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Getting Paid in 2017: What You Need to Know

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Find out what you need to know to get paid in 2017.

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Getting Paid in 2017: What You Need to Know

  1. 1. Getting Paid in 2017: What You Need to Know Presented by Elizabeth Woodcock December 15, 2016 webinar
  2. 2. @GoKareo Agenda 2 Agenda 2 • Welcome & Introductions • Getting Paid in 2017 • How Kareo Can Help • Your Questions
  3. 3. @GoKareo 33 How to Participate Today… Type your questions Download today’s resources View today’s presentation
  4. 4. @GoKareo 44 Connect via Social Connect with us via social media How to connect: 1) Follow @GoKareo on Twitter 2) Follow @LeaChatham on Twitter twitter.com@GoKareo facebook.com/GoKareo linkedin.com/company/kareo
  5. 5. @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
  6. 6. @GoKareo Agenda 6 Agenda 6 • Welcome & Introductions • Getting Paid in 2017 • How Kareo Can Help • Your Questions
  7. 7. @GoKareo 77 Medicare 2017: Overall Impact 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Law Actual Exception - 2014Q1 had a 0.5% rate increase 0.50% (0.26%) 0.24%
  8. 8. @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%
  9. 9. @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.
  10. 10. @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). 992xx 99487 Complex chronic care w/o pt visit 99489 Complex chronic care add’l 30 min
  11. 11. @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
  12. 12. @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).
  13. 13. @GoKareo 1313 Medicare 2017: Other Areas Telehealth ESRD-Related Services Advanced Care Planning Critical Care Telehealth Consults New Place of Service Code 02 Under Scrutiny Zero-Day Global Services billed with Modifier -25 Global Period @270 CPT Codes Surgeons in Groups of 10+ 9 States Informal Review PQRS/VBPM informal review streamlined for participating physicians
  14. 14. @GoKareo 1414 Medicare 2017: Other Areas Telehealth ESRD-Related Services Advanced Care Planning Critical Care Telehealth Consults New Place of Service Code 02 Under Scrutiny Zero-Day Global Services billed with Modifier -25 Global Period @270 CPT Codes Surgeons in Groups of 10+ 9 States Informal Review PQRS/VBPM informal review streamlined for participating physicians
  15. 15. @GoKareo 1515 Medicare 2017: Other Areas Telehealth ESRD-Related Services Advanced Care Planning Critical Care Telehealth Consults New Place of Service Code 02 Under Scrutiny Zero-Day Global Services billed with Modifier -25 Global Period @270 CPT Codes Surgeons in Groups of 10+ 9 States Informal Review PQRS/VBPM informal review streamlined for participating physicians
  16. 16. @GoKareo 1616 Medicare 2017: Other Areas Telehealth ESRD-Related Services Advanced Care Planning Critical Care Telehealth Consults New Place of Service Code 02 Under Scrutiny Zero-Day Global Services billed with Modifier -25 Global Period @270 CPT Codes Surgeons in Groups of 10+ 9 States Informal Review PQRS/VBPM informal review streamlined for participating physicians
  17. 17. @GoKareo 1717 Medicare 2017: Other Areas Telehealth ESRD-Related Services Advanced Care Planning Critical Care Telehealth Consults New Place of Service Code 02 Under Scrutiny Zero-Day Global Services billed with Modifier -25 Global Period @270 CPT Codes Surgeons in Groups of 10+ 9 States Informal Review PQRS/VBPM informal review streamlined for participating physicians
  18. 18. @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
  19. 19. @GoKareo 1919 Meaningful Use 2016 …any continuous 90- day period between January 1, 2016 and December 31, 2016. http://bit.ly/2fcXuUl
  20. 20. @GoKareo 2020 Payment Adjustments Year eRx PQRS EHR (MU) VBPM+ Total 2012 -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
  21. 21. @GoKareo 2121 Payment Adjustments CO237 = Legislative Penalty N699 = PQRS N700 = EHR Incentive Program N701 = Value-Based Payment Modifier http://go.cms.gov/2e1Zv5Z Medicare Remittance
  22. 22. @GoKareo 2222 Quality Payment Program (QPP) 1. Advanced Alternative Payment Model (APM) Participant 2. Everyone Else Merit-based Incentive Payment System
  23. 23. @GoKareo 2323 QPP Highlights
  24. 24. @GoKareo 2424 QPP Highlights $30,000 in Total Allowed Part B Charges 1. Allowed charges = Allowable for that particular service 99213 $200.00 $73.40 CPT® 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 $??
  25. 25. @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%
  26. 26. @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
  27. 27. @GoKareo 2727 QPP Highlights October 14, 2016 List 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
  28. 28. @GoKareo 2828 QPP Highlights Option Result Report 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.
  29. 29. @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
  30. 30. @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/
  31. 31. @GoKareo 3131 QPP Highlights Basically Replicates the Current Programs from a Reporting Perspective “MACRA requires us to measure performance, not reporting.” - CMS Source: CMS, Final Rule (10/14/16)
  32. 32. @GoKareo 3232 QPP Highlights Performance = Comparison to measure-specific benchmarks
  33. 33. @GoKareo 3333 QPP Highlights Quality Measure 100 Patients 80 Patients 80% 90% Measure-Specific https://qpp.cms.gov/ For a summary table of MIPS, see appendix…or
  34. 34. @GoKareo Agenda 34 Agenda 34 • Welcome & Introductions • Getting Paid in 2017 • How Kareo Can Help • Your Questions
  35. 35. @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
  36. 36. @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
  37. 37. @GoKareo 3737 Kareo Platform Kareo Clinical • Comprehensive dashboard • Simple charting • Easy ePrescribing • Convenient eLabs • Specialty templates • Electronic Superbill • Integrated Patient Portal • Secure messaging
  38. 38. @GoKareo 3838 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
  39. 39. @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
  40. 40. @GoKareo 4040
  41. 41. @GoKareo 4141 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!”
  42. 42. @GoKareo Agenda 42 Agenda 42 • Welcome & Introductions • Getting Paid in 2017 • How Kareo Can Help • Your Questions
  43. 43. @GoKareo 4343 How to Participate Today… Type your questions -- Questions After the Webinar -- 888.775.2736 x1 sales@kareo.com
  44. 44. Connect with Kareo Stop by and say hi! Kareo @GoKareo GoKareo Kareo 3353 Michelson Drive, Suite 400 Irvine, CA 92612 (888) 775-2736

Find out what you need to know to get paid in 2017.

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