Embed Size (px)
Citation preview
Presented By:
Heather Zumpano [email protected]
@HZumpano
Aneel Irfan [email protected] @Aneel_Irfan
Medicaid Medicare & MACRA
Quality Payment Program
Private Insurance Revenue Models
48 states reimburse for live video 2-way communication
19 states reimburse for remote patient monitoring
12 states reimburse for store and forward
30 states reimburse for a transmission/facility fee
2 states reimburse through the Dept. of Aging Services
For your state’s specific Medicaid Reimbursement Laws, visit the Center for
Connected Health Policy website: cchpca.org
Reimbursement By the Numbers:
29 states require signed informed consent prior to visit
24 states cover telehealth for state employees
24 states plus D.C. cover care regardless of origin
25 states recognize home as originating site
41 states cover service state-wide
28 states don’t require a telepresenter
Reimbursement By the Numbers:
15 states plus D.C. will pay any type of provider
For your state’s specific Medicaid Reimbursement Laws, visit the Center for Connected Health Policy website: cchpca.org
Guidelines based on traditional care models and limited to Health Professional Shortage Areas and specific care centers (i.e. CAH, FQHC, SNF, CMHC)
Legislation is making its way through Congress to expand Medicare coverage
Use the correct CPT/HCPCS code
2. Add the “GT” modifier to show the visit was virtual
3. The originating site uses HCPCS code Q3104 to
bill a transmission/facility fee
2017 List of Services and CPT Codes
1. Advanced Alternative Payment Models (APM)- Earn an incentive payment for participating in an innovative payment model
2. Merit-based Incentive Payment System (MIPS)- Earn a performance-based payment adjustment
To qualify, you must bill Medicare more than $30,000 in Part B charges and provide care for more than 100 Medicare patients a year. Visit https://qpp.cms.gov
1. Accountable Care
2. Episode-Based Payment Initiatives
3. Primary Care Transformation
4. Initiatives Focused on Medicaid and CHIP Populations
Source: https://innovation.cms.gov/initiatives/#views=models
5. Initiatives Focused on Medicaid/Medicare Enrollees
6. Initiatives to Accelerate Development and Testing of New Payment/Service Delivery Models
7. Initiatives to Speed Adoption of Best Practices
Source: https://innovation.cms.gov/initiatives/#views=models
Combination of Meaningful Use, PQRS, and the Value-Based Modifier into one performance based payment program
Allows providers to select their measures, track the data and report to CMS
Physicians are reimbursed per member per month or billed on a per case rate
CMS encourages participation in the APM and MIP programs as research methodologies to identify the future of health care payment reform
If you have an idea for a payment model for either payment track, CMS wants to hear from you. Each year they post their provisions for open discussion and incorporate ideas into the Final Rule.
Be the Change You Want to See!
Source: http://www.americantelemed.org/main/policy-page/state-policy-resource-center
34 states and DC have a Telemedicine Parity Law
Aetna
Anthem
Blue Cross/Blue Shield
Cigna
United Health Care
Institution to Institution- Payment models
include a monthly contract, hybrid payment, or fee schedule menu of services and specialties.
Employer Workforce- Physicians can offer
employers a primary care network using on-site kiosks, mobile apps, or computers to bring medical access to their employees. Services can be paid by an employer’s self-funded health plan, out-of-pocket by an employee, per member per month, or case rate.
Direct-to-Consumer- Patients can pay out-of pocket
or use their HSAs monthly or annually for access to these services. In many cases the virtual visit is about the same rate as a co-pay for an in-person visit.
International Agreements- the large demand for
U.S. doctors in other countries presents great opportunities to contract with foreign governments, NGAs, and medical practices. There are also less legal barriers to providing care in the global medical arena.
Thank You for Attending!
Heather Zumpano [email protected]
@HZumpano
Aneel Irfan [email protected] @Aneel_Irfan
