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POSTS BY TAG | CMS




Earlier this year the Centers for Medicare and Medicaid Services (CMS) made the biggest change to telehealth policy in decades. In one abrupt, little-advertised bulletin, it announced that it would begin paying for five entirely new “Category 2” telehealth services on January 1, 2019. In that instant, tens of millions of Medicare beneficiaries became eligible for new remote services. However, nine months later very few of their physicians know about the change, and even fewer have the tools to offer or bill for these services.

Most physicians and practice administrators still think of telehealth as largely unfunded. This is understandable because until 2019 Medicare still only reimbursed provider-to-patient video visits, and only for patients located in rural areas, and only when the patient was physically located at a medical facility such as a clinic or hospital. In effect, CMS only used telehealth to supplement specialist staffing at medical facilities in rural areas. It didn’t want to introduce competition against the traditional office visit.

So until this year, telehealth was progressing mainly in the private sector. Because of successful direct-to-consumer telehealth companies, we associate telehealth with several major benefits: convenience and time savings for patients, increased access to care, work-life balance for physicians, and lower costs. CMS took a big step towards these additional benefits in the public sector with its new Category 2 telehealth funding.

Category 2 Telehealth Services and Charge Codes


Here are the new Category 2 services that can be billed today for Medicare patients:

Interprofessional Internet Consultation
CPT® codes 99446, 99447, 99448, and 99449

This is a physician-to-physician service billed by a consulting specialist. The specialist uses phone or video to give treatment guidance to the referring physician, along with a written report. The specialist never has any contact with the patient. The reimbursement is small, but many specialists already offer phone advice to other physicians without always seeing the patient. Now they can be reimbursed for these calls - it removes a perverse financial incentive for them to always do an in-person consult when that might not be necessary and could be an extra expense and inconvenience for the patient.

Interprofessional Written Internet Consultation
CPT® code 99451

This is similar to the Interprofessional Internet Consultation above, but removes the voice or video requirement. The specialist’s treatment guidance is purely written in this scenario.

Interprofessional Referral Services
CPT® code 99452

This pays the referring physician (typically a primary care physician, family medicine doctor, or hospitalist) for their end of the interprofessional internet consultation described above. The billing is based on time spent preparing materials, reviewing documentation, and speaking with the specialist. It’s nice that both parties can now get reimbursed for something that they were already doing in many cases.

Remote Evaluation of Pre-Recorded Patient Information
HCPCS code G2010

Consumer wearable medical devices got ahead of reimbursement models, leaving physicians to wonder “how am I going to get reimbursed for interpreting this flood of patient-generated data?” Apparently by billing G2010. When a physician gets a medical recording or image directly from a patient, this code pays them to send their interpretation back. No voice or video involved, just text chat. The reimbursement is low, but then again, it’s a simple transaction and it could be high-volume with the right marketing and tools.

Virtual Check-in
HCPCS code G2012

This code pays a physician to talk with an established patient for 5-10 minutes, as long as it’s unrelated to any scheduled in-office visits from the past 7 days and doesn’t lead to an immediate office visit or procedure. Typically this would be used after the patient calls the practice with a complaint or question, and the call gets escalated to a physician. It can be proactive on the part of the practice as well. Many practices traditionally provide this service for free for their established patients - now there’s reimbursement available.

How to Get Reimbursed for Category 2 Telehealth Services


If you’re already meeting the requirements to bill for one of these services, then the remaining challenge is charge capture. Because of the time requirements and the coding complexity, it’s prohibitively time-consuming to capture the billing charges for these services unless you can do the charge capture in the same clinical communication software where the service itself took place.

In order to fully capitalize on these codes, health care organizations should invest in integrated charge capture and clinical communication software. This software can be used for interprofessional and provider-patient text chat, voice, and video. The same software then can guide the physician to bill the appropriate Category 2 charge code based on the type of service (provider-provider or provider-patient), type of communication (text, phone, or video), and the duration of the call. It has to be mobile because who is in front of a computer every time they talk on the phone? And it has to be easy and integrated so that the time spent on charge capture doesn’t exceed the time spent on the actual encounter!

Why miss out on telehealth reimbursement? Contact pMD to find out how our easy-to-use, integrated charge capture and clinical communication software can streamline your telehealth services!

Further Reading
https://www.aappublications.org/news/2019/01/04/coding010419
https://practice.asco.org/sites/default/files/drupalfiles/2018-12/Final-Rule-2019-Resource-FINAL-12-5-18.pdf
https://acpinternist.org/archives/2014/01/coding.htm

 

Find out more about pMD's suite of products, which includes our MIPS registrycharge capturesecure messagingclinical communication, and care navigation software and services, please contact pMD.


Questions?


As we approach the submission deadline for 2018 MIPS reporting and find ourselves in the second quarter of 2019, it’s important to understand the changes that are in store for this upcoming reporting year. As a qualified MIPS registry, pMD gives customers the tools to submit their 2019 MIPS data to CMS and navigate some of these changes using our robust dashboard. As there are a lot of updates to the MIPS reporting requirements each year, I would like to address a few of the many questions that have recently come up.

Changes to Eligibility: 6 New Clinician Types in MIPS Reporting

In prior years, the list of clinician type has been fairly short to only include physicians, their mid-level providers, and nurses. Starting in reporting year 2019, there are 6 additional clinician types that are now included in MIPS reporting:

Physical therapists
Occupational therapists
Qualified speech-language pathologists
Qualified audiologists
Clinical psychologists
Registered dietitians or nutrition professionals


Find yourself on this list?  There is no need to panic! You can easily check to see if you are required to report based on your Medicare Part B volume by using the Quality Payment Program’s tool: QPP Participation Status

For the first year since the program began, clinicians who were previously ineligible to report can opt-in beginning Year 3. Physicians interested in this must meet at least one of the following criteria and are an eligible clinician type:

1. Have ≤ $90K in Part B allowed charges for covered professional services
2. Provide care to ≤ 200 Part B-enrolled beneficiaries
3. Provide ≤ 200 covered professional services under the Physician Fee Schedule (PFS)

Interested in opting-in to MIPS this year?  Keep in mind that opting-in may be irreversible, but stay tuned for an announcement from CMS QPP on where and how to opt-in later this year!

Changes to MIPS Data Submission Methods

In previous years, claims-based submission was a viable option for many clinicians and organizations to report.  This year, claims submission is only available to small practices who have less than 15 providers. Larger groups may want to look into submitting through a qualified registry, QCDR, or your EHR. Questions about how to submit through a qualified registry? Give us a call at 800-587-4989 x2 to discuss your reporting options!

Individuals, groups, and virtual groups can begin to use multiple submission mechanisms for Year 3 reporting so you are no longer locked in to using just one mechanism or vendor. This change should make it easier for clinicians and health care organizations to leverage the tools they already have to submit different sections of reporting. The QPP has increased their capabilities, allowing the review of multiple submissions, selecting only the highest scores to keep as the final one for determination. In fact, they list out that “if the same measure is submitted via multiple collection types, the one with the greatest number of measure achievement points will be selected for scoring.“

Changes to MIPS Scoring

One of the more notable changes to Year 3 is the change to the final score breakdown. The contribution to the final score for the Quality category decreases to 45% and increases to 15% for the Cost category. There are no changes to the contributions of Promoting Interoperability or Improvement Activities categories.


MIPS Chart


Another change to the Quality category is that the small practice bonus for groups with less than 15 clinicians is awarded to the Quality section so long as there is at least 1 quality measure reported. This differs from Year 2 which awarded the 5 points to the final score total.

Changes to Payment Adjustments

As the QPP rolls out the MIPS program in stages, we will see increased difficulty in obtaining a positive payment adjustment. The first year of MIPS offered a “Test” submission in which by submitting any data, clinicians can easily avoid any penalties.  Last year, clinicians just had to score 15 points to avoid the penalty and be eligible for a positive payment adjustment. Beginning in calendar year 2019 (MIPS Year 3), the performance threshold had been increased to 30 points. Clinicians scoring under 30 points for their MIPS Final Score are subject to a negative payment adjustment. For groups trying to obtain the Exceptional Performance bonus, that threshold was also increased to 75 points.

Speaking of payment adjustments, the maximums have been increased for them as well.  Clinicians who fail to sufficiently report MIPS are subject to a penalty of up to -7% payment adjustment on Medicare Part B FFS payments. On the flip side, the maximum bonus can be up to a positive 7% payment adjustment - however, to keep budget neutrality, it will depend on overall submission performance and will be scaled and distributed appropriately.

A full list of changes to the Year 3 Final Rule and the most up-to-date information can be found on the QPP website.

MIPS Reporting with pMD

Questions on your 2019 reporting options? pMD takes the mystery out of MIPS and provides a simplified solution to meeting requirements. Feel free to take a look at what we offer for MIPS reporting here, or give us a call at 800-587-4989 x2!

Find out more about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, clinical communication, and care navigation software and services, please contact pMD.


Image: Antenna/fStop/Getty Images

Here's The Latest in Health Care:


•  In the summer "trauma season", emergency rooms are scrambling to find alternatives to much needed medications that are out of stock. Patients feel the effects of shortages the most as some must suffer through the pain or risk unusual reactions to the alternative drugs. The drug shortages have become severe enough that the Food and Drug Administration has allowed Pfizer, one of the main drug suppliers, to sell products that would normally have been recalled.  Read More

•  The Centers for Medicare and Medicaid Services recently proposed a rule that would allow home health providers to include the costs of remote patient monitoring in the home health agency's cost report.  In the proposed rule, home health providers will not be directly reimbursed for installation and use of equipment, however, these cost reports will help CMS determine if home health providers are appropriately being paid.  Read More

•  More and more nurse practitioners are turning to voluntary residency programs to help prepare them in dealing with the growing number of patients with complex health issues.  Mentored clinical training is a major part of many of these programs and can also include formal lectures and clinical rotations in other specialties.  Read More

•  The American Hospital Association (AHA), among other organizations, have asked the FDA for standards and support measures surrounding medical devices. The AHA outlined steps hospitals take to improve cybersecurity, however, can be vulnerable to medical devices running on legacy systems. Some additional recommendations from industry organizations: creating a central repository of all device patches and requiring manufacturers to implement secure device configurations with a recognized standard.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, secure messaging, clinical communication, MIPS registry, clinically integrated network, and care navigation software.

Image: Chiara Zarmati

Here's The Latest in Health Care:


•  Water from a canal in the Yuma, Arizona region has been linked to the deadly outbreak of E.Coli that tainted romaine lettuce this spring and killed five. The romaine lettuce had been distributed across the U.S. and sickened over 200 people in 36 states, according the Food and Drug Administration. The outbreak is officially over now.  Read More

•  On Thursday, Amazon announced it is acquiring virtual pharmacy PillPack, a New England-based startup that delivers medications and coordinates refills and renewals. Amazon paid just under $1 billion for the startup, sources say, however the terms of the deal have not yet been released.  Read More

•  The Centers of Medicare and Medicaid Services (CMS) recently proposed a new hospital payment rule that makes information sharing a "Conditions of Participation" (CoP). Many organizations support the proposed plan for the federal government to require data sharing among providers in order to participate in Medicare and include ACOs, insurers, patient advocacy groups, and health IT companies.  Read More

•  While much of modern life seemingly promotes connectivity through technology, it can actually have the opposite effect. Often times, these technologies can foster social isolation and loneliness, leaving many feeling depressed and anxious. The rate of persistent loneliness is not only high in young people but also affects more than a third of adults. What are some ways to combat loneliness in this age of modern technology? Experts urge people to engage in meaningful social connections such as joining programs and groups that pertain to your interests, simply meet a friend for coffee, or do something creative and nurturing to feel more connected and outside oneself.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture, secure messaging, clinical communication, MIPS registry, clinically integrated network, and care navigation software.

Image: Tony Cenicola/The New York Times

Here's The Latest in Health Care:


•  There are approximately 1.7 million children across 20 states in the U.S. who could be at risk of losing their Children's Health Insurance Medicaid (CHIP) coverage in February due to shortage of funding. A few states plan to use state funds to make up for the lack of federal funding and the states that can't afford it may resort to freezing enrollment or terminating coverage when federal money dissipates.  Read More

•  For those of us who don't have a gluten sensitivity, pursuing a gluten-free diet may not yield the health benefits we think it would. Unnecessarily avoiding gluten-containing grains in your diet can lower overall digestive health because fiber intake decreases. We also have to remember that gluten-free substitutes are not always any more healthy.  Read More

•  Less than two months after canceling two mandatory bundled payment programs created under the Obama administration, the Centers for Medicare and Medicaid Services (CMS) announced it is launching a new bundled payment program under the Trump administration. The Bundled Payments for Care Improvement (BPCI) Advanced model gives providers an incentive to deliver high-quality and efficient care to their patients.  Read More

•  The opioid crisis continues to devastate the U.S. and health care leaders are turning to new strategies to fight it. In 2018, the focus will be on efforts to assess patients on their pain levels upon admission, educating staff about safe opioid use, patient education, and exploring alternative pain relief methods.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture software.

Image: Joy Ho for NPR

Here's The Latest in Health Care:


•  On Monday, Google announced an open source version of their artificial intelligence (AI) tool, DeepVariant. This tool improves the accuracy of genomic sequencing, which addresses one of precision medicine's outstanding challenges. Big tech rivals, such as IBM, Microsoft, Apple, and Amazon are already speculated to be making moves into the health care AI space.  Read More

•  A recent study revealed that women who use hormonal birth control pills or contraceptive devices such as intrauterine contraceptive devices (IUDs) face a small yet significant risk for breast cancer. This is the first study to examine risks associated with current, modern forms of birth control in a large population, however, not the first to establish a link to cancer.  Read More

•  Health care spending in 2016 saw a slow in growth, likely due to an increase in insurance enrollment during the first few years of the Affordable Care Act (ACA).  According to the Centers for Medicare & Medicaid Services, per capita spending topped $10,000 in 2016 and spending per person was $10,348. Experts expect a continuation of growth in health care spending due to an aging population and growing health care costs.  Read More

•  Common ceramic household cookware, such as crockpots, may contain traces of lead, which can leak into food and cause lead poisoning. Where does the lead come from? Ceramic ware is glazed before entering a kiln to bake. Often, these glazes contain lead, which gives ceramic ware their attractive shine. Be sure to refer to the FDA's list of products that have been tested for lead contamination!  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture software.

Image: Luciano Lozano/Ikon Images/Getty Images

Here's The Latest in Health Care:


•  Doctors are reimbursed for everything ranging from office visits to lab work to medical procedures. But what about the tasks that pull allocated time away from actual face-to-face visits? Data suggests that doctors are spending a significant amount of time on desktop medicine tasks. The data also highlights a reduction in time spent with patients and yet, physicians are not reimbursed for their EHR time.  Read More

•  Do you find yourself zoning out in the middle of one-on-one conversations? Do you procrastinate more often than not? There are, according to the World Health Organization, six simple questions that can reliably identify whether you have adult attention-deficit/hyperactivity disorder (ADHD). It's important to note that the questions should be looked at in their totality, not individually. No single question stands out as an indicator of ADHD.  Read More

•  The federal government settled on an average rate increase of 0.45% for its finalized 2018 payment rates for Medicare Advantage (MA) plans. The rate announcement gives MA organizations the incentive to develop innovative provider network arrangements, encouraging enrollees to access high-quality healthcare services.  Read More

•  A report published Tuesday by the Centers for Disease Control and Prevention found that 1 in 10 pregnant women in the continental U.S. with a confirmed Zika infection had a baby with serious birth defects or brain damage. There is also more evidence that birth defects were a bigger risk in women who were infected in the first trimester of pregnancy.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture software.

Image: Scott Eells/Bloomberg/Getty Images

Here's The Latest in Health Care:


•  The Food and Drug Administration's (FDA) initiative to control how farmers can give antibiotics to livestock falls short in many areas.  According to the Government Accountability Office, the FDA initiative has not been collecting usage data that allows the program to know if efforts to curb the use of routine micro-doses of antibiotics, known as growth promoters, in livestock have been successful.  Read More

•  Thursday marked another blow to the GOP's efforts to pass the American Health Care Act. House Speaker Paul Ryan did not hold a floor vote as planned after President Donald Trump held meetings with conservative and moderate Republican caucuses, hoping to come to a deal. The House can lose no more than 21 votes for the bill to pass, however there's a likelihood of more than 25 members of the Freedom Caucus who plan to vote "no."  Read More

•  On Monday, an interim rule was released, delaying the expansion and implementation of major bundled payment initiatives. The Centers for Medicare & Medicaid Services say the additional three-month delay will allow the agency more time to review and modify the policy, if necessary. The delay also calls into question whether the new White House Administration is committed to the programs.  Read More

•  Oral health has never been a priority with the aging population. One reason? Medicare does not provide dental care, except for certain medical conditions, and California's Medicaid only covers some services. However, the effort to bring more dental care to older adults is advancing across the nation. New clinics and technologies are popping up to help improve oral health for the aging, such as an app that tracks dentures, which frequently disappear in nursing homes.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture software.

Image: Dr. Thomas Albini

Here's The Latest in Health Care:


•  Three women between the ages of 72 and 88 had lost most to all of their eyesight after participating in an unproven treatment where stem cells were injected into their eyes. The women later told doctors they thought they were participating in government-approved research after finding the study listed on a government website provided by the National Institutes of Health. Unfortunately, clinical trials do not need government approval to be listed the site.  Read More

•  In Trump's proposed health care budget, the Department of Health and Human Services should expect to see its budget slashed by more than $15 billion in 2018. The Department of Veterans Affairs, however, would see a $4.4 billion increase. The reduction takes funding away from the nation's foremost medical research agency as well as support programs for low-income individuals.  Read More

•  With the new 2017 Merit-Based Incentive Payment System (MIPS) performance period underway, providers are left in the dark as to whether or not they must comply with program criteria. Providers that bill $30,000 or less in Medicare charges or give care to 100 or fewer beneficiaries are exempt from MIPS. The Medical Group Management Association is calling for immediate release of 2017 MIPS eligibility information to find out if clinicians are part of the nearly one-third that are eligible for exemption.  Read More

•  Researchers say that over-the-counter birth control pills would be safe for teens and that there is no evidence that adolescents are at greater risk from birth control pills than adult women. In fact, some of the potential negative side effects of oral contraception are less likely in younger adults, according to Krishna Upadhya, assistant professor of pediatrics at Johns Hopkins University School of Medicine.  Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news. Brought to you by pMD, innovators in charge capture software.
To run a health care practice, it’s crucial to have the right information to navigate through the many government changes. So I’ve put together a MIPS For Dummies, of sorts. My goal is to give you some insight into the quickly approaching government changes to the reimbursement process. The Centers for Medicare & Medicaid Services (CMS) has released some preliminary information and here is what we know.

Let’s start with the basics. What does MIPS stand for?
Monkey-Identified Petite Scoliosis. Just kidding! MIPS is the Merit-Based Incentive Payment System and it is a new value-based payment model. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is the statute that created this new advancement of the value-based payment model.

What is MIPS?
MIPS is a new payment system outlining financial incentives (and penalties) based on the data submitted by practices, which judges the quality, outcomes, and efficiency of patient treatment. Imagine that the Value-Based Modifier Program, Physician Quality Reporting System (PQRS), and the Medicare Electronic Health Record (EHR) all met and joined forces under one larger, combined program.

Who is at the mercy of MIPS?
Perhaps you, if you’re reading this blog post. But really, MIPS reporting will be required for any clinician billing for professional services under Medicare Part B. This includes all physicians, dentists, chiropractors, physician assistants, physical or speech therapists, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and hospital-based eligible providers. Providers who are in their first year of Medicare or are below the low-volume threshold may not be required to participate in MIPS.

When is MIPS currently scheduled to roll out?
January 1, 2017! This time I’m not kidding…

Finally, here are some fun facts about MIPS:
1. Centers for Medicare & Medicaid Services (CMS) is no longer accepting comments on the proposed rule - The cut off date was June 27, 2016. However, the final rule with comment period was issued on 11/4/16, and you can comment on that for only a few more days! Cut off for the comment period for this version of the rule is 12/19/16.

2. Qualifying Advanced Alternative Payment Model (APM) Participants are eligible clinicians who are exempt from the MIPS model. This includes Accountable Care Organizations (ACOs), Patient Centered Medical Homes, and bundled payment models.

3. CMS released a fancy new (and surprisingly helpful!) website that guides practices through how to participate in each category of MIPS.

4. To participate in the ACI portion of MIPS you will need a 2014 or 2015 Edition Certified EHR before or on January 1, 2017.

5. If you're eligible for MIPS but decide not to participate in the program, you will receive an automatic negative 4% payment adjustment on your 2018 Medicare reimbursements. (This one is a not-so-fun fact).

Now, last but not least, pMD’s web portal can produce reports reflecting valuable quality data that can be leveraged for MIPS reporting, PQRS solutions and other government changes.

#MIPTASTIC #MIPSYALL #MIPSYEAH

Who is at the mercy of MIPS?
Perhaps you, if you’re reading this blog post. But really, MIPS reporting will be required for any clinician billing for professional services under Medicare Part B. …