Improving Oral Healthcare Quality Through Case Management

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Enhance oral healthcare quality through case management with a professional education program focusing on care coordination and dental case management. Learn about key components in delivering services, effective communication, and how to bill Medicaid for services. Discover how community support and agencies contribute to patient care. Explore dental office professionals' roles and certification requirements.

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Improving the Quality of Oral Healthcare through Case Management Dental Case Management Care Coordination D9992

Acknowledgements Improving the Quality of Oral Healthcare through Case Management is a professional education and training program designed to advance the knowledge, skill, and competency of the dental workforce. The curricula is made up of 6 training modules which have been made available through the generous support of the following organizations and agencies: Rhode Island Department of Health Rhode Island Executive Office of Health and Human Services Rhode Island Dental Association Medicaid|Medicare|CHIP Services Dental Association Health Resources and Services Administration

Module 8 Learning Objectives Participants will: Identify ways in which enhancing care coordination can improve a patient s motivation to decrease or avoid oral disease; Understand key components of delivering care coordination services and how each effects the patient experience; Develop a working knowledge of how community supports, the Medicaid Health Plans and the Medicaid agency contribute to effective communication and care coordination; Understand the role each dental office professional plays in delivering case management services; Effectively document and bill Medicaid for case management services delivered in the dental office

Improving the Quality of Oral Healthcare through Case Management Take the Module 8 Pre-Test Now https://www.surveymonkey.com/r/M8 Pre

RI EOHHS Case Management Policy A Toolkit for Billing

Implementation of Dental Case Management Before launching more broadly, RI EOHHS will test the four new codes. 2017 Pilot Initiative - volunteer dental practices - services are billed, reimbursed and tracked - certain outcomes will be evaluated A decision for a full launch of codes will be made in 2018

Dental Provider Qualifications 1. RI Medicaid-enrolled 2. Complete 5 online Case Management Learning Module Series 3. Complete 5 Module Pre & Post-Tests 4. Certification from RI EOHHS

Who Provides the Services? Employing a dedicated dental case manager can be difficult financially, which is why the dental case management services can be provided by a trained dental team.

Tips for Conducting a Needs Assessment Some important principles that apply to all assessment areas are: Start with active listening and allow patients to express their needs and desires Build a relationship on mutual respect and focus on strengths All of the needs areas should be addressed and prioritized, as per the patient s ability to participate. Ask open-ended questions. Involve family members and appropriate social resources

Assessing Needs Focus Areas Sample Questions &/or Solutions Dental Needs Assessment Emergency care (urgent issues, severe pain) Is eating/nutrition impacted? (painful/difficult to eat?) Will patient need extensive care Assess Patient Health Needs Chronic conditions (e.g. diabetes, heart disease) Medication use Mental Health status and treatment Clients' Cognitive/Functional Capacity Is care coordination appropriate? Assess Need for Social Support Literacy & oral health literacy levels (tool/s) Provide patient education Employ motivational interviewing skills Pre-Referral & Client Contract Build rapport, trust, allay fears, provide patient education. Provider and patient agree on expectations of dental treatment

Dental Treatment - Case Management Considerations Can take multiple visits for complex dental treatment plan Behavioral issues, intervention management (lots of unknowns when patient is in new environment) Management of covered vs. non- covered dental procedures Monitor co-occurring conditions (D/A, MH, chronic conditions) Patient Education, instructions, language, literacy Follow-up after extractions and intensive procedures (infection, pain management) Transportation assistance Advocacy/Education/Assurance: Does CM have to advocate on behalf of patient to dental provider? or educate and assure patient? Coordination of treatment between emergency provider, hospital, dental provider, and outside referrals Other life case management: Benefits, housing, substance use, medical, etc. http://www.achch.org/uploads/7/2/5/4/72547769/dental_poster_achchp_nhchc_5-2016final.pdf

Understanding Dental Case Management CDT Codes D9992 Dental Case Management Care Coordination Assisting in a patient s decisions regarding the coordination of oral health care services across multiple providers, provider types, specialty areas of treatment, health care settings, health care organizations and payment systems. This is the additional time and resources expended to provide experience or expertise beyond that possessed by the patient

Understanding Dental Case Management Code D9992 Care Coordination The deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient s care to facilitate the appropriate delivery of health care services. (CMSA Standards of Practice, 2010 p 24)

Practical Care Coordination Apply interprofessional practice principles that lead to: o safe, o timely, o efficient, o effective, o equitable planning and delivery of patient- and population-centered oral health care.

Practical Care Coordination Facilitate patient navigation in the health care delivery system through collaboration and communication with health care providers Provide appropriate referrals Document information and organize information to: support decisions o measure care processes o monitor clinical outcomes o

Practical Care Coordination In RI, the Medicaid Agency and/or the Medicaid Health Plans (the Plans) also provide care coordination services The Plans may be helpful to dental professionals in certain instances, especially patients with multiple or complex health issues Go to www.rieohhs.gov for more information Or, please call: DHS Call Center- 1 (855) 697-4347 Neighborhood Health Plan of Rhode Island 1-800-459- 6019 UnitedHealthcare Community Plan 1-800-587-5187

Typical Delivery of D9992 1. Patients receive a comprehensive assessment - Can be done as part of a Medical/Dental History Review 2. Services are developed based on assessment - Patient s interest in receiving case management services. 3. The intent is for Case Management services like D9992 is to provide other dental services on the same day.

EXAMPLE- Case Study 1 Successfully coordinate with Primary Physician (PCP) Issue: A needs assessment has revealed that a Medicaid- insured adult male has been having a difficult time navigating the healthcare system. He has multiple health issues that are affecting his oral health and he has not seen his PCP in years. Solution: Staff assist the patient to schedule a PCP visit and ask for a follow-up report upon completion. The dentist also works with the Nurse Care Manager at the patient s Health Plan to ensure that there is regular contact with patient to coordinate necessary medication, treatment and therapies, all of which benefit the patient s oral health. Billing: D9992 is billed to Medicaid along with the CM Pilot Form and the appropriate notes are entered into the patient record. (Although this coordination may involve multiple corresepondence, the code should be billed only once for each patient scenario.)

EXAMPLE - Case Study 2 Care Coordination for Special Needs Adult Issue: A Medicaid-insured special needs adult with a cardiac condition requires extensive dental treatment. The patient needs a referral to and an evaluation from a new cardiologist before treatment can begin. Solution: Staff assists the patient in getting a referral from his PCP and then arranges to receive reports from the cardiologist around the management of the patient s disease and approval to begin dental treatment. Billing: D9992 is billed to Medicaid along with the CM Pilot Form and the appropriate notes are entered into the patient record. (Although this coordination may involve multiple corresepondence, the code should be billed only once for each patient scenario.)

EOHHS Policy-Code Use During Pilot May be billed for all non-RIte Smiles enrollees (older children & adults (ages 21+) Initial Assessment should be completed and filed - Dental Needs Assessments: part of medical history or supplemental D9992 code may be billed to EOHHS one time per date of service for the same patient Additional dental services (including other case management) may be billed on the same day

EOHHS Policy-FQHC Code Use During Pilot May be billed for all non-RIte Smiles enrollees (older children & adults (ages 21+) Initial Assessment should be completed and filed - Dental Needs Assessments: part of medical history or supplemental D9992 code may be billed to EOHHS one time per date of service for the same patient D9992 must be billed with at least one other covered dental service (besides the other 3 CM codes) on the same day in order to qualify as a dental encounter

EOHHS Guide for Billing During the Pilot RI Medicaid has authorized you to bill for CM services, so your practice s claims will be monitored and tracked as they are submitted Submit Medicaid dental claim using the same process as all other Medicaid adult claims Exception: FQHCs must bill D9992 with another Medicaid-covered dental service on same day Including NOTES on the claim will always enhance the quality and integrity of your documentation

Recordkeeping

Recordkeeping Maintain patient records, whether written, taped, computerized, or stored in any other medium, in a manner designed to ensure confidentiality.

Recordkeeping Tips Document the type of support your office provided for the patient on that day in: -- the paper record and/or -- the electronic record Don t forget to indicate the staff person s name who provided the CM support Complete the RI EOHHS Data Collection Form

Data Collection Forms

Data Collection Form Instructions Complete each of the required boxes on the Form Don t forget to include the date and the baseline score and all subsequent scores to track change over time. Please complete the Form in Excel and save it for each individual Case Management patient with name and the initial date of service in the file name.

Data Collection Form Instructions To track patient progress, please choose the most appropriate score.

Data Collection Form Instructions The Form should be used as a patient agreement to engage patients in their care and updated on their progress. During the Pilot, please save the Form electronically. The Form should be submitted to Medicaid s fiscal agent DXC (formerly HPE) with the paper claim form via fax or mail.

Data Collection Form Instructions The saved electronic Forms should be sent weekly to the following e-mail address: Samuel.Zwetchkenbaum@health.ri.gov Electronic files are due either by close of business (COB) on Fri. of the current week, or by COB the following Mon.

In Closing The bottom line is that there are a number of ways to integrate dental case management into your organization, no matter your size or resource limitations. The most important thing is to make dental case management an integral part of clinic operations.