The Record - Providers receive reimbursement for conducting medication reconciliation post-discharge for MA PPO members

Providers receive reimbursement for conducting medication reconciliation post-discharge for MA PPO members

As of July 11, 2016, Blue Cross Blue Shield of Michigan is reimbursing health care providers who conduct medication reconciliation during an office visit within 30 days of a hospital discharge for Medicare Advantage PPO members. Medication reconciliation post-discharge is a new Medicare star ratings measure that we announced in the May Record.

Why conduct medication reconciliation?
Hospital admissions are associated with unintentional discontinuation of medications for chronic conditions, and significant changes can occur to a patient’s medication during hospitalization.

Performing a routine medication reconciliation after every discharge is an important step to ensure that medication errors are addressed and that patients understand their new medications, as well as medications that should no longer be taken.

The post-hospitalization follow-up visit provides an opportunity to address the condition that caused the hospitalization and to review the patient’s medications.

How to receive reimbursement for medication reconciliation post-discharge
When Medicare Advantage PPO members are discharged after a hospital stay, schedule a post-discharge office visit as soon as possible and perform medication reconciliation during the visit.

The outpatient medical record must state that the “current and discharge medications were reconciled.”

Bill *1111F with the post-discharge office visit claim within 30 days of the discharge.

Medication reconciliation should be performed after every inpatient discharge.

CPT 2 code *1111F states, “Discharge medications reconciled with the current medication list in outpatient medical record.”

In addition to the office visit, Blue Cross will reimburse providers an additional $10 for billing 1111F within 30 days of a patient’s discharge.

For more information about this measure, refer to the May 2016 Record article, which describes the measure in detail and provides specific documentation requirements.

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