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Medicare Advantage Reminder: Additional Payment for Post-Discharge Medication Reconciliation

Posted October 15, 2019

Blue Cross and Blue Shield of Illinois (BCBSIL) will reimburse providers who conduct medication reconciliation within 30 days of a hospital discharge for Blue Cross Medicare Advantage (PPO)SM (MA PPO) members if the requirements listed below are met. It’s important to conduct medication reconciliation after every discharge to help ensure that patients understand instructions for any new medications, as well as any medications that should no longer be taken. Post-discharge medication reconciliation may be conducted by the prescribing physician, or a clinical pharmacist or registered nurse.

To receive payment for post-discharge medication reconciliation for MA PPO members:

  • The provider must be contracted with BCBSIL.
  • The Current Procedural Terminology (CPT®) II code 1111F must be billed on the discharge day or within 30 days after an inpatient discharge. The inpatient discharge can be acute or non-acute hospitalizations.
  • The payment of $10 must be on the professional claim for this service, along with the CPT II code of 1111F. Our claims system does not pay if the expected amount of $10 is not on the claim and it does not pay more than the $10. Post-discharge medication reconciliation cannot be paid if charges are submitted on the facility claim. The rendering provider for the service must be documented on the claim, as completed by an individual physician or physician extender who has access to the member’s medical record.

The outpatient medical record must include:

  • The hospital discharge date;
  • The date the medication reconciliation was completed; and
  • Documentation indicating that the patient’s current list was reconciled against the hospital‘s discharge list of medications.

CPT II code 1111F for services provided to MA PPO members may be billed back to dates of service as early as Jan. 1, 2019, as long as timely filing rules set forth in the provider contract are followed.

If you have any questions regarding this information, contact your BCBSIL Provider Network Consultant team at govproviders@bcbsil.com or 855-653-8126.

CPT copyright 2018 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA.

This material is for educational purposes only and is not intended to be a definitive source for coding claims. Health care providers are instructed to submit claims using the most appropriate code(s) based upon the medical record documentation and coding guidelines and reference materials.