Medicare in - TriZetto Provider...+Value-Based Payment Modifier phases in the payment adjustments based on the size of the practice, so the penalty may be higher. Remember… 2018

By Elizabeth W. Woodcock, MBA, FACMPE, CPC

Medicare in

2017© 2

2017© 3

Elizabeth W. Woodcock, MBA, FACMPE, CPCSpeaker, Author, Trainerwww.elizabethwoodcock.com MBA, Wharton School of Business, University of Pennsylvania BA, Duke University Fellow, American College of Medical Practice Executives Certified Professional Coder Author, 16 textbooks and more than 500 Articles Founder and Principal, Woodcock & Associates Former Consultant, Medical Group Management Association; Group Practice Services Administrator, University of Virginia Health Services Foundation; Former Senior Associate, Health Care Advisory Board

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2017© 4

2017 Medicare Physician Fee Schedule CPT 2017 Meaningful Use Penalties Quality Payment Program Merit-based Incentive Payment System

Conclusion

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CMS Final RuleNovember 2, 2016

Publication Date: November 15, 2016http://bit.ly/2fFJ6Hf

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2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

LawActual

Exception - 2014Q1 had a 0.5% rate increase

0.50%

(0.26%)

0.24%

Chart1

-0.0540.016

-0.0420.015

-0.02450.015

-0.0440

-0.0510

-0.0990

-0.1060.011

-0.2120.02

-0.250

-0.2950.0018

-0.2650

-0.2440

-0.2120.005

0.0050.005

Sheet1

YearProjectedActual

2003-5.4%1.6%

2004-4.2%1.5%

2005-2.5%1.5%

2006-4.4%0.0%

2007-5.1%0.0%

2008-9.9%0.0%

2009-10.6%1.1%

2010-21.2%2.0%

2011-25.0%0.0%

2012-29.5%0.2%

2013-26.5%0.0%

2014-24.4%0.0%

2015-21.2%0.5%

20160.5%0.5%

Sheet1

Sheet2

Sheet3

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Average cuts based on claims processed under the taxonomy code associated with the specialty; represents RVU changes only. All other specialties 0% impact.

Allergy/Immunology 1% Independent Laboratory -5%Family Medicine 1% Ophthalmology -2%Geriatrics 1% Urology -2%Internal Medicine 1% Gastroenterology -1%Physical/Occupational Therapy 1% Interventional Radiology -1% Multispecialty Clinic/Other 1% Neurosurgery -1%

Oral/Maxillofacial Surgery -1%Vascular Surgery -1%Otolaryngology -1%Pathology -1%Radiology -1%Diagnostic Testing Facility -1%Optometry -1%

Review Your Appendix

2017© 8

Effective for services furnished beginning January 1, 2017… [Medicare] reduces by 20 percent the payment amounts…for the technical component (TC) (including the TC portion of a global service) of imaging services that are X-rays taken using film.

The modifier FX is required on claims for the technical component of the X-ray service, including when the service is billed globally,

Modifier FX

2017© 9

G0502: Initial psychiatric collaborative care management, first 70 minutes in the first calendar month of behavioral health care manager activities…

G0503: Subsequent psychiatric collaborative care management, first 60 minutes in a subsequent month of behavioral health care manager activities…

G0504: Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities…

Behavioral Health

Note: CPT codes are a registered trademark of the American Medical Association (AMA). Please review the complete definition in your CPT® Manual, and any applicable guidance from the Centers for Medicare & Medicaid Services if billing a Medicare-only “G” code.

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G0506: Comprehensive assessment of and care planning by the physician or other qualified health care professional for patients requiring chronic care management services, including assessment during the provision of a face-to-face service (billed separately from monthly care management services) (Add-on code, list separately in addition to primary service).

992xx*99487 Complex chronic care w/o pt vsit99489 Complex chronic care addl 30 min

*Example only; other qualified services available.

2017© 11

Review Your Appendix

99490 Chronic Care Management Highlight of Changes

• Creation of structured clinical summary record not required.

• Separate written patient consent not required; sufficient to document acceptance of services in medical record.

• 24/7 access equates to contact with health care professional; access to electronic care plan not required.

• Care plan can be shared with other practitioners via fax.

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CPT code 99358 Prolonged evaluation and management service before and/or after direct patient care, first hour; and

CPT code 99359 Prolonged evaluation and management service before and/or after direct patient care, each additional 30 minutes (List separately in addition to code for prolonged service).

Non-Face-to-Face Services

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TelehealthESRD-Related Services

Advanced Care PlanningCritical Care Telehealth ConsultsNew Place of Service Code 02

Under ScrutinyZero-Day Global Services billed

with Modifier -25

Global Period@270 CPT Codes

Surgeons in Groups of 10+9 States

Informal ReviewPQRS/VBPM informal review streamlined for participating

physicians

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TelehealthESRD-Related ServicesAdvanced Care PlanningCritical Care Telehealth ConsultsNew Place of Service Code 02


with Modifier -25




physicians

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Advanced Care PlanningCritical Care Telehealth Consults

New Place of Service Code

Under ScrutinyZero-Day

Global Services billed with Modifier -25




physicians

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with Modifier -25

Global Period@270 CPT CodesSurgeons in Groups of 10+9 States


physicians

Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode Island

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with Modifier -25




physicians

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Administration of moderate sedation, even when performed with a procedure, will need to be coded separately.

EndoscopistsModerate Sedation CPT Codes 99151, 99152, 99153, 99155, 99156, 99157

G0500 - moderate sedation for GI

endoscopy procedures

Medicare

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…any continuous 90-day period between January 1, 2016 and December 31, 2016.

http://bit.ly/2fcXuUl

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Year eRx PQRS EHR (MU) VBPM+ Total2012 -1.0% - - - -1.0%2013 -1.5% - - - -3.5%2014 -2.0% - - - -4.0%2015 - -1.5% -1.0% -1.0% -5.5%2016 - -2.0% -2.0% -2.0% -6.0%2017 - -2.0% -3.0% -4.0% -9.0%2018 - -2.0% -3.0% -4.0% -9.0%

+Value-Based Payment Modifier phases in the payment adjustments based on the size of the practice, so the penalty may be higher.

Remember… 2018 is being determined by your participation in 2016!!

Penalties for Not Participating (in the Government’s Programs) are Piling Up

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CO237 = Legislative Penalty

N699 = PQRSN700 = EHR Incentive Program

N701 = Value-Based Payment Modifier

http://go.cms.gov/2e1Zv5Z

Medicare Remittance

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CMS has examined impact to quality measures and has determined that the ICD-10 code updates will impact CMS’s ability to process data reported on certain quality measures for the 4th quarter of CY 2016. Therefore, CMS will not apply the 2017 or 2018 PQRS payment adjustments, as applicable, to any EP or group practice that fails to satisfactorily report for CY 2016 solely as a result of the impact of ICD-10 code updates on quality data reported for the 4th quarter of CY 2016. The Value Modifier program will consider solo practitioners and groups, as identified by their taxpayer identification number (TIN), who meet reporting requirements in order to avoid the PQRS payment adjustment (either as a group or by having at least 50% of the individual eligible professionals in the TIN avoid the PQRS adjustment) to be “Category 1,” meaning they will not incur the automatic downward adjustment under the Value Modifier program.

- December 13, 2016 Email from CMS

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http://go.cms.gov/2hLtodY

2017 Penalty[ Payment Adjustment

Reconsideration Application ]

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• Infrastructure – EP must demonstrate that they are in an area without sufficient internet access or face insurmountable barriers to obtaining infrastructure (e.g., lack of broadband or high cost build out for internet for facility).

• Extreme and Uncontrollable Circumstances – Examples may include a natural disaster or other unforeseeable barriers such as the issues some EP faced with implementing 2014 edition CEHRT or switching CEHRT products during the year.

• For EPs practicing in multiple locations: Lack of control over the availability of Certified EHR Technology at their practice location.

• By Specialist– EP must demonstrate that they meet the following criteria: Lack of face-to-face or telemedicine interaction with patients and Lack of follow-up need with patients

Anesthesiologists, pathologists, and radiologists may receive hardship exceptions without applying based on their primary specialty as listed in the Provider Enrollment Chain and Ownership System (PECOS) six months prior to the first day of the year in which the payment adjustment would otherwise apply

Source: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/PaymentAdj_EPTipsheet.pdf

https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/paymentadj_hardship.html [ Yet ]

2018 Penalty[ Hardship Application ]

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CMS is finalizing proposals that certain EPs, who are new participants in the EHR Incentive Program in 2017 and are transitioning to MIPS in 2017, can apply for a significant hardship exception from the 2018 payment adjustment as authorized under section 1848(a)(7)(B) of the Act using a CMS developed hardship exception application process specific to this policy.

- November 1, 2016 OPPS Final Rule from CMS

https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/paymentadj_hardship.html

2018 Penalty

[ Yet ]

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1. Advanced Alternative Payment Model (APM) Participant

2. Everyone Else

Merit-based Incentive Payment System

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$30,000 in Total Allowed Part B Charges

1. Allowed charges = Allowable for that particular service

99213 $200.00 $73.40CPT® Your Charge Allowed Charge*

*Reflects the 2016 National Payment Amount for 99213; non-facility price.

This is only an estimate, but this translates into $60,000 to $90,000 in gross charges for most medical practices.

Payment

$??

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“…Beneficiaries enrolled in Medicare Advantage plans that receive their Part B services through their Medicare Advantage plan will not be included in allowed charges billed under Medicare Part B for determining the low-volume threshold.”

- CMS

2. Part B = Traditional Medicare. It does not include Medicare Advantage.

$30,000 in Total Allowed Part B Charges

• First Year Medicare Participant^…

• Perform Services for

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“[We] intend to provide a NPI level lookup feature prior to or shortly after

the start of the performance period that will allow clinicians to determine if they do not exceed the low-volume threshold and are therefore excluded

from MIPS.”-CMS

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Source: CMS. https://qpp.cms.gov/docs/QPP_Advanced_APMs_in_2017.pdf

“These APMs are scheduled to be

implemented in 2017 or 2018 but have design

parameters that have not yet been finalized. We

will update this list … to reflect changes as they

are finalized.” 5 to 8%

New ACO Track One Model 2018http://go.cms.gov/2hPstJb

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Option ResultReport all required elements for 90 consecutive days

Bonus

Report >1 quality measure, >1 improvement activity and all ACI base measures

“Small” bonus

1 quality measure; 1 improvement activity OR all ACI base measures

No payment increase; no penalty

Advanced APM Automatic 5% increase

“Pick Your Pace” 2017

If you do nothing, you will be penalized 4% on all of your Medicare reimbursement.

2017© 33

Potential for 3x adjustment for

“exceptional performance”

+4%

-4%

+5%

-5%

+7%

-7%

+9%

-9%

Adjusted Medicare Part B Payment to Clinician[ based on a MIPS Composite Performance Score ]

2019 2020 2021 2022 onward

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1

Quality

2

Cost

3

Advancing Care Information

4

Improvement Activities

Eliminated in 2017

Composite

Performance Score

Advancing Care Information = New Name for “Meaningful Use”All measures can be viewed at https://qpp.cms.gov/

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Basically Replicates the Current Programs from a Reporting Perspective

“MACRA requires us to measure

performance, not reporting.” - CMS

Source: CMS, Final Rule (10/14/16)

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Performance = Comparison to measure-specific benchmarks

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Preventive Care and Screening: BMI Screening and Follow-up PlanReporting 2017 MIPS Benchmarks

Mechanism Decile 3 Decile 4 Decile 5 Decile 6 Decile 7 Decile 8 Decile 9Decile

10Claims 41.33 - 45.76 45.77 - 51.46 51.47 - 66.43 66.44 - 90.09 90.10 - 98.60 98.61 - 99.99 -- 100

EHR 28.73 - 31.80 31.81 - 34.45 34.46 - 37.23 37.24 - 40.19 40.20 - 43.64 43.65 - 48.75 48.76 - 68.18 >= 68.19Registry/

QCDR 39.80 - 45.63 45.64 - 50.91 50.92 - 56.68 56.69 - 64.88 64.89 - 75.81 75.82 - 87.12 87.13 - 97.33 >= 97.34Points 3-3.9 4-4.9 5-5.9 6-6.9 7-7.9 8-8.9 9-9.9 10

Notes: QCDR = Qualified Clinical Data Registry. Benchmarks differ based on the reporting threshold requirements, which vary by reporting mechanism. 3 points will be awarded for reporting below Decile 3 in 2017. Source:

https://qpp.cms.gov/docs/QPP_Quality_Benchmarks_Overview.zip

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• 2017 Medicare Physician Fee Schedule• CPT 2017• Meaningful Use• Penalties• Quality Payment Program

• Merit-based Incentive Payment System

2017© 41

Exempt from MIPS? Low-Volume Threshold Determination Period“…Define the low-volume threshold determination period to mean a 24 month assessment period, which includes a two-segment analysis of claims data during an initial 12-month period prior to the performance period followed by another 12-month period during the performance period. The initial 12-month segment of the low-volume threshold determination period would span from thelast 4 months of a calendar year 2 years prior to the performance period followed by the first 8 months of the next calendar year and include a 60-day claims run out, which will allow us to inform eligible clinicians and groups of their low-volume status during the month (December) prior to the start of the performance period. To conduct an analysis of the claims data regarding Medicare Part B allowed charges billed prior to the performance period, we are establishing an initial segment of the low-volume threshold determination period consisting of 12 months. 12 months of data starting from September 1, 2015 to August 31, 2016, with a 60 day claims run out.

Material in this Appendix from the Centers for Medicare & Medicaid Services (CMS) extracted from October 14, 2016 Final Rule, noting that it will be published in an upcoming Federal Register that will have a future date, unless otherwise specified. https://qpp.cms.gov/docs/CMS-5517-FC.pdf

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• Physician• Physician assistant• Nurse practitioner• Clinical nurse specialist • Certified registered nurse anesthetist

Eligible Clinicians

• Can instead report as a group• There will be an “election process.” “…If a group is submitting information

collectively, then it must be measured collectively for all four MIPS performance categories: quality, cost, improvement activities, and advancing care information.” - CMS

• “Virtual groups” can be formed, but not until 2018

2017© 43

Eligible Clinicians

“While we have multiple identifiers for participation and performance, we are finalizing the use of a single identifier, TIN/NPI, for applying the MIPS payment adjustment, regardless of how the MIPS eligible clinician is assessed…Each unique TIN/NPI combination will be considered a different MIPS eligible clinician, and MIPS performance will be assessed separately for each TIN under which an individual bills.”

“[Others]… may voluntarily report on measures and activities under MIPS, but will not be subject to the MIPS payment adjustment.”

Payment Adjustments will not be Applied to FQHC or RHC All-Inclusive Rates, so Participation is not Expected, but it is Voluntary

Source: CMS, Final Rule (10/14/16)TIN = Tax Identification NumberNPI = National Provider Identifier

MIPS = Merit-based Incentive Payment SystemFQHC = Federally Qualified Health Center

RHC = Rural Health Clinic

2017© 44

Basically Replicates PQRS from a Reporting Perspective

Per CMS, “The CPT codes that have historically been available under the PQRS program will be made available for the MIPS as part of the detailed measure specifications which will be posted prior to the performance period at QualityPaymentProgram.cms.gov.”

Almost Exactly the Same Measures (271), as well as Reporting Options

CMS Web Interface for Groups

Qualified Clinical Data Registry (QCDR)*Qualified RegistryElectronic Health Record

Claims

Accountable Care Organization~

*More information: https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/pqrs/qualified-clinical-data-registry-reporting.html

At least 50% of patients that meet the measure’s denominator criteria, regardless of the payer

Same, but only Medicare Part B

Sample provided by CMS; 248 Medicare beneficiaries

No separate reporting; via ACO

~“Official” ACO, recognized as able to successfully submit data to CMS (e.g., Medicare Shared Savings)

PQRS = Physician Quality Reporting System

2017© 45

Base Score50 Points

[ Required Measures* ]

*Failure to report any of these five elements successfully results in a “zero” base score, which automatically translates into a “zero” performance score for this category. ^MIPS-eligible clinicians who write fewer than 100 permissible prescriptions in a performance period may elect to report a null value.

Perform Security Risk Assessment

(Y/N)

ePrescribe^

Send Summary of Care

Request/Accept Summary of Care

Provide Patient Access

In 2017, can use 2014 or 2015 Edition

CEHRT; must be 2015 Edition

certified in 2018.

This table reflects the 2015 Edition of CEHRT (Certified EHR Technology). If using 2014 Edition, see the “Transition” objectivesapplicable for 2014 Edition users on the next page; these are slightly different. *Required for Base Score, noting that your performance also contributes to your supplemental performance score. Per CMS, “The performance score…is based on a MIPS eligible clinician’s performance rate for each measure reported for the performance score (calculated using the numerator/denominator).” If your ratio is 90 out of 100 patients, for example, you’ll get 90% of 10 points, which is 9 points. ^Recommended, as “Yes” achieves the full 10 points.

Category Maximum # of PointsProvide Patient Access* 10

Patient-Specific Education 10

View, Download or Transmit 10

Secure Messaging 10

Patient-Generated Health Data 10

Send a Summary of Care* 10

Require/Accept Summary of Care* 10

Clinical Information Reconciliation 10

Immunization Registry^ 10

Bonus: (Any) Public Health/Clinical Data Registry^ 5

Bonus: Report your improvement activities using CEHRT^

10

Need 50 Points Here to Maximize

Your Performance

Score(100)

155 Total

2015 Edition of CEHRT

This table reflects the 2014 Edition of CEHRT. *Required for Base Score, noting that your performance also contributes to your supplemental performance score. Per CMS, “The performance score…is based on a MIPS eligible clinician’s performance rate for each measure reported for the performance score (calculated using the numerator/denominator).” If your ratio is 90 out of 100 patients, for example, you’ll get 90% of 10 points, which is 9 points. ^Recommended, as “Yes” achieves the full 10 points.

Category Maximum # of Points

Provide Patient Access* 20

Patient-Specific Education 10

View, Download or Transmit 10

Secure Messaging 10

Health Information Exchange* 20

Medication Reconciliation 10

Immunization Registry^ 10

Bonus: (Any) Public Health/Clinical Data Registry^ 5

Bonus: Report your improvement activities using CEHRT^

10

Need 50 Points to Maximize

Your Performance

Score

MIPS CategoryAdvancing Care Information

2014 Edition of CEHRT

2017© 48

• Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms.

• Seeing new and follow-up Medicaid patients in a timely manner, including individuals dually eligible for Medicaid and Medicare (HIGH).

• Timely communication of test results defined as timely identification of abnormal test results with timely follow-up.

• Performance of regular practices that include providing specialist reports back to the referring…clinician or group to close the referral loop or where the referring …clinician or group initiates regular inquiries to specialist for specialist reports which could be documented or noted in the certified EHR technology.

• Implementation of regular care coordination training.

Improvement Activity

2017© 49

Elizabeth W. Woodcock, MBA, FACMPE, CPCWoodcock & AssociatesSpeaker, Trainer, Author

Atlanta, Georgia404.373.6195

[email protected]

These handouts may not be reproduced without the written consent of the speaker.

TOTAL 0% ORTHOPEDIC SURGERY 0%

ALLERGY/IMMUNOLOGY 1% OTOLARNGOLOGY -1%

ANESTHESIOLOGY 0% PATHOLOGY -1%

CARDIAC SURGERY 0% PEDIATRICS 0%

CARDIOLOGY 0% PHYSICAL MEDICINE 0%

COLON AND RECTAL SURGERY 0% PLASTIC SURGERY 0%

CRITICAL CARE 0% PSYCHIATRY 0%

DERMATOLOGY 0% PULMONARY DISEASE 0%

EMERGENCY MEDICINE 0% RADIATION ONCOLOGY 0%

ENDOCRINOLOGY 0% RADIOLOGY -1%

FAMILY PRACTICE 1% RHEUMATOLOGY 0%

GASTROENTEROLOGY -1% THORACIC SURGERY 0%

GENERAL PRACTICE 0% UROLOGY -2%

GENERAL SURGERY 0% VASCULAR SURGERY -1%

GERIATRICS 1% AUDIOLOGIST 0%

HAND SURGERY 0% CHIROPRACTOR 0%

HEMATOLOGY/ONCOLOGY 0% CLINICAL PSYCHOLOGIST 0%

INFECTIOUS DISEASE 0% CLINICAL SOCIAL WORKER 0%

INTERNAL MEDICINE 1% DIAGNOSTIC TESTING FACILITY -1%

INTERVENTIONAL PAIN MGMT 0% INDEPENDENT LABORATORY -5%

INTERVENTIONAL RADIOLOGY -1% NURSE ANES / ANES ASST 0%

MULTISPECIALTY CLINIC/OTHER 1% NURSE PRACTITIONER 0%

NEPHROLOGY 0% OPTOMETRY -1%

NEUROLOGY 0% PHYSICAL/OCCUPATIONAL THERAPY 1%

NEUROSURGERY -1% PHYSICIAN ASSISTANT 0%

NUCLEAR MEDICINE 0% PODIATRY 0%

OBSTETRICS/GYNECOLOGY 0% PORTABLE X-RAY SUPPLIER 0%

OPHTHALMOLOGY -2% RADIATION THERAPY CENTERS 0%

ORAL/MAXILLOFACIAL SURGERY -1% OTHER 0%

Source: Pages 1329-1330, Federal Register/November 15, 2016

(Link provided, but will be moved as of November 16 upon final publication)

https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-26668.pdf

Provided by Elizabeth Woodcock @ www.elizabethwoodcock.com

TABLE 62: CY 2017 PFS FINAL ESTIMATED IMPACT ON TOTAL ALLOWED CHARGES BY SPECIALTY

Specialty

Combined

Impact (%) Specialty

Combined

Impact (%)

https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-26668.pdf

TABLE 11: Summary of CY 2017 Chronic Care Management (CCM) Service Elements and Billing Requirements

Initiating Visit- Initiation during an AWV, IPPE, or face-to-face E/M visit (Level 4 or 5 visit not required), for new patients or patients not seen within 1 year prior to the commencement of chronic care management (CCM) services.

Structured Recording of Patient Information Using Certified EHR Technology – Structured recording of demographics, problems, medications and medication allergies using certified EHR technology. A full list of problems, medications and medication allergies in the EHR must inform the care plan, care coordination and ongoing clinical care.

24/7 Access & Continuity of Care

Provide 24/7 access to physicians or other qualified health care professionals or clinical staff including providing patients/caregivers with a means to make contact with health care professionals in the practice to address urgent needs regardless of the time of day or day of week.

Continuity of care with a designated member of the care team with whom the beneficiary is able to schedule successive routine appointments.

Comprehensive Care Management- Care management for chronic conditions including systematic assessment of the beneficiary’s medical, functional, and psychosocial needs; system-based approaches to ensure timely receipt of all recommended preventive care services; medication reconciliation with review of adherence and potential interactions; and oversight of beneficiary self-management of medications.

Comprehensive Care Plan

Creation, revision and/or monitoring (as per code descriptors) of an electronic patient-centered care plan based on a physical, mental, cognitive, psychosocial, functional and environmental (re)assessment and an inventory of resources and supports; a comprehensive care plan for all health issues.

Must at least electronically capture care plan information, and make this information available timely within and outside the billing practice as appropriate. Share care plan information electronically (can include fax) and timely within and outside the billing practice to individuals involved in the beneficiary’s care.

A copy of the plan of care must be given to the patient and/or caregiver Management of Care Transitions

Management of care transitions between and among health care providers and settings, including referrals to other clinicians; follow-up after an emergency department visit; and follow-up after discharges from hospitals, skilled nursing facilities or other health care facilities.

Create and exchange/transmit continuity of care document(s) timely with other practitioners and providers.

Source: Federal Register/November 15, 2016

https://www.federalregister.gov/documents/2016/11/15/2016-26668/medicare-program-revisions-to-payment-policies-under-the-physician-

fee-schedule-and-other-revisions

Provided by Elizabeth Woodcock @ www.elizabethwoodcock.com

Home- and Community-Based Care Coordination

Coordination with home and community based clinical service providers. Communication to and from home- and community-based providers regarding the patient’s psychosocial needs and functional deficits must be

documented in the patient’s medical record.

Enhanced Communication Opportunities- Enhanced opportunities for the beneficiary and any caregiver to communicate with the practitioner regarding the beneficiary’s care through not only telephone access, but also through the use of secure messaging, Internet, or other asynchronous non-face-to-face consultation methods.

Beneficiary Consent

Inform the beneficiary of the availability of CCM services; that only one practitioner can furnish and be paid for these services during a calendar month; and of their right to stop the CCM services at any time (effective at the end of the calendar month).

Document in the beneficiary’s medical record that the required information was explained and whether the beneficiary accepted or declined the services.

Medical Decision-Making- Complex CCM services require and include medical decision-making of moderate to high complexity (by the physician or other billing practitioner).

Supplemental Information for Webinar Attendees

1. Payment Reduction for X-Rays using Film

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-

MLN/MLNMattersArticles/Downloads/MM9727.pdf

2. Global Surgery Package Study

9 States Involved in Global Surgery Package Study

Florida, Kentucky, Louisiana, Nevada, New Jersey, North Dakota, Ohio, Oregon and Rhode

Island

Article from the American College of Surgeons

https://www.facs.org/advocacy/regulatory/medicare-a-b/global-codes

3. List of Quality Measures, Advancing Care Information Criteria and Improvement Activities

Also, details regarding the $30,000 Exclusion

https://qpp.cms.gov/

4. List of Advanced APMs

https://qpp.cms.gov/learn/apms

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9727.pdfhttps://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM9727.pdfhttps://www.facs.org/advocacy/regulatory/medicare-a-b/global-codeshttps://qpp.cms.gov/https://qpp.cms.gov/learn/apms

Make it a Successful YearON24 Attendee InterfaceYour SpeakerAgendaMedicare 2017Medicare 2017Medicare 2017Medicare 2017Medicare 2017Medicare 2017Medicare 2017Medicare 2017Medicare 2017Medicare 2017Medicare 2017Medicare 2017Medicare 2017CPT 2017Meaningful UseMeaningful UsePenaltiesPenaltiesPenaltiesPenaltiesPenaltiesQuality Payment ProgramQuality Payment ProgramQuality Payment ProgramQuality Payment ProgramQuality Payment ProgramQuality Payment ProgramQuality Payment ProgramQuality Payment ProgramQuality Payment ProgramQuality Payment ProgramQuality Payment ProgramQuality Payment ProgramQuality Payment ProgramConclusion AppendixImplementationImplementationQualityAdvancing Care InformationSlide Number 46Slide Number 47Improvement ActivityYour Speaker

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Medicare in - TriZetto Provider...+Value-Based Payment Modifier phases in the payment adjustments based on the size of the practice, so the penalty may be higher. Remember… 2018