Here's the good news: You can get paid for asthma education. Providers across the country are being compensated for teaching self-management skills to people with asthma.

Currently, emergency departments, outpatient hospital clinics, stand-alone clinics, home health agencies, case management companies, and even solo respiratory therapists are getting paid for asthma education.

Now, the bad news: There's no single universal billing code every type of provider can use in all types of settings to bill for asthma education. Medical coding and billing is complex - we have CPT codes, HCPC codes, revenue codes, ICD-9 codes, HCFA 1500 claim forms versus UB92 claim forms, etc. To top it all off, the rules vary from provider type, provider facility type, payer type, to the state in which you practice.

It's no wonder so many providers ask me how to get paid for their services.

Make Billing Personnel Your Friends
The first question I ask them is, "What are the first and last names of the people responsible for billing your services?" Get to know the personnel responsible for getting you paid. They're vital to your success in receiving compensation.

Next, make sure they understand your job. If they're not aware you perform asthma education, then the likelihood of getting a dime is slim to none.

Create a document that outlines every aspect of the services you provide during each and every education session. Include the education intervention, therapeutic assessments, physical assessments, diagnostic assessments, historical assessments, etc. Also include the amount of time you spend on each activity and any supporting materials or devices that you may use for the session.

Once they know exactly what you do, they should be able to tell you:

• if you're being paid for the services you currently provide
• who's paying you
• how you're getting paid
• if you're not being paid, the reasons why.

Using the New CPT Codes
Last year, the Centers for Medicare & Medicaid Services (CMS) released new CPT codes for education and training for patient self-management of chronic diseases. Although these codes currently aren't covered by Medicare, some providers across the country have been successfully using them to bill for their education services to other third-party payers, including Medicaid-managed care organizations and private insurance companies.

The codes are as follows:

• 98960 - Education and training for patient self-management by a qualified, non-physician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each 30 minutes; individual patient
• 98961 - Two to four patients; each 30 minutes
• 98962 - Five to eight patients; each 30 minutes.

As mentioned earlier, not all provider types will be able to bill with these codes. Organizations such as home health agencies and case management companies bill for asthma education by using revenue codes for their visits. Outpatient hospital clinics bill using facility fee codes.

CPT codes are used by providers who typically bill using these types of codes. Physician offices, free-standing clinics, and solo RTs bill using CPT codes.

This is why it's important to first understand how you're currently billing based on the type of facility in which you work. For example, if your facility uses only revenue codes, then you probably won't be successful billing the new CPT codes.

Four Requirements
Once you've identified that your facility uses a CPT billing methodology, you also must ensure your current or future program meets four requirements for using the new codes. (See Table below.)

All of your services must be prescribed by a physician. Most education and training services require a physician order; however, it should become a matter of policy so possible payers have a clear understanding of your program requirements.

Also, a "qualified" health care professional must provide the services. The National Asthma Educator Certification Board provides an examination to certify asthma educators. AE-C® health care professionals include: physicians, physician assistants, nurses, RTs, pulmonary function technologists, pharmacists, social workers, health educators, physical therapists, or occupational therapists.

Non-licensed individuals are eligible to take the examination if they have a minimum of 1,000 hours experience providing asthma education, counseling, or coordinating services.

By using AE-Cs in your program, you're demonstrating your commitment to the quality and consistency of your education and training services to patients and payers.

Your program also must be based on a standardized, well-defined curriculum that includes learning objectives, teaching methodology, and supporting documents used for teaching and training (e.g., environmental assessment or metered dose inhaler technique). Your curriculum not only demonstrates consistency in your approach, but it also promotes consistency among your staff.

Finally, your program's content needs to rely on accepted standards. The Global Initiative for Asthma (GINA) and National Asthma Education and Prevention Program (NAEPP) guidelines can help ensure that your program meets the gold standard of asthma management.

The 1997 NAEPP guidelines say asthma education messages should include: basic facts about asthma, the roles of medications, therapeutic skills, environmental control measures, and how to manage exacerbations. GINA has just released its new guidelines, and updated guidelines from the NAEPP are expected later this year. The point is, as the guidelines change, your program content should be updated to reflect current asthma practice standards.

This is how you develop an asthma program based on billing from the new CPT codes. Even if you're reimbursed through a different mechanism, it's a good idea to follow the requirements stipulated by CMS.

Steps to Reimbursement
So, how do you get paid?

1. Identify your facility type.
2. Identify your current billing methodology (i.e., revenue codes, CPT codes, HCPC codes, facility fee codes).
3. Identify your current and/or future payers.
4. Define your program: Include your educator profiles (licenses, certifications, experience), curriculum content, and adjunct teaching/training materials.
5. Define the number and length of each education session.
6. If you're using the CPT codes, identify the fee you will charge for 30-minute sessions for individuals, small groups, and larger groups.
7. Negotiate your fees and services with the payers.

This all may seem like a lot of work. It is. Like all of us, payers and patients want to get the most value out of their dollar, and asthma educators need to demonstrate what they're worth.

Shawn McCormick, BS, RRT, AE-C, owns Summit DME of San Antonio, a medical equipment company, and Zoey L.P., a pediatric asthma education resource company. She's the current chair of the National Asthma Educator Certification Board.

Table: Requirements for using the "Education and training for patient self-management" CPT codes:

• The education and training must be prescribed by a physician.
• A qualified non-physician health care professional must provide the services.
• The material must be taught from a standardized curriculum.
• The program's contents "must be consistent with guidelines or standards established or recognized by a physician society, nonphysician health care professional society/association, or other appropriate source."