HCCIntel Legislative News Practice Management Uncategorized

COVID-19 Update 04/24/20 – More on Medicare Telehealth Services-related Changes

As providers and practices continue to determine the best way to safely care for their patients while navigating the ever-changing regulatory requirements related to COVID-19, HCCI is committed to continuing to provide accurate, clarifying and timely information.

“Medicare telehealth services” refer to a certain list of services that would normally be provided in-person, but due to the Public Health Emergency, are temporarily being allowed by Medicare in all locations when they are furnished using two-way audio and video technology that permits real-time communication between the provider and the patient who are in different locations.

Medicare has also previously allowed these services in geographic areas that were rural or designated as a Healthcare Professional Shortage Area (HPSA), subject to distant and originating site requirements (temporarily waived).

As a result of the interim final rule published on 3/26/20, for visits conducted via telehealth, for Medicare’s purposes, providers should report the Place of Service (POS) where the patient would have been seen face-to-face (to allow for non-facility rate payment) and use modifier 95 to identify it as a telehealth service. Telehealth services no longer require POS 02.

The following are not considered Medicare telehealth services because they would not normally be provided face-to-face. Instead, providers should report the POS where the service was rendered, with no modifier required.

  • Telephone Evaluation & Management (E/M) Services: CPT code range 99441-99443 and CPT code range 98966-98968
  • Virtual Check-in (phone call): HCPCS code G2012
  • Review of recorded video and/or photo or image: HCPCS code G2010
  • E-visits (patient portal communications over a 7-day period): CPT code range 99421-99423 and HCPCS code range G2061-G2063
  • Remote Patient Monitoring: CPT codes 99453-99454, 99091, 99473-99474, 99457, 99458

Other Modifiers

  • CS Modifier: Physician and practitioner services that lead toeither an order for, or administration of, a COVID-19 lab test are not subject to a co-pay or deductible charges. The CS Modifier is added to the physician/practitioner service to define this circumstance and allow the claim to process without co-pay or deductible application.
  • CR Modifier: Catastrophe/disaster-related; required when an item or service is impacted by an emergency or disaster and Medicare payment for that item or service is conditioned on the presence of a “formal waiver.” Please note telehealth services are excluded from CR modifier use, so do not report for telehealth services. Be sure to follow the guidance provided by your local Medicare Administrator Contractors (MAC) as a recent NGS article advised to use CR for telephone E/M services.

Additional Key Updates

Previous HCCI Home-Based Primary Care-Specific Updates

Disclaimer: This information is current as of 4/24/2020. COVID-19 guidelines are changing daily. Please note for the purposes of the Home-Based Primary Care (HBPC) population: The Home Centered Care Institute (HCCI) focuses our content on CMS guidelines relevant for traditional Medicare billing. It’s always recommended to check with local MACs for specific guidance for your geographic region.

Event HBPC in the News Training Training & Education Uncategorized

HCCI and NNPEN Conference: Different Strategies, Shared Vision

HCCI NNPEN joint conference

How can Nurse Practitioners (NPs) and others effectively start-up and/or expand a home-based primary care (HBPC) practice? Just ask the participants who attended the February 7- 8 joint conference hosted by the Home Centered Care Institute (HCCI) and the National Nurse Practitioner Entrepreneur Network (NNPEN) in Phoenix.

With NPs being the fastest-growing segment of HBPC providers, the conference provided attendees with critical information on planning and operating a successful and sustainable HBPC practice. Participants brought varying backgrounds and HBPC experience levels to the conference, entitled, “Blueprint for Success: Building and Growing Your Home-Based Primary Care Practice.” The first day concluded with a well-attended “Open Office Hours” segment, where participants were able to ask questions about their specific situations, which invariably applied to many in the room.

The two organizations’ strategies are necessarily distinct. HCCI focuses on professional development for NPs who have a specific interest in HBPC while NNPEN, as Sandy Berkowitz, RN, JD, and Co-founder and CEO of NNPEN, explains, “focuses on supporting nurse practitioners as professionals who want to be their own boss.”

At the same time, though, HCCI and NNPEN have a similar vision. “We share the same vision and passion to create access for a primary care population of frail and elderly patients who are vastly underserved,” Berkowitz continues, “and to explore how advanced practice providers can do well by doing good.”

In sharing her own conference takeaways, Heather Hodge, Director of Education for HCCI, said, “During the conference, I was struck again by how providers are offering HBPC through a variety of business models. It’s not a one-size-fits-all. Plus, people seemed to take something from every session that they could immediately apply to their own situations. Finally, the conference gave people a place to ask their top-of-mind questions and share their successes and challenges, like managing different state laws, payer requirements, and so on. In all, the event helped many see they weren’t alone and that, if they were having an issue, someone else probably was, too.”

For NPs and others with questions about developing or sustaining an HBPC practice, HCCIntelligence™ offers webinars and a hotline at 630-283-9222 and [email protected].


HCCI in the News News Press Releases Uncategorized

Thomas Cornwell, MD, Transitions Roles at HCCI and Joins VillageMD

Founder of Home Centered Care Institute transitions from CEO to Executive Chairman and takes on new role with VillageMD

Schaumburg, IL, March 2, 2020

Thomas Cornwell, MD
Thomas Cornwell, MD

The Home Centered Care Institute (HCCI) announced today that its founder, Dr. Thomas Cornwell, will transition his role with the organization from Chief Executive Officer to Executive Chairman, effective March 9, 2020. At that time, he will also become the Senior Medical Director of Village Medical at Home, part of VillageMD.

Since founding HCCI, Dr. Cornwell has played a critical role in fulfilling the organization’s vision to spread home-based primary care (HBPC) to more patients by generating substantial awareness of HBPC and the need for expanding house call programs and the workforce.

HCCI has also played a role in the continuation of the Independence at Home Medicare Demonstration and the Centers for Medicare & Medicaid Services’ New Payment Models; educated over 500 unique learners and 260 HBPC practices; introduced a consulting practice focused on practice management and clinical care; created six HCCI Centers of Excellence for Home-Based Primary Care™; assembled a national faculty of HBPC leaders; and taught over 1,000 students and health system leaders at three medical universities in China along with partnering with Shandong University in Jinan to create an HCCI HBPC training center.

“I am incredibly proud of the team at HCCI and know it is in good hands and well-positioned for the future,” said Dr. Cornwell. “I am excited to be joining Village Medical at Home and combining their operational excellence with my twenty-five years of HBPC experience and clinical skills to further spread house calls nationally.”

Taking on his new role with Village Medical at Home means that Dr. Cornwell will no longer practice with Northwestern Medicine HomeCare Physicians. “I remain forever thankful for Northwestern Medicine’s support of HomeCare Physicians,” said Cornwell. “The numerous awards, media exposure, and national recognition we have received as a house calls practice – and, most importantly, the number of patient and caregiver lives we’ve been able to touch – are all a result of Northwestern’s incredible support.”

HCCI’s Board plans to review the existing leadership structure at their next meeting. In the interim, Julie Sacks, Chief Operating Officer, will continue to manage the daily operations of HCCI. Sacks shared her thoughts on the transition, saying, “Without Dr. Cornwell and our funders, there would be no HCCI. He had the incredible vision and passion to establish an organization that is transforming our health care system. I also consider it an honor to help steward HCCI through this important transition.”

Richard Maybury, Chairman of the Board for HCCI, also shared his perspective, adding, “Dr. Cornwell has been caring for patients in their homes for over 25 years, so his new role is a natural extension of that work. At the same time, HCCI is well-positioned for the future with a strong core of proprietary HBPC education delivered through multiple channels, a growing consulting practice, a key role in HBPC advocacy, a national network of leading academic healthcare institutions and HBPC faculty, and the right combination of experienced and tenured leaders and staff in place to take the organization forward.”

As Executive Chairman, Dr. Cornwell will be a member of the board; continue to act as a strategist; represent HCCI to the public, industry and media; and play a continued role in the organization’s ongoing growth and improvement, including fundraising.

Home Centered Care Institute

The Home Centered Care Institute (HCCI) is a national non-profit organization focused on advancing home-based primary care to ensure that medically complex and homebound or home-limited patients have access to high-quality care in their homes. HCCI works with leading academic medical centers, health systems, and industry experts to raise awareness of and advocate for expanding the model by growing the home-based primary care workforce through education and training and developing a research-based model for sustainable house call program implementation and growth. For more information, visit and follow @HCCInstitute.

Northwestern Medicine

Northwestern Medicine is the shared strategic vision of Northwestern Memorial HealthCare (NMHC) and Northwestern University Feinberg School of Medicine to transform the future of healthcare and become a premier integrated academic health system. Each day, 33,700 clinical and administrative staff, medical and science faculty, and medical students come together with a shared commitment to superior quality, academic excellence, scientific discovery and patient safety. For more information, visit


VillageMD is a leading provider of healthcare for organizations moving toward a primary care-led, high-value clinical model. The VillageMD solution provides the tools, technology, operations, and staffing support needed for physicians to drive the highest quality clinical results across a population. VillageMD works with physician groups, independent practice associations, and health systems to improve quality, deliver a first-rate patient experience, and lower costs in the communities they serve. VillageMD will continue to grow its Village Medical brand and scale its Village Medical at Home offering. VillageMD has grown to include more than 2,500 physicians across nine markets and is responsible for approximately 500,000 lives and $3 billion in total medical spend in value-based contracts. To learn more, please visit

Read the VillageMD press release here.

Read the HCCI Chairman of the Board letter here.

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HCCIntel Practice Management Training & Education Uncategorized

Annual Chart Audits Can Greatly Benefit HBPC Providers and Practices

medical charts

About this Article:

Regular chart audits can significantly help home-based primary care (HBPC) practices improve their coding accuracy and the quality of their documentation, while also identifying lost revenue due to under-coding or missed billing. In this interview, HCCI’s Brianna Plencner discusses how chart audits can also uncover potential compliance issues and ensure documentation and coding practices are current and appropriate.


In addition to its education offerings in home-based primary care (HBPC), the Home Centered Care Institute (HCCI) offers consulting services, including chart audits, which are a valuable tool that HBPC practices can use to evaluate provider performance and improve coding and documentation. “A formal audit provides confidential, qualified feedback on a provider’s documentation and coding practices,” explains Brianna Plencner, HCCI’s Manager of Practice Improvement.

A Certified Professional Medical Coder and Certified Professional Medical Auditor, Plencner also holds a diploma in Medical Insurance Billing and Coding. Before joining HCCI, she also served as practice manager for Northwestern Medicine HomeCare Physicians, which was founded by Dr. Thomas Cornwell, CEO of HCCI. HCCInsights recently asked Plencner to share her perspective on the benefits of conducting a chart audit.

HCCInsights: Why would an HBPC practice consider using an outside agency to perform a formal chart audit?

Plencner: First, there are many reasons to conduct routine chart audits. Medical practices can use the audit process to educate providers and staff and foster a culture of continuous quality improvement. Expert reviews of patient charts also promote more accurate and complete documentation and maximize the likelihood the practice will receive appropriate reimbursement for the services provided. Because the home-based patient population is complex, the practice’s coding must fully represent the severity of each patient’s illnesses and all the services rendered. At the same time, the audit process can minimize compliance risks by identifying and correcting billing errors.

In terms of why an outside agency would be used, external auditors inherently provide an objective point of view. Their audit decisions are not influenced by an intimate knowledge of the practice and are solely based on the data examined.

HCCInsights: How does the chart audit process work? What should a practice anticipate?

Plencner: Following the execution of a Business Associate Agreement (BAA)*, a nationally certified medical auditor will first work with you to remotely access your practice’s medical record, review a sampling of patient charts, and evaluate the quality of provider documentation and coding accuracy. Then, after a preliminary conversation with our main contact and/or the leadership at your practice, our experts will conduct a virtual meeting with your providers and practice staff to walk through the charts reviewed and discuss the findings and recommendations.

Practices also have the option of requesting that a consultant travel to their location to provide onsite coaching in coding and documentation. As needed, the consultant can also develop customized documentation tools and training plans and assist with incorporating these into the practice’s procedures. Again, the goal of all these activities is to enhance your documentation and increase your reimbursement.

*Editor’s Note: A Business Associate Agreement (BAA) is a legal document signed between a healthcare provider and contractor/vendor. A provider enters into a BAA with a contractor/vendor who might, in the course of the proposed work engagement, (e.g., HCCI) receive access to Protected Health Information (PHI).

HCCInsights: What types of things do the auditors review?

Plencner: It’s a pretty extensive list. Everything from Evaluation and Management (E/M) coding, to ensure the correct level of service is selected and the documentation supports medical necessity, to whether the necessary information is recorded, and timely signatures have been obtained. The auditor will also check whether all services provided were billed out. These are just a few examples of what’s typically reviewed.

HCCInsights: Based on your personal experience, what are the most common issues discovered during a formal HBPC chart audit?

Plencner: Among the top issues we typically discover are: (1) failure to document a complete history of present illness (HPI); (2) failure to document all services being provided, such as reviewing patient records and history, talking to other providers, ordering tests, etc., which is important for determining the correct level of Medical Decision Making (MDM); and (3) under-coding** the correct level of service, which – believe it or not – is actually more common in HBPC practices than over-coding.

**Editor’s Note: Under-coding” is reporting a lower level of service than the documentation supports.

HCCInsights: It seems like there are changes to billing and coding nearly every day – how do auditors keep up?

Plencner: Nationally certified medical auditors are required to complete a variety of continuing education requirements every year to maintain their accreditation. As experts in their field, HCCI auditors actively participate in coding and documentation “boot camps,” webinars and other credential-specific programs.

HCCInsights: Are chart audits required or optional?

Plencner: At a minimum, internal chart audits are a required component of a practice compliance plan. The industry standard is an annual audit of 10 charts per provider to determine coding accuracy and compliance. Practices without an internal billing staff, or practices desiring an unbiased third-party review, would find a lot of value from doing an external chart audit.

HCCInsights: Does HCCI offer other types of consulting services?

Plencner: Yes, HCCI can conduct practice assessments to evaluate operational standards, clinical functions, policies and procedures, and opportunities for improvement. All our consulting services are customized to the practice’s specific needs and concerns. We also can offer practices customized education, such as exclusive webinars and onsite, interactive training for the entire team.

HCCInsights: How would a practice learn more about initiating a chart audit through HCCI?

Plencner: Call us at 630-283-9222 or email  [email protected]. After an introductory call with your team, HCCI will be happy to provide you with a proposal that outlines the recommended scope of work and describes next steps. 

Editor’s Note: Those interested in coding will also want to attend our free HCCIntelligence™ webinar this month (Wednesday, February 19, 4:00 pm-5:00 pm Central Time) featuring the topic, What You Should Know about 2020 Coding Updates!

Caregiver Stories Event HCCIntel Uncategorized

Giving Begins at Home

“All those who provide care and comfort to people in their homes are privileged to witness the many ways in which ‘giving’ is expressed through families, caregivers, colleagues, and patients themselves,” offers Heather Hutchison, Chief Development Officer of the Home Centered Care Institute (HCCI).

As the holiday season approaches, we will be asked to give through our time and talents — and financially. GivingTuesday, a global day of giving, helps to remind us that we can give to a purpose, a cause, that reaches well beyond ourselves, like home-based primary care (HBPC). HBPC’s purpose is to care for those who are homebound or home-limited and this cause, by its very name, begins at home.

In the spirit of GivingTuesday, HCCI would ask you to share your stories of giving with us (while keeping HIPAA standards in mind, of course) so that they might be shared with others. It’s as easy as sending an email to [email protected] with “Giving Begins at Home” in the subject line. To inspire us all, we will consider these stories for sharing in our upcoming newsletters and through social media with the hashtag #HCCIgivingbeginsathome.

If you’re moved beyond the sharing of a story to support HCCI with a charitable gift for GivingTuesday, we would be grateful. Simply click here to make a donation that will make a real difference to patients and families who need us most, including educating providers and practices who bring health care to their homes.

Your meaningful and moving stories will remind us of the needs of others. Whether that story is about a caregiver being vulnerable enough to share their challenges with their visiting physician or nurse practitioner or about a patient expressing heartfelt gratitude to their caregiver.  Whether it’s about climbing three floors to visit a patient or listening to a story that’s been told many times before. A hand stretched out, a shoulder leaned on, a smile that warms the heart. All of these are stories about giving, stories that touch the lives of HBPC providers, practice leaders and operations staff.

“Wonderful and meaningful stories about giving are prevalent in our everyday lives and in the lives of those for whom we care,” added Hutchison. “We reflect on those stories for their inspiration. Yes, giving comes in many forms.”

Happy GivingTuesday!


Benefits of HBPC Caregiver Stories HCCIntel Uncategorized

Community Paramedics Make House Calls and Change Lives

Ottawa  |  Elizabeth Payne  |  Aug 21, 2019

Maria Makkos greets Stephanie Rose at the front door of Makkos’s Arnprior apartment building.

“You are here to see me?” she asks, grinning broadly as she leads the community paramedic to her tidy unit.

Over her shoulder, Rose, the paramedic, carries a heavy black bag containing a blood pressure cuff, equipment for drawing blood, papers and other medical equipment.

Makkos, 82, is the third client the community paramedic has seen this morning.

Rose checks Makkos’s blood pressure, which is high. When they sort through her medication, Rose discovers the elderly woman hasn’t been taking it regularly.

“You are busted, I caught you red-handed,” says Rose with a laugh and a wag of the finger.

Makkos, who still drives and walks to stay fit, says she is determined to remain healthy so she doesn’t have to go into the hospital.

“Don’t’ worry, that is the last place we want you to be,” says Rose. “We are going to help you stay here, but we just want to make sure you are safe.” Taking her medicine on time, she tells Makkos, is crucial to staying healthy and in her own home.

Before she leaves, Makkos wistfully jokes that she wants Rose’s visit to last all day.

In a role reminiscent of a family doctor doing house calls, Rose visits clients to check on their health and just to chat. The conversations, sprinkled with laughter, are as important as the testing to determine what people need to remain independent and as healthy as possible, she says.  Read more

Benefits of HBPC Event Events HBPC in the News HCCIntel Legislative News Uncategorized

AAHCM and HCCI present a webinar on new CMS Primary Cares Payment Models

Woman watching a webinar

The American Academy of Home Care Medicine (AAHCM) in collaboration with the Home Centered Care Institute (HCCI) will host a webinar Tues. July 30 at 4 pm (ET) on the new CMS Primary Cares Initiative payment models relevant to home care medicine. The three different payment models will be discussed in detail; Primary Care First (PCF), Seriously Ill Population (SIP), and Direct Contracting (DC).


CMS Primary Cares Initiative

In April, the Center for Medicare and Medicaid Innovation (CMMI) announced a CMS Primary Cares Initiative which includes new payment demonstrations meant to promote value-based care, with a shift of up to 25 percent of primary care Medicare fee-for-service patients to these new models. Primary Care First (PCF), Seriously Ill Population (SIP), and Direct Contracting (DC) will offer enhanced payment for home care medicine and other providers to provide primary care for people with advanced illness.

Primary Care First (PCF) & Seriously Ill Population (SIP)

The Primary Care First (PCF) and Seriously Ill Population (SIP) models will be offered in 22 states and 4 regions for a January 2020 start date:   STATEWIDE in Alaska, Arkansas, California, Colorado, Delaware, Florida, Hawaii, Louisiana, Maine, Massachusetts, Michigan, Montana, Nebraska, New Hampshire, New Jersey, North Dakota, Ohio, Oklahoma, Oregon, Rhode Island, Tennessee, and Virginia. In Local Regions of Greater Buffalo, NY, Kansas City (Kansas and Missouri), Greater Philadelphia (Pennsylvania), North Hudson-Capital Area, NY, and Northern Kentucky.

PCF/SIP Timeline:   A letter of intent (LOI) is not required for PCF or SIP.   A request for application (RFA) will be released in the coming weeks and is required for participation.  Both models are scheduled to begin January 2020.

Direct Contracting

The Direct Contracting (DC) path will engage practices or groups of providers who can reach 5,000 beneficiaries by Year 3 (with potential exceptions for smaller practices), as well as Health systems, Accountable Care Organizations, Medicare Advantage plans, and Medicaid Managed Care Organizations.  DC builds upon the Next Generation ACO model and has no geographic limitations on who may apply.   The DC path will include three models: Professional PBP, Global PBP, Geographic PBP (Proposed).

Timeline:  A Letter of Intent (LOI) is required to apply for participation in the DC Models and is due on Friday, August 2. The LOI is non-binding. CMS will then release the request for application (RFA), which will be required for participation. All models are scheduled to begin January 2020 except the DC Geographic Option, which will begin at a later date.


Independence At Home: Year 3 Results

Independence At Home Year 3 Results

Independence at Home Demonstration

The IAH Demonstration tests a payment incentive and service delivery model for home-based primary care for Medicare fee-for-service (FFS) beneficiaries with multiple chronic illnesses. The demonstration tests whether home-based primary care that is designed to provide comprehensive, coordinated, continuous, and accessible care to high-need patients and to coordinate health care across all treatment settings reduces preventable hospitalizations, readmissions, and emergency room visits, improves health outcomes commensurate with beneficiaries’ stage of chronic illness, improves the efficiency of care, reduces the cost of health care services, and achieves beneficiary and family caregiver satisfaction.

Beneficiaries’ care is monitored using several quality measures. A savings benchmark is established that estimates what would have been spent for applicable beneficiaries in the absence of the demonstration. Practices that generate Medicare savings relative to their benchmark in excess of a minimum savings requirement may share in savings; the proportion of savings that a practice may receive as an incentive payment is adjusted based on its performance on these quality measures.

Independence at Home: Year 3 Results

In the third performance year of the demonstration, the Centers for Medicare & Medicaid Services (CMS) found that IAH practices saved approximately 4.7 percent, equating to $16.3 million, an average of $1,431 per beneficiary of their applicable beneficiaries. CMS will provide incentive payments to seven practices (as shown in Table 1*) for an aggregate amount of $7,219,784. In the third performance year of the demonstration, 11,382 beneficiaries were enrolled in the demonstration at 15 participating practices. For the third performance year, 14 out of the 15 IAH practices improved on at least one quality measure from performance year 2. Five of the practices met the performance thresholds for all six quality measures.  Click here to download the full report*

HBPC in the News Uncategorized

Unnecessary ED visits from chronically ill patients cost $8.3 billion

Emergency Department

About 30% of emergency department visits among patients with common chronic conditions are potentially unnecessary, leading to $8.3 billion in additional costs for the industry, according to a new analysis.

The report, released Thursday by Premier, found that six common chronic conditions accounted for 60% of 24 million ED visits in 2017; out of that 60%, about a third of those visits—or 4.3 million—were likely preventable and could be treated in a less expensive outpatient setting.

The frequency of unnecessary ED visits from the chronically ill is unsurprising given the fee-for-service payment environment the majority of providers remain in, said Joe Damore, senior vice president of population health consulting at Premier. On average, only 10% of providers’ payment models are tied to value-based models, he said, so providers don’t have an incentive to effectively manage patients to prevent disease progression and promote wellness. Read the full article

HCCIntel Uncategorized

I Heart House Calls

February is Heart Month, and to celebrate, HCCI kicking off a new YouTube web video series aptly named “I Heart House Calls!”

“I Heart House Calls” features stories told by the people of home-based primary care, those who provide house calls and those who have experienced it’s life-affirming impact. In this webisode, click to see Gresham Bayne, the father of the modern day house call, describe what makes house call medicine so special and enduring.

Have house calls had an impact on your life? Regardless of whether you’re a provider, a family member, caretaker, or patient, if house calls have made an impact on your life, we’d love to hear from you and share your story. Contact HCCI at 630-283-9200 or [email protected]