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CODING

Impact of reimbursement and compliance to WRVU-based compensation

By John McDaniel bio All physician contracts including any form of WRVU based compensation may need to be reviewed and probably amended because of the increase in WRVUʹs (work relative value units) associated with E&M CPT codes effective Jan. 1, 2021. This has been necessitated by CMS whereby the final decision involved eliminating CPT Code 99201 and leaving CPT Code 99211 unchanged. The changes for CPT Codes 99202‐99205 and 99212‐99215 have resulted in increased physician/provider reimbursement since the WRVUs for these codes have been significantly changed. Indeed, this increase in the WRVU component will certainly affect physician compensation. While the major commercial payers have not yet announced their intention to utilize the 2021 E&M codes, those decisions will greatly impact both provider reimbursement and WRVU utilization. It should be noted… . . . read more.

WRVUs

The new paradigm for physician compensation: payment for value/quality v. volume

By John McDaniel bio How will physician compensation arrangements be impacted by quality incentive payments with respect to determining Fair Market Value and commercial reasonability? The enactment of the Medicare Access and CHIP Reauthorization Act (MACRA) in November 2016 set forth future options for payment from Medicare, those being participation in the Merit‐Based Incentive Payment System (MIPS) or participation in one or more Alternative Payment Models (APMs). Both models will likely change how physicians are compensated. MIPS requires participating Medicare providers to be subject to payment adjustments, both positive or negative, based on their performance as determined by four measures, those being (1) quality, (2) advancing care information, (3) clinical practice improvement activities and (4) cost. While MIPS was designed to provide incentives for both quality and value improvements, it… . . . read more.

Medicare

New deadline of Dec. 13 to update APM Incentive billing info

Is your office among the clinicians that need to verify Medicare billing information by Dec. 13 in order to receive payments? The Centers for Medicare & Medicaid Services (CMS) Quality Payment Program website includes 2020 Alternative Payment Model (APM) Incentive Payment details. To access information on the incentive amount and organization paid, clinicians and surrogates can log in to the QPP website using their HARP credentials. Many eligible clinicians who were Qualifying APM Participants (QPs) based on their 2018 performance began receiving their 2020 5% APM Incentive Payments last month. If you have already received your payment, you do not need to do anything. CMS also posted a new 2020 APM Incentive Payment Fact Sheet to explain: Who is eligible to receive an APM incentive payment in 2020 How CMS determines your 2020 APM… . . . read more.

BILLING & COLLECTIONS

Retaining patients as insurance landscape shifts

By Kerri Lenderman bio Walmart’s July announcement that they plan to start selling Medicare insurance should have resonated with America’s physicians as more than an interesting headline to interrupt a summer of coronavirus news.  Indeed, it should be a wakeup call and a reminder that unsettling and unconventional forces with deep pockets and consumer brand loyalty are forming a tsunami of disruption in how insurance will be marketed and influenced for years to come. Competition for Medicare market share has always been steep.  Historically it manifested in the form of aggressive health plan marketing campaigns from insurers and brokers, all trying to lock in Medicare eligibles – especially people approaching age 65.  Selecting a plan is overwhelming with dozens of plan options to choose from in a given market, including… . . . read more.

QPP

Deadline Oct. 5 to ask for MIPS targeted review

If you participated in the Merit-based Incentive Payment System (MIPS) in 2019, your performance feedback, including your MIPS final score and payment adjustment factor(s), is now available for review on the Quality Payment Program website. This final score determines the payment adjustment you will receive in 2021, with a positive, negative, or neutral payment adjustment being applied to the Medicare paid amount for covered professional services furnished by a MIPS eligible clinician in 2021. MIPS eligible clinicians, groups, and virtual groups (along with their designated support staff or authorized third-party intermediary), including APM participants, may request the Centers for Medicare & Medicaid Services (CMS) to review the calculation of their 2020 MIPS payment adjustment factor(s) through a process called targeted review. The deadline to submit your request is Oct. 5, 8 p.m…. . . . read more.

QUALITY PAYMENT PROGRAM

2019 Performance Period Suppressed MIPS Quality Measures

In the 2019 Physician Fee Schedule Final Rule (83 FR 59847), the Centers for Medicare & Medicaid Services (CMS) established a policy that provides for the suppression of measures in certain circumstances. Starting with the 2019 performance period, for measures significantly impacted by clinical guideline changes or other changes where the CMS believes that adherence to guidelines in the existing measures could result in patient harm or otherwise cause misleading results as to what is measured as good quality of care, we will reduce the denominator of available measure achievement points for the quality performance category by 10 points for each impacted measure that is submitted by MIPS eligible clinicians and groups. Such policy will “hold harmless” any clinician or group submitting data on a suppressed measure. The measures identified… . . . read more.

CORONAVIRUS

AMA puts out telemedicine guide

The American Medical Association (AMA) has compiled a guide to help physicians get telemedicine up and running so they can safely care for patients. The telemedicine quick guide outlines the first steps to get started and lays out key considerations to implementing telemedicine and explains policy, coding and payment. Even if your practice didn’t use telemedicine before, it may be an option now. Federal government agencies temporarily relaxed certain federal privacy regulations during the COVID-19 crisis and expanded payment policies. For example, the Centers for Medicare & Medicaid Services (CMS) is letting physicians provide beneficiaries a wider range of health care services without having to visit a health care facility. This CMS fact sheet explains more. Also, the Health and Human Services (HHS) Inspector General is waiving Medicare’s cost-sharing requirements for COVID-19 treatment delivered via telehealth from a doctor’s office or hospital emergency department. Learn more with… . . . read more.

PANDEMIC

Protecting your medical practice during uncertain times

By John W. McDaniel bio Given the recent disruption and decreased demand for physician office services, coupled with the foreboding predictions associated with the COVID-19 pandemic, both hospital- affiliated and private medical practices are having to adjust their operations in order to provide billable patient care services while salvaging the cash flow/liquidity of the practice. Indeed, physicians have been slow to adopt telemedicine as an essential adjunct service; yet, the current external environment beyond our control has caused physicians to respond and explore ways to optimize operational changes in terms of modifying the traditional business model of physician practices in order to be financially viable now and in the future. The greatest change has resulted in realizing the benefits of telemedicine as physicians are discovering the benefits of performing patient assessments… . . . read more.

BILLING AND COLLECTIONS

CMS to launch new MIPS Participation Framework in 2021 Performance Period

CMS is implementing a new participation framework for the Merit-based Incentive Payment System (MIPS), called the MIPS Value Pathways (MVPs), starting with the 2021 performance period. The goal of this new framework is to move away from siloed performance category measures and activities, and move toward an aligned set of measures and activities that are more meaningful to clinicians and patient care. With the MVPs framework, CMS is aiming to connect measures and activities across the Quality, Cost, Promoting Interoperability, and Improvement Activities performance categories of MIPS for different specialties and conditions. The new framework is designed to: Simplify MIPS and reduce clinician burden; Improve value and create a more cohesive and meaningful participation experience; and Better align with Alternative Payment Models (APMs) to help ease the transition from MIPS… . . . read more.

QUALITY PAYMENT PROGRAM

MIPS 2020 payment adjustments in effect based on 2018 performance

In July 2019, each Merit-based Incentive Payment System (MIPS) eligible clinician received a 2018 MIPS Final Score and associated payment adjustment factor(s) as part of their 2018 MIPS performance feedback, available on the Quality Payment Program website. 2020 MIPS payment adjustments, based on each MIPS eligible clinician’s 2018 MIPS final score, will now be applied to payments made for Part B covered professional services payable under the Physician Fee Schedule. Payment adjustments are determined by the final score associated with your Taxpayer Identification Number (TIN)/National Provider Identifier (NPI) combination. MIPS eligible clinicians, identified by TIN/NPI combination for the 2018 performance period, will receive a positive, neutral, or negative MIPS payment adjustment in 2020 if they: Were a clinician type that was included in MIPS; Enrolled in Medicare prior to Jan…. . . . read more.


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