Upload
kareo
View
94
Download
0
Embed Size (px)
Citation preview
webinar
Getting Paid in 2018: What Independent Medical Practices Need to Know
Presented by: Elizabeth Woodcock MBA, FACMPE, CPC December 13, 2017
kareo.com
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
kareo.com 33
How to Participate Today…
Type your questions
Download today’s resources
View today’s presentation
kareo.com 44
Connect via Social
Connect with us via social media
How to connect:
1)Follow @GoKareo on Twitter
2)Search for #KareoTip
3)Join the conversation using #KareoTip
twitter.com@GoKareo
facebook.com/GoKareo
linkedin.com/company/kareo
kareo.com 55
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!”
kareo.com 66
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
kareo.com
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
kareo.com 99
Trends from the Top
•Cost of Pharmaceuticals•Opioid Crisis•Insurance Mandate
kareo.com 1010
Trends from the Top
kareo.com 1111
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”
kareo.com 1212
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...
kareo.com 1313
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
kareo.com 1414
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
kareo.com 1616
Medicare Physician Fee Schedule
2018 Medicare Physician Fee
Schedule
0.31%
kareo.com 1717
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%
kareo.com 1818
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
kareo.com 2020
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
kareo.com 2121
CPT® Codes – and Reimbursement
October 1, 2017“no longer reimburse
consultation services…”
October 1, 2017“no longer reimburse
consultation services…”
kareo.com 2222
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%”
kareo.com 2323
CPT® Codes – and Reimbursement
1995 v. 1997 Documentation Guidelines for E/M Services1995 v. 1997 Documentation Guidelines for E/M Services
Quality Payment ProgramUpdate
kareo.com 2525
Quality Payment Program
$90,000 In Medicare Part B Total Allowed Charges
- or -
200 Medicare Part B Patients
kareo.com 2626
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
kareo.com 2727
Quality Payment Program
Quality Measures
kareo.com 2828
Quality Payment Program
Quality/Cost: 12 monthsACI/IA: 90 days
IA = Improvement ActivityACI = Advancing Care Information
Composite Performance ScoreComposite Performance Score
kareo.com 2929
Quality Payment Program
Points required to avoid the 5% penalty [imposed in 2020]
kareo.com
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
kareo.com 3131
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.
kareo.com 3232
Kareo Platform
kareo.com
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
kareo.com 3535
How to Participate Today…
Type your questions
-- Questions After the Webinar --
888.775.2736 x1
kareo.com 3636
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
Connect with KareoStop by and say hi!
Kareo @GoKareo GoKareo Kareo
3353 Michelson Drive, Suite 400Irvine, CA 92612(888) 775-2736