Getting Paid in 2017: What You Need to Know

Getting Paid in 2017:What You Need to Know

Presented by Elizabeth Woodcock

December 15, 2016

webinar

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• Welcome & Introductions• Getting Paid in 2017• How Kareo Can Help• Your Questions

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How to Participate Today…

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Speaker

Elizabeth Woodcock, MBA, FACMPE, CPC Professional Speaker, Trainer, & Author

Specializing in Medical Practice Management

Author of 12 Best-Selling Practice Management Books

Fellow in the American College of Medical Practice Executives

Certified Professional Coder

MBA in Healthcare Management from The Wharton School of Business

BA from Duke University

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Medicare 2017: Overall Impact

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

LawActual

Exception - 2014Q1 had a 0.5% rate increase

0.50%

(0.26%)

0.24%

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Medicare 2017: Specialty Impact

Average cuts based on claims processed under the taxonomy code associated with the specialty; represents RVU changes only. All other specialties 0% impact.

For a listing of all specialties, see appendix

Allergy/Immunology 1% Independent Laboratory -5%Family Medicine 1% Ophthalmology -2%Geriatrics 1% Urology -2%Internal Medicine 1% Gastroenterology -1%Physical/Occupational Therapy 1% Interventional Radiology -1% Multi-Specialty Clinic/Other 1% Neurosurgery -1%

Oral/Maxillofacial Surgery -1%Vascular Surgery -1%Otolaryngology -1%Pathology -1%Radiology -1%Diagnostic Testing Facility -1%Optometry -1%

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Medicare 2017: Behavioral Health

G0502: Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral healthcare manager activities…

G0503: Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral healthcare manager activities…

G0504: Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral healthcare manager activities…

Note: CPT codes are a registered trademark of the American Medical Association (AMA). Please review the complete definition in your CPT® Manual, and any applicable guidance from the Centers for Medicare & Medicaid Services if billing a Medicare-only “G” code.

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Medicare 2017: Chronic Care Management

G0506: Comprehensive assessment of and care planning by the physician or other qualified healthcare professional for patients requiring chronic care management services, including assessment during the provision of a face-to-face service (billed separately from monthly care management services) (Add-on code, list separately in addition to primary service).

992xx99487 Complex chronic care w/o pt visit99489 Complex chronic care add’l 30 min

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Medicare 2017: Chronic Care Management

• Creation of structured clinical summary record not required.• Separate written patient consent not required; sufficient to

document acceptance of services in medical record.• 24/7 access equates to contact with healthcare professional;

access to electronic care plan not required.• Care plan can be shared with other practitioners via fax.

For a listing of all changes, please review appendix

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Medicare 2017: Non-Face-to-Face Services

• CPT code 99358 Prolonged evaluation and management service before and/or after direct patient care, first hour; and

• CPT code 99359 Prolonged evaluation and management service before and/or after direct patient care, each additional 30 minutes (List separately in addition to code for prolonged service).

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Medicare 2017: Other Areas

Telehealth

ESRD-Related ServicesAdvanced Care Planning

Critical Care Telehealth ConsultsNew Place of Service Code 02

Under ScrutinyZero-Day Global Services billed

with Modifier -25

Global Period@270 CPT Codes

Surgeons in Groups of 10+9 States

Informal ReviewPQRS/VBPM informal review streamlined for participating

physicians

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Telehealth




with Modifier -25




physicians

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Telehealth




with Modifier -25




physicians

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Telehealth




with Modifier -25




physicians

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Telehealth




with Modifier -25




physicians

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CPT Changes 2017

•

Administration of moderate sedation, even when performed with a procedure, will need to be coded separately.

Endoscopists

Moderate Sedation CPT Codes 99151, 99152, 99153, 99155, 99156, 99157

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Meaningful Use 2016

…any continuous 90-day period between January 1, 2016 and December 31, 2016.

http://bit.ly/2fcXuUl

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Payment Adjustments

Year eRx PQRS EHR (MU) VBPM+ Total2012 -1.0% - - - -1.0%2013 -1.5% - - - -3.5%2014 -2.0% - - - -4.0%2015 - -1.5% -1.0% -1.0% -5.5%2016 - -2.0% -2.0% -2.0% -8.0%2017 - -2.0% -3.0% -4.0% -9.0%2018 - -2.0% -3.0% -4.0% -9.0%

+Value-Based Payment Modifier phases in the payment adjustments based on the size of the practice, so the penalty may be higher.

Remember… 2018 is being determined by your participation in 2016!!

Penalties for Not Participating (in the Government’s Programs) are Piling Up

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Payment Adjustments

CO237 = Legislative Penalty

N699 = PQRSN700 = EHR Incentive ProgramN701 = Value-Based Payment

Modifierhttp://go.cms.gov/2e1Zv5Z

Medicare Remittance

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Quality Payment Program (QPP)

1. Advanced Alternative Payment Model (APM) Participant

2. Everyone Else

Merit-based Incentive Payment System

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QPP Highlights

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QPP Highlights

$30,000 in Total Allowed Part B Charges

1. Allowed charges = Allowable for that particular service

99213 $200.00 $73.40CPT® Your Charge Allowed Charge*

*Reflects the current (2016) National Payment Amount for 99213; non-facility price.

This is only an estimate, but this translates into $60,000 to $90,000 in gross charges for most medical practices.

Payment

$??

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QPP Highlights

“…Beneficiaries enrolled in Medicare Advantage plans that receive their Part B services through their Medicare Advantage plan will not be included in allowed charges billed under Medicare Part B for determining the low-volume threshold.”

- CMS

2. Part B = Traditional Medicare. It does not include Medicare Advantage.

$30,000 in Total Allowed Part B Charges

• First Year Medicare Participant^…

• Perform Services for <100 Medicare patients

• Not enrolled in Medicare

^Per CMS, “a professional who first becomes a Medicare-enrolled eligible clinician within the PECOS.” CMS will perform a quarterly check.

32.5%

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QPP Highlights

“[We] intend to provide a NPI level lookup feature prior to or shortly

after the start of the performance period that will allow clinicians to

determine if they do not exceed the low-volume threshold and are

therefore excluded from MIPS.” -CMS

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QPP Highlights

October 14, 2016List of Advanced APMs

Source: CMS. https://qpp.cms.gov/docs/QPP_Advanced_APMs_in_2017.pdf

“These APMs are scheduled to be

implemented in 2017 or 2018 but have design

parameters that have not yet been finalized. We will

update this list … to reflect changes as they are

finalized.” 5 to 8% New ACO Track One Model 2018

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QPP Highlights

Option ResultReport all required elements for 90 consecutive days

Bonus

Report >1 quality measure, >1 improvement activity and all ACI measures

“Small” bonus

1 quality measure; 1 improvement activity OR all ACI measures

No payment increase; no penalty

Advanced APM Automatic 5% increase

“Pick Your Pace” 2017

If you do nothing, you will be penalized 4% on all of your Medicare reimbursement in 2019.

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QPP Highlights

Potential for 3x adjustment

for “exceptional performance”

+4%

-4%

+5%

-5%

+7%

-7%

+9%

-9%

Adjusted Medicare Part B Payment to Clinician[ based on a MIPS Composite Performance Score ]

2019 2020 2021 2022 onward

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QPP Highlights

1

Quality

2

Cost

3

Advancing Care Information

4

Improvement Activities

Eliminated in 2017

Composite Performance

Score

Advancing Care Information = New Name for “Meaningful Use”All measures can be viewed at https://qpp.cms.gov/

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QPP Highlights

Basically Replicates the Current Programs from a Reporting Perspective

HOWEVER…“MACRA requires us to measure performance, not reporting.” - CMS

Source: CMS, Final Rule (10/14/16)

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QPP Highlights

Performance = Comparison to measure-specific benchmarks

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QPP Highlights

“Benchmark”QualityMeasure

100 Patients

80 Patients

80% 90%Measure-Specific

https://qpp.cms.gov/For a summary table of MIPS, see appendix…or

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Awards and Rankings

Growth awards The speed at which

medical practices are moving to Kareo and referring it to other

providers.

Best places to work Happy, engaged

employees stay longer, have more experience and

offer better customer service

Analyst reviews 3rd party recognition,

driven by direct customer feedback,

equals trust and credibility

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Kareo Platform

Kareo Billing

• Centralized A/R Management

• Intuitive Billing Analytics • Easy & accurate charge

capture• ICD-10 Ready• Smarter billing/patient

collections• Secure messaging• Powerful scheduler/appt.

reminders

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Kareo Platform

Kareo Clinical

• Comprehensive dashboard

• Simple charting• Easy ePrescribing• Convenient eLabs• Specialty templates• Electronic Superbill• Integrated Patient

Portal • Secure messaging

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Kareo Platform

Kareo Managed Billing• Dedicated team of specialists • Simple scheduling/calendar• Charge Capture (web/mobile)• Nationwide Billing Rules Engine• Claims tracking• Billing Tasks• Billing Analytics

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Kareo Platform

Kareo Marketing• Marketing and front

office automation• Online visibility and SEO • Online appt. scheduling • Email, text & voice

recording appt. reminders

• Post visit patient reviews• Practice analytics for ROI• Patient communications

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Discover Kareo’s Role

• PAHCOM has approved 1 CEU credit.• Each attendee will receive an email today

with a link to request certification. Certificates will be mailed within the next few days.

• Attendees must be logged into the webinar to receive credit.

• You’ll be asked at the end of the webinar if you want a CEU certificate.

“…Make Your Practice a Best Practice!”

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Getting Paid in 2017: What You Need to Know

Health & Medicine

Transcript of Getting Paid in 2017: What You Need to Know