Getting Paid in 2017: What You Need to Know
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Transcript of 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
@GoKareo
Agenda
2
Agenda
2
• Welcome & Introductions• Getting Paid in 2017• How Kareo Can Help• Your Questions
@GoKareo 33
How to Participate Today…
Type your questions
Download today’s resources
View today’s presentation
@GoKareo 44
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Connect with us via social media
How to connect:
1) Follow @GoKareo on Twitter2) Follow @LeaChatham on Twitter
twitter.com@GoKareo
facebook.com/GoKareo
linkedin.com/company/kareo
@GoKareo 55
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
@GoKareo
Agenda
6
Agenda
6
• Welcome & Introductions• Getting Paid in 2017• How Kareo Can Help• Your Questions
@GoKareo 77
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%
@GoKareo 88
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%
@GoKareo 99
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.
@GoKareo 1010
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
@GoKareo 1111
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
@GoKareo 1212
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).
@GoKareo 1313
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
@GoKareo 1414
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
@GoKareo 1515
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
@GoKareo 1616
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
@GoKareo 1717
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
@GoKareo 1818
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
@GoKareo 1919
Meaningful Use 2016
…any continuous 90-day period between January 1, 2016 and December 31, 2016.
http://bit.ly/2fcXuUl
@GoKareo 2020
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
@GoKareo 2121
Payment Adjustments
CO237 = Legislative Penalty
N699 = PQRSN700 = EHR Incentive ProgramN701 = Value-Based Payment
Modifierhttp://go.cms.gov/2e1Zv5Z
Medicare Remittance
@GoKareo 2222
Quality Payment Program (QPP)
1. Advanced Alternative Payment Model (APM) Participant
2. Everyone Else
Merit-based Incentive Payment System
@GoKareo 2323
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
$??
@GoKareo 2525
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%
@GoKareo 2626
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
@GoKareo 2727
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
@GoKareo 2828
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.
@GoKareo 2929
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
@GoKareo 3030
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/
@GoKareo 3131
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)
@GoKareo 3232
QPP Highlights
Performance = Comparison to measure-specific benchmarks
@GoKareo 3333
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
@GoKareo
Agenda
34
Agenda
34
• Welcome & Introductions• Getting Paid in 2017• How Kareo Can Help• Your Questions
@GoKareo 3535
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
@GoKareo 3636
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
@GoKareo 3737
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
@GoKareo 3939
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
@GoKareo 4040
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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!”
@GoKareo
Agenda
42
Agenda
42
• Welcome & Introductions• Getting Paid in 2017• How Kareo Can Help• Your Questions
@GoKareo 4343
How to Participate Today…
Type your questions
-- Questions After the Webinar --
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