0:16
Kim Dues: Good morning.
0:22
Holly Cassano: Good morning Kim; how are you?
0:39
Kim Dues: I’m excellent; how are you?
0:48
Holly Cassano: Good; thank you.
0:51
Kim Dues: Okay.
0:52
So first I would like to thank all of you for attending our Facebook live today
0:57
and introduce myself.
0:58
My name is Kim Dues, I am CPC, CRC, ICD-10, AAPC certified; a coder
1:08
and auditor and have been in the healthcare
1:10
industry for over 22 years.
1:12
I am a regional director
1:14
for Billing Paradise in Texas and the central US territory.
1:18
I provide client services and revenue
1:20
cycle management system to my respective client base.
1:26
Our MACRA MIPS subject today, I have personally worked with numerous providers over the
1:32
past several years on PQRS extrapolation and successfully submitted through a registered
1:39
portal
1:40
for all of them.
1:41
The name of the portal I have used in the past is called New Jersey Innovation
1:47
Institute.
1:49
It’s njii.com.
1:51
They’re excellent and they are very helpful to help you review your
1:58
measures before they are submitted so you understand what the results will be.
2:05
I’m here today to discuss with my co host Holly Cassano who is a CPC, CRC, ICD-10 certified
2:13
with AAPC also since 2006.
2:17
She has also worked in the healthcare industry for well over 20
2:21
years.
2:22
Along with that she is also a regional director for Billing Paradise in Florida and the
2:29
Northeast US providing client services and revenue cycle management system to her respective
2:34
client base.
2:39
She is here to help me discuss today’s Facebook – she is here to discuss the Facebook live
2:52
broadcast regarding the current changes to healthcare, the landscape for MACRA and MIPS.
3:07
Together we will be conversing on the various nuances that provider must be aware of to
3:11
avoid
3:12
negative payment adjustments going forward.
3:15
That will impact not just their CMS contracts but
3:18
all payer contracts across the board that you participate with and how you can prepare
3:25
your
3:26
practice.
3:28
All right.
3:30
So –
3:31
Holly Cassano: Thank you Kim.
3:33
Kim Dues: I’d like to say on behalf of Billing Paradise, they are pleased to offer the following
3:39
tools and services; some are free and some are at cost to existing and new clients.
3:46
Billing
3:47
Paradise is a billing company, they offer coding, auditing, revenue cycle management
3:54
– so we
3:57
have a MIPS eligibility status verification, we have a quality payment program, it’s
4:03
called the
4:05
QPP measuring.
4:07
We have a MIPS calculator.
4:09
We can help you with your provider specific
4:12
PQRS codes which is what you submit, either through your EHR or on paper.
4:19
Those are
4:21
provider specific.
4:22
So we can help you zero in on your provider specialty.
4:26
We have the MIPS
4:27
checklist and we also have a free loss recovery revenue, we call that our LRRA.
4:34
This is a value
4:35
pack report that will assist practices in discovering their monetary deficiencies within
4:40
their
4:41
revenue cycle process.
4:43
And we offer solutions to the missing dollars.
4:46
We also have a free 60 minute MACRA consultation post webinar; you can sign up for it and
4:54
it’ll be on first come first serve basis.
5:01
So Holly, we’re just going to dive into it.
5:03
We’re going to go into what clinicians and elements of
5:06
Medicare payments are impacted by the QPP.
5:09
So do you want to speak a little on that?
5:11
Holly Cassano: Yeah.
5:12
That sounds great Kim and thank you for the very welcoming
5:15
introduction.
5:16
Kim Dues: You’re welcome.
5:17
Holly Cassano: Yeah.
5:19
So basically CMS estimate that over 710,000 providers will be affected
5:25
by the Quality Payment Program which is also called QPP and those changes which are this
5:31
this year
5:32
2017.
5:33
And this actually launches the first performance year for the QPP.
5:36
Of note, not all
5:38
providers will be subject to the coming changes; close to half of US physicians are not familiar
5:43
with MACRA and MIPS initiatives and per initiatives. [0:05:44] recent survey of about 600
5:48
doctors; additionally almost eight out of 10 physicians stated that their preference
5:54
for fee for
5:55
service is definitely over the various risk sharing value based programs under MACRA and
6:01
MIPS.
6:02
But what they are forgetting is that MACRA and MIPS is here for the duration.
6:06
Kim Dues: It most definitely is here for the duration.
6:09
Kim Dues: Yeah Definitely, for the duration
6:10
Holly Cassano: [0:06:07] some staggering numbers when you think about 710,000
6:12
providers and the –
6:15
Kim Dues: I think though, eight out of 10.
6:17
Holly Cassano: Yeah.
6:18
Eight out of 10 and I’ve been familiar and would prefer fee for service
6:20
but that’s because they really don’t understand MACRA and MIPS so that’s what we’re here
6:25
to
6:26
hopefully assist people with.
6:32
Of note providers and payments that are included, any services billed under the Medicare
6:37
Physician Fee Schedule MPFS will be impacted.
6:39
Specifically, the adjustments will apply to the
6:43
work, practice expense and physician liability insurance malpractice and the relative value
6:48
units
6:49
which are also known as RVUs.
6:50
Physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered
6:54
registered nurse anesthetists [0:06:55] and groups that include any of these clinicians are included.
7:02
And
7:03
then the providers and payments that will be excluded are the Inpatient Prospective
7:06
Payment
7:07
System IPPS, Outpatient Prospective Payment System OPPS and Ambulatory Surgical Center
7:11
Payments System ASCPS.
7:12
Physician groups that fall below the low value threshold
7:16
of 30,000 or less in Medicare billing charges or 100 or less in Medicare patients and then
7:25
also
7:26
providers in their first year of billing Medicare will be excluded.
7:28
Kim Dues: Let me add to this Holly that Medicare has been very busy sending out letters to
7:35
providers, letting them know their eligibility.
7:39
We have – yeah, they’re sending them out and
7:42
doctors are receiving them and so if they get a letter from Medicare stating that they
7:48
are eligible
7:50
for the MIPS program, they need to give that to their revenue cycle department and let
7:55
them
7:56
know so that they put a plan together.
7:59
And so that’s what this webinar is about, is to help you
8:01
put a plan together, to make you aware how just very important this is.
8:07
So everything you just said, what does that mean Holly?
8:10
Holly Cassano: What it really means is that a physician’s MIPS score represents his
8:14
or her
8:15
comparative performance in four categories.
8:18
And the four starts with 50% being in quality
8:21
measures, 25% in meaningful use of their EHR, 15% goes to clinical quality improvement
8:27
activities and 10% goes to products basically, yeah.
8:31
Kim Dues: Right.
8:32
So that’s their breakdown.
8:34
So that gives you 100% of the breakdown.
8:36
Holly Cassano: Yeah 50% is fitting in that clinical quality measure program.
8:42
So that’s why
8:43
those PQRS measures that were resubmitted prior really need to be looked at by specialties
8:50
going
8:51
forward.
8:52
Kim Dues: Well absolutely; and some of the PQRS measures have just dropped off, some
8:57
of the
8:58
ones that we have used in 2016, they got rid of them and so now they, you need to review
9:04
the
9:05
PQRS measures and make sure.
9:06
And furthermore, Medicare is going to tell you, if you are using
9:10
PQRS measures and you are closely monitoring your EOBs which you have to monitor your
9:15
EOBs for Medicare, there’s a treasure trove of information on there.
9:20
You can also – what’s the
9:21
website you go out to find the meetings for the – it’s the Washington – anyway,
9:28
you have to
9:29
really read your dunning messages on the bottom of your EOB.
9:33
Holly Cassano: Yeah, I mean funny.
9:36
You can just – we can provide that post meeting but you
9:40
can go to your MIPS [0:09:40] website, you can go to your local Medicare intermediary
9:45
like for Florida we have –
9:47
Kim Dues: Sure.
9:49
Right.
9:50
And if you don’t understand one of those messages then you go to your
9:55
local Mac and then you’ll be able to read up on it.
9:59
But monitor those EOBs and the letter that
10:03
you get from Medicare, put a plan together and because we’re already going into the
10:07
month of
10:08
June.
10:09
Okay, so let's talk about transitioning from PQRS to the MIPS program.
10:17
So three small –
10:18
Holly Cassano: Well we have – go ahead sorry.
10:22
Kim Dues: Go ahead.
10:23
Holly Cassano: I was going to say that we have just a couple of tips for small practice
10:26
providers
10:27
that we want to share.
10:30
Everyone is to review and understand your 2015 quality and resource use
10:35
report, your QRUR which you should already have and if you don’t have that, then again
10:38
you
10:39
can go to your local Mac website and they can instruct you on how to download that.
10:44
Determine
10:45
your MIPS eligibility and document all future encounters in your EHR.
10:49
For providers that have
10:52
participated in the physician quality reporting system program in the past years and even
10:56
for
10:57
those that did not accomplish requirements created by the standards for Medicare and
11:00
Medicaid
11:01
services for the merit based incentive payment system MIPS can be daunting.
11:05
So below, what
11:06
we have done is we have decided to outrun few things that you can do as a small practice
11:11
provider and set yourself up for MIPS success going forward.
11:15
Kim Dues: So let's talk a little bit about that EHR; in that EHR, if there is not one
11:20
person that’s
11:21
watching that EHR for the company, there really should be.
11:25
You need to have somebody
11:26
monitoring the EHR, monitoring your PQRS measures and how they are collecting.
11:31
Make sure
11:32
they are collecting all the PQRS measures for your specialty.
11:36
If they’re not, then you have to
11:37
jump on it and what I mean by jumping on it is you get on the phone with that practice
11:44
management company and you start talking to them about how can I fix this; what are the
11:50
steps
11:51
for me to fix this?
11:52
If you have to buy I.T time in order to get it fixed then do it because it will be worth
11:59
it.
12:00
Holly Cassano: I agree and just additionally, for MIPS eligibility, 2017 is the year to
12:07
determine
12:08
your MIPS eligibility as we said.
12:10
And CMS has designated 2017 as a transition year which will
12:14
allow the small practice providers to be exempt from the MIPS payment adjustments, that will
12:16
be
12:17
applied in 2019.
12:18
This is the year to review the requirements for MIPS eligible providers and the
12:23
exemption criteria in order to be able to determine if the practice should take action
12:27
this year in
12:28
order to bypass a 4% negative payment adjustment in 2019.
12:33
And that’s pretty significant.
12:35
Kim Dues: For the MIPS eligibility?
12:38
Holly Cassano: Mm-hmm.
12:41
The other thing we want to drive home is that you really need to
12:43
document all your patient encounters.
12:44
So in order to meet with compliance for MIPS, all patient
12:48
encounters must be documented in whatever EHR your practice uses.
12:52
This is really the only way
12:53
that the MIPS program can quantify the data as it moves Medicare providers to a performance
12:59
based payment system.
13:01
The system actually rewards use of health I.T and high quality care and
13:05
the program applies to all patients for all payers not just patients that use Medicare
13:10
for
13:11
Part-B [0:13:07].
13:12
It’s pretty much mission critical just to really document all patient
13:15
encounters using your EHR in order to ready yourself to extract a report for comprehensive
13:20
data
13:21
to CMS which requires best practices in overall patient care.
13:25
What are your thoughts on that?
13:27
Kim Dues: I think that there needs to be an echo through the canyon that says documentation,
13:34
documentation.
13:35
That’s the echo, that’s really what this is all about.
13:39
Everything is going to loop
13:41
back around to provider documentation.
13:44
So not only for coding but it’s also going to be for your
13:48
MIPS measures.
13:49
Holly Cassano: Yeah, for your MIPS measures.
13:52
Yeah I mean, I’d like to expand from that –
13:59
Kim Dues: Because this is about quality, it’s about quality.
14:00
Holly Cassano: Oh yeah.
14:01
Quality of care.
14:02
Kim Dues: And so the only way you can tell them about quality is documentation.
14:06
Holly Cassano: Absolutely.
14:08
I like to always say because you know that I do a lot of government
14:12
auditing, working with providers that have had issues with Medicare, I have been doing
14:17
that for a
14:18
long time.
14:19
And also I worked with risk adjustment for many, many years and actually –
14:25
Kim Dues: Absolutely.
14:26
Because you and I have worked on a few projects.
14:28
Holly Cassano: Oh yeah, we’ve worked on quite a few.
14:33
And so one of the things – just to kind
14:34
of share a little bit of insight is with the documentation, how important it is.
14:39
The AAPC had
14:41
asked me to assist them in developing their risk adjustment credential and the national
14:46
credential [0:14:44] years ago.
14:48
So I was on a team with about seven other folks with the AAPC
14:52
and we worked on that.
14:54
And let me tell you something, it was a four month process and one of
14:57
the biggest hurdles that we had to conquer was really discussing what components of that
15:04
exam
15:05
that we want to make, circle around documentation and how important it is.
15:10
And it was very
15:11
interesting to kind of get that perspective because there was people from health plans,
15:15
big health
15:16
plans on that committee as well as there was a doctor, other folks like myself amongst
15:21
the eight
15:22
of us in total.
15:23
And one of the things I always like to say is you’ve got to bulletproof your documentation.
15:28
So in
15:29
order to bulletproof your documentation, you first must have to know what you need to
15:33
document.
15:34
Wouldn’t you agree?
15:36
Kim Dues: Absolutely.
15:38
Absolutely you do.
15:39
You absolutely do.
15:40
Holly Cassano: And unfortunately, as we both know, and through no fault of the providers,
15:45
because they build a school really, to be able to service their patients and to treat
15:51
their patients.
15:52
Kim Dues: That’s right, to take care of them.
15:54
To take care of them; that’s right.
15:55
Holly Cassano: Right.
15:56
They don't [15:53] go to school to understand all the different
15:58
elements of a note that they need to document.
16:01
So it can be a bit of a challenge.
16:04
Kim Dues: Right.
16:05
So it boils down to collaboration.
16:06
It boils down to collaboration on the
16:08
clinical side and it boils down to that collaboration between the clinical and the billing.
16:13
There
16:14
has to be a bridge that they meet in the middle and then they start talking about documentation.
16:21
And it’s not about the revenue side, you know what I’m going to say, it’s not about
16:29
the – it’s
16:30
about the revenue side, explaining to the providers, what the elements are of that particular
16:36
code
16:38
and how we meet the specific elements of that code so that the documentation proves it.
16:46
Holly Cassano: Correct.
16:48
Kim Dues: So hypothetically, a doctor – let's just say an urgent care center, they have
16:58
impacted
16:59
ear wax.
17:00
They can't just say in the documentation that it was impacted ear wax and here’s
17:05
the
17:06
code.
17:07
You have to describe the way that wax was removed in order for us to choose the right
17:12
code.
17:13
So that is the documentation part of it and that’s just a very simple example but I
17:19
was just
17:20
reading an article from our buddy Barbra Kabazie last night and that’s a big shout out to
17:25
Barbara
17:26
because we love her and I was reading an article with one of the team leads last night and
17:32
we
17:33
were discussing the fact that that is what the documentation was missing, it was missing
17:37
that
17:39
explanation on how you actually – we see in the documentation that you did a procedure
17:46
but you
17:47
have to tell us how you did it so that we can choose the right code.
17:50
So that’s what the billing side brings to the provider.
17:52
Of course the provider is the expert,
17:54
obviously he is the medical trained doctor and he brings that to the table.
18:02
And so it’s those two
18:05
departments meeting in the middle in regards to documentation.
18:09
Holly Cassano: Yes.
18:11
No I completely agree.
18:13
It’s funny you know.
18:15
With the use if these EHRs
18:17
it’s so easy to do what I like to call the point and click mentality.
18:23
Because sometimes providers
18:25
on their busy day, as they’re seeing people, they’re just pointing and clicking, pointing
18:27
and
18:28
clicking and they are like, okay.
18:29
And then, and sometimes at the end, they go through it so fast,
18:30
you can really literally point and click your way into a level five like on any given day
18:37
all day
18:38
long.
18:39
A lot of these EHRs allow that.
18:41
So with that being said, you have to be cognizant not only
18:45
of what it is that you are pointing and clicking and when you recheck [0:18:46] but also
18:49
with
18:50
these measures to make sure that they are appropriate for the type of service that you
18:53
are
18:54
providing to those patients and is it within your specialty.
18:59
I often times have to – I can recall many conversations with many different types of
19:06
providers in
19:07
different settings trying to explain to them that this is not a level five, it will never
19:13
be a level five
19:15
and this is why.
19:16
Because it’s really based on medical necessity as we all know.
19:19
And CMS will
19:21
tell you right on their website that medical necessity is the overall confectionary for
19:26
any level of
19:27
servic, up or down.
19:28
It’s how they look at it.
19:30
Under coding is not good and over coding as we
19:32
know is not good.
19:33
So you just have to make sure that your documentation is bullet proof as I like
19:37
to say because then it will stand and hold up in the event of any type of audit.
19:42
You just have to
19:43
understand from the documentation –
19:44
Kim Dues: Right.
19:45
And that’s why getting an outside audit is a smart thing to do, to use
19:49
internally for your own purposes.
19:52
You can see – you can have a bellgraph [0:19:53] given as to
19:57
how many 99 – between 99211 and 99215 and the 99201s all the way to the 99205s, you
20:06
can see
20:07
a bellgraph [0:20:05] of what your – and so that’s really powerful information for
20:13
a doctor’s
20:14
office to have to help them zero down and drill into their documentation through that
20:21
audit.
20:22
It’s
20:23
really powerful to allow that to take place in your practice.
20:28
And Holly and I also know, it’s a little scary, we also know that it’s scary to make
20:33
a decision like
20:34
that, to let somebody else in, to take a look but it’s necessary.
20:38
And then you use that information
20:40
to empower your documentation.
20:41
Holly Cassano: You don’t know what you don’t know until you get audited.
20:47
And then that is a
20:49
real eye opener for many people in practice today.
20:52
And it also has been the cause of many
20:54
practices shutting down unfortunately.
20:56
Not because they intentionally did anything wrong but
20:59
the –
21:00
Kim Dues: No they didn’t wake up in the morning.
21:04
No.
21:05
Holly Cassano: Yeah.
21:06
The intent generally is not there.
21:07
I would say in all the cases that I’ve
21:08
ever been on to review, I was in maybe like 2%or 3%, wasn’t any even like maybe and
21:15
inkling of
21:16
intent or possibly.
21:18
I couldn’t have – most of it is matters of don’t understand or billing steps
21:26
don’t understand and that’s – these are things that we can help you while we’re
21:30
talking about
21:31
Billing Paradise, the company that we represent, this is what we’re trying to say, is that
21:36
doing a
21:37
baseline audit, letting us maybe do a baseline audit for your practice doesn’t mean you
21:41
have to
21:42
sign up for services with us, we can just do a baseline audit for you.
21:45
We can do an LRR8 for
21:47
you; we can do the MACRA 60 minute consult for you.
21:51
You don’t know what you don’t know
21:53
until you get audited.
21:55
And that’s something that you really need to consider in your practice.
22:01
So we could definitely talk to you more about that after the presentation but getting back
22:07
on –
22:08
yeah getting back on track you–
22:09
Kim Dues: Right so let's –
22:10
Holly Cassano: There are a variety of options; I’m going to hand that one off to you for
22:12
MIPS
22:13
okay?
22:14
Kim Dues: Okay.
22:17
So MIPS does present some challenges, one is simply that there are multiple
22:22
options to choose from as an eligible provider who wants to participate in MIPS.
22:27
The
22:28
requirements for MIPS participation vary depending upon what option a provider chooses.
22:33
Of
22:34
note, MIPS eligible providers need not select on a final participation option this year.
22:43
CMS is
22:45
not requiring registration for the program for 2017 so providers can take all of 2017
22:52
to decide the
22:53
MIPS participation going forward.
23:00
The current and the future forecast.
23:05
So 2017 –
23:07
Holly Cassano: Yeah.
23:08
There’s a timeline.
23:09
Kim Dues: Yeah.
23:10
This is a timeline but basically MIPS reporting begins in 2017.
23:15
And then that
23:16
reflects in 2019 payments.
23:18
Holly Cassano: Yeah.
23:20
It does.
23:22
Basically the way MACRA started, it was approved back in
23:28
2015 by CMS and in 2016 the QPP quality payment programs proposed the finals rules were
23:34
released.
23:35
And then as of 2017 this year, this is the MIPS inaugural performance year that begins.
23:42
There are multiple reporting options for providers that allows them to select an option which
23:48
will
23:49
work best for the practice.
23:51
And there are several options which can be selected in order to avoid
23:54
a negative payment adjustment.
23:56
One is reporting some data which means maybe a month of
24:00
data, two months of data, something like that.
24:04
Then you can go to a 90 day data reporting period
24:06
and then you can do a full year of data reporting for this year.
24:09
It’s really up to you.
24:10
Kim Dues: Right.
24:11
And I mean of course – right, the full year is optimal but some may not be
24:17
ready and we’re not talking about just Medicare, we’re talking about all your payers.
24:24
All your
24:25
payers across the board, all your patients.
24:27
That is the data that you are collecting all your MIPS,
24:34
all of it.
24:35
And then that information is going to be sent through a portal to CMS.
24:39
A registered
24:41
portal with CMS.
24:42
Holly Cassano: Absolutely.
24:44
Yeah.
24:45
Kim Dues: And then the adjustments will show up in 2019.
24:48
Holly Cassano: Correct.
24:49
And providers can – as I said, providers can even begin collecting
24:54
performance data as of January one of this year or they can select any continuous period
25:02
ending
25:03
no later than October second of 2017.
25:04
Kim Dues: Yeah.
25:05
Holly Cassano: So continuing with the timeline as of 1/1/2017 providers who were ready to
25:11
begin participating in the programs were able to start collecting performance data and could
25:16
result in a positive payment adjustment.
25:19
MIPS payment adjustments for 2019 will be based on
25:22
that performance this year of 2017.
25:26
Then October second of this year, providers who are not yet
25:29
prepared to participate have until October second of this year to begin collecting performance
25:35
data and still could qualify for a nominal positive payment adjustment if they start
25:41
in October.
25:42
MIPS payment adjustments again in 2019 will be based on performance of this year 2017.
25:46
And
25:47
then lastly as of 12/31/2018, a meaningful use physician quality reporting system PQRS
25:53
and the
25:54
value based modifier VBM payment adjustments.
25:58
Finally and I’m sure with many people clapping, well sunset for Medicare providers at the
26:03
end of
26:04
2018.
26:05
All of it has been very challenging for providers that we’ve interacted with and Kim I’m
26:11
sure you have quite a few that you’ve interacted with.
26:13
Kim Dues: Right.
26:14
I mean honestly at minimum, my recommendation is to get 90 days at
26:19
minimum.
26:20
That’s just my recommendation.
26:21
Holly Cassano: Yeah.
26:22
I would at least go for 90 days; I wouldn’t want to go for less than that.
26:26
Kim Dues: Right.
26:27
And so this is why I said in the beginning, we’re already turning the corner,
26:31
tomorrow is the first of June so if you’re going to collect 90 days, that’s June, July,
26:37
August.
26:38
If
26:39
you’re going to – so I’m just saying there’s really only – there’s only six
26:42
months left to really
26:44
grab that data.
26:45
And 90 days is – that’s just my suggestion.
26:49
So –
26:51
Holly Cassano: I want to ask you a question about PQRS.
26:55
Because I remember you were
26:57
talking to me about it.
26:58
I have worked with some providers who are on the PQRS program but I
27:04
know you’ve done a lot of extensive work with providers and PQRS.
27:07
So can you maybe share
27:09
one of your as I like to call it, horror stories about a provider and how you straightened
27:15
it out and
27:16
what you did?
27:17
Kim Dues: Oh yeah.
27:22
Well, I’ll just take a – all right I’ll just take a little practice that I worked
27:27
with.
27:28
This little practice, they were basically started from the ground floor up.
27:33
They had a pretty
27:36
decent practice management system EHR combination under one umbrella.
27:42
Not too bad but one
27:44
of the problems we ran into is once the provider’s wife who was the office manager, once we had
27:53
our meeting and laid out a ground plan for submitting her PQRS data, then what we were
28:01
doing
28:02
is we were talking about the collection of that data.
28:04
So we dove into the EHR, we found like
28:07
98% of the measure but there were two really big measures and it was a paying management
28:13
practice.
28:14
There were two really big measures that the EHR was not collecting.
28:18
So we went
28:20
round and round and round with the practice management system and they basically said
28:25
that
28:26
they weren’t going to make a change to the EHR specifically for that.
28:30
So what we did is we basically found a back door process so that the EHR will collect
28:39
those two
28:40
measures.
28:41
And so this is what I’m saying to the group of viewers, is that in the event you have
28:46
an EHR that is not collecting all your measures and you need them to collect all your measures,
28:53
then you have to be proactive enough to look at your EHR, find a back door so that it will
29:04
collect
29:05
those measures and that they will show up on a report.
29:08
Because it’s the report that you’re going
29:09
to be submitting.
29:12
So what you do is you find that back avenue and you work with your revenue cycle team
29:17
also.
29:18
And if you don’t have a revenue cycle team, here we are, Billing Paradise, we can help
29:22
you with
29:23
that.
29:24
So we can find the backdoor for you to make sure those measures are collective so that
29:29
they
29:30
show up on the report.
29:31
So that when you submit them to a portal – now I do know that some of
29:35
the EHRs, they do have a method where they will submit them for you but what they are
29:44
not
29:45
doing is they are not scrubbing your PQRS measures, they are not telling you where you’re
29:50
deficient, they are not giving you advice.
29:52
And so I really, I really recommend using a registered
29:57
portal and this is what they do.
30:00
Yes you pay them a fee but what they give you for that fee is
30:04
they let you know ahead of time that basically your measures will pass because they’ve
30:10
scrubbed
30:11
them, they know what the – they know what is expected of that particular specialty and
30:15
those
30:16
measures and that’s what you want.
30:18
You want a registry that’s going to help you.
30:20
And so in the beginning, I mentioned a company called New Jersey Institute and it’s njii.com.
30:29
They are excellent, their staff is very knowledgeable, they help you out, they’ve worked with
30:36
hundreds and hundreds of practice management systems.
30:39
They’ve reviewed hundreds of reports,
30:41
hundreds of specialties and they are just very, very good.
30:45
So that is the company that I have used
30:48
and I have leaned on to make sure that those measures are correct and to make sure that
30:53
everything is the way it’s supposed to be before they are submitted through the portal.
30:58
And then
30:59
once they are submitted they are gone; you can't reach back in and take –
31:02
Holly Cassano: That’s good
31:03
Kim Dues: So I do recommend that portal.
31:05
It is very important.
31:06
Yes I understand that it’s free
31:09
to use an EMR portal and yes they will submit them for you, but they’re not going to scrub
31:15
them
31:16
for you.
31:17
Holly Cassano: No they won’t.
31:18
Kim Dues: That’ going to be something you pay for.
31:19
Holly Cassano: Also on that website, correct me if I’m wrong, don’t they have an area
31:25
you can
31:26
go to where they list all of the specialty measures?
31:28
Kim Dues: They do and it’s just – yeah the website is super user friendly.
31:35
They have all the
31:36
measures out there, you just have to find your specialty, click on it, drill down into
31:41
them and then
31:42
you start the hard work of going into your EMR to make sure that your EMR is capturing
31:49
those
31:50
measures that you see there.
31:51
Holly Cassano: Yeah.
31:52
If I’m –
31:53
Kim Dues: They have an excellent website.
31:54
Holly Cassano: So for those providers that possibly may not have done any type of PQRS
31:59
or are
32:00
very limited with it, they’ll be able to land and they can download the measures for
32:06
their
32:07
specialty which will help them with MACRA and MIPS going forward to identify that.
32:11
Kim Dues: Yeah.
32:13
Honestly, this is going to be the easiest year to get involved, it has been really
32:18
a nail biter since 11 honestly it has been.
32:22
And it’s, this is really the easiest year to get involved
32:24
and so I really encourage all those watching and anybody that will see this little podcast
32:34
later on
32:35
to really take that to heart because this really is the year to get involved.
32:40
And these measures are
32:41
not going to go away, the quality payment system is, it’s coming down the pike, right
32:47
Holly?
32:48
Things are going to change a little bit yeah?
32:50
Holly Cassano: Absolutely.
32:51
Yes.
32:52
Outcome might be going away or coming back in some
32:55
regurgitated format.
32:56
However these measures are not going away.
32:59
Because really what’s
33:00
happening is the government is gearing up with all the other payers, kind of come together
33:07
under
33:08
this one umbrella and under a risk type of environment as I like to call it.
33:14
Everyone’s heard of
33:15
Medicare advantage, risk adjustments all these kind of stuff.
33:16
This is kind of what it’s all heading
33:18
towards.
33:19
And so it’s going to be – it’s not going to be exactly like a Medicare advantage plan,
33:26
it’s not going to be exactly like that.
33:28
Because there are a lot of problems within that system that
33:30
I’m sure people have read in recent headlines over the past week or so with large payers.
33:37
But it is really, what it’s all about is trying to gain control of the chronic disease
33:43
issues within our
33:44
country.
33:45
We are one of the sickest countries in the world with chronic disease unfortunately.
33:51
But that’s what this is; trying to get healthcare under control, trying to get cost under control.
33:57
Trying to make sure that we have more preventative care with well women visits, well child
34:03
visits, well man visits.
34:05
All this kind of stuff is where it’s –
34:08
Kim Dues: Going on [0:34:05]
34:09
Holly Cassano: Yeah.
34:10
Because the cost–
34:11
Kim Dues: Yeah.
34:12
Your annual visit, it’s very important.
34:13
Holly Cassano: Absolutely.
34:14
These annual visits[0:34:12] all of it; well visits, all of it.
34:18
And they
34:19
are trying really to get not just the primary care docs involved as the gate keepers but
34:22
they are
34:23
really trying to get the specialists involved.
34:25
That’s what all this five star ratings that you’ve
34:29
heard about too not to get sidetracked but just to kind of expand a little bit, that’s
34:34
really where
34:35
this is coming from because it used to be just health plans were under a five star rating
34:40
plan.
34:41
Well now they’re not.
34:42
It’s also hospitals, it’s practices, it’s providers.
34:44
This is one of the first
34:45
years that providers are being looked at.
34:49
So when Medicare says, okay with MIPS, with the MIPS program, they’re basically saying
34:55
that
34:56
we’re giving you a free pass if you get on board.
34:58
Kim Dues: They are?
35:00
Holly Cassano: All right.
35:01
So when Medicare does that, you need to sit up and listen and kind of
35:06
see what it’s all about.
35:07
You may not like it, you may not want to have to do it, you may have to
35:11
expand resources to help you join in but you really need to sit up and listen and take
35:19
notice or
35:21
Medicare gives you a free pass as I like to say.
35:25
What do you think Kim?
35:27
Kim Dues: I agree.
35:28
It’s this whole risk adjustment umbrella with all the payers.
35:33
That’s another
35:34
thing that’s not going away.
35:37
That’s why this is just another program because it’s a program that
35:43
is expanding.
35:45
So in the past, we submitted our measures strictly for the Medicare patients.
35:50
So
35:51
this is a good example.
35:52
It is now expanding to all your payers; they want to see it on all your
35:56
payers
35:57
Holly Cassano: Absolutely.
36:00
So and I think – go ahead.
36:04
Kim Dues: I was just going to say it’s not going anywhere, it’s just going to continue
36:08
to expand
36:09
and so it’s really about just jumping on that train and getting involved and stay involved.
36:16
Holly Cassano: Exactly.
36:18
Really all it is, is they’re trying to get providers to document better on
36:24
these parentheses[0:36:22] processes.
36:26
No matter whether it’s MIPS, risk adjustments, all these
36:29
different things; PQRS.
36:30
They are trying to really gain the knowledge that they are lacking on
36:38
where is our [0:36:36] country with healthcare.
36:41
Kim Dues: Right.
36:42
And ICD-10 is helping that correct?
36:44
Holly Cassano: I say it’s definitely helping that.
36:49
But now what’s happening is they kind of give
36:51
everyone a free pass for the first year of ICD-10 about getting it right, making sure
36:57
you’re
36:58
submitting very clear diagnosis codes that are accurate.
37:01
Making sure everything is specific,
37:04
documenting it properly.
37:05
But now what’s happening is now they are going back and they’re
37:09
auditing the ICD-10 codes.
37:11
They didn’t do it for a little bit but now the start to go back and they
37:15
are auditing providers on their ICD-10s.
37:17
So with Medicare business free pass, there’s always a give and take with that.
37:21
So this year, just
37:22
kind of give me your free pass of MIPS, so guarantee, the [Inaudible] [0:37:24] comes
37:28
with 4%
37:29
and other elevated payment adjustment rates that will continue, forward through this.
37:31
You can
37:32
see this is going to be audits and things of that nature just to make sure that this
37:38
is what is really
37:39
happening, this is what you’re recording and you need some documenting appropriately.
37:44
So look
37:45
at that, I strongly suggest everyone to devote the resources that will be necessary and these
37:51
are
37:52
things that we can help you with going forward.
37:54
Kim Dues: Absolutely we can help you with.
37:56
Absolutely.
37:57
Holly Cassano: Yeah.
37:58
Billing Paradise, Kim and I are definitely set up to help providers
38:03
strategize and get themselves in line for MIPS as it come forward.
38:08
Go ahead Kim; sorry.
38:09
Kim Dues: Absolutely.
38:10
No that’s fine.
38:11
So we went over the MIPS performance period, did we
38:14
go –
38:15
Holly Cassano: Yeah.
38:16
There’s still – for 1/1/2018 it really is the first full reporting performance
38:21
period for MIPS in a full calendar year being from January one through December 31 st which
38:27
is
38:28
two years prior to the payment adjustment year.
38:30
And with that, the payment adjustments for
38:32
2020 will be solely based on performance in 2019.
38:35
The 2018 requirements are still subject to
38:38
change as CMS releases more Information during the course of 2017.
38:45
And as of 3/31/2018 all
38:47
participating providers must submit all data to CMS for 2017 regardless of when the actual
38:53
data
38:54
collection began in 2017 no later than March 31 st .
38:58
Kim Dues: Right.
38:59
So march 31 st , that’s the day when everybody submits their MIPS for 2017,
39:03
that’s the day you’re going to turn in that information.
39:07
Holly Cassano: Mm-hmm.
39:09
Kim Dues: So the payment adjustments, the 2019 MIPS payment adjustments will either
39:16
be a
39:17
positive or a negative of up to 4% plus providers can earn up to a 12% bonus for achieving the
39:26
25 th percentile or qualifying alternative payment model a.k.a APM of 5% participant
39:37
incentive
39:38
payment.
39:39
So this is just another incentive.
39:44
So in 2020, MIPS payment adjustment will either be
39:47
a positive or a negative of up to 5% plus providers and earn up to a 50% bonus for achieving
39:55
the
39:56
25 th percentile qualifying APM; 5% participant incentive.
40:02
So it’s going up.
40:03
So it starts its ride in
40:04
2019 and then it goes up to 15% for that dangling –
40:12
Holly Cassano: It actually goes all the way up.
40:15
In 2021 it goes up to 7% and then you get –
40:17
positive or negative.
40:18
And then you can gain up to a 21% bonus.
40:22
Kim Dues: Right.
40:23
Plus the 21% bonus.
40:24
Holly Cassano: And then in 2022, that –
40:27
Kim Dues: So in 2022 MIPS payment adjustment for 9% plus up to a 27% bonus for achieving
40:41
25 th percentile.
40:43
Go ahead.
40:45
Holly Cassano: Now Kim, you want to kind of discuss a little bit about the messages on
40:52
the
40:53
Medicare EOBs that people will see?
40:55
Kim Dues: Yeah.
40:56
So just like I was saying before, when it comes to those EOB messages, you
41:00
have got to read those messages.
41:02
You need to take a look – I know that everybody is posting
41:06
electronically, fine.
41:09
We know that Medicare requires that everybody take their payment
41:13
electronically and do the bank account, but someone on the revenue team has got to sit
41:18
back and
41:19
they’ve got to read those messages; especially the negative messages.
41:23
So the messages as it
41:25
relates to – there was a message for a sequestration, it was a reduction and that’s CO-253.
41:33
So
41:34
that’s its own message.
41:35
But as it pertains to the MIPS adjustment messages, there is one that’s
41:41
going to be an N-701 that’s payment adjusted based on value based payment modifier.
41:47
There’s an N-699 payment adjusted based on the PQRS incentive program and then there’s
41:55
a
41:56
CO-237 legislative regulatory penalty to designate when a negative or downward payment
42:02
adjustment will be applied.
42:04
So you got to watch for these but just my point of bringing this up
42:10
and just throwing this out there today is, these negative adjustments will not be the
42:17
same
42:18
adjustment that sequestration was; sequestration is its own baby.
42:23
It’s not going to be the same.
42:27
So and you still may see that CO-253; I’m sure some of them, we are all seeing the sequestration
42:37
percentage reduction on our payments but just know that the MIPS negative adjustments will
42:43
come on a different message.
42:44
That’s my point on that one.
42:46
Holly Cassano: Yeah.
42:47
Sequestration I think really threw a lot of people for a loop, they thought
42:50
they were getting penalized when other people weren’t but that was across the board basically
42:53
because of the reduction –
42:54
Kim Dues: Yeah it was cross board to everybody.
42:58
Sure.
43:00
So that’s why I’m saying that either a
43:04
practice manager or the billing manager or whoever it is that’s leading that billing
43:09
team,
43:10
somebody’s got to be reading those dunning messages on the bottom of the EOB.
43:14
Holly Cassano: Absolutely.
43:16
So I think we’re coming to the end of our presentation today
43:21
correct?
43:22
Kim Dues: We are coming to the end of our little chat.
43:25
Holly Cassano: So.
43:26
Kim Dues: It’s MACRA.
43:28
Holly Cassano: Yeah.
43:30
So I’d like to thank everybody but I think were – are we going to open it
43:33
up for Q and A or are they going to email us?
43:35
Kim Dues: I think we can take some questions and we can try to answer some of those questions
43:43
here.
43:44
So if any of you watching, if you have any question, just go ahead and send them along
43:50
and we’ll try to answer them and if not I know that we’re going to want your email
43:56
address to
43:58
follow up with you or to – if you decide to take advantage of our –
44:06
Holly Cassano: MACRA forums.
44:08
Kim Dues: Our free 60 minute MACRA course [0:44:11] of course we said that’s first
44:16
come first serve and then the other one is the LRRA, the Lost Revenue Recovery Audit,
44:21
we can
44:22
do that for you and talk to you about what’s happening with your revenue cycle and where
44:28
some
44:29
of your – what’s happening with some of your payments.
44:33
And of course, again we’ll be reading
44:36
those denials and digging down into those.
44:39
So if anybody has anything, that’s fine, they can just
44:42
send it along.
44:44
Holly Cassano: What email should they be sending it to Kim?
44:50
Kim Dues: They can send it to mine or yours and mine is kim@BillingParadise.com or you
44:57
can
44:58
send it to Holly, holly@BillingParadise.com really simple.
45:02
We’ll get those emails right away.
45:06
Holly Cassano: Sounds good.
45:08
Kim Dues: Yeah.
45:09
Holly Cassano: I enjoyed our chat; we’re going to be doing this –
45:12
Kim Dues: I enjoyed our chat too.
45:14
Holly Cassano: Yeah.
45:15
We’re going to be doing this going forward on a variety of different
45:20
topics.
45:21
We’re still determining if we want to do it on a monthly basis, maybe by weekly or
45:25
something like that but we’ll let you know on our Facebook.
45:29
And please go ahead and check out
45:30
Billing Paradise’s Facebook page and hit like and share.
45:34
We appreciate that.
45:35
And I guess we
45:37
want to thank everyone for joining us today and hope it was informative for you and please
45:41
give
45:42
us feedback.
45:44
Kim Dues: Yes.
45:45
Thank you.
45:46
Thank you.
45:47
Holly Cassano: Have a wonderful day.
45:48
Kim Dues: Have a wonderful day everybody and thanks so much again.
45:49
Holly Cassano: Thank you.
45:50
Kim Dues: See you soon.
45:51
Bye Holly; thank you.
45:53
Holly Cassano: Bye.
45:54
Bye Kim
45:55
Kim Dues: Bye-bye.
45:56
[0:45:52] [Video Ends]
Transcription services credit to transcriptionstar.com
