Introduction Presentation: Elizabeth W. Woodcock, MBA, FACMPE, CPC Kareo Special Offer: Matt Kelly, Account Executive, Kareo Questions
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1 Medical Billing Made Easy Presents Getting Paid in 2012: What You Need to Know Now to Make it Happen Beginning now Today s Program Introduction Presentation: Elizabeth W. Woodcock, MBA, FACMPE, CPC Kareo Special Offer: Matt Kelly, Account Executive, Kareo Questions E. Woodcock How to Participate Today Arrow = Open/close your panel Questions = Submit text questions Follow-up with video link within 24 hours 1
2 Getting Paid in 2012: What You Need to Know Now to Make it Happen Elizabeth W. Woodcock, MBA, FACMPE, CPC Agenda CPT Changes 2012 Medicare 2012 Affordable Care Act Commercial Payers Voluntary Incentive Programs CPT copyright 2011 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. E. Woodcock CPT Changes 2012 New vs Established Patients...A new patient is one who has not received any professional services from the physician or another physician of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years. E. Woodcock
3 Decision Tree for New vs Established Patients Received any professional service from the physician or another physician in group of same specialty within last three years? Yes No Exact same specialty? New patient Yes No Exact same subspecialty? New Patient Yes No Established New patient Source: American Medical Association, Current Procedural Terminology (CPT) 2012 Standard Edition, Evaluation and Management Guidelines CPT Changes 2012 Prolonged service without direct patient contact 99358: Prolonged E/M service before and/or after direct (face-to-face) patient care; first hour 99359: each additional 30 minutes Can now be used by a other qualified health care professional E. Woodcock CPT Changes 2012 Clarifications Skin replacement surgery Stress tests Cardiac caths For each cath, table displaying add-on procedure codes Pulmonary diagnostic testing and therapies Contact lens fitting Components of a vaccine E. Woodcock
4 CPT Changes 2012 No H1N1-specific codes and eliminated E. Woodcock CPT Changes 2012 Modifier -33 Preventive Services: When the primary purpose of the service is the delivery of an evidence-based service in accordance with a US Preventive Services Task Force A or B rating in effect and other preventive services identified in preventive services mandates (legislative or regulatory), the service may be identified by adding 33 to the procedure. For separately reported services specifically identified as preventive, the modifier should not be used. CMS Pub Medicare Claims Processing Transmittal#2172 Change Request#7344 Appendix M CMS Pub One-Time Notification Transmittal#864 E. Woodcock Medicare % 1.5% 1.5% 0.0% 0.0% 0.0% 1.1% 2.0% 0.0% 5.40% 4.20% 2.45% 4.40% 5.10% 9.90% 10.60% 2012: 27.4 % Law Actual 21.20% 25.00% E. Woodcock
5 Medicare % Decrease in Conversion Factor ($ $ ) Changes to Relative Value Units Biggest hit: Radiation Oncology at (6%) Appendix: Impact by Specialty Obstetrics codes up significantly... Hospital observation and nursing home discharge Changes to Geographic Practice Cost Indices E. Woodcock Medicare 2012 New Health Risk Assessment Required component of an Annual Wellness Visit (AWV) As of January 1, 2012 G0438 Annual wellness visit, first visit Paid at G0439 Annual wellness visit, subsequent visit Paid at E. Woodcock Medicare 2012 Others? Expansion of the multiple procedure payment reduction policy; (25% ) Coverage of additional telehealth services, such as smoking cessation Practices wholly owned or operated by hospital must coordinate billing as of July 1, 2012 E. Woodcock
6 Affordable Care Act Primary Care Incentive Program (PCIP) Medicare reimbursement: Bonus of 10% of payments for selected codes, paid quarterly Primary care (IM, FP, Peds, Geriatrics; Physicians, NPs, PAs and CNSs) for whom primary care services account for at least 60% of allowed charges Look Up Tool on each Medicare Carrier s Website 2012: Special Incentive Remittance E. Woodcock Affordable Care Act HPSA Surgical Incentive Payment (HSIP) Incentive payments made for general surgeons in HPSAs, for major surgical procedures (i.e., 10 or 90-day global) HPSA =Healthcare Professional Shortage Area E. Woodcock Affordable Care Act Medicaid / Medicare Rate Parity Primary care providers accepting Medicaid, rates for E/M services and vaccines guaranteed to be at or equal to Medicare 2014: Expansion of Insurance E. Woodcock
7 Commercial Payers The Rise of High-Deductible Health Plans MGMA research: 10% of practice s revenue now derived from High Deductible Health Plans : MGMA Practice Perspectives on Payment 2009, Median data reported. *Estimate is statistically different from estimate for previous year shown (p<.05). Note: The 2011 estimate includes 0.3% of all firms offering health benefits that offer both an HDHP/HRA and an HSA-qualified HDHP. The comparable percentages for 2005, 2006, 2007, 2008 and 2009 are 0.3%, 0.4%, 0.2%, 0.3% and 0.1%, respectively. Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, Published 10/10. E. Woodcock Commercial Payers Patient Responsibility as a Percent of Total Revenues 30% 20% 12% Source: 2007 & 2013: The Retailish Future of Patient Collections, Celent, February 2009, : MGMA Practice Perspectives on Payment 2009, Median data reported. E. Woodcock Voluntary Incentive Programs Centers for Medicare & Medicaid Services Programs Electronic Prescribing (erx) Program Physician Quality Reporting System (PQRS) Electronic Health Record (EHR) Incentive Program E. Woodcock
8 Voluntary Incentive Programs erx Program If you qualified to participate, you needed to have submitted 10 G8553 s by June 30 or declared a hardship by Nov 8. Important: You can still get the bonus!! Need 25 G8553 s by December 31, 2011 (date of service) G At least one prescription created during the encounter was generated and transmitted electronically using a qualified erx system. Free qualified system: E. Woodcock Voluntary Incentive Programs Overview of erx & PQRS Bonus Payments [ Reimbursement based on Percent of Medicare Fee-for-Service Total Allowed Professional Charges ] Year erx PQRS 1 Total % 1%+0.5% 2.5% % 0.5%+0.5% 2.0% % 0.5%+0.5% 1.5% %+0.5% 1.0% Extra 0.5% is based on participation in a Maintenance of Certification Program. Bonus payments based on percentage of total Medicare allowed charges. E. Woodcock Voluntary Incentive Programs EHR Incentive Program: Medicare Payment -- Annual payment -- ibility Year of elig Year Total 2011 $18,000 $12,000 $8,000 $4,000 $2,000 $ - $44, $ - $18,000 $12,000 $8,000 $4,000 $2,000 $44, $ - $ - $15,000 $12,000 $8,000 $4,000 $39, $ - $ - $ - $12,000 $8,000 $4,000 $24, $ - $ - $ - $ - $ - $ - $ - HPSA: Additional 10% HPSA = Health Professional Shortage Area E. Woodcock
9 Voluntary Incentive Programs Although you must have participated to avoid the penalties, you have to give up the erx Medicare bonus if you are a successful participant in the EHR Incentive Program through Medicare E. Woodcock Voluntary Incentive Programs EHR Incentive Program: Medicaid Payment -- Annual payment -- lity Year of eligibi Year $21,250 $ - $ - $ - $ - $ $8,500 $21,250 $ - $ - $ - $ $8,500 $8,500 $21,250 $ - $ - $ $8,500 $8,500 $8,500 $21,250 $ - $ $8,500 $8,500 $8,500 $8,500 $21,250 $ $8,500 $8,500 $8,500 $8,500 $8,500 $21, $ - $8,500 $8,500 $8,500 $8,500 $8, $ - $ - $8,500 $8,500 $8,500 $8, $ - $ - $ - $8,500 $8,500 $8, $ - $ - $ - $ - $8,500 $8, $ - $ - $ - $ - $ - $8,500 TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,750 E. Woodcock Voluntary Incentive Programs Overview of Penalties Year erx PQRS EHR Total % % % 15% % 15% % % % -1.5% -1.0% -4.5% % -2.0% -2.0% -6.0% % -2.0% -3.0% -7.0% % -2.0% up to -5% up to -9% % -2.0% up to -5% up to -9% E. Woodcock
10 Speaker Elizabeth W. Woodcock, MBA, FACMPE, CPC Woodcock & Associates Speaker, Trainer, Author Atlanta, Georgia These handouts may not be reproduced without the written consent of the speaker. E. Woodcock INSANELY EASY Matt Kelly Account Executive Medical Billing Made Easy
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