PAGE 1 KAREO | CONFIDENTIAL
Getting Paid In 2014What You Need to Know
PAGE 2 KAREO | CONFIDENTIAL
Your Hosts Today…
Elizabeth WoodcockMBA, FACMPE, CPC
.
Lea ChathamContent Marketing Manager, Kareo
PAGE 3 KAREO | CONFIDENTIAL
Participate via Social
Facebook.com/GoKareo
Twitter.com/GoKareo
Linkedin.com/company/Kareo
We’ll be live tweeting during today’s webinar!
How to participate:
1. Follow @GoKareo on Twitter
2. Search for #KareoTip
3. Join the conversation using #KareoTip
PAGE 4 KAREO | CONFIDENTIAL
Our Schedule for Today…
1 Introduction & Welcome Elizabeth
2 Getting Paid in 2014: What You Need to Know
3 Discover Kareo’s Role
4 Answer Questions
PAGE 5 KAREO | CONFIDENTIAL
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
Elizabeth W. Woodcock, MBA, FACMPE, CPCWoodcock & AssociatesSpeaker, Trainer, Author
Atlanta, Georgia404.373.6195
PAGE 6 KAREO | CONFIDENTIAL
Our Schedule for Today…
1 Introduction & Welcome Elizabeth
2 Getting Paid in 2014: What You Need to Know
3 Discover Kareo’s Role
4 Answer Questions
PAGE 7 KAREO | CONFIDENTIAL
Agenda
Medicare 2014 CPT® Changes 2014 Affordable Care Act “Voluntary” Incentive Programs
© E. Woodcock | www.elizabethwoodcock.com | 2013
PAGE 8 KAREO | CONFIDENTIAL
Medicare 2014
Final Physician Fee SchedulePublished November 27
© E. Woodcock | www.elizabethwoodcock.com | 2013
http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeeSched
PAGE 9 KAREO | CONFIDENTIAL
Law
Actual
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Medicare 2014
© E. Woodcock | www.elizabethwoodcock.com | 2013
-5.40%-4.20%
-2.45%-4.40% -5.10%
-9.90% -10.60%
-21.20%
-25.00%
-29.50%
-26.50%
1.6% 1.5% 1.5%0.0% 0.0% 0.0% 1.1% 2.0%
0.0% 0.2% 0.0%
-20.1%
PAGE 10 KAREO | CONFIDENTIAL
Medicare 2014
January-MarchPayment patchBi-Partisan agreement to fix the Sustainable
Growth Rate
© E. Woodcock | www.elizabethwoodcock.com | 2013
If legislation passes both Houses…
0.5% Increase via the SGR law
~1.6% Decrease via the Budget law (extension of Sequestration)
------------------------
~1.1% Decrease
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Medicare 2014
Changes to the RVUs
Final Physician Fee Schedule
See Appendix for full listing. Table above includes physician specialties only. All other physician specialties
are between -1 and +1%.
© E. Woodcock | www.elizabethwoodcock.com | 2013
DIAGNOSTIC TESTING FACILITY -11%PATHOLOGY -6%INDEPENDENT LABORATORY -5%RHEUMATOLOGY -4%INTERVENTIONAL PAIN MGMT -4%ALLERGY/IMMUNOLOGY -3%OTOLARNGOLOGY -2%RADIOLOGY -2%VASCULAR SURGERY -2%PORTABLE X-RAY SUPPLIER -2%DERMATOLOGY -2%GASTROENTEROLOGY -2%HEMATOLOGY/ONCOLOGY -2%INTERVENTIONAL RADIOLOGY -2%ORTHOPEDIC SURGERY -2%
Losers
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Medicare 2014
Changes to the RVUs
Final Physician Fee Schedule
See Appendix for full listing. Table above includes physician specialties only. All other physician specialties
are between -1 and +1%.
© E. Woodcock | www.elizabethwoodcock.com | 2013
Winners
CHIROPRACTOR 12%CLINICAL PSYCHOLOGIST 8%CLINICAL SOCIAL WORKER 8%PSYCHIATRY 6%NURSE ANES / ANES ASST 3%CARDIAC SURGERY 2%CRITICAL CARE 2%EMERGENCY MEDICINE 2%INFECTIOUS DISEASE 2%
PAGE 13 KAREO | CONFIDENTIAL
Medicare 2014
Other Highlights
© E. Woodcock | www.elizabethwoodcock.com | 2013
Complex Chronic Care Coordination[Calendar Month]
Total Duration of Staff Care Coordination Services Code(s)
Less than 30 minutes Not reported separately
31 to 74 minutes 99487 or 99488 x 1
75 to 104 minutes 99487 or 99488 x 1 and 99489 x 1
105 minutes or more
99487 or 99488 x 1 and 99489 x 2 or more for each additional 30 minutes
Covered by Medicare: 2015
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Medicare 2014
What’s NOT changing?
© E. Woodcock | www.elizabethwoodcock.com | 2013
Combined E/M code with single rate?
Facility, not Professional
Incident-to billing?
No change, just emphasis on state scope of practice
PAGE 15 KAREO | CONFIDENTIAL
CPT Changes 2014
15
• Upper and lower GI endoscopies
175 New
107 Revision
s
47 Deletions
Gastroenterology
© E. Woodcock | www.elizabethwoodcock.com | 2013
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CPT Changes 2014
Highlights
Abscess drainage Shoulder and elbow prosthesis removal Breast biopsies Peripheral vascular stents Chemodenervations
© E. Woodcock | www.elizabethwoodcock.com | 2013
PAGE 17 KAREO | CONFIDENTIAL
Affordable Care Act
As an entity, the exchange isn’t offering participation options –
lies at the payer level…and reimbursement does too.
1. Who is Selling on Your Exchange?2. Are You a Participating Provider?3. What is Your Fee Schedule?
© E. Woodcock | www.elizabethwoodcock.com | 2013
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Affordable Care Act
Health plans will pay for
the first 30 days after a patient misses a premium payment
Days 31 to 90 may result in withheld payments to physicians – or retroactive takebacks
© E. Woodcock | www.elizabethwoodcock.com | 2013
PAGE 19 KAREO | CONFIDENTIAL
Affordable Care Act
Medicaid / Medicare Rate Parity 2013-2014 Primary care providers and specialty physicians
boarded as internists and pediatrics accepting Medicaid, rates guaranteed to be at or equal to Medicare• Evaluation & Management (E/M) services
• Vaccines
66%
© E. Woodcock | www.elizabethwoodcock.com | 2013
Final Rule Released November 6, 2012; but many states still haven’t paid
http://www.aap.org/en-us/advocacy-and-policy/state-advocacy/Documents/State_Md_Payment_Increase.pdf
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Physician Quality Reporting System
2014: 0.5%
2015: -1.5% penalty if practices are not successfully participating, based on 2013 performance
2016 and beyond: -2% penalty
Note: For 2011-2014, an additional 0.5% is available if the clinician participates via a “Maintenance of Certification Program” (MOCP)
refer to your specialty society
37
© E. Woodcock | www.elizabethwoodcock.com | 2013
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Physician Quality Reporting System
21
Measures
DomainsOut of
Report each measure for at least 50% of the Medicare Part B FFS patients seen during the reporting period to which the measure applies.
© E. Woodcock | www.elizabethwoodcock.com | 2013
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eRx
E-prescribing bonus is gone in 2014• if no e-prescribing, -2%
[ Still time to gain the bonus, however, just need to submit 25 by February 2014 for 2013 dates of service!! ]
Needed 10 G8553’s for unique encounters—with any billable code—by June 30, 2013 to avoid the 2014
penaltyPlease confirm “N365” on your RA’s
© E. Woodcock | www.elizabethwoodcock.com | 2013
PAGE 23 KAREO | CONFIDENTIAL
Value-Based Modifier
Not a Modifier in the sense of a CPT code !!
Source (image): Healthcareisbusiness.blogspot.com
[ Mandatory ] Tiering
System*
Practices of 10 or more eligible professionals
subject to VBM in 2016, based
on 2014 performance
© E. Woodcock | www.elizabethwoodcock.com | 2013
PAGE 24 KAREO | CONFIDENTIAL
EHR Incentive Program
Stage Two 2014
• 90 days only (Stage One too!)
• 20 criteria + 9 CQMs*
• 17 core criteria, 3 menu-based criteria
• Most controversial? 5% of your patients must download, view or transmit their health information and 5% of your patients must send you a secure electronic message.
*CQM=Clinical Quality Measure
© E. Woodcock | www.elizabethwoodcock.com | 2013
PAGE 25 KAREO | CONFIDENTIAL
EHR Incentive Program
December 6, 2013
• Delay Stage Three until 2017
• Stage Two will last through 2016
© E. Woodcock | www.elizabethwoodcock.com | 2013
http://www.cms.gov/eHealth/ListServ_Stage3Implementation.html
PAGE 26 KAREO | CONFIDENTIAL
“Voluntary” Incentive Programs
Overview of Payment Adjustments
Year eRx PQRS EHR VBMSeques-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% -2.0%* -2.0% -9.0%
2018 - -2.0% up to -5% -2.0%* -2.0% up to -11%
2019 - -2.0% up to -5% -2.0%* -2.0% up to -11%
+As of April 1, 2013. ^Only groups with 100+ eligible professionals in 2015; CMS is proposing to add groups of 10 to 99 EPs in 2016 although they would not be subject to the payment adjustment of -2.0%. *Assumed by speaker based on 2015 final rule and 2016
proposal by CMS as published in the July 19 2013 Federal Register.
Applied to all Medicare
reimbursement
PAGE 27 KAREO | CONFIDENTIAL
Our Schedule for Today…
1 Introduction & Welcome Elizabeth
2 Getting Paid in 2014: What You Need to Know
3 Discover Kareo’s Role
4 Answer Questions
PAGE 28 KAREO | CONFIDENTIAL
Discover Kareo’s Role
“…Make Your Practice a Best Practice!”
PAGE 29 KAREO | CONFIDENTIAL
Discover Kareo’s Role
Cloud-based
Medical Billing
Patient Payment Services
Insurance Billing & Remittance
Scheduling & Practice Management
Electronic Health Records
Medical Billing Services
20,000 Providers Nationwide
PAGE 30 KAREO | CONFIDENTIAL
Discover Kareo’s Role
PAGE 31 KAREO | CONFIDENTIAL
Discover Kareo’s Role
PAGE 32 KAREO | CONFIDENTIAL
Discover Kareo’s Role
Standard Fee Schedule
• @ practice level• Allowables by payer
PAGE 33 KAREO | CONFIDENTIAL
Discover Kareo’s Role
•Standard Fee Schedule
•New CPT Codes• Auto updated by Kareo• Customize by Practice• “Retire” old codes
PAGE 34 KAREO | CONFIDENTIAL
Discover Kareo’s Role
•Standard Fee Schedule
•New CPT Codes
•Claim Tracking• No Response Queues• Clearinghouse Reports
PAGE 35 KAREO | CONFIDENTIAL
Discover Kareo’s Role
•Standard Fee Schedule
•New CPT Codes
•Claim Tracking
•Patient Collections• Credit card processing• Online payments
PAGE 36 KAREO | CONFIDENTIAL
Discover Kareo’s Role
•Standard Fee Schedule
•New CPT Codes
•Claim Tracking
•Patient Collections
•Meaningful Use• Attestation Reporting
PAGE 37 KAREO | CONFIDENTIAL
Our Schedule for Today…
1 Introduction & Welcome Elizabeth
2 Getting Paid in 2014: What You Need to Know
3 Discover Kareo’s Role
4 Answer Questions
PAGE 38 KAREO | CONFIDENTIAL
Let’s Answer Your Questions
888.775.2736 x1
http://www.kareo.com/chat
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Getting Paid in 2014
What You Need to Know
Thank You So Much!