Applies to:

Priority Health Medicare Advantage plans

Definition

A reconciliation of medications after discharge is designed to identify and eliminate medication side effects and interactions that could result in illness or injury.

Process: The Medicare Advantage plan member who has been discharged from an inpatient stay meets with a qualified health care provider (prescribing practitioner, clinical pharmacist or registered nurse). Together, they review the member's complete medication regimen that was in place prior to admission and compare and reconcile it with the regimen prescribed at discharge. This ensures that new prescriptions are obtained and discontinued medications are discarded.

Timeline: Service is completed immediately (e.g., within the first week) following discharge from a hospital or skilled nursing facility inpatient stay, by a qualified health care provider, in cooperation with the enrollee's physician.

Post-discharge medication reconciliation coverage

Priority Health offers this supplemental benefit for Medicare Part C (Medicare Advantage) plan members who do not qualify for this service under Original Medicare's home health benefit.

This benefit is listed in the Medicare Managed Care manual, Chapter 4, sections 30.1, 30.2, 30.3, & 90.5. It's included in the Evidence of Coverage (EOC) documents for all of our Medicare Advantage plans. The EOC is the contract for covered services between the member and Priority Health.

Documenting medication reconciliations

When complete, fax the Medication Reconciliation form to the Priority Health Care Management care coordinator at 616.942.0024.

Post-discharge medication reconciliation billing

Bill revenue code 0583 with HCPCS S5109.

Beginning July 1, 2018:

Bill revenue code 0583 with HCPCS S5109 AND ALSO bill revenue code 1111F (CPT II code).

Charges for the 1111F code should be $0 or $0.01. You will not receive payment for the additional code, but you must bill both codes to receive payment for this service.