Getting Paid in 2016: What You Need to Know - Update
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Getting Paid in 2016: What You Need to Know. February Update.
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Getting Paid in 2016: What You Need to Know - Update
- 1. Getting Paid in 2016: What You Need to Know Presented by Elizabeth Woodcock February 11, 2016 webinar
- 2. @GoKareo Agenda 2 Agenda 2 • Welcome & Introductions • Getting Paid in 2016 • Kareo’s Role • Your Questions
- 3. @GoKareo 33 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
- 4. @GoKareo 44 Participate via Social We’ll be live tweeting during today’s webinar How to participate: 1) Follow @GoKareo on Twitter 2) Follow @LeaChatham on Twitter 3) Search for #KareoTip 4) Join the conversation using #KareoTip twitter.com@GoKareo facebook.com/GoKareo
- 5. @GoKareo Agenda 5 Agenda 5 • Welcome & Introductions • Getting Paid in 2016 • Kareo’s Role • Your Questions
- 6. @GoKareo 66 Medicare 2016 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Law Actual Exception - 2014Q1 had a 0.5% rate increase -0.77%
- 7. @GoKareo 77 Medicare 2016 CPT Descriptor 2015 wRVU 2016 Work RVU % Change 45330 Flexible sigmoidoscopy 0.96 0.84 -13% 45378 Colonoscopy 3.69 3.36 -9% 45380 Colonoscopy w/ Biopsy 4.43 3.66 -17% 45382 Colonoscopy w/ Control of Bleeding 5.68 4.76 -16% 45388 Colonoscopy, Flexible with Ablation 5.86 4.98 -15% Revaluing of the Lower GI Endoscopy Codes Pathology – 8% Increase
- 8. @GoKareo 88 Medicare 2016 Average cuts based on claims processed under the taxonomy code associated with the specialty; represents RVU changes only. All other specialties 0% impact. Pathology 8% Gastroenterology -4% Interventional Radiology 1% Radiation Oncology -2% Dermatology 1% Neurosurgery -1% Plastic Surgery 1% Neurology -1% Colorectal Surgery -1% Nuclear Medicine -1% Ophthalmology -1% Physical Medicine & Rehab -1% Vascular Surgery -1% Audiologist -1%
- 9. @GoKareo 99 Medicare 2016 99497 Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health professional; first 30 minutes, face-to-face with the patient, family member(s) and/or surrogate + Add-on 99498 … each additional 30 minutes CPT Work RVU 99497 1.50 99498 1.40 AWV = Annual Wellness Visit (Medicare)
- 10. @GoKareo 1010 Medicare 2016 99490 Chronic Care Management Services 99495 and 99496 Transitional Care Management DOS: Date of the E/M Visit [in contrast to the final day of the 30-day period post-discharge] “Direct” supervision is required
- 11. @GoKareo 1111 CPT® Changes 2016 69209 The removal of impacted cerumen using irrigation/lavage (unilateral) 99415-6 Prolonged, face-to-face clinical staff services under direct supervision 99406-9 Behavior change intervention can be reported with a -25 modifier in addition to preventive services Also… Vaccines | Radiology | Respiratory | Urinary… and
- 12. @GoKareo 1212 New Payer More Patient Financial Accountability Affordable Care Act’s Healthcare Exchange Majority of Enrollees have Chosen the “Bronze” Plan (Highest Patient Responsibility) More and More Insurers have Narrowed their Networks – and Limited Out-of-Network Benefits Employers are Choosing to Offer More Plans with High Deductible Options at a Lower Cost – Employees are Buying Insurers are Limiting Coverage Where Possible – and Increasing Referral/Authorization Requirements More Patient Financial Accountability
- 13. @GoKareo 1313 Meaningful Use 2015 CMS Final Rule October 16, 2015
- 14. @GoKareo 1414 Meaningful Use 2015 1st Year Meaningful Use Annual Incentive Payments 2011 2012 2013 2014 2015 2016 [….] TOTAL 2011 MCR $18,000 $12,000 $8,000 $4,000 $2,000 $0 $0 $44,000 MCD $21,250 $8,500 $8,500 $8,500 $8,500 $8,500 $0 $63,750 2012 MCR $18,000 $12,000 $8,000 $4,000 $2,000 $0 $44,000 MCD $21,250 $8,500 $8,500 $8,500 $8,500 $8,500 $63,750 2013 MCR $15,000 $12,000 $8,000 $4,000 $0 $39,000 MCD $21,250 $8,500 $8,500 $8,500 $17,000 $63,750 2014 MCR $12,000 $8,000 $4,000 $0 $24,000 MCD $21,250 $8,500 $8,500 $25,500 $63,750 2015 MCR $0 $0 $0 $0 MCD $21,250 $8,500 $34,000 $63,750 2016 MCR $0 $0 $0 MCD $21,250 $ 42,500 $63,750 MCR = Medicare; MCD = Medicaid. MCD participants must begin participation by 2016.
- 15. @GoKareo 1515 Meaningful Use 2015 • Patients who secure electronic message • Patients who download, view online or transmit to a third party their health information electronically • Smoking cessation • Vitals • After-visit summary and more…
- 16. @GoKareo 1616 Meaningful Use 2015 1. Protect Electronic Health Information 2. Clinical Decision Support (CDS)– 5 rules for 4+ CQMs or high priority health conditions; drug-drug and drug-allergy interaction checks 3. CPOE – 60% meds; 30% lab and radiology orders 4. ePrescribing – 50% queried for drug formulary and transmitted electronically 5. Summary of Care – create and transmit for 10% transitions of care and referrals The items listed herein are for Stage 2 participants, with the Stage 1 requirements marked in red, noting that the measurements are not as extensive as those required for Stage 2. CQM = clinical quality measure; CPOE = computerized provider order entry. 6. Patient-specific education – 10% of all unique patients 7. Medication reconciliation – 50% of all transitions of care 8. Patient electronic access – 50% provided access within 4 business days; one patient views, downloads or transmits 9. Secure electronic messaging – [Y or N] – capability? 10. Public Health/Clinical Data Registry Reporting https://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/2015EP_TableofContents.pdf
- 17. @GoKareo 1717 Meaningful Use 2015 2.2.d EHR Certification/Vendor Issues (CEHRT Issues) I, _____________________________, on behalf of the provider(s) listed in Section 3 and/or 4, am requesting this Medicare EHR Incentive Program Hardship Exception and attest that the provider(s) faced extreme and uncontrollable circumstances in the form of issues with the certification of the EHR product or products such as delays or decertification, issues with the implementation of the CEHRT such as switching products, or issues related to insufficient time to make changes to the CEHRT to meet CMS regulatory requirements for reporting in 2015. I further attest that this extreme and uncontrollable circumstance in the form of EHR certification/vendor issues constitutes a significant hardship in demonstrating meaningful use https://www.cms.gov/Regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/HardshipApplication.pdf CEHRT=Certified Electronic Health Record Technology
- 18. @GoKareo 1818 Meaningful Use 2015 #1!!! http://bit.ly/1dB9eg3 Government Sample
- 19. @GoKareo 1919 Meaningful Use 2016 One Patient
- 20. @GoKareo 2020 ICD10 Metrics October 1-27, 2015 Historical Baseline* Total Claims Submitted 4.6 million per day 4.6 million per day Total Claims Rejected due to incomplete or invalid information 2.0% of total claims submitted 2.0% of total claims submitted Total Claims Rejected due to invalid ICD-10 codes 0.09% of total claims submitted 0.17% of total claims submitted Total Claims Rejected due to invalid ICD-9 codes 0.11% of total claims submitted 0.17% of total claims submitted Total Claims Denied 10.1% of total claims processed 10% of total claims processed *Metrics for total ICD-9 and ICD-10 claims rejections were estimated based on end-to-end testing conducted in 2015 since CMS has not historically collected this data. Other metrics are based on historical claims submissions. Source: CMS, https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-29.html
- 21. @GoKareo 2121 ICD10 1. No denials on the basis of specificity for 12 months. 2. Advance payments available. 3. Ombudsman. Humana and United said… they had adopted a liberal approach to specificity as long ~10/15 MGMA “Town Hall” meeting, as reported by Robert Tennant, senior policy advisor for the Medical Group Management Association July 2015
- 22. @GoKareo 2222 Pay-for-Performance PQRS Claims Registry EHR (2) GPRO Qualified Clinical Data Registry CAHPS for PQRS Can also qualify for MU CQMs Can also qualify for MU CQMs Can report 1 measures group Not limited to PQRS measures 2+ Eligible Professionals
- 23. @GoKareo 2323 Pay-for-Performance PQRS VBPM Size of Group Paymt Adj’mt Perf’ce Year 100+ 2015 2013 10+ 2016 2014 All 2017 2015 Automatic Penalty 1% (2015)* 2% (2016)+ 2% for <9 EPs; 4% for >9 (2017)+ *Must have reported through GPRO +GPRO – or at least 50% of the EPs in the TIN must have reported. The exception is solo practitioners, who must participate successfully.
- 24. @GoKareo 2424 Penalties Year eRx PQRS EHR VBPM+ Seques- 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% -4.0% -2.0% -11.0% 2018 - -2.0% -4.0% -4.0% -2.0% -12.0% +Table reports maximum penalty. ~Applies only to Medicare payment, not the allowable In 2013, the Sequestration cuts started in April of that year. Applied to all Medicare reimbursement 2016 Performa nce
- 25. @GoKareo 2525 What’s Next? However, every eligible professional will be assigned a “composite score” Will replace PQRS, VBPM and MU! 1. Participate in an Alternative Payment Model 2. Low Medicare volume 3. New provider Category Yr 1 (2019) Yr 2 (2020) 2021 + Quality 50% 45% 30% Meaningful Use* 25% 25% 25% Resource Use 10% 15% 30% Clinical Practice Improvement 15% 15% 15% Max. Reduction (4%) (5%) (7%-9%) *MU weight can decrease to 15% if adoption reaches 75%; the weight would then be redistributed to another category.
- 26. @GoKareo Agenda 26 Agenda 26 • Welcome & Introductions • Getting Paid in 2016 • Kareo’s Role • Your Questions
- 27. @GoKareo 2727 Awards Cloud-based Billing, Scheduling & Practice Management Electronic Health Records Medical Billing Services Practice Marketing & Patient Engagement Free Education, Training, & Support Ranked #1 by Black Book 3 Years
- 28. @GoKareo 2828 Discover Kareo’s Role Kareo Practice Management • Fee schedule updates • End-to-end claim management • Task Management • ICD-10 Ready • Patient collections
- 29. @GoKareo 2929 Discover Kareo’s Role Kareo EHR • Fully-mobile EHR • 2014 Edition Certified for MU • ICD-10 ready • Flexible documentation • Specialty templates • Electronic Superbill • Patient Portal
- 30. @GoKareo 3030 Kareo Medical Billing: Web, Mobile & Messaging! • Web and Mobile Software • Calendar & Patient Check-in • IBM & MAC Enabled • Secure Messaging • Revenue Cycle Performance for Visibility • Kareo Success Team
- 31. @GoKareo Agenda 31 Agenda 31 • Welcome & Introductions • Getting Paid in 2016 • Kareo’s Role • Your Questions
- 32. Connect with Kareo Stop by and say hi! Kareo @GoKareo GoKareo Kareo 3353 Michelson Drive, Suite 400 Irvine, CA 92612 (888) 775-2736
Editor's Notes
- 281 measures and 18 in GPRO