Medical Billing Framework

The medical billing process begins with patients scheduling appointments with their healthcare providers for routine check-ups or preventive care visits. Following confirmation, patients receive a HECS Assessment via text or email, which they complete remotely, capturing data on lifestyle habits like physical activity, nutrition, stress management, and sleep patterns. Once gathered, HECS analyzes the data to produce a lifestyle risk profile (LRP).

At the visit, healthcare providers have access to the LRP within the patient’s electronic health record (EHR), offering insights into the patient's current lifestyle risk factors. Documentation of the HECS assessment, including assessment date, results, and follow-up recommendations, is recorded in the patient's EHR. Subsequently, healthcare providers submit a claim for reimbursement using CPT code 96160, supported by appropriate modifiers and documentation. Upon submission, the payer processes the claim, and if deemed reimbursable, the healthcare provider receives payment (typically $2.00-$6.00 per assessment). Based on the HECS assessment insights, healthcare providers develop personalized care plans to address identified health risks or concerns, scheduling follow-up appointments or interventions to support behavior change and enhance the patient's overall health and well-being.