Getting Paid in 2014
 

Getting Paid in 2014

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Recorded webinar: http://www.kareo.com/resources/webinars ...

Recorded webinar: http://www.kareo.com/resources/webinars

Are you wondering how healthcare reform, ICD-10 and the government’s new value-based modifier will affect your practice in 2014? This is no time to go into retreat mode. In this high-energy educational webinar, national speaker and author Elizabeth Woodcock highlights the key changes in payment for practices in 2014.

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  • 1235 pages
  • 116 new molecular pathology codes
  • Down from 2% in 2010; 2013 - .5 as well.
  • National Quality Strategy Domains Patient and Family Engagement Patient Safety Care Coordination Population and Public Health Efficient Use of Healthcare Resources Clinical Processes/Effectiveness Adding 47 and 4 measures groups (knee replacement and GI surgery) – taking away 46.
  • Down from 2% in 2010
  • Down from 2% in 2010
  • November Medicare Fee Schedule is loaded. If need to change due to SRG, it is an easy fix!
  • 2014 CPT codes are in Kareo and ready for use on January 1st!
  • Critical tool to keep you finger on the pulse of claims grace period under ACA!

Getting Paid in 2014 Getting Paid in 2014 Presentation Transcript

  • Getting Paid In 2014 What You Need to Know PAGE 1 KAREO | CONFIDENTIAL
  • Your Hosts Today… Elizabeth Woodcock MBA, FACMPE, CPC . Lea Chatham Content Marketing Manager, Kareo PAGE 2 KAREO | CONFIDENTIAL
  • Participate via Social We’ll be live tweeting during today’s webinar! How to participate: 1. Follow @GoKareo on Twitter 2. Search for #KareoTip 3. Join the conversation using #KareoTip Twitter.com/GoKareo Facebook.com/GoKareo Linkedin.com/company/Kareo PAGE 3 KAREO | CONFIDENTIAL
  • 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 PAGE 4 KAREO | CONFIDENTIAL
  • 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 PAGE 5 KAREO | CONFIDENTIAL Elizabeth W. Woodcock, MBA, FACMPE, CPC Woodcock & Associates Speaker, Trainer, Author Atlanta, Georgia 404.373.6195 elizabeth@elizabethwoodcock.com www.elizabethwoodcock.com
  • 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 PAGE 6 KAREO | CONFIDENTIAL
  • Agenda  Medicare 2014  CPT® Changes 2014  Affordable Care Act  “Voluntary” Incentive Programs © E. Woodcock | www.elizabethwoodcock.com | 2013 PAGE 7 KAREO | CONFIDENTIAL
  • Medicare 2014 Final Physician Fee Schedule Published November 27 http://www.cms.gov/Medicare/Medicare-Fee-forService-Payment/PhysicianFeeSched © E. Woodcock | www.elizabethwoodcock.com | 2013 PAGE 8 KAREO | CONFIDENTIAL
  • Medicare 2014 January-March Payment patch Bi-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 © E. Woodcock | www.elizabethwoodcock.com | 2013 PAGE 10 KAREO | CONFIDENTIAL
  • Medicare 2014 DIAGNOSTIC TESTING FACILITY PATHOLOGY INDEPENDENT LABORATORY RHEUMATOLOGY Changes to the RVUs INTERVENTIONAL PAIN MGMT Final Physician Fee Schedule ALLERGY/IMMUNOLOGY OTOLARNGOLOGY RADIOLOGY VASCULAR SURGERY PORTABLE X-RAY SUPPLIER DERMATOLOGY GASTROENTEROLOGY HEMATOLOGY/ONCOLOGY See Appendix for full listing. Table INTERVENTIONAL RADIOLOGY above includes physician specialties only. All other physician specialties ORTHOPEDIC SURGERY are between -1 and +1%. © E. Woodcock | www.elizabethwoodcock.com | 2013 PAGE 11 KAREO | CONFIDENTIAL -11% -6% -5% -4% -4% -3% -2% -2% -2% -2% -2% -2% -2% -2% -2%
  • Medicare 2014 CHIROPRACTOR Changes to the RVUs CLINICAL PSYCHOLOGIST Final Physician Fee Schedule CLINICAL SOCIAL WORKER PSYCHIATRY NURSE ANES / ANES ASST CARDIAC SURGERY CRITICAL CARE EMERGENCY MEDICINE INFECTIOUS DISEASE See Appendix for full listing. Table above includes physician specialties only. All other physician specialties are between -1 and +1%. © E. Woodcock | www.elizabethwoodcock.com | 2013 PAGE 12 KAREO | CONFIDENTIAL 12% 8% 8% 6% 3% 2% 2% 2% 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 © E. Woodcock | www.elizabethwoodcock.com | 2013 PAGE 13 KAREO | CONFIDENTIAL
  • Medicare 2014 What’s NOT changing? Combined E/M code with single rate? Incident-to billing? Facility, not Professional No change, just emphasis on state scope of practice © E. Woodcock | www.elizabethwoodcock.com | 2013 PAGE 14 KAREO | CONFIDENTIAL
  • CPT Changes 2014 47 Deletions Gastroenterology 107 Revisions •Upper and lower GI endoscopies 175 New © E. Woodcock | www.elizabethwoodcock.com | 2013 PAGE 15 KAREO | CONFIDENTIAL 15
  • CPT Changes 2014 Highlights  Abscess drainage  Shoulder and elbow prosthesis removal  Breast biopsies  Peripheral vascular stents  Chemodenervations © E. Woodcock | www.elizabethwoodcock.com | 2013 PAGE 16 KAREO | CONFIDENTIAL
  • 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? © E. Woodcock | www.elizabethwoodcock.com | 2013 PAGE 17 KAREO | CONFIDENTIAL
  • 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 © E. Woodcock | www.elizabethwoodcock.com | 2013 PAGE 18 KAREO | CONFIDENTIAL
  • Affordable Care Act Medicaid / Medicare Rate Parity 66%  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 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 © E. Woodcock | www.elizabethwoodcock.com | 2013 PAGE 19 KAREO | CONFIDENTIAL
  • Physician Quality Reporting System 37 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 © E. Woodcock | www.elizabethwoodcock.com | 2013 PAGE 20 KAREO | CONFIDENTIAL
  • Physician Quality Reporting System 21 Measures Domains Report each measure for at least 50% of the Medicare Part B FFS patients seen during the reporting period to which the measure applies. © E. Woodcock | www.elizabethwoodcock.com | 2013 PAGE 21 KAREO | CONFIDENTIAL
  • eRx E-prescribing bonus is gone in 2014 • if no e-prescribing, -2% Needed 10 G8553’s for unique encounters—with any billable code—by June 30, 2013 to avoid the 2014 penalty Please confirm ―N365‖ on your RA’s [ Still time to gain the bonus, however, just need to submit 25 by February 2014 for 2013 dates of service!! ] © E. Woodcock | www.elizabethwoodcock.com | 2013 PAGE 22 KAREO | CONFIDENTIAL
  • Value-Based Modifier Not a Modifier in the sense of a CPT code !! Source (image): Healthcareisbusiness.blogspot.com [ Mandatory ] Tiering System* © E. Woodcock | www.elizabethwoodcock.com | 2013 PAGE 23 KAREO | CONFIDENTIAL
  • 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 © E. Woodcock | www.elizabethwoodcock.com | 2013 PAGE 24 KAREO | CONFIDENTIAL
  • 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 © E. Woodcock | www.elizabethwoodcock.com | 2013 PAGE 25 KAREO | CONFIDENTIAL
  • “Voluntary” Incentive Programs Overview of Payment Adjustments Year eRx PQRS EHR 2012 -1.0% 2013 -1.5% 2014 -2.0% 2015 -1.5% -1.0% 2016 -2.0% -2.0% 2017 -2.0% -3.0% 2018 -2.0% up to -5% 2019 -2.0% up to -5% VBM -1.0%^ -2.0%^ -2.0%* -2.0%* -2.0%* +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. PAGE 26 KAREO | CONFIDENTIAL Sequestration -2.0%+ -2.0% -2.0% -2.0% -2.0% -2.0% -2.0% Total -1.0% -3.5% -4.0% -5.5% -8.0% -9.0% up to -11% up to -11% Applied to all Medicare reimbursement
  • 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 PAGE 27 KAREO | CONFIDENTIAL
  • Discover Kareo’s Role “…Make Your Practice a Best Practice!” PAGE 28 KAREO | CONFIDENTIAL
  • Discover Kareo’s Role Cloud-based Medical Billing Patient Payment Services Insurance Billing & Remittance Scheduling & Practice Management Electronic Health Records Medical Billing Services 20,000 Providers Nationwide PAGE 29 KAREO | CONFIDENTIAL
  • Discover Kareo’s Role PAGE 30 KAREO | CONFIDENTIAL
  • Discover Kareo’s Role PAGE 31 KAREO | CONFIDENTIAL
  • Discover Kareo’s Role Standard Fee Schedule • @ practice level • Allowables by payer PAGE 32 KAREO | CONFIDENTIAL
  • Discover Kareo’s Role •Standard Fee Schedule •New CPT Codes • Auto updated by Kareo • Customize by Practice • “Retire” old codes PAGE 33 KAREO | CONFIDENTIAL
  • Discover Kareo’s Role •Standard Fee Schedule •New CPT Codes •Claim Tracking • No Response Queues • Clearinghouse Reports PAGE 34 KAREO | CONFIDENTIAL
  • Discover Kareo’s Role •Standard Fee Schedule •New CPT Codes •Claim Tracking •Patient Collections • Credit card processing • Online payments PAGE 35 KAREO | CONFIDENTIAL
  • Discover Kareo’s Role •Standard Fee Schedule •New CPT Codes •Claim Tracking •Patient Collections •Meaningful Use • Attestation Reporting PAGE 36 KAREO | CONFIDENTIAL
  • 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 PAGE 37 KAREO | CONFIDENTIAL
  • Let’s Answer Your Questions -- Questions -888.775.2736 x1 sales@kareo.com http://www.kareo.com/chat Twitter.com/GoKareo Facebook.com/GoKareo Linkedin.com/company/Kareo PAGE 38 KAREO | CONFIDENTIAL
  • Getting Paid in 2014 What You Need to Know Thank You So Much!