Getting paid in 2018: What Independent Medical Practices Need to Know

webinar

Getting Paid in 2018: What Independent Medical Practices Need to Know

Presented by: Elizabeth Woodcock MBA, FACMPE, CPC December 13, 2017

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Agenda

2

Agenda

2

• Welcome & Introductions

• Trends from the Top

• Medicare Physician Fee

Schedule

• CPT® Codes – and

Reimbursement

• Quality Payment Program

• How Kareo Can Help

• Your Questions

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How to Participate Today…

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View today’s presentation

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Discover Kareo’s Role

• PAHCOM has approved 1 CEU credit• You’ll be asked at the end of the webinar if

you want a CEU certificate• Certificates will be emailed within the next

few days• Attendees must be logged into the live

webinar session to receive credit

“Make Your Practice a Best Practice!”

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Speaker

• Professional speaker and trainer specializing in medical practice management

• 25 years experience in medical practice operations and revenue cycle management

• Author of 16 best-selling practice management books and publish dozens of articles in national healthcare management journals

Elizabeth Woodcock MBA, FACMPE, CPC

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Agenda

7

Agenda

7

• Welcome & Introductions

• Trends from the Top

• Medicare Physician Fee

Schedule

• CPT® Codes – and

Reimbursement

• Quality Payment Program

• How Kareo Can Help

• Your Questions

Trends from the TopImpact of the Trump Administration on Medical Practices

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Trends from the Top

•Cost of Pharmaceuticals•Opioid Crisis•Insurance Mandate

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Trends from the Top

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Trends from the Top

Created by the Affordable Care Act

“The center is to test innovative payment and delivery system models … to give priority to … models … including medical homes, all-payer payment reform, and arrangements that transition from fee-for-service reimbursement to global fees and salary-based payment”

“New Direction”

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Trends from the Top

Bundled Payments…

CMS Scrapped the mandatory hip fracture and cardiac rehab bundled payment programs and

scaled back the mandatory Comprehensive Care for Joint Replacement Model...

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Trends from the Top

• Reduced the measures to 6 (from 9)• Eliminated the requirement for a Cross-Cutting Measure • Eliminated the requirement for reporting across Domains• Reduced the penalties for

“unsuccessful” reporting – didn’t meet requirements or didn’t report at all

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Trends from the Top

Cost/Quality Low Quality

Average Quality

High Quality

Low Cost +0.0% +1.0* +2.0*

Average Cost +0.0% +0.0% +1.0*

High Cost +0.0% +0.0% +0.0%Source: Table 23: Final 2018 VM Amounts Under the Quality-Tiering Approach…

CMS: “…reduce the maximum upward adjustment under the quality-tiering methodology to two times an adjustment factor (+2.0x)…”

-based Payment Modifier

Medicare Physician Fee Schedule Update

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Medicare Physician Fee Schedule

2018 Medicare Physician Fee

Schedule

0.31%

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Medicare Physician Fee Schedule

Average cuts based on claims processed under the taxonomy code associated with the specialty; represents RVU changes only. All other specialties 0% impact.

Clinical Social Worker 3% Diagnostic Testing Facility -4%Clinical Psychologist 2% Allergy/Immunology -3%Dermatology 1% Nurse Anes/Anes Asst -2%Infectious Disease 1% Physical/Occupational Therapy -2%Plastic Surgery 1% Otolaryngology -2%Psychiatry 1% Pathology -1%Radiation Oncology 1% Urology -1%Rheumatology 1% Vascular Surgery -1%Podiatry 1% Oral/Maxillofacial Surgery -1%Cardiology 1% Anesthesiology -1%Chiropractor 1% Independent Laboratory -1%Portable X-Ray Supplier 1%Radiation Therapy Centers 1%

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Medicare Physician Fee Schedule

Mobile Health DevicesMobile Health DevicesMobile Health DevicesMobile Health Devices Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time

99091

1.1 wRVUs

CPT® Codes – and ReimbursementUpdate

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CPT® Codes – and Reimbursement

• Psychiatric collaborative care management

• General behavioral health integration care

• Observation care services

• Chest and abdominal X-rays

• Muscle flaps

• Upper gastrointestinal - and lower and upper/lower intestinal - endoscopic procedure anesthesia

• Habilitative or rehabilitative services (modifiers)

170 new, 60 revised, and 82 deleted CPT® codes170 new, 60 revised, and 82 deleted CPT® codes

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CPT® Codes – and Reimbursement

October 1, 2017“no longer reimburse

consultation services…”

October 1, 2017“no longer reimburse

consultation services…”

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CPT® Codes – and Reimbursement

January 1, 2018Modifiers 25 & 57

“the maximum allowance … will be

reduced by 50%”

January 1, 2018Modifiers 25 & 57

“the maximum allowance … will be

reduced by 50%”

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CPT® Codes – and Reimbursement

1995 v. 1997 Documentation Guidelines for E/M Services1995 v. 1997 Documentation Guidelines for E/M Services

Quality Payment ProgramUpdate

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Quality Payment Program

$90,000 In Medicare Part B Total Allowed Charges

- or -

200 Medicare Part B Patients

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Quality Payment Program

Automatically Exempt in 2017

-and –

Can Apply for Hardship in 2018

In a 2017 Natural Disaster?In a 2017 Natural Disaster?

* All 67 counties in Florida * All 159 counties in Georgia * All 64 parishes of Louisiana * All 78 municipios in Puerto Rico * All 46 counties and the Catawba Indian Nation of South Carolina * The following counties in Texas: Aransas; Austin; Bee; Brazoria; Calhoun; Chambers; Colorado; Dewitt; Fayette; Fort Bend; Galveston; Goliad; Gonzales; Harris; Jackson; Jefferson; Jim Wells; Karnes; Kleberg; Lavaca; Liberty; Live Oak; Matagorda; Nueces; Refugio; San Patricio; Victoria; Waller; Wharton; and Wilson All of the U.S. Virgin Islands. * California: Butte, Lake, Mendocino, Napa, Sonoma, Orange, Nevada and Yuba. Please consult with CMS’ listings.

http://go.cms.gov/2BeAbUD

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Quality Payment Program

Quality Measures

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Quality Payment Program

Quality/Cost: 12 monthsACI/IA: 90 days

IA = Improvement ActivityACI = Advancing Care Information

Composite Performance ScoreComposite Performance Score

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Quality Payment Program

Points required to avoid the 5% penalty [imposed in 2020]

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Agenda

30

Agenda

30

• Welcome & Introductions

• Trends from the Top

• Medicare Physician Fee

Schedule

• CPT® Codes – and

Reimbursement

• Quality Payment Program

• 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.

Analyst reviews3rd party

recognition, driven by direct customer feedback, equals

trust and credibility.

Best places to work

Happy, engaged employees stay

longer, have more experience and

offer better customer service.

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Kareo Platform

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Agenda

34

Agenda

34

• Welcome & Introductions

• Trends from the Top

• Medicare Physician Fee Schedule

• CPT® Codes – and Reimbursement

• Quality Payment Program

• How Kareo Can Help

• Your Questions

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How to Participate Today…

Type your questions

-- Questions After the Webinar --

888.775.2736 x1

sales@kareo.com

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More Kareo Hosted Webinars

Join us in 2 upcoming Kareo hosted webinars with focus on MIPS!

Webinar: 2018 MIPS Action Plan for Independent Practices(4 Sessions)December 14, 2017 - 8:00 AM Pacific & 11:00 AM PacificDecember 15, 2017 - 8:00 AM Pacific & 11:00 AM Pacific

Webinar: 2018 MIPS Success With Kareo (4 Sessions)December 19, 2017 - 8:00 AM Pacific & 11:00 AM PacificDecember 20, 2017 - 8:00 AM Pacific & 11:00 AM Pacific

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