As 2018 is coming to a close, many independent practices are wondering what to expect in 2019. Patient financial responsibility continues to be a challenge for many practices. The Quality Payment Program (MIPs) continues to evolve. CMS is proposing changes to the way E/M visits are paid. HIPAA data breaches are more prevalent than ever, with several large payers and healthcare organizations receiving large fines in 2018. In this information-packed webinar, we'll discuss: -CMS Proposed changes to E/M payment and documentation requirements -Updates to the Quality Payment Program -Maximizing payer revenue through fee schedule review and opting out of “Accelerated Payments” -Understanding generational differences in patient payment habits that will improve your overall patient collections -Changes to the ACA taking effect in 2019 -HIPAA breaches and how you can mitigate the risk in your practice

1. webinar
Getting Paid In 2019
Aimee Heckman, CPPM, CPB December 12, 2018

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Agenda
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Agenda
2
• Welcome & Introductions
• State of the Industry in 2018
• E/M Gets an Update
• Quality Payment Program
• Preparing for Success in 2019
• How Kareo Can Help
• Your Questions

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How to Participate Today
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Kareo and PAHCOM
• PAHCOM has approved 1 CEU credit
• You’ll be asked at the end of the
webinar if you want a CEU certificate
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webinar to receive credit
Supporting Your Professional Development

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Speaker
• Healthcare Business Consultant and President
at Ease RCM Solutions
• Certified Physician Practice Manager (CPPM)
and Certified Professional Biller (CPB)
• More than 30 years experience in Medical
Practice Management, Revenue Cycle
Management, PM/EHR implementation, and
business development
Aimee Heckman, CPPM, CPB

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Agenda
7
Agenda
7
• Welcome & Introductions
• State of the Industry in 2018
• E/M Gets an Update
• Quality Payment Program
• Preparing for Success in 2019
• How Kareo Can Help
• Your Questions

8. State of the Industry 2018
Impact of ACA Changes and HIPAA Breaches

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State of the Industry in 2018 – ACA Changes
ACA Changes - Elimination of Individual Mandate Penalty
• Congressional Budget Office estimates decline of 3 million
individual enrollments between 2018 and 2019
• Long term 3-13 million fewer insured
• Less incentive for individuals to maintain coverage all year
• Budgetary impact is uncertain because most who are likely to
drop coverage don’t currently get subsidies

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State of the Industry in 2018 – ACA Changes
“New” Plan Options – Short-term Health Plans
• Not required to meet the “essential coverage” requirements of
ACA
• Allowed to charge more for pre-existing conditions
• Attractive to younger, healthier individuals with incomes above
the limits for receiving federal subsidies
• Cost approximately 50% of what ACA compliant plans do
• Have higher deductibles than ACA plans
• May contain exclusions for coverage which payers are required to
disclose

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State of the Industry in 2018 – ACA Changes
Association Health Plans
• Allow smaller employers and self-employed individuals to band
together for better prices
• Provided by many of the same insurers as group and marketplace
plans
• Small Business Associations are promoting
• May be an option for small practices to consider

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State of the Industry in 2018 – ACA Changes
Potential Impact on Your Practice
• Increase in uninsured patients
• Greater chance of eligibility related rejections and denials
• Eligibility verification is more critical than ever for EVERY VISIT

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State of the Industry in 2018 – HIPAA Breaches

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State of the Industry in 2018 – HIPAA Breaches

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State of the Industry in 2018 – HIPAA Breaches

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State of the Industry in 2018 – HIPAA Breaches

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State of the Industry in 2018 – HIPAA Breaches
Security Risk Analysis is Critical
• Identify potential threats and vulnerabilities
• Assess effectiveness of current security measures
• Determine likelihood and impact of specific threats
• Prioritize mitigation of identified risks based on severity of impact
• Document your analysis and results
• Review and update periodically
Ongoing Training is Your Best Defense!

18. E/M Gets an Update
Why Overhaul E/M?

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E/M Gets an Update

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E/M Gets an Update
Why Overhaul E/M?
• Current documentation requirements based on 1995/1997
guidelines
• Physician burnout rates of 42% or more
• Patient dissatisfaction with doctors spending more time clicking
on computers than engaging face-to-face

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E/M Gets an Update
2019 Changes
• Elimination of requirement to document medical necessity of a
home visit versus an office visit
• Allowing providers to focus documentation on what has changed
since the last visit rather than having to re-document information
already contained in the medical record, provided that there is
evidence that the provider reviewed the information
• Clarifying that providers do not need to re-enter information on
chief complaint and history that has been entered by staff or the
patient – the provider must indicate that the information was
reviewed

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E/M Gets an Update
2021 Changes
• E/M office/outpatient visits levels 2-4 combined into one level
• Level 1 and level 5 codes will remain separate
• Increased flexibility for coding based on MDM or time rather than
95/97 standards
Keep in mind that commercial payers may or may not follow
suit.

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E/M Gets an Update
Effect of Proposed Changes from CMS
• Expected savings of 21 million administrative hours over 10 years
• Anticipated savings of $87 million in 2019 alone

24. Quality Payment Program
2017 Results and 2019 Changes

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Quality Payment Program – 2017 Results
2017 QPP Participation
• 93% earned positive
adjustment
• 2% received neutral
adjustment
• 5% received negative
adjustment
Positive Neutral Negative

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Quality Payment Program – 2019 Changes
2019 Category Weighting
• Quality: 45%
• Promoting Interoperability: 25%
• Improvement Activities: 15%
• Cost: 15%
45%
25%
15%
15%

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Quality Payment Program – 2019 Changes
The Bar Is Raised for 2019
• Minimum points to avoid penalty increases to 30
• Negative adjustment increased to 7% maximum
• Must use 2015 Certified EHR
Minimum Performance Periods Unchanged
• Quality: 12 months
• Cost: 12 months
• Improvement Activities: 90 days continuous
• Promoting Interoperability: 90 days continuous

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Quality Payment Program – 2019 Changes
Expanded Definition of MIPS Eligible Clinician
• Physical Therapist
• Occupational Therapist
• Qualified Speech-Language Pathologist
• Qualified Audiologist
• Clinical Psychologist
• Registered Dietitian or Nutrition Professional

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Quality Payment Program – 2019 Changes
Low-Volume Threshold (LVT)
• $90K or less in Part B allowed charges for covered professional
services
• Provide care to 200 or fewer Part B enrolled beneficiaries
OR
• Provide 200 or fewer covered professional services under the
Physician Fee Schedule
• Option to opt-in to MIPS if at least one but not all three of the
LVT criteria are met

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Quality Payment Program – 2019 Changes
Small Practices Get a Little Extra Help
• Increased small practice bonus to 6 points and including it as part
of the Quality category
• Continuing to award 3 points for submitted quality measures that
don’t meet data completeness requirements
• Continued support for small and rural practices through the
Small, Underserved, and Rural (SURS) technical assistance
initiative

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Quality Payment Program – 2019 Changes
Small, Underserved, and Rural Support Initiative
• Free support to small practices of 15 providers or less
• Help determine MIPS eligibility
• Assist in choosing appropriate measures and activities
• Perform practice readiness assessments and assist in developing
strategies for implementing Certified Electronic Health Record
Technology (CEHRT)
• Did I mention it’s FREE?
Get the help you need to participate and succeed in the Quality
Payment Program

32. Preparing for Success in 2019
Fine Tune Your Revenue Cycle

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Preparing for Success in 2019
Review Payer Contracts and Fee Schedules
• Track contract renewal dates using a simple spreadsheet that
includes payer name, address, original effective date, anniversary
date, termination notice requirement, and contact information
for payer representative
• Review current fee schedules and compare to actual payments
from your top payers
• Look for instances where allowed amount is your full fee
Opt-out of “Accelerated Payments”
• Don’t allow 2-3% of your revenue to be lost to service fees
• Payers cannot require you to accept “virtual credit cards” and
MUST provide information on how to opt-out

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Preparing for Success in 2019
Be Proactive In Minimizing the Impact of Patient Bad Debt
• Make sure your financial policy is up to date and includes language
on your no-show policy, self-pay policy, requirement for payment at
time of service for copays, deductibles, and past due balances
• Use the start of a new year as opportunity to update patient
demographic information AND get updated financial policy signed
• Know the statute of limitation on collecting debt in your state
• Remember that medical debt is now weighted differently in credit
scores, making medical bills a lower priority
• When using collection agency, know the rules about assessing fees to
patients, particularly Medicare beneficiaries

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Preparing for Success in 2019
Percent of Unpaid Medical Bills by Generation
44
47
60
58
61
68
64
68
74
0
10
20
30
40
50
60
70
80
2014 2015 2016
Baby Boomer Gen X Millennial
TransUnion Healthcare Millennial Report

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Preparing for Success in 2019
Make Your Bill More Likely to Get Paid
• Credit/debit cards are preferred payment method for most patients
• New technology allows payment of bills via text, phone, and credit
card on file
• Providing pre-service estimates can help patients understand their
responsibility and increase the likelihood of payment
• Offer multiple methods for receiving bills
• Educate patients on their responsibility

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Agenda
37
Agenda
37
• Welcome & Introductions
• State of the Industry in 2018
• E/M Gets an Update
• Quality Payment Program
• Preparing for Success in 2019
• How Kareo Can Help
• Your Questions

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Awards and Rankings
Growth Awards
The speed at which medical
practices are moving to Kareo and
referring it to other providers.
Software Reviews and Rankings
3rd party recognition, driven by
direct customer feedback, equals
trust and credibility.

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Kareo Platform

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Kareo Platform Extensions

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How to Participate Today…
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-- Questions After the Webinar --
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sales@kareo.com

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