"Children with special health care needs make up 16.2% of the child health population and yet account for 45.7% of the medical care dollar (in 2000)."
Source: Health Services Use and Health Care Expenditures for Children With Disabilities, Pediatrics 2004
- Medical Home
Introduction - Medical Home Strategies
- Engage Families as Partners
- Identify Children & Youth with Special Health Care Needs
- Use Planned Encounters
- Improve Care Coordination:
Create Care Plans - Support Adolescent
Transitions - Collaborate with
Community Resources - Refine Coding &
Reimbursement Practices - Find Regional Centers
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Site last updated:
October 15, 2009
National Resources
National Center of Medical Home for CSHCN: Coding and Reimbursement
AAP Coding Hotline
aapcodinghotline@aap.org
(800) 433-9016 ext. 4022
Catalyst Center: Improving Financing of Care for Children and Youth with Special Health Care Needs
- Health Insurance & Financing Toolkit (link)
There are pressures on pediatricians and other primary care providers to see patients quickly, making it difficult to provide coordinated care for chronically ill children with complex needs. This section includes management tools to assist practices in tracking and evaluating reimbursement for care of children with special needs.
Coding Strategies in a Medical Home
- Identify eligible patients, if billing to state programs;
- Label charts;
- Keep billing form in front of chart;
- Train all staff to document care coordination activities;
- Meet with your billing department to discuss strategies on how to bill for these codes;
- Design a system for your practice on how to tally and submit billing information.
Videos
Physicians describe how documenting care coordination through better coding can improve reimbursement.
Medical Home Resources
The Care Coordination Toolkit provides billing information for coordination of care with descriptions of individual codes, proper documentation and an easy to follow billing slip for physician and non-physician time. There is also a link and number for the AAP Coding Hotline.