2017 Proposed Rule Physician Fee Schedule in the Federal Register
|
|
- Britton Underwood
- 5 years ago
- Views:
Transcription
1 2017 Proposed Rule Physician Fee Schedule in the Federal Register Thursday, December 15, 2016 Noon 1:00 Pacific / 1:00 2:00 Mountain / 2:00 3:00 Central / 3:00-4:00 PM Eastern Lucy Zielinski, Vice President Alex Pinto, Manager GE Healthcare Camden Group
2 Webinar Objectives o Cite the major changes to the 2017 Physician Fee Schedule final rule o Understand the impact of the 2017 Physician Fee Schedule changes to physicians o Determine the roadmap for physicians 2
3 Physician Fee Schedule: Background and 2017 Final Rule 3
4 Medicare/Physician Fee Schedule History Affordable Care Act Physician Quality Reporting System became permanent Health Care Financing Administration adopted CPT for Medicare Part B Charge-based fee changed to Resource- Based Relative Value Expenses started exceeding yearly targets MIPS and alternative APM under Physician Fee Schedule proposal Promotion of meaningful use of certified EHR technology Medicare Program is established Introduced the Medicare Economic Index ( MEI ) Value Performance Standard replaced by Sustainable Growth Rate formula Physician Quality Reporting System is established as an adjustment for payments 4
5 Key Forces Driving Change Volume-to-Value Payment Models Innovation and Technology ACA and Health Reform Consumerism Collaboration Competition Interoperability and Analytics Total cost of care 5
6 2017 Final Rule - CMS Resources Additional Resources Read the rule Agency/Docket Number: CMS-1654-F 6
7 Relative Value Unit Payments under the PFS are based on the national uniform RVUs that account for the relative resources used in furnishing a service. Practice Expense ( PE ) Malpractice Expense ( MP ) Adjusted for Geographic cost variations Physician Work RELATIVE VALUE UNIT ( RVU ) 7
8 Calculating Payments Formula for Calculating Payments Payment = [(RVU work x GPCI work) + (RVU PE x GPCI PE) + (RVU MP x GPCI MP)] x CF* RVU GPCI PE MP CF Relative Value Unit Geographic Practice Cost Indices Practice Expense Malpractice Expense Conversion Factor (updated annually for PFS) *Different formula used for anesthesia 8
9 Payment Modifiers Impact on payments 2017 CMS Final Rule, Physician Fee Schedule: No Change Between Proposed and Final Rule 9
10 2017 Major Provisions 1. Conversion factor and RVU changes 2. Primary Care and Telehealth services 3. Potentially mis-valued codes and other reductions 4. Diabetes Prevention Program ( DPP ) expansion 5. Other provisions 6. MACRA provisions 10
11 Key Changes for 2017: Conversion Factor and RVU Changes 11
12 Conversion Factor Difference PFS Anesthesia $ $ $ $ $ $ The proposed rule called for minor cent decreases in the conversion factor 12
13 For Example 99213: Office or other outpatient visit for the evaluation and management of an established patient (Proposed) Work RVU (Final) PE RVU MP RVU Total RVUs Conversion Factor Payment* $73.40 $73.34 $73.57 Proposed: *Excludes GPCI adjustment Final: $.06 decrease $.17 increase 13
14 PFS 2017 Impact by Specialty -5% Independent Laboratory -2% Ophthalmology, Urology -1% Diagnostic Testing, Gastroenterology, Interventional Radiology, Neurosurgery, Optometry, Oral/Maxillo Surgery, Otolaryngology, Pathology, Radiology, Vascular Surgery +1% Allergy/Immunology, Family Practice, General Practice, Geriatrics, Internal Medicine, Multispecialty Clinics/Other, Physical/Occupational Therapy, Changes reflect the combined RVU impact of work, PE, and MP changes; Specialties not listed should have a combined impact of 0 14
15 PE RVUs Rule Changes PE Inputs for Digital Imaging Revised Calculations for Professional PACS Workstation Time Standardization of Clinical Labor Time Imaging: Standard clinical labor time has been finalized for 4 of the 5 tasks Additionally, removed the film-based supply and equipment items, but maintained clinical labor minutes assigned related to film technology Pathology: Standard clinical labor time have been finalized for 6 of the 17 tasks Equipment recommendations for scope equipment Structure separates the scope and the associated video system 15
16 Digital Imaging Practice Expense Revised calculations for Professional PACS time Diagnostic Procedures: ½ Pre-Service Time + 1/1 Intra-Service Time Therapeutic Procedures: ½ Pre-Service Time + ½ Post-Service Time 16
17 Digital Technology Final Digital Imaging Clinical Labor Task Minutes CL Task Digital Technology Typical Minutes Availability of prior images confirmed 2 Patient clinical information and questionnaire reviewed by technologist, order from physician confirmed, and exam protocoled by radiologist. Review examination with interpreting MD 2 2 Exam documents scanned into PACS. Exam completed in RIS system to generate billing process and to populate images into Radiologist work queue. 1 17
18 Pathology Services Final Pathology CL Task Minutes CL Task Standard CL Time (minutes) Accession specimen/prepare for examination 4 Assemble and deliver slides with paperwork to pathologists 0.5 Assemble other light microscopy slides, open nerve biopsy slides, and clinical history, and present to pathologist to prepare clinical pathologic interpretation Clean room/equipment following procedure (including any equipment maintenance that must be done after the procedure) Dispose of remaining specimens, spent chemicals/other consumables, and hazardous waste Prepare, pack, and transport specimens and records for inhouse storage and external storage (where applicable)
19 Scope Video System Video System Endoscopy Equipment Item (ES031) Finalized as standalone prices for each scope type, and separate prices for the video systems that are used with scopes Scope accessories can be priced separately and are individually evaluated for inclusion in PE methods Changes only for certain codes that make use of specified scopes Scope Video System Monitor Processor Digital Capture Cart Printer Types of Scopes Non- Video Flexible Semi- Rigid Rigid Scopes are further defined by their diagnostic/ therapeutic use 19
20 Reviewed Codes Listed are the Reviewed Codes that Use Scopes Flexible Laryngoscopy family CPT codes 31572, 31573, 31574, 31575, 31576, 31577, 31578, and Laryngoplasty family CPT codes 31580,31584, 31587, , 31591, and
21 Key Changes for 2017: Primary Care and Telehealth Services 21
22 Primary Care Services Separate payment for: non- faceto-face prolonged E/M services; patients with behavioral conditions, mobility-related impairments, and complex CCM Revisions to the scope of service elements for CCM to reduce administrative burden New codes for comprehensive assessment and care planning for patients with cognitive impairment 22
23 Primary Care Services Integrating Behavioral Health CPT Description* wrvu G0502 Initial psychiatric care management 1.70 G0503 Subsequent psychiatric care management 1.53 G0504 Initial/Subsequent psychiatric care management, additional 30 minutes 0.82 G0507 Behavioral healthcare, at least 20 minutes/month 0.61 G0505 Assessment for cognitive impairment 3.44 G0506 Assessment for Chronic Care Management care plan 0.87 G0501 Resource-intensive service for patients with specialized mobility-assistive technology (add-on to E/M) TBD** * Descriptions may be abbreviated; ** Pending further CMS analysis 23
24 Primary Care Services Prolonged and Complex CCM Services CPT Description wrvu Prolonged services Prolonged E/M service before and/or after direct patient care Prolonged E/M service before and/or after direct patient care, each additional 30 minutes Complex CCM services Complex CCM services without patient visit Complex CCM services, additional 30 minutes CCM, 20 minutes/month 0.61 Transition care management Transition care management 14-day discharge Transition care management 7-day discharge 3.05 Italicized codes are 2016 payable services ; no changes to wrvus in
25 Chronic Care Management CCM Scope of service element/ billing requirement Initiating visit Structured recording of patient information using CEHRT Proposed revision Change to patient not seen within 1 year Remove creation of a structured clinical summary via qualified EHR, due to redundancy 24/7 Access to care Change to means to make contact Continuity of care Comprehensive care management Electronic comprehensive care plan Electronic sharing of care plan Beneficiary receipt of care plan Documentation of care plan Management of care transitions Home- and community-based care coordination Change to schedule routine appointments Same Same Required to be timely, but defers methodology Remove written or electronic Remove Change to create and exchange continuity of care documents Same Enhanced communication opportunities Beneficiary consent Same Adjust written consent to be optional Source: Proposed PFS Rule, Table 11 25
26 Telehealth Services Criteria for Payments for Telehealth The service must be on the list of Medicare telehealth services and meet the following requirements: Service must be furnished via an interactive telecommunications system Service must be furnished by a physician or other authorized practitioner Service must be furnished to an eligible telehealth individual Individual receiving the service must be located in a telehealth originating site 26
27 27
28 Proposed Telehealth Additions ESRD, dialysis less than 1 full month per day Younger than 2 years old to 11 years old to 19 years of age For 20 years and older Advance care planning First 30 minutes Each additional 30 minutes Consults for Critical Care Services G0508 Initial telehealth consultation G0509 Subsequent telehealth consultation 28
29 Key Changes for 2017: Mis-Valued Codes and Reductions 29
30 Mis-Valued Services 0-day global procedures with 25 modifier (Table 7 and 8) ESRD ( ) Endoscopes Drug delivery implants (11981 and 11983) Moderate sedation Global surgery package (Table 9 and 10) Therapy Codes (Table 24) 30
31 Multiple Procedure Payment System The professional component ( PC ) of advanced imaging services for Multiple Procedure Payment System ( MPPR ) will be reduced from 25 percent to 5 percent. Diagnostic cardiovascular services Diagnostic imaging services Diagnostic ophthalmology services Therapy services 31
32 Reduction for X-Rays Proposed payment reduction for x-rays taken using plain film Append Modifier FX when x-rays taken using film 20% technical component reduction 32
33 Key Changes for 2017: Diabetes Prevention Program 33
34 Diabetes Self-Management and the DPP Low utilization of diabetes self-management training ( DSMT ) G0108-G0109 Proposes expansion of the Diabetes Prevention Program ( DPP ) into Medicare beginning January 1, 2018 Helps at-risk seniors and people with disabilities from advancing to type 2 diabetes Medicare Diabetes Prevention Program ( MDPP ) 12 months of sessions using a CDC approved DPP curriculum 26 sessions over 6 months followed by 6 sessions over months 7 through 12 34
35 Key Changes for 2017: Other Provisions 35
36 Other Provisions * CCM/TCM in RHCs and FQHCs Appropriate use criteria ( AUC ) for advanced diagnostic imaging services Release of Part C Medicare Advantage Bid Pricing Data and Medical Loss Ratio Data Recoupment of payments to providers sharing the same TIN ACO participants who report PQRS/MIPS measures separately MSSP quality measure sets Physician self-referral updates * List is not comprehensive 36
37 MACRA 37
38 MACRA: QPP MACRA QPP MIPS Alternative Payment Model ( APM ) APMs Fee-For-Service ( FFS ) system Innovative payment model Since most physician practices will likely focus on MIPS initially, lets take a closer look at components of the MIPS track. 38
39 MIPS categories IMPROVEMENT ACTIVITIES QUALITY ADVANCING CARE INFORMATION ( ACI ) COST MIPS GE Healthcare Camden Group October 20,
40 MIPS scoring in % Cost 15% 25% 60% Improvement activities Advancing care information Quality Composite Score = 0 to 100 GE Healthcare Camden Group October 20,
41 Proposed Timeframe 41
42 MIPS: Sample financial impact Reporting years 2017 to 2020 Reporting Year Payment Year MIPS Adjustment /+ 4% Financial Impact 1 ($) (+-) 1 Clinician ,000 80, ,000 $500 million Score > 70 10% adjustment /+ 5% /+ 7% /+ 9% 10, , ,000 14, , ,000 18, , ,000 1 $200K per provider in Medicare allowables 42
43 What does it take to be a high performer? Monitor performance of measures compared to historical values and past CMS benchmarks in an effort to: Exceed performance threshold on quality measures Exceed performance on ACI measures Align improvement activities to support performance 43
44 PFS Roadmap 1. Review rule and comment August 2016 Review rule Comment by Sept 6, Develop work plan October 2016 Create Steering Committee Develop 2017 work plan Perform gap and impact analysis September 2016 Determine financial impact Review new covered services Perform gap analysis Review QRUR report 5. Implement work plan January 2017 Begin using new codes Activate new codes and edits Report 2016 quality data, MU attestations, etc Review final rule and update work plan November December 2016 Revise work plan based on final rule Update code sets and pricing in systems Establish edits to support changes 6. Track and Monitor January December 2017 Monitor and track compliance 44
45 Questions 45
46 Thank You! 46
47 To Complete the Program Evaluation The URL below will take you to HFMA on-line evaluation form. You will need to enter your member I.D. # (can be found in your confirmation when you registered) Enter this Meeting Code: 16AT70 URL: Your comments are very important and enables us to bring you the highest quality programs! 47
Highlights of the 2018 Medicare Physician Fee Schedule (MPFS) Final Rule
Highlights of the 2018 Medicare Physician Fee Schedule (MPFS) Final Rule Physician Payment Update & Misvalued Codes Target The update to payments under the PFS in 2018 will be +0.31 percent. This reflects
More informationCY 2018 Medicare Physician Fee Schedule Proposed Rule Summary
CY 2018 Medicare Physician Fee Schedule Proposed Rule Summary On July 13, 2017, the Center for Medicare and Medicaid Services (CMS) released the proposed Medicare Physician Fee Schedule (MPFS) for 2018.
More informationMACRA Frequently Asked Questions
Following the release of the Quality Payment Program Interim Final Rule, the American Medical Association (AMA) conducted numerous informational and training sessions for physicians and medical societies.
More informationGlossary of Acronyms for the Quality Payment Program
The Physicians Advocacy Institute s Medicare Quality Payment Program (QPP) Physician Education Initiative Glossary of Acronyms for the Quality Payment Program 1 P a g e MEDICARE QPP PHYSICIAN EDUCATION
More informationCY 2019 Physician Fee Schedule Proposed Rule Summary
CY 2019 Physician Fee Schedule Proposed Rule Summary On July 11, 2018, the Center for Medicare and Medicaid Services (CMS) released the proposed Medicare Physician Fee Schedule (MPFS) for 2019, which for
More informationMedical Practice Executive Insights
Proposed 2019 Medicare Physician Payment and Quality Reporting Changes MGMA MEMBER-EXCLUSIVE ANALYSIS The Centers for Medicare & Medicaid Services (CMS) recently proposed changes to both Medicare physician
More informationCMS Quality Payment Program: Performance and Reporting Requirements
CMS Quality Payment Program: Performance and Reporting Requirements Session #QU1, February 19, 2017 Kristine Martin Anderson, Executive Vice President, Booz Allen Hamilton Colleen Bruce, Lead Associate,
More informationAmerican Health Lawyers Association Institute on Medicare and Medicaid Payment Issues. History of the Physician Fee Schedule
American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues March 20-22, 2013 Baltimore, Maryland Sidney S. Welch, Esq. 1 History of the Physician Fee Schedule Prior to 1992,
More informationAAWC ALERT Call for Action from Physicians
AAWC ALERT Call for Action from Physicians The 2019 CMS Proposed Rule for the Physician Fee Schedule has multiple changes to payment & documentation requirements. See Attachment A for summary of major
More information2017/2018. KPN Health, Inc. Quality Payment Program Solutions Guide. KPN Health, Inc. A CMS Qualified Clinical Data Registry (QCDR) KPN Health, Inc.
2017/2018 KPN Health, Inc. Quality Payment Program Solutions Guide KPN Health, Inc. A CMS Qualified Clinical Data Registry (QCDR) KPN Health, Inc. 214-591-6990 info@kpnhealth.com www.kpnhealth.com 2017/2018
More information2015 MEDICARE UPDATES
Disclaimer 2015 MEDICARE UPDATES The information contained in these slides are current at the time of writing. However, CMS can change the information at any time. Please monitor the ISMA website and all
More information2014 CMS PROPOSED PHYSICIAN FEE SCHEDULE OVERVIEW & ANALYSIS
2014 CMS PROPOSED PHYSICIAN FEE SCHEDULE OVERVIEW & ANALYSIS OVERVIEW: The Centers for Medicare and Medicaid Services (CMS) released the proposed 2014 Medicare Physician Fee Schedule in July. Final code
More informationInitial Summary of the 2019 Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP) Proposed Rule
Initial Summary of the 2019 Medicare Physician Fee Schedule (PFS) and Quality Payment Program (QPP) Proposed Rule On July 12, 2018, the Centers for Medicare and Medicaid Services (CMS) released the Revisions
More informationMIPS (Merit-based Incentive Payment System) Clinical Practice Improvement Activities
MIPS (Merit-based Incentive Payment System) Clinical Practice Improvement Activities Today we will cover: 2 General review of the Quality Payment Programs as per the final rule. Who is Eligible/Exceptions
More informationStrategic Implications & Conclusion
Kelly Court Chief Quality Officer Wisconsin Hospital Association Brian Vamstad Government Relations Consultant Gundersen Health System Overview and Key Takeaways of the Medicare Quality Payment Program
More informationMIPS Deep Dive: 9 steps to Reporting. Sharon Phelps QPP Webinar Series Webinar 4 June 20, 2017
MIPS Deep Dive: 9 steps to Reporting Sharon Phelps QPP Webinar Series Webinar 4 June 20, 2017 HealthInsight Our business is redesigning health care systems for the better HealthInsight is a private, non-profit,
More informationCoding & Billing Strategies 2017 Update
Coding & Billing Strategies 2017 Update California Academy of Family Physicians January 31, 2017 Today s Speaker: Mary Jean Sage The Sage Associates 791 Price Street, #135 Pismo Beach, CA 93449 Tel: (805)
More informationTelemedicine Guidance
Telemedicine Guidance GEORGIA DEPARTMENT OF COMMUNITY HEALTH DIVISION OF MEDICAID Revised: October 1, 2017 Policy Revisions Record Telemedicine Guidance 2017 REVISION DATE Oct. 1, 2017 SECTION REVISION
More information2017 Quality Reporting: Claims and Administrative Data-Based Quality Measures For Medicare Shared Savings Program and Next Generation ACO Model ACOs
2017 Quality Reporting: Claims and Administrative Data-Based Quality Measures For Medicare Shared Savings Program and Next Generation ACO Model ACOs June 15, 2017 Rabia Khan, MPH, CMS Chris Beadles, MD,
More informationWELCOME. Kate Gainer, PharmD Executive Vice President and CEO Iowa Pharmacy Association
WHAT IS MACRA? WELCOME Kate Gainer, PharmD Executive Vice President and CEO Iowa Pharmacy Association WELCOME Anthony Pudlo, PharmD, MBA, BCACP Vice President of Professional Affairs Iowa Pharmacy Association
More information2017 Physician Fee Schedule Impact on Medicare ACOs REGULATORY UPDATES
2017 Physician Fee Schedule Impact on Medicare ACOs REGULATORY UPDATES 2017 Physician Fee Schedule Impact on Medicare ACOs 1. Allowing ACO Participants to report PQRS separately from ACO 2. ACO Quality
More informationOverview of Selected Provisions of the Medicare Physician Fee Schedule Proposed Rule for Calendar Year 2018
Overview of Selected Provisions of the Medicare Physician Fee Schedule Proposed Rule for Calendar Year 2018 On July 13, 2017, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule
More informationClinically Focused. Outcomes Oriented. Technology Driven. Chronic Care Management. eqguide. (CPT Codes 99490, 99487, 99489)
Clinically Focused. Outcomes Oriented. Technology Driven. 2017 Chronic Care Management eqguide (CPT Codes 99490, 99487, 99489) www.eqhs.org Table of Contents 01 State of Population Health and Chronic Care
More informationMerit-Based Incentive Payment System: 2018 Performance Year
Knowledge Brief Merit-Based Incentive Payment System: Performance Year The Merit-based Incentive Payment System (MIPS) impacts the 2020 Medicare Part B payment for billed visits in calendar year. MIPS
More informationMedicare Physician Fee Schedule Final Rule for Calendar Year 2018 Detailed Summary of the Payment Provisions
Medicare Physician Fee Schedule Final Rule for Calendar Year 2018 Detailed Summary of the Payment Provisions The American College of Radiology (ACR) has prepared this detailed analysis of changes to the
More informationOverview of Quality Payment Program
Overview of Quality Payment Program Policies for 2017 & 2018 Performance Years The Medicare program has transformed how it reimburses psychiatrists and other clinicians for providing services, under the
More informationThird Party Payer Days. IMGMA February 25, 2015
Third Party Payer Days IMGMA February 25, 2015 Agenda 2015 Medicare Physician Fee Schedule Medicare Physician Fee Schedule Database Transitional Care Management - Reminder Medicare - Coverage Guidelines
More informationCMS Issues 2018 Proposed Physician Fee Schedule: What Spine Surgeons Should Know
CMS Issues 2018 Proposed Physician Fee Schedule: What Spine Surgeons Should Know Overview On July 13, 2017, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that updates payment
More informationQUALITY PAYMENT PROGRAM
NOTICE OF PROPOSED RULE MAKING Medicare Access and CHIP Reauthorization Act of 2015 QUALITY PAYMENT PROGRAM Executive Summary On April 27, 2016, the Department of Health and Human Services issued a Notice
More informationCMS Priorities, MACRA and The Quality Payment Program
CMS Priorities, MACRA and The Quality Payment Program Ashby Wolfe, MD, MPP, MPH Chief Medical Officer, Region IX Centers for Medicare and Medicaid Services Presentation on behalf of HSAG November 16, 2016
More informationQuality Payment Program: The future of reimbursement
Quality Payment Program: The future of reimbursement Presented by Evan M. Gwilliam, DC MBA BS CPC CCPC NCICS CCCPC CPC-I MCS-P CPMA CMQP Executive Vice President 1 Dr. Evan Gwilliam Education Bachelor
More informationThe Quality Payment Program: Overview & Roles and Responsibilities
The Quality Payment Program: Overview & Roles and Responsibilities National Tribal Health Conference Susy Postal DNP, RN-BC Chief Health Informatics Officer September 27, 2017 INDIAN HEALTH SERVICE / OFFICE
More informationSubmitted electronically:
Mr. Andy Slavitt Acting Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-5517-FC P.O. Box 8013 7500 Security Boulevard Baltimore, MD 21244-8013
More informationMedicare Physician Fee Schedule. September 10, 2018
September 10, 2018 Ms. Seema Verma, MPH Administrator Centers for Medicare & Medicaid Services Department of Health and Human Services Attention: CMS-1694-P P.O. Box 8011 Baltimore, MD 21244-1850 Submitted
More informationKate Goodrich, MD MHS. Director, Center for Clinical Standards & Quality. Center for Medicare and Medicaid Services (CMS) May 6, 2016
Kate Goodrich, MD MHS Director, Center for Clinical Standards & Quality Center for Medicare and Medicaid Services (CMS) May 6, 2016 THE MEDICARE ACCESS & CHIP REAUTHORIZATION ACT OF 2015 Quality Payment
More informationChronic Care Management. Sharon A. Shover, CPC, CEMC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky
Chronic Care Management Sharon A. Shover, CPC, CEMC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky 40223 502.992.3511 sshover@blueandco.com Agenda Chronic Care Management (CCM) History Define Requirements
More informationReimbursement Environment
Reimbursement Environment 1 2017 Medicare Physician Fee Schedule Enhancing Integrative Medicine: CMS adopting additional care management codes in 2017 MPFS. Support patient centered and collaborative strategies.
More informationUnderstanding Medicare s New Quality Payment Program
Understanding Medicare s New Quality Payment Program Your introduction to MACRA and getting started with MIPS 1 Understanding Medicare s New Quality Payment Program 2016 Mingle Analytics. All Rights Reserved.
More informationChildren s Hospital Association Summary of Final Regulation. November 9, 2012
Medicaid Program; Payment for Services Furnished by Certain Primary Care Physicians and Charges for Vaccine Administration under the Vaccine for Children Program Children s Hospital Association Summary
More informationPHYSICIAN FEE SCHEDULE PAYMENT GROUND RULES: A COMPARISON OF THE OMFS AND MEDICARE *
PHYSICIAN FEE SCHEDULE PAYMENT GROUND RULES: A COMPARISON OF THE OMFS AND MEDICARE * Ground Rule and/or OVERALL FEE SCHEDULE DESIGN Conversion factor Separate conversion factors for: Evaluation & Management
More informationMedicare Physician Payment Reform:
Medicare Physician Payment Reform: Implications and Options for Physicians and Hospitals Background The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law on April 14, 2015.
More informationThe Healthcare Roundtable
The Healthcare Roundtable MACRA Update Jayme R. Matchinski Greensfelder, Hemker & Gale, P.C. April 7, 2017 New Orleans, Louisiana This presentation and outline are limited to a discussion of general principles
More informationMedicare Physician Payment Reform
Medicare Physician Payment Reform What practices need to know about MIPS and APMs in 2018 MGMA Government Affairs 2018 MGMA. All rights reserved. - 1 - MIPS Timeline for 2017 Performance Period Mar. 31,
More informationTake Action Now to Avoid Medicare Penalties
Take Action Now to Avoid Medicare Penalties The Centers for Medicare and Medicaid Services (CMS) says over 33,600 psychiatrists provide services reimbursed under Medicare Part B. The Merit-based Incentive
More informationMACRA & Implications for Telemedicine. June 20, 2016
MACRA & Implications for Telemedicine June 20, 2016 Presentation Overview Introductions Deep Dive Into MACRA Implications for Telemedicine Questions Growth in Value-Based Care Over Next Two Years Growth
More informationMarch 28, Dear Dr. Yong:
March 28, 2018 Pierre Yong, MD Director Quality Measurement and Value-Based Incentives Group Centers for Medicare and Medicaid Services 7500 Security Boulevard Baltimore, MD 21244 Dear Dr. Yong: The American
More informationChronic Care Management Coding Guidelines Effective January 1, 2017
Capture Billing & Consulting, Inc. 25055 Riding Plaza, Suite 160 South Riding, VA 20152 (703) 327-1800 Chronic Care Management Coding Guidelines Effective January 1, 2017 The Centers for Medicare and Medicaid
More informationLegislative Update Wipfli CAH/RHC Conference
Legislative Update Wipfli CAH/RHC Conference Nathan Baugh Director, Government Relations (202) 543-0348 Baughn@capitolassociates.org www.narhc.org Overview NARHC Washington Update MACRA Overview and Update
More informationCONTENTS. Introduction...3. Current State of Regulatory Burden...4. Burden Level by Regulatory Issue...5. The Move Toward Value...
R E G U L ATO RY B U R D E N S U RV E Y OCTOBER 2018 1 CONTENTS Introduction...3 Current State of Regulatory Burden...4 Burden Level by Regulatory Issue...5 The Move Toward Value...6 The Medicare Quality
More informationThe Quality Payment Program: Your Questions Answered
APRIL 20, 2017 The Quality Payment Program: Your Questions Answered Quality Payment Program Panel BETH HOUCK, MBA Vice President, Client Services SA Ignite MATTHEW BARRON, MBA Director, Advisory Services
More informationDescribe the process for implementing an OP CDI program
1 Outpatient CDI: The Marriage of MACRA and HCCs Marion Kruse, RN, MBA Founding Partner LYM Consulting Columbus, OH Learning Objectives At the completion of this educational activity, the learner will
More informationACCOUNTABLE CARE ORGANIZATION & ALTERNATIVE PAYMENT MODEL SUMMIT
ACCOUNTABLE CARE ORGANIZATION & ALTERNATIVE PAYMENT MODEL SUMMIT The Centers for Medicare and Medicaid Services Kate Goodrich, MD MHS Director, Clinical Standards & Quality Chief Medical Officer 1 DISCLAIMERS
More informationStatement for the Record. American College of Physicians. Hearing before the House Energy & Commerce Subcommittee on Health
Statement for the Record American College of Physicians Hearing before the House Energy & Commerce Subcommittee on Health A Permanent Solution to the SGR: The Time Is Now January 21-22, 2015 The American
More informationPhysician Compensation Directions and Health Reform. July 2017
Physician Compensation Directions and Health Reform July 2017 Speaker Introduction Wayne Hartley Vice President, AMGA Consulting Over 20 Years of Medical Group & Consulting Experience Allina Health, Minneapolis,
More informationQuality Payment Program Year 2: 2018 MIPS Participation. An Introductory Guide for CRNAs in 2018
Quality Payment Program Year 2: 2018 MIPS Participation An Introductory Guide for CRNAs in 2018 Quality Payment Program (QPP) The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) established
More informationMACRA and MIPS. How Medicare Meaningful Use and PQRS are Changing
MACRA and MIPS How Medicare Meaningful Use and PQRS are Changing Link to recorded session: https://attendee.gotowebinar.com/recording/1305549490878052097 Presenting Today: Molly Goodhart Joined Quatris
More informationMedicare Quality Payment Program: Deep Dive FAQs for 2017 Performance Year Hospital-Employed Physicians
Medicare Quality Payment Program: Deep Dive FAQs for 2017 Performance Year Hospital-Employed Physicians This document supplements the AMA s MIPS Action Plan 10 Key Steps for 2017 and provides additional
More informationMACRA Implementation: A Review of the Quality Payment Program
MACRA Implementation: A Review of the Quality Payment Program Neal Logue, Kirk Sadur Centers for Medicare and Medicaid Services, Region IX, September 15, 2017 Disclaimer This presentation was prepared
More informationUnderstanding PQRS and the Value-Based Modifier: CMS Plan to Achieve High Value Care through Transforming Payment Systems
Understanding PQRS and the Value-Based Modifier: CMS Plan to Achieve High Value Care through Transforming Payment Systems Dr. Ashby Wolfe, Chief Medical Officer Centers for Medicare and Medicaid Services,
More informationError! Unknown document property name.
September 10, 2018 Seema Verma, Administrator Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1693-P, P.O. Box 8016, Baltimore, MD 21244-8016 RE: CMS-1693-P
More informationSeptember 8, Dear Acting Administrator Slavitt:
September 8, 2015 Andy Slavitt Acting Administrator Centers for Medicare and Medicaid Services U.S. Department of Health and Human Services Attn: CMS-1631-P Room 445 G, Hubert H. Humphrey Building 200
More informationDisclosure Statement
2017 Coding and Medicare Changes for Physician Fee Schedule Billing Presented by Jean Acevedo, CHC CPC CENTC LHRM Disclosure Statement No financial relationships to disclose. 1 Disclaimer The information
More informationMedicare s Proposed CY 2016 Physician Fee Schedule
Issue Brief Medicare s Proposed CY 2016 Physician Fee Schedule Background On July 15, 2015, the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register the proposed CY 2016 Medicare
More informationCalendar Year 2014 Medicare Physician Fee Schedule Final Rule
Calendar Year 2014 Medicare Physician Fee Schedule Final Rule Non-Facility Cap After receiving many negative comments on this issue from physician groups, along with the House GOP Doctors Caucus letter
More informationAre physicians ready for macra/qpp?
Are physicians ready for macra/qpp? Results from a KPMG-AMA Survey kpmg.com ama-assn.org Contents Summary Executive Summary 2 Background and Survey Objectives 5 What is MACRA? 5 AMA and KPMG collaboration
More informationCY2015 Final Rule Summary Medical Oncology
CY2015 Final Rule Summary Medical Oncology Medicare Physician Fee Schedule (MPFS) Prepared By: Revenue Cycle Inc. Prepared On: October 31, 2014 http://www.revenuecycleinc.com/disclaimer. 1817 West By using
More informationSteps toward Sustainability with the second year of the Quality Payment Program
Steps toward Sustainability with the second year of the Quality Payment Program Deanna Graham, QI Consultant, Qualis Health March 27, 2018 Speaker Deanna Graham QI Principal Qualis Health 2 Qualis Health
More informationWHY SHOULD A CHC/FQHC CARE?
Suzanne Niemi, CPA, CMPE, CCE Alaska Primary Care Association April 2017 Medicare Part A & Part B MACRA / MIPS Chronic Care Management Billing WHY SHOULD A CHC/FQHC CARE? 2 DEFINITIONS FQHC Federally Qualified
More informationMACRA: Disrupting the health care system at every level
Health Policy Brief MACRA: Disrupting the health care system at every level Produced by the Deloitte Center for Health Solutions and the Deloitte Center for Regulatory Strategies Executive summary The
More informationAMGA Webinar: MSSP Final Rule. Scott Hines, MD Chief Quality Officer Crystal Run Healthcare July 16, 2015
AMGA Webinar: MSSP Final Rule Scott Hines, MD Chief Quality Officer Crystal Run Healthcare July 16, 2015 Crystal Run Healthcare Physician owned MSG in NY State, founded 1996 >350 providers, >30 locations
More informationCHRONIC CARE MANAGEMENT IMPLEMENTATION GUIDE
CHRONIC CARE MANAGEMENT IMPLEMENTATION GUIDE TABLE OF CONTENTS What is Chronic Care Management (CCM)?... 2 Why CCM?... 2 Clinician/Practice Benefits... 3 Patient Benefits... 4 What is Included in CCM?...
More informationHere is what we know. Here is what you can do. Here is what we are doing.
With the repeal of the sustainable growth rate (SGR) behind us, we are moving into a new era of Medicare physician payment under the Medicare Access and CHIP Reauthorization Act (MACRA). Introducing the
More informationWashington Update. Agenda
Washington Update Agenda Trending topics Quality Payment Program: Mid-Year Status Report Proposed 2018 Medicare regulations Healthcare Reform Update Q&A 1 Non Discrimination Standards Where did it come
More informationTransitional Care Management (TCM) and Chronic Care Management (CCM) Overview and Billing Process. April 19, :00 PM
Transitional Care Management (TCM) and Chronic Care Management (CCM) Overview and Billing Process April 19, 2016 2:00 PM 2 Discussion Topics TCM Requirements TCM Services and C247 Process Medical Decision
More informationNational Fee Analyzer. Charge data for evaluating fees nationally
National Fee Analyzer Charge data for evaluating fees nationally 2013 Contents Introduction...1 Key to Proper Reimbursement... 1 The Medical Coding System... 1 What This Book Has to Offer... 2 A Coding
More informationMACRA Open Call December 5 th, 2016
MACRA Open Call December 5 th, 2016 Leila Volinsky, MHA, MSN, RN Quality Reporting Program Administrator This material was prepared by the New England QIN-QIO, the Medicare Quality Innovation Network-Quality
More informationPALLIATIVE CARE: CHARTING A COURSE MEETING OF THE PATIENT QUALITY OF LIFE COALITION FEBRUARY 18, 2015
PALLIATIVE CARE: CHARTING A COURSE MEETING OF THE PATIENT QUALITY OF LIFE COALITION FEBRUARY 18, 2015 HENRY R. DESMARAIS, MD, MPA HEALTH POLICY ALTERNATIVES, INC. A POSSIBLE OPTION MENU QUALITY Ø Add palliative
More informationMACRA and the Quality Payment Program. Frequently Asked Questions Edition
MACRA and the Quality Payment Program Frequently Asked Questions 2018 Edition What is MACRA?...3 What is the Quality Payment Program?...3 How do payments work under the QPP?...3 What is at risk under
More informationCY2017 Medicare Outpatient Prospective Payment System (OPPS) Final Rule with Interim Final Comment (IFC)
Housekeeping You will not hear any audio until the webinar begins. To join the audio, select call me and enter your phone number or select I will call in. If you select I will call in, follow the prompts
More informationMACRA Quality Payment Program
The American College of Surgeons Resources for the New Medicare Physician System Table of Contents Understanding the... 3 Navigating MIPS in 2017... 4 MIPS Reporting: Individuals or Groups... 6 2017: The
More information19 th Annual Western Regional Conference Women in Government May 21, 2016 Seattle, WA
TELE TODAY 19 th Annual Western Regional Conference Women in Government May 21, 2016 Seattle, WA 877 707 7172 cchpca.org Mei Wa Kwong, JD Senior Policy Associate & Project Director DISCLAIMERS Any information
More informationUnder the MACRAscope:
Under the MACRAscope: G08: Under the MACRAscope: MIPS and EHRs Robert Tennant, MA Director, HIT Policy, MGMA Government Affairs rtennant@mgma.org Learning Objectives This session will provide you with
More informationWelcome to Making Sense of Accountable Care. What s in it for you?
Welcome to Making Sense of Accountable Care. What s in it for you? Lynn Barr, CEO Caravan Health Source: CMS MACRA LAN Powerpoint, October 2015 3 Step 1: Pick Your Destination MIPS Option 1: Do Nothing
More informationThe Quality Payment Program Overview Fact Sheet
Quality Payment Program The Quality Payment Program Overview Background On October 14, 2016, the Department of Health and Human Services (HHS) issued its final rule with comment period implementing the
More informationRE: CMS-1677-P; Medicare Program; Request for Information on CMS Flexibilities and Efficiencies
June 13, 2017 Ms. Seema Verma Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-1677-P P.O. Box 8011 Baltimore, MD 21244-1850 RE: CMS-1677-P;
More informationCMS Update. CT HIMA Annual Meeting September 17, Renee Richard Provider Relations Specialist
CMS Update CT HIMA Annual Meeting September 17, 2018 Renee Richard Provider Relations Specialist Disclaimers This presentation was prepared as a tool to assist providers and is not intended to grant rights
More informationAlternative Payment Models and Health IT
Alternative Payment Models and Health IT Health DataPalooza Preconference May 8, 2016 Kelly Cronin, MS, MPH, Director, Office of Care Transformation, ONC/HHS HHS Goals for Medicare Payment Reform In January
More informationMLN Matters Number: MM6740 Revised Related Change Request (CR) #: Related CR Transmittal #: R1875CP Implementation Date: January 4, 2010
News Flash Flu Season is upon us! CMS encourages providers to begin taking advantage of each office visit to encourage your patients with Medicare to get a seasonal flu shot; it s their best defense against
More informationThe Evolving Landscape of Healthcare Payment: Incentive Programs and ACO Model Optimization. Quality Forum August 19, 2015
The Evolving Landscape of Healthcare Payment: Incentive Programs and ACO Model Optimization Quality Forum August 19, 2015 Ross Manson rmanson@eidebailly.com 701.239.8634 Barb Pritchard bpritchard@eidebailly.com
More informationMACRA is Coming: Reimbursement for Quality and the Shift to Population-Based Care
MACRA is Coming: Reimbursement for Quality and the Shift to Population-Based Care AMERICAN NEUROLOGICAL ASSOCIATION October 17, 2017 Marc R. Nuwer, MD PhD Professor and Vice Chair UCLA Lyell K. Jones,
More informationMichelle Brunsen & Sandy Swallow May 25, , Telligen, Inc.
MIPS Survive and Thrive: Advancing Care Information Michelle Brunsen & Sandy Swallow May 25, 2017 2016, Telligen, Inc. Objectives Quality Payment Program Updates Advancing Care Information (ACI) Category
More informationStatement for the Record. American College of Physicians. U.S. House Committee on Ways and Means Subcommittee on Health
Statement for the Record American College of Physicians U.S. House Committee on Ways and Means Subcommittee on Health Hearing on Implementation of MACRA s Physician Payment Policies March 21, 2018 The
More informationCMS-1676-F 120. and makes a separate payment to the distant site practitioner furnishing the service.
CMS-1676-F 120 C. Medicare Telehealth Services 1. Billing and Payment for Telehealth Services Several conditions must be met for Medicare to make payments for telehealth services under the PFS. The service
More informationQuality Measurement and Reporting Kickoff
Quality Measurement and Reporting Kickoff All Shared Savings Program ACOs April 11, 2017 Sandra Adams, RN; Rabia Khan, MPH Division of Shared Savings Program Medicare Shared Savings Program DISCLAIMER
More informationLEGAL CONSIDERATIONS FOR FQHCS: REIMBURSEMENT FOR TELEMEDICINE SERVICES
LEGAL CONSIDERATIONS FOR FQHCS: REIMBURSEMENT FOR TELEMEDICINE SERVICES SOUTH CAROLINA PRIMARY HEALTH CARE ASSOCIATION SOUTH CAROLINA PRIMARY HEALTH CARE ASSOCIATION 2017 STATE POLICY & ISSUES FORUM Jeanne
More informationRED SIGNAL REPORTSM RADIOLOGY. August 2018 Vol. 1 No. 1. Claims Data Signals & Solutions to Reduce Risks and Improve Patient Safety.
RED SIGNAL REPORTSM August 2018 Vol. 1 No. 1 Claims Data Signals & Solutions to Reduce Risks and Improve Patient Safety. RADIOLOGY MEDICAL LIABILITY INSURANCE BUSINESS ANALYTICS RISK MANAGEMENT & EDUCATION
More informationProviding and Billing Medicare for Chronic Care Management Services
Providing and Billing Medicare for Chronic Care Management Services (and Other Fee-For-Service Population Health Management Services) No portion of this white paper may be used or duplicated by any person
More informationProvider-Based RHC Billing June 8, 2018
Provider-Based RHC Billing June 8, 2018 Sharon Shover, CPC, CEMC 502.992.3511 Provider-Based RHC Billing Agenda RHC Encounters Payment for RHC Services Same Day Visits Revenue Codes CG Modifier & QVL Non-RHC
More informationDecoding the QPP Year 2 Quality Measure Benchmarks and Deciles to Maximize Performance
Decoding the QPP Year 2 Quality Measure Benchmarks and s to Maximize Performance Leila Volinsky, MHA, MSN, RN, PCMH CCE, CPHQ Senior Program Administrator New England Regional Lead Quality Payment Program
More information2017 Transition Year Flexibility Improvement Activities Category Options
The Physicians Advocacy Institute s Medicare Quality Payment Program (QPP) Physician Education Initiative 2017 Transition Year Flexibility Improvement Activities Category Options 1 P a g e Ad MEDICARE
More information