Are you wondering how the implementation of ICD-10, dramatic changes to meaningful use and the government’s newest incentive program will affect your practice in 2016? This is no time to go into retreat mode. In this high-energy educational webinar, national speaker and author Elizabeth Woodcock highlights the key changes in payments for practices in 2016.
Take this webinar’s tactics back to your practice to improve your bottom line in 2016. You’ll come away from this event:
- With an overview the new CPT codes that will go into effect in 2016, as well as the fall-out from the October 2015 implementation of ICD-10
- Aware of the reimbursement changes to the 2016 Medicare Physician Fee Schedule, including the Advanced Care Planning codes
- Having the ground rules for participating in the government’s incentive programs for 2016 to gain incentives and avoid penalties
- Understanding the new government incentive program, the Merit-based Incentive Payment System, and how to prepare
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Speaker
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
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Participate via Social
We’ll be live tweeting during today’s
webinar
How to participate:
1) Follow @GoKareo on Twitter
2) Follow @LeaChatham on Twitter
3) Search for #KareoTip
4) Join the conversation using #KareoTip
twitter.com@GoKareo
facebook.com/GoKareo
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Medicare 2016
2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Law
Actual
Exception - 2014Q1 had a 0.5% rate increase
-0.77%
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Medicare 2016
CPT Descriptor
2015
wRVU
2016
Work
RVU
%
Change
45330 Flexible sigmoidoscopy 0.96 0.84 -13%
45378 Colonoscopy 3.69 3.36 -9%
45380 Colonoscopy w/ Biopsy 4.43 3.66 -17%
45382 Colonoscopy w/ Control of Bleeding 5.68 4.76 -16%
45388 Colonoscopy, Flexible with Ablation 5.86 4.98 -15%
Revaluing of the Lower
GI Endoscopy Codes
Pathology – % Increase
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Medicare 2016
Average cuts based on claims processed under the taxonomy code associated with the specialty; represents RVU changes
only. All other specialties 0% impact.
Pathology 8% Gastroenterology -4%
Interventional Radiology 1% Radiation Oncology -2%
Dermatology 1% Neurosurgery -1%
Plastic Surgery 1% Neurology -1%
Colorectal Surgery -1%
Nuclear Medicine -1%
Ophthalmology -1%
Physical Medicine & Rehab -1%
Vascular Surgery -1%
Audiologist -1%
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Medicare 2016
99497 Advance care planning including the explanation and discussion of
advance directives such as standard forms (with completion of such
forms, when performed), by the physician or other qualified health
professional; first 30 minutes, face-to-face with the patient, family
member(s) and/or surrogate
+ Add-on 99498 … each additional 30 minutes
CPT Work RVU
99497 1.50
99498 1.40
AWV = Annual Wellness Visit (Medicare)
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Medicare 2016
99490 Chronic Care Management Services
99495 and 99496 Transitional Care Management
DOS: Date of the E/M Visit
[in contrast to the final day of the
30-day period post-discharge]
“Direct”
supervision is
required
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CPT® Changes 2016
69209 The removal of impacted cerumen using irrigation/lavage (unilateral)
99415-6 Prolonged, face-to-face clinical staff services under direct
supervision
99406-9 Behavior change intervention can be reported with a -25 modifier in
addition to preventive services
Also… Vaccines | Radiology |
Respiratory | Urinary… and
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New Payer
More Patient Financial
Accountability
Affordable Care Act’s
Healthcare Exchange
Majority of Enrollees have
Chosen the “Bronze” Plan
(Highest Patient Responsibility)
More and More Insurers have
Narrowed their Networks – and
Limited Out-of-Network
Benefits
Employers are Choosing to
Offer More Plans with High
Deductible Options at a Lower
Cost – Employees are Buying
Insurers are Limiting Coverage
Where Possible – and
Increasing
Referral/Authorization
Requirements
More Patient Financial
Accountability
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Meaningful Use 2015
[Last Day to Start in Order to
Get the 90 Days in]
CMS Final Rule
October 16, 2015
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Meaningful Use 2015
[EHR Incentive Programs] If an EP, eligible hospital or Critical Access Hospital (CAH) is unable to
effectively plan for a reporting period in 2015 due to the timing of the publication of the 2015 through
2017 Modifications final rule, can they apply for a hardship exception?
Yes, if a provider is unable to meet the requirements of meaningful use for an EHR reporting period in
2015 for reasons related to the timing of the publication of the final rule, a provider may apply for a
hardship exception under the "extreme and uncontrollable" circumstances category. Each hardship
exception application will be reviewed on a case-by-case basis, as required by law.
In the past, CMS has considered these applications seriously and, in fact, has approved over 85% of
hardship exemptions.
(FAQ 12845)
Source: https://questions.cms.gov/faq.php?id=5005&faqId=12845
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Meaningful Use 2015
• Patients who secure electronic message
• Patients who download, view online or
transmit to a third party their health
information electronically
• Smoking cessation
• Vitals
• After-visit summary and more…
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Meaningful Use 2015
1. Protect Electronic Health
Information
2. Clinical Decision Support
(CDS)– 5 rules for 4+ CQMs or
high priority health conditions;
drug-drug and drug-allergy
interaction checks
3. CPOE – 60% meds; 30% lab
and radiology orders
4. ePrescribing – 50% queried
for drug formulary and
transmitted electronically
5. Summary of Care – create
and transmit for 10%
transitions of care and referrals
The items listed herein are for Stage 2 participants, with the Stage 1 requirements marked in red, noting that the measurements
are not as extensive as those required for Stage 2. CQM = clinical quality measure; CPOE = computerized provider order entry.
5. Patient-specific education –
10% of all unique patients
6. Medication reconciliation –
50% of all transitions of care
7. Patient electronic access –
50% provided access within 4
business days; one patient
views, downloads or transmits
8. Secure electronic messaging
– [Y or N] – capability?
9. Public Health/Clinical Data
Registry Reporting
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ICD10
Metrics October 1-27, 2015 Historical Baseline*
Total Claims Submitted 4.6 million per day 4.6 million per day
Total Claims Rejected
due to incomplete or
invalid information
2.0% of total claims
submitted
2.0% of total claims
submitted
Total Claims Rejected
due to invalid ICD-10
codes
0.09% of total claims
submitted
0.17% of total claims
submitted
Total Claims Rejected
due to invalid ICD-9
codes
0.11% of total claims
submitted
0.17% of total claims
submitted
Total Claims Denied
10.1% of total claims
processed
10% of total claims
processed
*Metrics for total ICD-9 and ICD-10 claims rejections were estimated based on end-to-end testing
conducted in 2015 since CMS has not historically collected this data. Other metrics are based on
historical claims submissions.
Source: CMS, https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-29.html
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ICD10
1. No denials on the basis of specificity for
12 months.
2. Advance payments available.
3. Ombudsman.
Humana and United said… they had adopted a liberal
approach to specificity as long as the codes made sense…~10/15 MGMA “Town Hall” meeting, as reported
by Robert Tennant, senior policy advisor for the
Medical Group Management Association
July 2015
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Pay-for-Performance
PQRS
VBPM
Size of
Group
Paymt
Adj’mt
Perf’ce
Year
100+ 2015 2013
10+ 2016 2014
All 2017 2015
Automatic Penalty
1% (2015)*
2% (2016)+
2% for <9 EPs; 4% for >9 (2017)+
*Must have reported through GPRO
+GPRO – or at least 50% of the EPs in the TIN must have reported. The exception is
solo practitioners, who must participate successfully.
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Penalties
Year eRx PQRS EHR VBPM+
Seques-
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% -4.0% -2.0% -11.0%
2018 - -2.0% up to -5% -4.0% -2.0% up to -13%
+Table reports maximum penalty.
~Applies only to Medicare payment, not the allowable
In 2013, the Sequestration cuts started in April of that year.
Applied to all Medicare
reimbursement
2015
Performance
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What’s Next?
However, every eligible professional will be assigned a “composite score”
Will replace PQRS, VBPM and MU!
1. Participate in an
Alternative
Payment Model
2. Low Medicare
volume
3. New provider
Category Yr 1
(2019)
Yr 2
(2020)
2021 +
Quality 50% 45% 30%
Meaningful Use* 25% 25% 25%
Resource Use 10% 15% 30%
Clinical Practice
Improvement
15% 15% 15%
Max. Reduction (4%) (5%) (7%-9%)
*MU weight can decrease to 15% if adoption reaches 75%; the weight would then be
redistributed to another category.
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Awards
Cloud-based
Billing, Scheduling & Practice Management
Electronic Health Records
Medical Billing Services
Practice Marketing & Patient Engagement
Free Education, Training, & Support
Ranked #1 by Black Book 3 Years
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Discover Kareo’s Role
Kareo EHR
• Free fully-mobile EHR
• 2014 Edition Certified for MU
• ICD-10 ready
• Flexible documentation
• Specialty templates
• Electronic Superbill
• Patient Portal
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Kareo Medical Billing: Web, Mobile & Messaging!
• Web and Mobile Software
• Calendar & Patient Check-in
• IBM & MAC Enabled
• Secure Messaging
• Revenue Cycle Performance
for Visibility
• Kareo Success Team