Medicare initiated payment for transitional care management (TCM), recognizing that many patients discharged from facilities are at high risk for clinical instability or readmission. The TCM service codes pay primary care physicians to provide the patient care required to ensure safe return to independent living. The timing of service delivery stipulated by Medicare must be followed. In order to successfully employ TCM service codes, staff roles must be clearly identified.
Medicare initiated payment for Chronic Care Management (CCM) services in order to provide physician compensation for non-face-to-face patient care services not covered by the existing evaluation and management (E/M) service codes. Data review, phone calls with other service providers, care planning and so forth have heretofore been unpaid. These CCM service codes have been vastly underutilized, and in response, Medicare has proposed changes. However, it remains to be seen whether the agency can improve the documentation requirements and payment sufficiently. Since payment enhancements are planned, now is the time to consider whether you want to start billing for CCM services.
What are the origins of our current physician payment structure? The resource-based relative value scale (RBRVS) assigns relative value units (RVUs) to professional services. In this first session, learn how services are defined and values assigned. Is this a “rigged” system? Find out.
The Affordable Care Act (ACA) stipulated that Medicare establish Annual Wellness Visits (AWVs) for Medicare beneficiaries. These service codes offer the opportunity for primary care clinicians to focus on disease prevention and health promotion. The evaluation and management (E/M) service codes were designed for problem identification and management. The AWVs provide payment for primary care services heretofore uncompensated.
In this age of immense technological and scientific advances, the time-honored patient-clinician relationship can, at times, feel under siege. In examining how changing practice patterns have altered the ritual, Dr. Verghese will discuss some aspects of the relationship that are both timeless and critical to diagnosis and cost-effective care.
The changing landscape of healthcare has unsettled patients as well as clinicians. Recent ethical guidelines require scaling back of scarce resources, and accountable care organizations (ACOs) require payment and delivery reforms that seek to tie reimbursements to quality metrics and reductions in the total cost of care. These changes can unsettle patients, who have concerns about the impact of physician compensation on their healthcare. This presentation offers perspective on the evolving healthcare model and provides strategies for communicating with patients regarding their concerns.
The PCMH is a relatively new model of healthcare provision that can be challenging to understand and incorporate into clinical practice. This session will place the PCMH into perspective within the broader healthcare quality movement, present evidence regarding the effectiveness of the PCMH in delivering quality healthcare, provide guidance regarding the transition from current fee-for-service model to the national PCMH-like model of care, and examine how PCMH principles will impact primary care practices starting in 2015.
MACRA (Medicare Access and CHIP Reauthorization Act) establishes “value-based” payment models. Importantly, MACRA changes neither the importance of the physician service codes as defined in the AMA’s CPT Manual nor the relevance of the RVUs assigned to each service in Medicare’s annual physician fee schedule (PFS). There are two payment options within MACRA: (1) Alternative Payment Models (AMPs), which require high levels of cross specialty collaboration and risk sharing and (2) the Merit-based Incentive Payment System (MIPS). Nearly all physicians will be part of the MIPS. Within this “system,” Medicare payments will be adjusted upward or downward based on the composite performance score (CPS). CPS has 4 components: quality, resource use, clinical practice improvement, and meaningful use of certified EHR technology. Your CPS will be calculated based on information collected by Medicare and information that you submit or is submitted on your behalf. Optimization with MACRA is achievable with planning and EHR tools that improve patient care.
Medical group visits are moving into the mainstream in primary care. They are very popular in the care of prenatal patients, diabetes, and those with chronic health conditions. Participants in this session will learn about different types of group visits and receive insights on overcoming patient confidentiality concerns.
This activity is designed to improve PCPs understanding of leadership in order to help them apply this to their practice.
Expert faculty will discuss the most recent and talked about articles published in the past year.