In today's healthcare industry, medical practices and billing companies must continue evolving to keep pace with ever-changing policies. Proactively staying up to date on the latest audits, changes, and laws will help ensure that you get paid for everything you are owed this year. Kareo, a Tebra company, has teamed up with practice management expert Dr. Elizabeth Woodcock to inform you of the latest tools and resources to help practices and billing companies maximize collections and revenue in 2023.

1. Presented by Elizabeth W. Woodcock DrPH, MBA, FACMPE, CPC
Woodcock & Associates
Getting Paid in 2023:
Strategies to Maximize
Your Revenue

2. Safe
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4. Kareo and PAHCOM
Supporting Your
Professional Development
• PAHCOM has approved 1 CEU credit
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5. Kareo and AAPC
Supporting Your
Professional Development
• AAPC has approved 1 CEU credit
• If you would like a certificate, please email
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*This program has the prior approval of AAPC for 1 continuing education hour.
Granting of prior approval in no way constitutes endorsement by AAPC of the
program content or the program sponsor.

6. Elizabeth W. Woodcock DrPH, MBA, FACMPE, CPC
• DrPH, Bloomberg School of Public Health, Johns Hopkins University
• MBA, The Wharton School of Business, University of Pennsylvania
• BA, Duke University
• Fellow, American College of Medical Practice Executives
• Certified Professional Coder, American Academy of Professional Coders
• Author, 18 textbooks and more than 500 articles
• Founder and Principal, Woodcock & Associates
• Founder and Executive Director, Patient Access Collaborative
• Adjunct Assistant Professor, Rollins School of Public Health, Emory University
• Former Consultant, Medical Group Management Association; Group Practice
Services Administrator, University of Virginia Health Services Foundation; Senior
Associate, Health Care Advisory Board
Speaker, Author, Trainer | www.elizabethwoodcock.com

7. © 2023
 Public Health Emergency
 Telemedicine
 Medicare Reimbursement
 Sequestration
 No Surprises Act
 Quality Payment Program
 CPT 2023
 New Competitive Landscape (& OtherTrends)
 Action Steps
Resources

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https://go.cms.gov/3rqc548
https://aspr.hhs.gov/legal/PHE/Pages/covid19-11Jan23.aspx

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•20% for Hospitals
•Medicaid
•Telemedicine

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© 2023

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• Access to care
• Promotes equity
• Cost effective
• Safe, efficient,
effective delivery
platform
• Potential for
overuse,
overpayment,
fraud, and
poor-quality
care
https://www.cms.gov/medicare/medicare-general-information/telehealth/telehealth-codes
POS 10: Telehealth Provided in Patient’s Home

12. © 2023
12
Extends COVID-era waiver for telemedicine
services. Patients can be at home – and audio-
only services are covered for Medicare;
additional guidelines for mental health,
community health centers. Through December
31, 2024.
https://www.govinfo.gov/content/pkg/BILLS-117hr2617enr/pdf/BILLS-
117hr2617enr.pdf
Page 1439 (start there)

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Location
Device
Services
Provider
Payment
Relationship
Privacy
Rx …the DEA & the
states are also
involved.
https://www.fsmb.org/siteassets/advocacy/pdf/states-waiving-
licensure-requirements-for-telehealth-in-response-to-covid-19.pdf

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But wait…
Consolidated
Appropriations Act 2023
December 29, 2022
“…such services furnished on or after January 1,
2023, and before January 1, 2024 [are adjusted] by
2.5 percent; and…such services furnished
on or after January 1, 2024, and before January 1,
2025, [are adjusted] by 1.25 percent.”
https://www.govinfo.gov/content/pkg/BILLS-117hr2617enr/pdf/BILLS-
117hr2617enr.pdf
Page 1439 (start there)

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Final 2023 Conversion Factor:
$33.8872

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Diagnostic Testing
Facility +7%
Infectious Disease
+4%
Internal Medicine
+3%
Interventional
Radiology
-3%
Vascular Surgery
-3%
See Appendix for listing of all specialties

17. Source: https://public-
inspection.federalregister
.gov/2022-23873.pdf
POS = Place of Service

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https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PFSlookup
This free, easy-to-use tool will give
you the rate for any CPT code for
Medicare for your location.

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https://www.cms.gov/Medicare/Prevention/PrevntionGenInfo/medicare-
preventive-services/MPS-QuickReferenceChart-1.html

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CARC CO253
Sequestration - reduction in federal payment.
CARC=Claim adjustment reason code
2030
Jan 1 – Mar 31: 0%
Apr 1 – June 30: –1%
As of July 1: -2%
2022

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Broad-reaching in terms of
WHO must comply – and
for which patients;
consider erring on the side
of caution

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Between April 15 and August 11, 2022 from
more than 46,000 disputes initiated through
the process, a payment determination was
made in about 1,200 cases.
Source: HHS Federal Independent Dispute Resolution Process Status Update;
https://www.dol.gov/sites/dolgov/files/EBSA/about-ebsa/our-activities/resource-
center/faqs/federal-independent-dispute-resolution-process-status-update.pdf
Independent
Dispute Resolution

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• Performance Year (PY) 2022
• Performance Year (PY) 2023

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https://qpp-cm-prod-
content.s3.amazonaws.com/uploads/1783/QPP%202020%20Participation%20Results
%20Infographic.pdf
2022 is the final year
for the “exceptional
performance” bonus
2020 Reporting Year (Most Recent Available)

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What is
the
Business
Case?
How much
does trying to
get a perfect
score cost me?

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You’ll be notified by email if your request was approved or
denied. You can also check the status of your application by
signing into QPP. If approved, this will also be added to your
eligibility profile in the QPP Participation Status Tool on a
rolling basis.

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PY2023
• Performance threshold = 75 points
• Same weighting of categories…
Quality Measures
• Changes to 76 current
measures
• Addition of 9 new measures
• Removal of 11 measures,
including flu & pneumococcal
vaccine
…but there are changes

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225 new codes, 75 deletions, and 93 revisions
• Observation merged with inpatient codes (99217, 99218-220,
99224-226 are deleted)
• 99241/251 are deleted
• 98978 is new code for remote cognitive behavior therapy
monitoring
• 99418 is new code for inpatient or observation prolonged services
• New “appendix” -- taxonomy for artificial intelligence applications

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Category CPT® Code Time (Minutes)
Initial 99221 40
99222 55
99223 75
Subsequent 99231 25
99232 35
99233 50
Same-day 99234 45
99235 70
99236 85
Discharge 99238 >30
99239 < 30
Consistent with
office-based E/M
changes in 2022,
the facility-based
E/M codes are
revised to require
a medically
appropriate history
“and/or” exam and
medical decision
making (MDM),
instead of all three
key components.
The time in the
code’s description
must be met or
exceeded to report
Download: https://www.ama-
assn.org/system/files/2023-e-m-descriptors-
guidelines.pdf

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31
Insurers Telemedicine Cos

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“Over 80 percent of the country lacks
adequate healthcare infrastructure in
some shape or form…”
-GoodRx Research
“Healthcare Deserts”
https://www.datawrapper.de/_/0HrLo/

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34
• Relationships between the payers and employers mean
they’re in driver seat (e.g., telemedicine is free, while patient charged a copay to
see you)
• Big money is involved
• Changes traditional paradigm of referrals for care

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Increase in claim
denials reported
by medical
practices across
the United States
With careful planning and execution, 75% can be
reversed*
*OIG Report: Medicare Advantage Appeal Outcomes and Audit Findings Raise Concerns About Service and
Payment Denials (September 2018). “CMS cited 56 percent of audited contracts
for making inappropriate denials.”
https://oig.hhs.gov/oei/reports/oei-09-16-00410.pdf

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38
Monthly Volume Changes Compared to 2019

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39
Public Health Emergency: Are my insurance verification and collections
protocols in order? (Including exceptions)
Telemedicine: Are there telemedicine services that I can provide for my
patients that promote safe and quality care? (Consider alterative to in-
person care)
Medicare Reimbursement: Have I researched and communicated the
impact on the practice to my providers? For Medicare – and beyond?
Quality Payment Program: If I must comply, am I confident that I am
using the 2023 measures?
CPT Updates: Have I reviewed the 2023 updates? Have I scanned my
specialty society for other relevant updates?

40. © 2023
40

41. • What is my
schedule lag time?
• Does my team
come to me when
we’ve crossed a
threshold (e.g., 21
days)?
• What is my
template utilization
rate?

42. Awards and Rankings

45. Questions & Answers

46. Learn more about today’s presenter:
Elizabeth W. Woodcock, DrPH, MBA, FACMPE, CPC
Woodcock & Associates
Speaker, Author, Trainer
Atlanta, Georgia
www.elizabethwoodcock.com
Thank you

47. Source:
https://public-
inspection.federalreg
ister.gov/2022-
23873.pdf
Appendix

48. Note: A table showing the estimated impact of all of the changes on total payments for selected high-
volume procedures is available under “downloads” on the CY 2023 PFS final rule website at
http://www.cms.gov/Medicare/Medicare-Fee-for-ServicePayment/PhysicianFeeSched/
Source:
https://public-
inspection.federalreg
ister.gov/2022-
23873.pdf
Appendix