Most providers are missing out on medication reconciliation reimbursements. Are you?

It’s estimated that 85 percent of providers aren’t submitting reimbursement claims for conducting medication reconciliation with their attributed Blue Cross Blue Shield of Michigan members after hospital discharge.

To receive reimbursement, follow these steps when patients are discharged after a hospital stay:

• Schedule a post-discharge office visit as soon as possible.
• Perform medication reconciliation during the visit by reconciling the hospital discharge medications against the outpatient medication list.
• Document the following in the outpatient medical record: “Current and discharge medications were reconciled.”
• Submit *1111F with the post-discharge office visit claim within 30 days of the discharge.
• CPT II code *1111F states, “Discharge medications reconciled with the current medication list in outpatient medical record.”

When medication reconciliation is conducted by the prescribing primary care doctor or the ongoing care provider within 30 days of a hospital discharge and a claim is submitted for *1111F, Blue Cross will reimburse as follows:

• $10 for Medicare Plus Blue^SM
• $35 for Blue Cross commercial

About the HEDIS^® measure
Medication reconciliation post-discharge assesses patients age 18 and older who were discharged from an acute or non-acute inpatient stay between Jan. 1 and Dec. 1 of the measurement year. It looks at patients whose medications were reconciled from the date of discharge through 30 days after discharge (31 days total).

For more information

• Frequently asked questions: Reimbursement for medication reconciliation within 30 days of an inpatient discharge to home.
• “New Medicare star ratings measure: Medication reconciliation post-discharge”
• “Providers receive reimbursement for conducting medication reconciliation post-discharge for MA PPO members”

HEDIS is a registered trademark of the National Committee for Quality Assurance.