Billing and Coding for HIV Care

Primary Care Development Corporation (PCDC)

Information on team roles and responsibilities as well as strategies for billing and coding for HIV care. The focus of this webinar is on billing for AIDS service organization and community-based organization-specific services.

Watch clips from this webinar and download the slides. Also, see these tip sheets: Best Practices: Avoiding Billing Denials and STI Screening Codes.

The role of billing and coding to help your agency sustain services over the long term, like the importance of having software in place to manage electronic medical records.

General overview of billing and coding for primary care with a subsequent review of the same for HIV care, including a review of ICD-10 codes, CPT codes, evaluation and management coding, and modifiers..

Case study of coding for HIV care, with HIV care coding, with a case study (preventive medicine counseling), HIV diagnosis codes, ICD-10 codes for HIV screening, Medicare HIV codes, codes for lab tests fro HIV and sexually transmitted infections, and modifiers for HIV screening.

Review of screening for sexually transmitted infections or STIs: syphilis, gonorrhea, hepatitis B, chlamydia.

Review of who is involved in billing and coding in a clinic and their roles: front desk staff, medical assistant and nurse, the provider (who performs the patient visit, documents the encounter, and selects diagnosis and procedure codes), and billing staff.

Sequence of steps involved in billing for clinic services that occur, in order: the patient visit; review and confirmation of codes by billing staff; codes submitted to the clearinghouse to submit claims to the appropriate insurance carrier(s); and resolution of bill covered by carrier and patient.

The process that helps organizations get paid the full amount for their services.

Review of insurance carriers that agencies can contract with in order to secure reimbursement (Health Maintenance Organizations, Preferred Provider Organizations, Point of Service--a type of managed care plan, Medicare, Medicaid, Managed Care Organizations). Also, review of the research, outreach, and tips for initiating carrier contracting.

The education, training, residency, board certification, and licensing process for provider staff. Credentialed staff are necessary in order to secure reimbursement from insurance carriers.

Review of procedure codes for PrEP and PEP medical office visits and preventive medicine procedure codes.

This webinar was facilitated and presented by Chaim Shmulewitz, PCDC Project Manager, and Maia Morse, MPH, CPC-A, PCDC Senior Program Manager.

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