
much
SPEAKER_00 (22:14):
going
SPEAKER_02 (22:14):
on.
SPEAKER_00 (22:15):
Yeah.
SPEAKER_02 (22:15):
So are these, these services we've been discussing,
are they only for primary careproviders?
What about specialists?
What are your thoughts on those?
SPEAKER_00 (22:24):
Well, Transitional care is for everybody.
Principal care management is foreverybody, but only one provider
can bill it a month.
So it's kind of like thepreventive care visits, you
know, like first come, firstserve.
Oh, sorry, I can't do it.
Oh, so you're mad.
But I mean, some of them areprimary care.
Some of them are just oneprovider base.
(22:47):
And a lot of times you just haveto check your edits to make sure
who's gonna be billing to see,or your eligibility to see if
you're able to bill for theirservices.
But the most important thing isthat to know that they are
available and to get consentwhere it's needed and to make
sure that if they do overlap,that you make sure that you can
(23:08):
unbundle what isn't so you canget paid appropriately.
Because some of these codesdon't overlap and you are able
to get paid for both, but youjust got to watch because
there's a lot of edits that mayhit if you try to build them on
the same day.
So you got to watch all of that.
SPEAKER_02 (23:24):
Gotcha.
Makes a lot of sense.
So, so you may have already kindof addressed this.
I think we probably have that,you know, if telehealth has the
possibility of ending, canproviders still perform these
and get paid?
I think the answer to that isyes, but let me just confirm.
Does anything change if, youknow, and who knows what will
(23:45):
happen, right?
Yeah.
You know, we get closer toSeptember.
They always wait to the lastsecond to pass some, law or
extension, but let's say it wereto end, the extension that we
have through September were toend, does that affect any of
this?
SPEAKER_00 (24:02):
It doesn't.
That's what I love about this.
It does not.
It doesn't.
You know, it's such a platformthat is undervalued.
I mean, and just remember thattransitional care management
services can be performed.
It's an E&M service, so it canbe performed audio-video, but
(24:22):
it's not contingent uponaudio-video.
If they come to the office andyou bill for it, you know, it
still meets it.
But all of the categories ofservice that relate to
value-based care are notcontingent upon telehealth
services.
They can be performed viatelehealth, but it's not
(24:42):
contingent upon telehealthservices.
So it will be ongoing and thelist will continue to expand.
It will continue forever.
Yeah, exactly.
SPEAKER_02 (24:51):
As more and more medical studies are done to show
that, look, when you have thiscare program, that kind of helps
bridge gaps, right?
Somebody gets discharged fromthe hospital.
What do you want to do?
You want to prevent them frombeing readmitted.
So it's like, you can't justwish for the best upon
(25:12):
discharge.
There are actual things that youcan do.
And that's what these servicesare, right?
These are the services that youcan, that you as a provider can
do to try.
So number one, you're providingbetter care when you do this
stuff to begin with.
And number two, you get paid forit.
So, I think that's really kindof the take-home message that I
(25:32):
get from what I'm hearing yousay.
SPEAKER_00 (25:35):
Yeah, I mean, there's so...
Like I said, I mean...
Providers are afraid becausethey feel like they don't have
the bandwidth.
But remember, these are timebased codes.
So and based upon the codedescriptors, you have to meet
the timeline based upon it's notlike a half type of deal, you
need to meet the all of theminutes.
But the max per month is like 20to 30 minutes.
(25:55):
And then anything that you goover that you have to meet the
next interval.
But I mean, how much of this areyou doing already that you're
not getting paid for?
Exactly.
You're already doing the
SPEAKER_01 (26:06):
work.
SPEAKER_00 (26:07):
Exactly.
You're doing the work, so whynot?
So start thinking about thereturn on investment.
Start thinking about, okay,well, I'm not getting my money
here.
Maybe I can start doing this tomake the work that I'm already
doing worth it and that thepatient is aware and I'm getting
reimbursed for all of the timeand effort that I'm spending
behind it.
SPEAKER_02 (26:27):
Yeah.
Such good advice.
And I think...
I think this is a really, reallyimportant topic because I think
you are spot on.
A lot of providers don't realizethe opportunities here.
And as you mentioned, there'snew codes, right?
And these things have beenbuilding over the years.
(26:48):
And so if you haven't reallybeen paying attention, you're
probably going to miss out onthose opportunities.
SPEAKER_00 (26:55):
Oh, and I can't stress enough that, especially
with the...
the advanced primary caremanagement codes because the
primary care has always been thelesser of the providers who
aren't specialists to see thedecline in the dollar and not
realizing that they can getmore.
And the more offices that Iconsult with, the more I realize
(27:18):
that they are in a bubblebecause they simply feel that
they can't afford it.
But when you, you know, youknow, solicit or not solicit,
but when you, you know, engagewith a consultant, you know, you
get a whole new world, right?
But you don't realize that it'sa return on investment to engage
the consultant so you could beaware of what's happening.
(27:38):
I had one doctor's office whowas getting ready to spend an
entire EMR system because theygot another tax ID number
because that's what they thoughtthey needed to do.
And I was just like, Are youusing the same system?
And I'm like, well, you don'tneed to do that.
Oh, we don't.
You just saved us so much money.
I was like, well, hello.
You don't need to do that.
(27:58):
So it's just, you know, selfself-awareness.
But then there also has to besome transparency from the
offices to be, you know, to beable to engage in a consultant,
because that's the only way thatthey're going to really
understand all of this.
SPEAKER_02 (28:16):
Yeah, I agree with you.
So Maya, I could talk all daywith you about all this stuff.
We are unfortunately kind ofrunning towards the end of time.
So I want to give you, if youhave any last minute thoughts
about this topic or maybe adifferent topic, anything kind
of parting words that you mightshare with the audience before
we wrap up today.
SPEAKER_00 (28:36):
I know I'm so sad, but I'll say this.
Offices need to be aware thatoffice visits or E&M visits are
not the only means of incomewhen you're primary care or when
you're a non-procedural office.
There's just a lot of valuebased upon exploring, right?
(29:00):
But once you explore, don't beafraid to explore more because
more than likely, you're missingout on more than what you think
you are if you're only billingfor E&M services if you're a
primary care office.
Yes.
And I think that that's just thebiggest takeaway.
And it's not contingent upontelehealth.
(29:21):
It's contingent upon value-basedcare equaling the quality of
life for your patients, nomatter what age they are.
So you have to really be mindfulof the care that you're
providing and the codes thatyou're billing to get the
revenue that you want or thatyou're expecting.
Don't expect for...
(29:44):
your staff to, or, you know,pressuring your staff for, you
know, revenue cycle managementwhen you're only doing 10 E&M
codes a day, when you could bebilling 20 E&M codes based upon
the value-based care alone.
So think about that and engagethem with a consultant.
SPEAKER_02 (30:01):
Yeah.
I think that's such a goodpoint.
And that's kind of how westarted was, you know, I was
saying, look, 20 years ago, itwas just those E&M codes, you
know, you're your office visitcodes.
And so I think people can getstuck in that paradigm.
And what you just described isspot on.
In addition to what those, whatyou're doing, you're doing all
this other stuff already.
(30:22):
And you might need to, you know,you might need to boost the way
you document it or this or that,but you're doing that kind of
care.
And so take advantage of thosecodes.
SPEAKER_00 (30:32):
Absolutely.
And I think, you know, don't beafraid or don't think that it's
the physician practice does notalways weigh on just what the
physician does.
If you have an ancillary staffthat is capable with your
oversight, because it's generalsupervision for most of these,
you're able to perform thesewith general supervision and
(30:53):
still be paid because generalsupervision means that you are
supervising the service, but thebill goes out in your name and
you are certifying that theservice was performed under your
supervision.
So that's extremely important.
And it's just a lot ofopportunity.
And if you haven't done soalready, take a look at it and
see how it benefits you.
SPEAKER_02 (31:12):
Thank you so much, Maya.
And we are going to include yourcontact information in the show
notes because I'm sure there arepeople out there listening that
this will resonate with andthey'll want to know how they
can do it in their ownpractices.
And so I highly recommend youreach out to Maya and get some
more information on this.
(31:32):
So thank you, Maya, for beinghere today.
SPEAKER_00 (31:34):
Thank you, CJ.
So good to talk to you.
Yes.
SPEAKER_02 (31:38):
And thank you to all of our listeners for listening
to another episode.
As always, we welcome yourfeedback on topics.
What other topics would you liketo hear about?
And if you know great speakerslike Maya or guests that we
should have on, please feel freeto recommend those to us.
Until next time, everybody, takecare.
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