Getting Paid in 2014

KAREO | CONFIDENTIAL

Getting Paid In 2014What You Need to Know


Your Hosts Today…

Elizabeth WoodcockMBA, FACMPE, CPC

.

Lea ChathamContent Marketing Manager, Kareo


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Our Schedule for Today…

1 Introduction & Welcome Elizabeth

2 Getting Paid in 2014: What You Need to Know

3 Discover Kareo’s Role

4 Answer Questions


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

Elizabeth W. Woodcock, MBA, FACMPE, CPCWoodcock & AssociatesSpeaker, Trainer, Author

Atlanta, Georgia404.373.6195

[email protected]






4 Answer Questions


Agenda

Medicare 2014 CPT® Changes 2014 Affordable Care Act “Voluntary” Incentive Programs

© E. Woodcock | www.elizabethwoodcock.com | 2013


Medicare 2014

Final Physician Fee SchedulePublished November 27


http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched


Law

Actual

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Medicare 2014


-5.40%-4.20%

-2.45%-4.40% -5.10%

-9.90% -10.60%

-21.20%

-25.00%

-29.50%

-26.50%

1.6% 1.5% 1.5%0.0% 0.0% 0.0% 1.1% 2.0%

0.0% 0.2% 0.0%

-20.1%


Medicare 2014

January-MarchPayment patchBi-Partisan agreement to fix the Sustainable

Growth Rate


If legislation passes both Houses…

0.5% Increase via the SGR law

~1.6% Decrease via the Budget law (extension of Sequestration)

------------------------

~1.1% Decrease


Medicare 2014

Changes to the RVUs

Final Physician Fee Schedule

See Appendix for full listing. Table above includes physician specialties only. All other physician specialties

are between -1 and +1%.


DIAGNOSTIC TESTING FACILITY -11%PATHOLOGY -6%INDEPENDENT LABORATORY -5%RHEUMATOLOGY -4%INTERVENTIONAL PAIN MGMT -4%ALLERGY/IMMUNOLOGY -3%OTOLARNGOLOGY -2%RADIOLOGY -2%VASCULAR SURGERY -2%PORTABLE X-RAY SUPPLIER -2%DERMATOLOGY -2%GASTROENTEROLOGY -2%HEMATOLOGY/ONCOLOGY -2%INTERVENTIONAL RADIOLOGY -2%ORTHOPEDIC SURGERY -2%

Losers


Medicare 2014

Changes to the RVUs

Final Physician Fee Schedule

See Appendix for full listing. Table above includes physician specialties only. All other physician specialties

are between -1 and +1%.


Winners

CHIROPRACTOR 12%CLINICAL PSYCHOLOGIST 8%CLINICAL SOCIAL WORKER 8%PSYCHIATRY 6%NURSE ANES / ANES ASST 3%CARDIAC SURGERY 2%CRITICAL CARE 2%EMERGENCY MEDICINE 2%INFECTIOUS DISEASE 2%


Medicare 2014

Other Highlights


Complex Chronic Care Coordination[Calendar Month]

Total Duration of Staff Care Coordination Services Code(s)

Less than 30 minutes Not reported separately

31 to 74 minutes 99487 or 99488 x 1

75 to 104 minutes 99487 or 99488 x 1 and 99489 x 1

105 minutes or more

99487 or 99488 x 1 and 99489 x 2 or more for each additional 30 minutes

Covered by Medicare: 2015


Medicare 2014

What’s NOT changing?


Combined E/M code with single rate?

Facility, not Professional

Incident-to billing?

No change, just emphasis on state scope of practice


CPT Changes 2014

15

• Upper and lower GI endoscopies

175 New

107 Revision

s

47 Deletions

Gastroenterology



CPT Changes 2014

Highlights

Abscess drainage Shoulder and elbow prosthesis removal Breast biopsies Peripheral vascular stents Chemodenervations



Affordable Care Act

As an entity, the exchange isn’t offering participation options –

lies at the payer level…and reimbursement does too.

1. Who is Selling on Your Exchange?2. Are You a Participating Provider?3. What is Your Fee Schedule?



Affordable Care Act

Health plans will pay for

the first 30 days after a patient misses a premium payment

Days 31 to 90 may result in withheld payments to physicians – or retroactive takebacks



Affordable Care Act

Medicaid / Medicare Rate Parity 2013-2014 Primary care providers and specialty physicians

boarded as internists and pediatrics accepting Medicaid, rates guaranteed to be at or equal to Medicare• Evaluation & Management (E/M) services

• Vaccines

66%


Final Rule Released November 6, 2012; but many states still haven’t paid

http://www.aap.org/en-us/advocacy-and-policy/state-advocacy/Documents/State_Md_Payment_Increase.pdf


Physician Quality Reporting System

2014: 0.5%

2015: -1.5% penalty if practices are not successfully participating, based on 2013 performance

2016 and beyond: -2% penalty

Note: For 2011-2014, an additional 0.5% is available if the clinician participates via a “Maintenance of Certification Program” (MOCP)

refer to your specialty society

37



Physician Quality Reporting System

21

Measures

DomainsOut of

Report each measure for at least 50% of the Medicare Part B FFS patients seen during the reporting period to which the measure applies.



eRx

E-prescribing bonus is gone in 2014• if no e-prescribing, -2%

[ Still time to gain the bonus, however, just need to submit 25 by February 2014 for 2013 dates of service!! ]

Needed 10 G8553’s for unique encounters—with any billable code—by June 30, 2013 to avoid the 2014

penaltyPlease confirm “N365” on your RA’s



Value-Based Modifier

Not a Modifier in the sense of a CPT code !!

Source (image): Healthcareisbusiness.blogspot.com

[ Mandatory ] Tiering

System*

Practices of 10 or more eligible professionals

subject to VBM in 2016, based

on 2014 performance



EHR Incentive Program

Stage Two 2014

• 90 days only (Stage One too!)

• 20 criteria + 9 CQMs*

• 17 core criteria, 3 menu-based criteria

• Most controversial? 5% of your patients must download, view or transmit their health information and 5% of your patients must send you a secure electronic message.

*CQM=Clinical Quality Measure



EHR Incentive Program

December 6, 2013

• Delay Stage Three until 2017

• Stage Two will last through 2016


http://www.cms.gov/eHealth/ListServ_Stage3Implementation.html


“Voluntary” Incentive Programs

Overview of Payment Adjustments

Year eRx PQRS EHR VBMSeques-tration Total

2012 -1.0% - - - -1.0%

2013 -1.5% - - - -2.0%+ -3.5%

2014 -2.0% - - - -2.0% -4.0%

2015 - -1.5% -1.0% -1.0%^ -2.0% -5.5%

2016 - -2.0% -2.0% -2.0%^ -2.0% -8.0%

2017 - -2.0% -3.0% -2.0%* -2.0% -9.0%

2018 - -2.0% up to -5% -2.0%* -2.0% up to -11%

2019 - -2.0% up to -5% -2.0%* -2.0% up to -11%

+As of April 1, 2013. ^Only groups with 100+ eligible professionals in 2015; CMS is proposing to add groups of 10 to 99 EPs in 2016 although they would not be subject to the payment adjustment of -2.0%. *Assumed by speaker based on 2015 final rule and 2016

proposal by CMS as published in the July 19 2013 Federal Register.

Applied to all Medicare

reimbursement






4 Answer Questions


Discover Kareo’s Role

“…Make Your Practice a Best Practice!”



Cloud-based

Medical Billing

Patient Payment Services

Insurance Billing & Remittance

Scheduling & Practice Management

Electronic Health Records

Medical Billing Services

20,000 Providers Nationwide



Standard Fee Schedule

• @ practice level• Allowables by payer



•Standard Fee Schedule

•New CPT Codes• Auto updated by Kareo• Customize by Practice• “Retire” old codes




•New CPT Codes

•Claim Tracking• No Response Queues• Clearinghouse Reports




•New CPT Codes

•Claim Tracking

•Patient Collections• Credit card processing• Online payments




•New CPT Codes

•Claim Tracking

•Patient Collections

•Meaningful Use• Attestation Reporting






4 Answer Questions


Let’s Answer Your Questions

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Getting Paid in 2014

What You Need to Know

Thank You So Much!

Getting Paid in 2014

Health & Medicine

Transcript of Getting Paid in 2014