Podcasts about physician fee schedule

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Play Episode Listen Later Jan 28, 2025 30:19

It could be the shot heard ‘round the world: the announcement recently of Stargate, a multi-billion-dollar artificial intelligence (AI) project now underway in the U.S. and backed by huge corporations, including Oracle, Open AI, and SoftBank, among others. But what will be the impact on healthcare, and notably, health information management (HIM) professionals?Reporting on this huge healthcare issue during the next edition of Talk Ten Tuesdays will be the legendary Rose Dunn.Dunn, who served as past president and former interim CEO of the American Health Information Management Association (AHIMA), will do double duty next Tuesday. She will also handle reporting duties for the Talk Ten Tuesdays Coding Report, substituting for Christine Geiger. In that capacity, Dunn is expected to report on the 60-Day Refund Rule, part of the 2025 Physician Fee Schedule.Also part of the broadcast will be these instantly recognizable panelists, who will report more news during their segments:• Social Determinants of Health: Tiffany Ferguson, CEO for Phoenix Medical Management, Inc., will report on the news that is happening at the intersection of medical record auditing and the SDoH.• CDI Report: Cheryl Ericson, Director of Clinical Documentation Integrity (CDI) for the vaunted Brundage Group, will report the latest documentation quandaries your team is likely to encounter this year.• News Desk: Timothy Powell, ICD10monitor national correspondent and regulatory expert, will anchor the Talk Ten Tuesdays News Desk.• MyTalk: Angela Comfort, veteran healthcare subject matter expert, will co-host the long-running and popular weekly Internet broadcast. Comfort is the assistant vice president of revenue integrity for Montefiore Health.

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CMS Releases Final 2025 Physician Fee Schedule - Part 3

Neurology Minute

Play Episode Listen Later Dec 4, 2024 2:59

In part three of this three-part series, Dr. Jason Crowell and Max Goldman discuss potential legislative actions affecting the 2025 Medicare Physician Fee Schedule. Show references: Fee for Service Page Webinar sign up link Full Physician Fee Schedule Final Rule

CMS Releases Final 2025 Physician Fee Schedule - Part 2

Neurology Minute

Play Episode Listen Later Dec 3, 2024 4:16

In part two of this three-part series, Dr. Jason Crowell and Matt Kerschner explores advancements and challenges in telehealth services for 2025. Show references: Fee for Service Page Webinar sign up link Full Physician Fee Schedule Final Rule

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CMS Releases Final 2025 Physician Fee Schedule - Part 1

Neurology Minute

Play Episode Listen Later Dec 2, 2024 3:11

In part one of this three-part series, Dr. Jason Crowell and Matt Kerschner discuss the key updates and changes to the Medicare Physician Fee Schedule for 2025. Show references: Fee for Service Page Webinar sign up link Full Physician Fee Schedule Final Rule

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CURiE Conversations: The Physician Fee Schedule Was Not Built for High-Cost Supplies and Equipment

ACRO Podcast

Play Episode Listen Later Sep 24, 2024 27:20

In this episode of the ACRO podcast CURiE edition, CURiE deputy editor Dr. Chris Jahraus speaks with author Drs. Tarita Thomas and Amulya Yalamanchili about their published article, "The Physician Fee Schedule Was Not Built for High-Cost Supplies and Equipment." Read the article here: https://www.cureus.com/articles/282828-the-physician-fee-schedule-was-not-built-for-high-cost-supplies-and-equipment#!/ Contemporary Updates: Radiotherapy Innovation & Evidence (CURiE) is the official publication platform of the American College of Radiation Oncology through the Cureus Journal of Medical Science.

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July 2024: Physician Fee Schedule

ACEP Nowcast

Play Episode Listen Later Jul 30, 2024 26:44

In this episode of ACEP Nowcast, host Amy Faith Ho, MD, MPH, FACEP, chats with Michael Granovsky, MD, FACEP, about this year’s latest CMS physician fee schedule. Read more on ACEPNow.com Revisit ACEP Nowcast podcast episodes. Catch up on all of ACEP Now in past issues.

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CMS Newsroom Update: Physician Fee Schedule 2025

CodeCast | Medical Billing and Coding Insights

Play Episode Listen Later Jul 23, 2024 21:39

CMS published their PFS on July 10th. You have 90 days to comment and be heard on these changes including the proposed 2.93% reduction to the Physician Fee schedule. In this edition of the CodeCast, Terry goes over the talking points and what Part B providers can expect coming into the new 2025 calendar year. […] The post CMS Newsroom Update: Physician Fee Schedule 2025 appeared first on Terry Fletcher Consulting, Inc..

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2024 Summer Rulemaking (Policy Podcast July 2024)

ASN Kidney News Podcast

Play Episode Listen Later Jul 19, 2024 22:40

Hosts Tod Ibrahim and David White discuss the recently released CY2025 End-Stage Renal Disease Prospective Payment System and Quality Incentive Program (ESRD PPS QIP) proposed rule and the CY2025 Medicare Physician Fee Schedule proposed rule.

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2024 Summer Rulemaking (Policy Podcast July 2024)

ASN NephWatch

Play Episode Listen Later Jul 19, 2024 22:40

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Physician Fee Schedule Proposed Rule

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Play Episode Listen Later Jul 18, 2024 18:07

Kristen O'Brien, Rachel Hollander and Jeff Davis join Priya Rathakrishnan to discuss the Calendar Year 2025 Physician Fee Schedule Proposed Rule and specifically highlight several coding proposals made by CMS. To learn more about the proposed rule, read our +Insight here.

What to Expect in 2024 Health Care Policy (January 2024)

ASN Kidney News Podcast

Play Episode Listen Later Jan 11, 2024 21:50

Congressional Affairs Manager Zach Kribs joins hosts Tod Ibrahim and David White to discuss what to expect this year in both federal regulatory and Congressional health care policy.

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What to Expect in 2024 Health Care Policy (January 2024)

ASN NephWatch

Play Episode Listen Later Jan 11, 2024 21:50

Congressional Affairs Manager Zach Kribs joins hosts Tod Ibrahim and David White to discuss what to expect this year in both federal regulatory and Congressional health care policy.

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Week In Review: 2024 Medicare Physician Fee Schedule

MGMA Podcasts

Play Episode Listen Later Dec 22, 2023 11:22

In this episode of the MGMA Week in Review podcast, we welcome MGMA editor and writer Colleen Luckett to the show to share her thoughts on the latest MGMA Stat on the 2024 Medicare Physician Fee Schedule. Sources: MGMA Stat: https://www.mgma.com/mgma-stat/social-determinants-of-health-a-driving-force-in-medical-group-data-collection Physician Fee Schedule: 2024 Medicare Physician Fee Schedule Resources: MGMA Stat: mgma.com/stat Ask an Advisor: www.mgma.com/ask-an-advisor MGMA Membership: www.mgma.com/membership MGMA Advocacy: www.mgma.com/advocacy MGMA Consulting: www.mgma.com/consulting/overview If you would like additional tools and resources related to medical practice leadership or you have stories to share with us, email us at podcasts@mgma.com or email Daniel Williams directly at dwilliams@mgma.com. Thank you again for taking the time to listen to the MGMA podcast network.

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What Do Therapists Need To Do About Medicare? Opting in or out for 2024: An interview with Joy Alafia, CAE

The Modern Therapist's Survival Guide with Curt Widhalm and Katie Vernoy

Play Episode Listen Later Dec 18, 2023 48:41

What Do Therapists Need To Do About Medicare? Opting in or out for 2024: An interview with Joy Alafia, CAE Curt and Katie interview Joy Alafia, Executive Director of California Association of Marriage and Family Therapists, on the journey for MFTs and Counselors to become eligible to be Medicare providers. We look at the high-level tasks that every therapist needs to take. We also talk about the decision-making process for whether you should opt in or opt out, providing some basic guidance and resources on the steps you need to take now. Transcripts for this episode will be available at mtsgpodcast.com! In this podcast episode, we talk about MFTs and Counselors becoming Medicare Providers Curt and Katie have spent hours in advocacy efforts for MFTs and Counselors to become Medicare providers through their past involvement in the California Association of Marriage and Family Therapists (CAMFT). And it's finally gone through! We asked Joy Alafia to come join us to discuss this journey as well as what therapists need to do now that we're eligible to be Medicare providers. We answer the following questions and have a step by step guide in our show notes at mtsgpodcast.com: What was the process for MFTs and Counselors to be included in Medicare? Now that Marriage and Family Therapists and Counselors are eligible to bill Medicare, what do we need to do? What do therapists need to do if they would like to Opt In to provide Medicare services? What do therapists need to do if they would like to Opt Out of billing Medicare? What should therapists consider when deciding whether to take Medicare? · Clinical specialty – if you work with folks 65 and older or with disabled folks, you will want to strongly consider taking Medicare as these clients are typically eligible and would like to use their insurance · Access – if you have the ability (i.e., space in your caseload) to see Medicare patients, there is a huge need for providers who accept this insurance · Credibility – there is increased credibility as a provider when you are able to take Medicare · Rates – check out what the rates are for the areas where you see clients. To do so, look for your locality on the Physician Fee Schedule and multiply the rates by 75% if you are a masters level provider. If the rates are sufficient, you will consistently get clients and will consistently get paid. If the rates are not sufficient for your business, you will want to consider opting out and remaining private pay for these clients. · Documentation requirements – the documentation requirements are similar for most insurance plans, especially Medicaid. If you're able to keep clean, efficient documentation, this should not be a deterrent for taking Medicare · Billing complexity – you will want to make sure to take trainings available (see below) to understand how you will need to bill this insurance plan and/or hire a biller who does · Consistency and recession-proofing your practice – Medicare is known to pay consistently and provide a lot of clients for your practice. As the population ages, this will be a larger and larger portion of the folks seeking mental health services. You may want to consider taking Medicare. Resources for Modern Therapists mentioned in this Podcast Episode: We've pulled together LOTS of resources mentioned in this episode and put together some handy-dandy links. California Association of Marriage and Family Therapists (CAMFT) California Association of Marriage and Family Therapists (CAMFT) CAMFT's Medicare Corner (for CAMFT members) CAMFT's Medicare Webinars A TON of other Resources can be found on our website at mtsgpodcast.com. Stay in Touch with Curt, Katie, and the whole Therapy Reimagined #TherapyMovement: Our Linktree: https://linktr.ee/therapyreimagined Modern Therapist's Survival Guide Creative Credits: Voice Over by DW McCann https://www.facebook.com/McCannDW/ Music by Crystal Grooms Mangano https://groomsymusic.com/

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Final Rules and Health Equity

medicare health equity physician fee schedule

Play Episode Listen Later Nov 9, 2023 10:57

Kayla Holgash joins Julia Grabo to discuss health equity initiatives in some of last week's Medicare final rules for calendar year 2024: the Outpatient Prospective Payment System and Physician Fee Schedule.

The real cost of the 2024 Medicare physician fee schedule with Jason Marino

AMA COVID-19 Update

Play Episode Listen Later Nov 6, 2023 14:52

Physician Medicare payment is down 26% since 2001, when adjusted for inflation. When you look at the numbers, it's clear that the government needs to fix Medicare now for physicians. Jason Marino, director of Congressional affairs for the AMA, joins to break down the facts and figures and explain why reforming Medicare physician payment just makes sense. American Medical Association CXO Todd Unger hosts.

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Maximizing Profit: Understanding the 2024 Physician Fee Schedule

The PainExam podcast

Play Episode Listen Later Sep 26, 2023 37:44

The 2024 Physician Fee Schedule and Remote Patient Care with Rachel Trobman, CEO of Upside Health. Dr. Rosenblum and Rachel Trobman cover topics ranging from Remote Patient Care coding, acronyms, implementation, reimbursement and much more! Upcoming Workshops and Events ASPN Webinar: Continuing Eduction and Board Prep October 4, 2023 8PM Maximizing Profit: Understanding the 2024 Physician Fee Schedule Wednesday, September 20, 2023 8:00 PM NYC Regional Anesthesia and Pain Ultrasound CME Workshop Saturday, October 28, 2023 8:00 AM Charleston, SC Regional Anesthesia and Pain Ultrasound CME Workshop Sunday, October 29, 2023 9:00 AM NRAP Academy: Regenerative Pain Medicine Course NYC Saturday, November 11, 2023 8:00 AM NYC Regional Anesthesia and Pain Ultrasound CME Workshop Saturday, December 16, 2023 7:30 AM NYC Regional Anesthesia and Pain Ultrasound CME Workshop Saturday, January 6, 2024 7:30 AM

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The 2024 Physician Fee Schedule: Maximizing Physician Profit

The PMRExam Podcast

Play Episode Listen Later Sep 26, 2023 37:44

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Driving the Deal: Navigating the 2024 Physician Fee Schedule Proposed Rule with Holly Stokes

McDermott Health Podcast Channel

Play Episode Listen Later Aug 15, 2023 17:04

In this episode, host Brian Fortune, senior managing director at Farragut Square Group (FSG), is joined by FSG's own Assistant Vice President, Holly Stokes, in an insightful overview of the recently released 2024 Physician Fee Schedule (PFS) proposed rule. They shed light on the PFS's significance and impact on providers. Holly provides a comprehensive overview of the proposed changes, including the notable 3.4% cut to the conversion factor, and presents an outlook for potential congressional intervention as well as other specialty-specific changes.

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Telehealth Policies in the 2024 Physician Fee Schedule Proposed Rule

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Play Episode Listen Later Aug 3, 2023 16:37

Rachel Stauffer and Rachel Hollander explore the telehealth policies in the CY 2024 Physician Fee Schedule Proposed Rule and highlight key areas stakeholders should pay attention to during the comment period.

Having a Voice in the Payment System Based on RVUs for CPT® Codes

The Nurse Practitioner - The Nurse Practitioner Podcast

Play Episode Listen Later Aug 1, 2023 19:31

In this episode of The Nurse Practitioner Podcast, Julia Rogers, DNP, APRN, CNS, FNP-BC, FAANP discusses having a voice in the payment system based on RVUs for CPT® codes. Physician Fee Schedule: https://www.cms.gov/medicare/medicare-fee-service-payment/physicianfeesched/pfs-relative-value-files/rvu23b _________________________________________________________________ Podcast Sponsored By: Dakins Wound Cleanser When it comes to treating persistent, hard-to-heal, or complex wounds, you need a solution you can trust. Dakin's Wound Cleanser is an FDA approved device for wound cleansing and management. It's powerful, cost effective, and easy to order. Studies have shown this formulation to be effective in killing 99.99999% of MRSA, VRE and biofilm-forming bacteria within 30 seconds! (Barsoumian et. al) Visit http://shop.getdakins.com/affiliates/default.aspx?Affiliate=4&Target=Home to request a sample today!

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Highlights of the CY 2024 Physician Fee Schedule Proposed Rule

Play Episode Listen Later Jul 26, 2023 14:49

CMS recently released the CY 2024 Physician Fee Schedule Proposed Rule, which includes proposals related to Medicare physician payment and the Quality Payment Program (QPP). Jeffrey Davis and Rachel Hollander join the Breakroom to explore key takeaways of the proposed rule, including the conversion factor, the new add-on code for complexity and several delayed policies.

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In Depth: CMS Physician Fee Schedule Conversion Factor

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Play Episode Listen Later Jun 8, 2023 12:03

Rachel Hollander and Kristen O'Brien join the breakroom to give us a deep dive into the CMS Physician Fee Schedule Conversion Factor, what's wrong with it, what's being done to fix it and why it matters to healthcare stakeholders.

OTO: Reimbursement Trends in Pediatric Otolaryngology From 2000 to 2020: A CMS Physician Fee Schedule Analysis

SAGE Otolaryngology

Play Episode Listen Later Feb 2, 2023 32:54

Join Otolaryngology–Head and Neck Surgery's Editor in Chief Cecelia E. Schmalbach, MD, MSc, as she discusses the article “Reimbursement Trends in Pediatric Otolaryngology From 2000 to 2020: A CMS Physician Fee Schedule Analysis” with senior author Jay R. Shah, MD, and Associate Editor Thomas Q. Gallagher, DO. This engaging conversation touches on Common Procedural Terminology (CPT) codes, relative value units, reevaluation of CPT codes, and trends in reimbursements. Click here to read the full article.

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2023 Physician Fee Schedule + New Chronic Pain Management Codes

The PainExam podcast

Play Episode Listen Later Dec 21, 2022 35:48

Rachel Trobman, CEO of Upside Health and David Rosenblum, MD discuss updates to the 2023 Physician Fee Schedule + New Chronic Pain Management Codes, Remote Patient Monitoring and more! Claim CME Credit! This Podcast is not worth any CME Credit, but Credit can be Claimed for reflecting on content: The CE experience for this Podcast is powered by CMEfy - click here to reflect and earn credits: https://earnc.me/9AX9LN Upcoming Courses and Workshops! Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- Dec 3, 2022 Regenerative Interventional Pain Course NYC- Jan, 28, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine Tamarindo, Costa Rica- Feb. 19, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- March 11, 2023 Ultrasound Guided Regional Anesthesia and Pain Medicine NYC- April 22, 2023 Pain Management Board Review/Refresher Course/ Ultrasound Training NYC- June 9-11, 2023 NRAP: NYC Regional Anesthesia and Pain Ultrasound CME Workshop Registration, Sat, Dec 3, 2022 at 7:30 AM | Eventbrite For up to date Calendar, Click Here!

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In the first episode of Season 3, Meg, Melissa, and Brede catch up on all the Medicare news that happened over summer break including the passage of the Inflation Reduction Act, the Physician Fee Schedule proposed changes for MSSP, and the many new Requests for Information. Meg also checks in with Jason Rose, Chief Executive Officer of AdhereHealth, a healthcare technology solutions company centered on improving medication adherence, to get his take on the changes to Part D in the Inflation Reduction Act.

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The Virtual Shift: Foley & Lardner team on CMS 2023 Proposed Physician Fee Schedule

HealthcareNOW Radio - Insights and Discussion on Healthcare, Healthcare Information Technology and More

Play Episode Listen Later Jul 29, 2022 27:16

Host Tom Foley invites Foley & Lardner attorney team, TJ Ferrante, Nathaniel Lacktman, and Rachel Goodman to discuss the CMS 2023 Proposed Physician Fee Schedule. Discussion focus is on changes and additions to remote patient monitoring. The proposed rule is currently in comment period and they encourage you to participate. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

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Cost Efficiency with the CMS Merit-Based Incentive Payment System

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Play Episode Listen Later Jul 19, 2022 30:14

With the recent announcement of the 2023 Physician Fee Schedule, the Centers for Medicare & Medicaid Services (CMS) remains committed to encouraging and incentivizing cost efficiency by providers. Physicians electing to participate in the CMS Merit-Based Incentive Payment System (MIPS) will experience +/-9 percent impact in their traditional Medicare reimbursement based on their performance, 30 percent (2.7 percent of the total) of which is derived from cost efficiency based solely on claims data. During the next live edition of Talk Ten Tuesday, James S. Kennedy MD, will briefly review these MIPS inpatient and outpatient episode models, including screening colonoscopies, cataract surgery, knee and hip replacements, and many others that are being assessed, all of which make a coder's and CDI specialist's job more important than ever.For further information, you can hear Dr. Kennedy speak on this subject at the AAPC Regional HEALTHCON being held in Denver on August 4, 2022; learn more athttps://www.aapc.com/medical-coding-education/conferences/regional/denver/#tab-agenda.The live broadcast will also feature these other segments:Coding Report: Laurie Johnson, senior healthcare consultant with Revenue Cycle Solutions, LLC will report on the latest coding news.Tuesday Focus: PSIs, Providers and Queries: Christel Kemble, the PSI/HAC consultant for Covenant HIM, will report on the recent study concerning the Hospital-Acquired Condition (HAC) reduction program.News Desk: Timothy Powell, CPA, a consultant with Besler, will anchor the Talk Ten Tuesdays News Desk.Journaling John: John Zelem, MD, FACS, founder and CEO for Streamline Solutions Consulting, will continue with his next journal entry.Point of View: Terry Fletcher, a guest cohost who will be substituting for Dr. Erica Remer, will report on a subject that has appeared on her radar screen.

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July 15, 2022 This Week in Cardiology Podcast

This Week in Cardiology

Play Episode Listen Later Jul 15, 2022 20:45

The LIFE study, multimorbidity and evidence translation, cardiac arrest and therapeutic fashion, diabetes and cardiology, and EP cuts are the topics John Mandrola, MD, tackles in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I – LIFE Study and Substudy - LIFE: ARNI Does Not Best Valsartan in Advanced Heart Failure https://www.medscape.com/viewarticle/952681 - Tolerability of Sacubitril/Valsartan in Patients With Advanced Heart Failure: Analysis of the LIFE Trial Run-In https://www.jacc.org/doi/10.1016/j.jchf.2022.04.013 - Effect of Treatment With Sacubitril/Valsartan in Patients With Advanced Heart Failure and Reduced Ejection FractionA Randomized Clinical Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2785700 II – Early Angiography and Therapeutic Fashion - Emergency Angiography for Cardiac Arrest Without ST Elevation? https://www.medscape.com/viewarticle/975434 - Emergency vs Delayed Coronary Angiogram in Survivors of Out-of-Hospital Cardiac ArrestResults of the Randomized, Multicentric EMERGE Trial https://jamanetwork.com/journals/jamacardiology/article-abstract/2793310 - Immediate Coronary Angiography in Survivors of Out-of-Hospital Cardiac Arrest https://www.nejm.org/doi/full/10.1056/NEJM199706053362302 - Coronary Angiography after Cardiac Arrest without ST-Segment Elevation https://www.nejm.org/doi/10.1056/NEJMoa1816897 - Randomized Pilot Clinical Trial of Early Coronary Angiography Versus No Early Coronary Angiography After Cardiac Arrest Without ST-Segment Elevation https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.120.049569 - Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation https://www.nejm.org/doi/10.1056/NEJMoa2101909 - Most healthcare interventions tested in Cochrane Reviews are not effective according to high quality evidence: a systematic review and meta-analysis https://www.jclinepi.com/article/S0895-4356(22)00100-7/fulltext III – Diabetes and Cardiology - Medicare Advantage Tied to Less Use of Pricey Diabetes Drugs https://www.medscape.com/viewarticle/977181 - Diabetes Care Among Older Adults Enrolled in Medicare Advantage Versus Traditional Medicare Fee-For-Service Plans: The Diabetes Collaborative Registry https://doi.org/10.2337/dc21-1178 IV – EP Cuts - EP Ablation Rate Changes in 2022 Physician Fee Schedule https://www.acc.org/Latest-in-Cardiology/Articles/2021/11/18/01/44/EP-Ablation-Rate-Changes-in-2022-Physician-Fee-Schedule You also may like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Impact of COVID, 2021 wRVU Values, and 2022 Physician Fee Schedule on Fair Market Value and Stark Law Compliance

Stark Integrity

Play Episode Listen Later Mar 30, 2022 22:44

2020 and 2021 will have a long-term impact on Stark Law Compliance. In this episode, Captain Integrity Bob Wade details how the massive changes of the past couple years impact Fair Market Value and Stark Law Compliance. Hear the double whammy on physician compensation caused by COVID and the Physician Fee Schedule, why you need to be very careful in looking at total compensation, how to bill appropriately, insights from top surveys, and where there have been cash increases. Learn more at CaptainIntegrity.com

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Fast Facts for Ambulatory Care Pharmacist: 2022 Physician Fee Schedule Updates

ASHPOfficial

Play Episode Listen Later Dec 6, 2021 35:32

This podcast episode reviews updates to the Physician Fee Schedule and their effect on ambulatory care pharmacy practice. Listeners will receive an overview of the Physician Fee Schedule and its impact on various scenarios pharmacists may encounter in practice. The information presented during the podcast reflects solely the opinions of the presenter. The information and materials are not, and are not intended as, a comprehensive source of drug information on this topic. The contents of the podcast have not been reviewed by ASHP, and should neither be interpreted as the official policies of ASHP, nor an endorsement of any product(s), nor should they be considered as a substitute for the professional judgment of the pharmacist or physician.

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Managing The PTA Payment Cut

Agile&Me: A physical therapy leadership podcast series

Play Episode Listen Later Nov 14, 2021 42:35

In this podcast titled, “Managing The Proposed CMS Fee Schedule Cuts" we speak to TIffany Warden and Lindsey Nicholson. Patrick Slotman. Tiffany currently serves as the Clinical Compliance Officer at Alliance Physical Therapy. Lindsey is the Vice President of Clinical Operations at Alliance Physical Therapy Partners. Alliance Physical Therapy Partners is a leader in outpatient physical therapy. Our discussion focuses on:· What are the proposed payment reductions currently planned to take place at the start of 2022. · The background and current situation as it pertains to the proposed 2022 Medicare · Physician Fee Schedule and the implementation of a payment differential for PTAs and OTAs in 2022· What does it mean for the clinician and how the payment differential is applied· The likelihood of other payors following the payment reductions being introduced by CMS· How clinicians can manage and mitigate the payment reductions · Tactics and strategies to offset the lower reimbursement levels

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2022 Proposed Physician Fee Schedule: Part 2

MiraMed Global Services Podcast

Play Episode Listen Later Sep 9, 2021 8:56

Last week, we published an alert that outlined some of the key provisions of the Medicare Physician Fee Schedule (PFS) Proposed Rule (PR) for 2022 that may affect hospitals. As promised in that alert, this week's article will provide additional details arising from the 2022 PR.

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De Minimus Debunked: Physician Fee Schedule Updates 2022

Gravity Healthcare Hacks

Play Episode Listen Later Aug 1, 2021 7:32

In this episode, Melissa Brown, CEO/Host, will unpack some of the critical elements of the Physician Fee Schedule proposed rule, and discuss the advocacy that needs to occur prior to the final rule.

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Health Policy Breakroom - Ep 76 2022 CMS PFS Proposed Rules

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Play Episode Listen Later Jul 15, 2021 21:51

Sheila Madhani is back in the Policy Breakroom to explain the revisions to payment policies under the CY 2022 Physician Fee Schedule. She'll cover the key takeaways in payment changes, COVID flexibilities like telehealth, and the policies across the rules that promote health equity.

UCR 045: Modifier Rules and other data in the National Physician Fee Schedule Relative Value File; where it is in AUACodingToday and how we made it easier to understand

Urology Coding and Reimbursement Podcast

Play Episode Listen Later Apr 3, 2021 29:56

April 3, 2021Mark, Ray, and Scott had a question this week on whether or not you could use the bilateral modifier (-50) for code:54351 - Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnosticYou may be surprised at the answer!This prompted the discussion on data and where it comes from and how we have interpreted it and summarized it in AUACodingToday.com. The interpretation and summarization help make coding more efficient. Join the discussion:Urology Coding and Reimbursement Group - Join for free and ask your questions, and share your wisdom. Click Here to Start Your Free Trial of AUACodingToday.com

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Navigating Healthcare in 2021

Health Professional Radio - Podcast 454422

Play Episode Listen Later Jan 31, 2021 9:08

Dr. Michael Blackman, Chief Medical Officer at Greenway Health, a leading health information technology services provider, discusses navigating healthcare in 2021, how Greenway will further support its ambulatory care clients in the new year, major changes/updates regarding the 2021 Physician Fee Schedule, the role of interoperability in COVID-19 vaccine distribution, and more.

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Physician Fee Schedule and Hospital Outpatient Final Rules & Their Impact on Urology

AUA Inside Tract

Play Episode Listen Later Dec 29, 2020 64:20

Today's advocacy update from the AUA Inside Tract Podcast is a webinar about the Physician Fee Schedule and Hospital Outpatient final rules and s their impact on urology. This discussion includes a general overview of what new updates will take effect on or after January 1, 2021.

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Regulatory News Roundup: A Special 60-Minute Open Door Forum

NextGen®️ Advisors Podcast

Play Episode Listen Later Dec 7, 2020 59:07

Amid the chaos created by the coronavirus pandemic, the Centers for Medicare & Medicaid Services (CMS) released two major final rules this week: the 2021 Physician Fee Schedule and the Outpatient Prospective Payment System (OPPS), with the latter having been widely anticipated. Both final rules portend significant new regulatory changes for providers, patients, and payors. Given the gravity of these new changes, the next upcoming Monitor Mondays broadcast will encompass a special live open door forum to answer questions from listeners.Segments to be featured during the live broadcast include the following:Court Report: Famed whistleblower attorney Mary Inman, partner in the London law office of Constantine Cannon, will return to the broadcast to report on three major whistleblower cases.COVID-19: Frontline physician John Foggle will provide a real-time update on the raging spread of the coronavirus — at a time when Centers for Disease Control and Prevention (CDC) Director Robert Redfield is predicting that the U.S. death toll from COVID-19 could eclipse 450,000 by February.Monday Focus: Utilization Review: Dr. John Zelem, founder of Streamline Solutions Consulting, Inc., will report on the role of utilization review amid the pandemic.Rural Health Report: The nation’s rural communities are reported to be ravaged by COVID-19. Leslie Marsh, the CEO for Lexingtion Regional Health Center, will report on how her facility is being impacted by the pandemic.The Special Report: Andrew Dombro, MD will report on the impact of COVID-19 on providers and patients engaged in chronic care management.Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment, reporting on legal implications facing healthcare providers.Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.RAC Report: Healthcare attorney Knicole Emanuel, a partner at the law firm of Practus, will file the Monitor Mondays RAC Report.Legislative Update: Former CMS official Matthew Albright, now chief legislative affairs officer for Zelis, will report on the status of healthcare legislation associated with the current COVID-19 pandemic.SDoH Report: Ellen Fink-Samnick, a nationally recognized expert on the social determinants of health (SDoH), will report on the news that’s happening at the intersection of COVID-19 and the SDoH. Ellen will also conduct the Monitor Mondays Listeners Survey.

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Significant Potential Changes in the Proposed CMS 2021 Fee Schedule

Play Episode Listen Later Aug 28, 2020 19:36

In this episode, the NextGen® Advisors are joined by government affairs advisor, Chris Emper to discuss the potential game-changing impact of CMS's proposed 2021 Physician Fee Schedule. Tune in to learn more about how these payment changes could affect your practice's staffing, workflow, documentation requirements and revenue.

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The 2021 Proposed Physician Fee Schedule is out

CodeCast | Medical Billing and Coding Insights

Play Episode Listen Later Aug 11, 2020 29:00

In the last week, CMS proposed Medicare payment rules for outpatient services and physicians for 2021, including finalized payment rules for inpatient rehabilitation hospitals and psychiatric facilities. Looking specifically at the 2021 Physician Fee Schedule proposed rule, scheduled to be published on August 17th in the IFR, it had some surprises. The Budget Neutrality Act […] The post The 2021 Proposed Physician Fee Schedule is out appeared first on Terry Fletcher Consulting, Inc..

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AOTA Medicare Telehealth Success!!

Occupational Therapy Insights

Play Episode Listen Later May 1, 2020

At President Trump’s direction, and building on its recent historic efforts to help the U.S. healthcare system manage the 2019 Novel Coronavirus (COVID-19) pandemic, the Centers for Medicare & Medicaid Services today issued another round of sweeping regulatory waivers and rule changes to deliver expanded care to the nation’s seniors and provide flexibility to the healthcare system as America reopens. These changes include making it easier for Medicare and Medicaid beneficiaries to get tested for COVID-19 and continuing CMS’s efforts to further expand beneficiaries’ access to telehealth services. CMS is taking action to ensure states and localities have the flexibilities they need to ramp up diagnostic testing and access to medical care, key precursors to ensuring a phased, safe, and gradual reopening of America. Today’s actions are informed by requests from healthcare providers as well as by the Coronavirus Aid, Relief, and Economic Security Act, or CARES Act. CMS’s goals during the pandemic are to 1) expand the healthcare workforce by removing barriers for physicians, nurses, and other clinicians to be readily hired from the local community or other states; 2) ensure that local hospitals and health systems have the capacity to handle COVID-19 patients through temporary expansion sites (also known as the CMS Hospital Without Walls initiative); 3) increase access to telehealth for Medicare patients so they can get care from their physicians and other clinicians while staying safely at home; 4) expand at-home and community-based testing to minimize transmission of COVID-19 among Medicare and Medicaid beneficiaries; and 5) put patients over paperwork by giving providers, healthcare facilities, Medicare Advantage and Part D plans, and states temporary relief from many reporting and audit requirements so they can focus on patient care. “I’m very encouraged that the sacrifices of the American people during the pandemic are working. The war is far from over, but in various areas of the country the tide is turning in our favor,” said CMS Administrator Seema Verma. “Building on what was already extraordinary, unprecedented relief for the American healthcare system, CMS is seeking to capitalize on our gains by helping to safely reopen the American healthcare system in accord with President Trump's guidelines.” Made possible by President Trump’s recent emergency declaration and emergency rule making, many of CMS’s temporary changes will apply immediately for the duration of the Public Health Emergency declaration. They build on an unprecedented array of temporary regulatory waivers and new rules CMS announced March 30 and April 10. Providers and states do not need to apply for the blanket waivers announced today and can begin using the flexibilities immediately. CMS also is requiring nursing homes to inform residents, their families, and representatives of COVID-19 outbreaks in their facilities. New rules to support and expand COVID-19 diagnostic testing for Medicare and Medicaid beneficiaries “Testing is vital, and CMS’s changes will make getting tested easier and more accessible for Medicare and Medicaid beneficiaries,” Verma said. Under the new waivers and rule changes, Medicare will no longer require an order from the treating physician or other practitioner for beneficiaries to get COVID-19 tests and certain laboratory tests required as part of a COVID-19 diagnosis. During the Public Health Emergency, COVID-19 tests may be covered when ordered by any healthcare professional authorized to do so under state law. To help ensure that Medicare beneficiaries have broad access to testing related to COVID-19, a written practitioner’s order is no longer required for the COVID-19 test for Medicare payment purposes. Pharmacists can work with a physician or other practitioner to provide assessment and specimen collection services, and the physician or other practitioner can bill Medicare for the services. Pharmacists also can perform certain COVID-19 tests if they are enrolled in Medicare as a laboratory, in accordance with a pharmacist’s scope of practice and state law. With these changes, beneficiaries can get tested at “parking lot” test sites operated by pharmacies and other entities consistent with state requirements. Such point-of-care sites are a key component in expanding COVID-19 testing capacity. CMS will pay hospitals and practitioners to assess beneficiaries and collect laboratory samples for COVID-19 testing, and make separate payment when that is the only service the patient receives. This builds on previous action to pay laboratories for technicians to collect samples for COVID-19 testing from homebound beneficiaries and those in certain non-hospital settings, and encourages broader testing by hospitals and physician practices. To help facilitate expanded testing and reopen the country, CMS is announcing that Medicare and Medicaid are covering certain serology (antibody) tests, which may aid in determining whether a person may have developed an immune response and may not be at immediate risk for COVID-19 reinfection. Medicare and Medicaid will cover laboratory processing of certain FDA-authorized tests that beneficiaries self-collect at home. Additional highlights of the waivers and rule changes announced today: Increase Hospital Capacity - CMS Hospitals Without Walls Under its Hospitals Without Walls initiative. CMS has taken multiple steps to allow hospitals to provide services in other healthcare facilities and sites that aren’t part of the existing hospital, and to set up temporary expansion sites to help address patient needs. Previously, hospitals were required to provide services within their existing departments. CMS is giving providers flexibility during the pandemic to increase the number of beds for COVID-19 patients while receiving stable, predictable Medicare payments. For example, teaching hospitals can increase the number of temporary beds without facing reduced payments for indirect medical education. In addition, inpatient psychiatric facilities and inpatient rehabilitation facilities can admit more patients to alleviate pressure on acute-care hospital bed capacity without facing reduced teaching status payments. Similarly, hospital systems that include rural health clinics can increase their bed capacity without affecting the rural health clinic’s payments. CMS is excepting certain requirements to enable freestanding inpatient rehabilitation facilities to accept patients from acute-care hospitals experiencing a surge, even if the patients do not require rehabilitation care. This makes use of available beds in freestanding inpatient rehabilitation facilities and helps acute-care hospitals to make room for COVID-19 patients. CMS is highlighting flexibilities that allow payment for outpatient hospital services -- such as wound care, drug administration, and behavioral health services -- that are delivered in temporary expansion locations, including parking lot tents, converted hotels, or patients’ homes (when they’re temporarily designated as part of a hospital). Under current law, most provider-based hospital outpatient departments that relocate off-campus are paid at lower rates under the Physician Fee Schedule, rather than the Outpatient Prospective Payment System (OPPS). CMS will allow certain provider-based hospital outpatient departments that relocate off-campus to obtain a temporary exception and continue to be paid under the OPPS. Importantly, hospitals may also relocate outpatient departments to more than one off-campus location, or partially relocate off-campus while still furnishing care at the original site. Long-term acute-care hospitals can now accept any acute-care hospital patients and be paid at a higher Medicare payment rate, as mandated by the CARES Act. This will make better use during the pandemic of available beds and staffing in long-term acute-care hospitals. Healthcare Workforce Augmentation: To bolster the U.S. healthcare workforce amid the pandemic, CMS continues to remove barriers for hiring and retaining physicians, nurses, and other healthcare professionals to keep staffing levels high at hospitals, health clinics, and other facilities. CMS also is cutting red tape so that health professionals can concentrate on the highest-level work they’re licensed for. Since beneficiaries may need in-home services during the COVID-19 pandemic, nurse practitioners, clinical nurse specialists, and physician assistants can now provide home health services, as mandated by the CARES Act. These practitioners can now (1) order home health services; (2) establish and periodically review a plan of care for home health patients; and (3) certify and re-certify that the patient is eligible for home health services. Previously, Medicare and Medicaid home health beneficiaries could only receive home health services with the certification of a physician. These changes are effective for both Medicare and Medicaid. CMS will not reduce Medicare payments for teaching hospitals that shift their residents to other hospitals to meet COVID-related needs, or penalize hospitals without teaching programs that accept these residents. This change removes barriers so teaching hospitals can lend available medical staff support to other hospitals. CMS is allowing physical and occupational therapists to delegate maintenance therapy services to physical and occupational therapy assistants in outpatient settings. This frees up physical and occupational therapists to perform other important services and improve beneficiary access. Consistent with a change made for hospitals, CMS is waiving a requirement for ambulatory surgery centers to periodically reappraise medical staff privileges during the COVID-19 emergency declaration. This will allow physicians and other practitioners whose privileges are expiring to continue taking care of patients. Put Patients Over Paperwork/Decrease Administrative Burden CMS continues to ease federal rules and institute new flexibilities to ensure that states and localities can focus on caring for patients during the pandemic and that care is not delayed due to administrative red tape. CMS is allowing payment for certain partial hospitalization services – that is, individual psychotherapy, patient education, and group psychotherapy – that are delivered in temporary expansion locations, including patients’ homes. CMS is temporarily allowing Community Mental Health Centers to offer partial hospitalization and other mental health services to clients in the safety of their homes. Previously, clients had to travel to a clinic to get these intensive services. Now, Community Mental Health Centers can furnish certain therapy and counseling services in a client’s home to ensure access to necessary services and maintain continuity of care. CMS will not enforce certain clinical criteria in local coverage determinations that limit access to therapeutic continuous glucose monitors for beneficiaries with diabetes. As a result, clinicians will have greater flexibility to allow more of their diabetic patients to monitor their glucose and adjust insulin doses at home. Further Expand Telehealth in Medicare: CMS directed a historic expansion of telehealth services so that doctors and other providers can deliver a wider range of care to Medicare beneficiaries in their homes. Beneficiaries thus don’t have to travel to a healthcare facility and risk exposure to COVID-19. For the duration of the COVID-19 emergency, CMS is waiving limitations on the types of clinical practitioners that can furnish Medicare telehealth services. Prior to this change, only doctors, nurse practitioners, physician assistants, and certain others could deliver telehealth services. Now, other practitioners are able to provide telehealth services, including physical therapists, occupational therapists, and speech language pathologists. Hospitals may bill for services furnished remotely by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is at home when the home is serving as a temporary provider based department of the hospital. Examples of such services include counseling and educational service as well as therapy services. This change expands the types of healthcare providers that can provide using telehealth technology. Hospitals may bill as the originating site for telehealth services furnished by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is located at home. CMS previously announced that Medicare would pay for certain services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians. Now, CMS is broadening that list to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020. Until now, CMS only added new services to the list of Medicare services that may be furnished via telehealth using its rulemaking process. CMS is changing its process during the emergency, and will add new telehealth services on a sub-regulatory basis, considering requests by practitioners now learning to use telehealth as broadly as possible. This will speed up the process of adding services. As mandated by the CARES Act, CMS is paying for Medicare telehealth services provided by rural health clinics and federally qualified health clinics. Previously, these clinics could not be paid to provide telehealth expertise as “distant sites.” Now, Medicare beneficiaries located in rural and other medically underserved areas will have more options to access care from their home without having to travel Since some Medicare beneficiaries don’t have access to interactive audio-video technology that is required for Medicare telehealth services, or choose not to use it even if offered by their practitioner, CMS is waiving the video requirement for certain telephone evaluation and management services, and adding them to the list of Medicare telehealth services. As a result, Medicare beneficiaries will be able to use an audio-only telephone to get these services. In addition, CMS is making changes to the Medicare Shared Savings Program to give the 517 accountable care organizations (ACOs) serving more than 11 million beneficiaries greater financial stability and predictability during the COVID-19 pandemic. ACOs are groups of doctors, hospitals, and other healthcare providers, that come together voluntarily to give coordinated high-quality care to their Medicare patients. The goal of coordinated care is to ensure that patients get the right care at the right time, while avoiding unnecessary duplication of services and preventing medical errors. When an ACO succeeds both in delivering high-quality care and spending healthcare dollars more wisely, it may share in any savings it achieves for the Medicare program. Because the impact of the pandemic varies across the country, CMS is making adjustments to the financial methodology to account for COVID-19 costs so that ACOs will be treated equitably regardless of the extent to which their patient populations are affected by the pandemic. CMS is also forgoing the annual application cycle for 2021 and giving ACOs whose participation is set to end this year the option to extend for another year. ACOs that are required to increase their financial risk over the course of their current agreement period in the program will have the option to maintain their current risk level for next year, instead of being advanced automatically to the next risk level. CMS is permitting states operating a Basic Health Program to submit revised BHP Blueprints for temporary changes tied to the COVID-19 public health emergency that are not restrictive and could be effective retroactive to the first day of the COVID-19 public health emergency declaration. Previously, revised BHP Blueprints could only be submitted prospectively. CMS sets and enforces essential quality and safety standards for the nation’s healthcare system. It is also the nation’s largest health insurer, serving more than 140 million Americans through Medicare, Medicaid, the Children’s Health Insurance Program, and federal Health Insurance Exchanges. For additional background information on the waivers and rule changes, go to: https://www.cms.gov/newsroom/fact-sheets/additional-backgroundsweeping-regulatory-changes-help-us-healthcare-system-address-covid-19-patient For more information on the COVID-19 waivers and guidance, and the Interim Final Rule, please go to the CMS COVID-19 flexibilities webpage: https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current-emergencies/coronavirus-waivers. These actions, and earlier CMS actions in response to COVID-19, are part of the ongoing White House Coronavirus Task Force efforts. To keep up with the important work the Task Force is doing in response to COVID-19, visit www.coronavirus.gov. For a complete and updated list of CMS actions, and other information specific to CMS, please visit the Current Emergencies Website.

2020 Changes in Physician Payment

VillageMD Working Smarter

Play Episode Listen Later Jan 8, 2020 16:38

These CMS changes to the physician fee schedule are more good news for primary care! In this episode, we are joined by several special guests to walk us through these changes. We focus primarily on the codes that will significantly impact primary care physicians. All references and handouts are available on our website: https://vmdworkingsmarter.com/conversations/Thank you to all of our listeners for your comments and feedback. We love hearing from you! We are now available on Apple, Spotify, or wherever you get your podcasts. Don’t forget to subscribe and leave us a rating or comment. If you have a question, comment, or if you want to be a guest on Working Smarter, visit our website at: https://vmdworkingsmarter.com/

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Health Policy Breakroom Ep. 01: Overview of 2020 PFS and OPPS Final Rules

health policy opps breakroom physician fee schedule jessica roth

Play Episode Listen Later Nov 14, 2019 16:57

Introducing the Health Policy Breakroom, a new podcast from McDermott+Consulting! This episode, Emma Zimmerman is joined by McDermott+ Senior Directors Sheila Madhani and Jessica Roth to discuss the 2020 Physician Fee Schedule and Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System final rules. To view accompanying slides with more information on the rules, click here https://www.mcdermottplus.com/wp-content/uploads/2019/11/PFS-OPPS-ASC-CY-2020-Final-Rules.pdf. And stay turned for additional episodes on various provisions of the rules coming soon!

K&L Gates Triage: Quality Payment Program Updates in the CY2020 Physician Fee Schedule Proposed Rule - Part 3

K&L Gates Health Care Triage

Play Episode Listen Later Oct 17, 2019 9:39

In this week’s episode, Steve Pine presents the last installment of our three part series addressing the CMS Quality Payment Program (QPP) updates in the CY2020 Physician Fee Schedule (PFS) Proposed Rule. In this episode, Mr. Pine explains a number of Advanced Alternative Payment Models (APM) proposals, including new incentive structures and changes to applicable reporting requirements. Presenters: Steven G. Pine Download Presentation Materials

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K&L Gates Triage: Quality Payment Program Updates in the CY2020 Physician Fee Schedule Proposed Rule - Part 2

K&L Gates Health Care Triage

Play Episode Listen Later Oct 4, 2019 11:35

In this week’s episode, Kathy Barger presents the second in a three part series addressing the CMS Quality Payment Program (QPP) updates in the CY2020 Physician Fee Schedule (PFS) Proposed Rule. In this episode, Ms. Barger discusses several additional key Merit-Based Incentive Payment System (MIPS) proposals presented in the proposed rule, including those related to the weighting of performance categories and updates to MIPS performance thresholds. Presenters: Kathy G. Barger Download Presentation Materials

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K&L Gates Triage: Quality Payment Program Updates in the CY2020 Physician Fee Schedule Proposed Rule - Part 1

K&L Gates Health Care Triage

Play Episode Listen Later Sep 26, 2019 7:45

In this week’s episode, Limo Cherian presents the first segment of a three part series addressing the Centers for Medicare & Medicaid Services (CMS) Quality Payment Program (QPP) updates in the CY2020 Physician Fee Schedule (PFS) Proposed Rule. Ms. Cherian presents an overview of the QPP and discusses CMS’ newly proposed framework for Merit-based Incentive Payment System (MIPS) participation, the MIPS Value Pathways. Presenters: Limo T. Cherian Download Presentation Materials

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AMDA-On-The-Hill Volume VI

AMDA ON-THE-GO

Play Episode Listen Later Aug 26, 2019 12:03

The latest policy news from Director of Policy and Advocacy Alex Bardakh. Questions? Email Alex at abardakh@paltc.org Related Resources: Article on Physician Fee Schedule and Quality Payment Program Proposed Rules Article on Skilled Nursing Facilities Final FY 2020 Payment and Policy Changes Rule Info on Advanced Alternative Payment Models

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Around the Corner in Digital Health: What's Next for Care Coordination & Reimbursement

Of Digital Interest Podcast

Play Episode Listen Later Apr 11, 2019 23:59

The end of 2018 and the first months of 2019 brought a number of regulatory developments impacting care coordination and the adoption and reimbursement of digital health services. From the Centers for Medicare & Medicaid Services' (CMS) Regulatory Sprint to Coordinated Care and Pathways to Success initiatives to the updated Physician Fee Schedule, speakers Dale Van Demark and Lisa Schmitz Mazur discuss the rules and regulations that have the potential to enhance or hinder access to digital health solutions and how digital health companies can position themselves for success in this evolving regulatory landscape.

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New Codes for New Services

VillageMD Working Smarter

Play Episode Listen Later Mar 20, 2019 12:23

Starting January 2019, CMS has approved new codes for services that primary care physicians perform. This episode provides more detail on these services, which were previously introduced in our first episode. This will provide you information on how and when these codes relate to your practice.If you have a question, comment, if you want one of the samples we reference, or if you want to be a guest on Working Smarter, visit our website at: https://vmdworkingsmarter.com/

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Save Your Vision

Try Not To Blink

Play Episode Listen Later Mar 4, 2019 40:47

For a fact sheet on the CY 2019 Physician Fee Schedule proposed rule, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-07-12-2.htmlTo view the CY 2019 Physician Fee Schedule proposed rule, please visit: https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-14985.pdf For a fact sheet on the CY 2019 Quality Payment Program proposed rule, please visit: https://www.cms.gov/Medicare/Quality-Payment-Program/Resource-Library/2019-QPP-proposed-rule-fact-sheet.pdfTo view the CY 2019 Quality Payment Program proposed rule, please visit: https://s3.amazonaws.com/public-inspection.federalregister.gov/2018-14985.pdfFor a fact sheet on the Medicare Advantage Qualifying Payment Arrangement Incentive (MAQI) Demonstration, please visit: https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-07-12.html

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Episode 1: Evaluation and Management Coding

CMS: Beyond the policy

Play Episode Listen Later Feb 19, 2019 9:41

An overview of recent changes to Evaluation and Management Coding as finalized in the 2019 Physician Fee Schedule.

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What You Need to Know About the Final 2019 Medicare Physician Fee Schedule and Quality Payment Program Rule

ASCO in Action Podcast

Play Episode Listen Later Jan 8, 2019 8:25

Subscribe through iTunes and Google Play. Welcome to this ASCO in Action podcast. This is ASCO's podcast series where we explore policy and practice issues that have an impact on oncologists, the entire cancer care delivery team, and most importantly, the individuals we care for-- people with cancer. My name is Clifford Hudis, and I'm the CEO of ASCO, as well as the host of the ASCO in Action podcast series. For today's podcast, I'm going to give our listeners a quick update on an important announcement from the Centers for Medicare and Medicaid Services. In an August podcast, I outlined the proposed Medicare Physician Fee Schedule and the Quality Payment Program Rule for 2019. This is commonly referred to as the Physician Fee Schedule. Today, I'm going to provide an update on where we are with this for next year. I have to say in passing, it's probably a good day for me not to have a guest, because I'm here with a terrible cold. So what is the 2019 Medicare Physician Fee Schedule? This is a fee schedule which consists of a complete listing of all of the fees that Medicare uses to pay doctors or other providers and suppliers. It's a comprehensive listing of the maximum fees. And it's updated each year and then used to provide reimbursement to physicians and other providers working on a fee-for-service basis. Now at ASCO, we, every year, review this rule very closely. And we try to determine and predict the impact that it will have on our members, and of course, on our patients. There are three provisions in particular that we want to highlight today. The first of these is related to care provided in calendar year 2019. And CMS estimates that there will be, overall, a 1% reimbursement cut for hematology and oncology, as well as radiation oncology specialties. It is important to note, however, that the actual impact on any individual physician or physician practice will depend on their mix of services-- that is, what it is they exactly provide and bill. Now the administration has publicly stated its aim to reduce the growing administrative burden that we've all been noting and complaining about for the last few years. And the second item we want to point out is there is some evidence of their sensitivity to this issue in the 2019 fee schedule. They intend to reduce the documentation required for evaluation and management services, frequently referred to as E/M. What CMS did is finalize provisions that consolidate E/M payments. And ASCO had expressed concerns about this previously, which the agency acknowledged, along with other stakeholders, by revising the proposal. And, if fully implemented, they believe that the impact will be delayed-- that is, it will not impact providers until 2021. But by that time, CMS plans to consolidate what has historically been Levels 2, 3, and 4 into a single billing level, and then to pay for Level 5 E/M services separately. So overall, this represents a simplification. And it fulfills one of their stated aims, again, of reducing some of the administrative burden that practitioners face. Finally, the third area that I want to highlight is a new rule starting in 2019 that refers to the amount of reimbursement you will receive for new Medicare Part B drugs. Currently, those drugs in Part B are reimbursed at wholesale acquisition cost plus 6%. They will, going forward, be reimbursed at wholesale acquisition cost plus 3%. It's critically important to emphasize that this relates only to those new drugs that are introduced into the supply chain this year. This new provision will also apply to drugs that have not yet reported an average sales price. But the point is it will not apply to drugs that have already been in use. So it only applies to new drugs, meaning that its reach is going to be relatively limited. However, what you can imagine going forward with each new year and new drugs being introduced is that the percentage over wholesale acquisition cost will translate into more and more absolute dollars. And therefore, this may be a growing concern for practices. I want to switch our attention and talk about the Quality Payment Program, or QPP. In the final rule, there is an update to QPP for 2019. The final 2019 payment adjustment for Merit-based Incentive Payment System, or MIPS, practices and providers will become plus or minus 7%. And it will have adjustments to maintain budget neutrality, as well as to reward exceptional performance. Other noteworthy changes will include an increase in the MIPS performance threshold from 15 points, which is where we were in 2018, up to 30 points for 2019. CMS also finalized two new optional opioid-related measures that MIPS providers can use to report on under the Promoting Interoperability category. These measures will give providers an opportunity to earn bonus points and therefore potentially boost their overall MIPS score. These are the two measures specifically. One allows for checking a prescription drug monitoring program, or PDMP, prior to submitting an electronic opioid prescription for any individual patient. And the second is an attempt to verify an existing opioid treatment agreement with the patient receiving the prescription. So I hope that this summary of the updates to the Physician Fee Schedule for 2019 is helpful to our listeners. Ultimately, our goal is to make sure that oncologists can provide the right treatment to the right patient at the right time. And we aim to help CMS implement policies that will advance that goal. ASCO will continue to work closely with the administration to ensure that CMS understands the needs of the oncology community and the full impact that the rule is likely to have. I would encourage you, if you need more information on the Medicare Physician Reimbursement Plan for 2019, to visit ASCO in Action's website. That's at ASCO.org/ASCOaction. And ASCOaction is written as one word. We have a link to the final rule there. And we also have a helpful, I think, webinar that explains the final rule schedule and QPP rule in greater detail. So hoping this is helpful. Until next time, I want to thank you all for listening to this ASCO in Action podcast and hope you don't catch my cold.

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To Link, or not to Link: That is the Question for Physician Documentation

Play Episode Listen Later Nov 27, 2018 29:26

Are you experiencing this dilemma at your facility? You ask your physicians to add linking verbiage to their documentation for accuracy, which in turn has a negative impact on their publicly reported scores regarding complications and other metrics. Should physicians exclude the linking verbiage? Should they enter “as expected,” or should they simply avoid addressing these issues? Reporting on this complex issue during the next edition of Talk Ten Tuesdays will be Sharon Savinsky, clinical documentation improvement specialist (CDIS) team manager at Winchester Medical Center in Winchester, Va.Other segments to be featured on the broadcast include:News Desk: Laurie Johnson will anchor the Talk Ten-Tuesdays News Desk. Johnson is a senior healthcare consultant with Revenue Cycle Solutions, LLC and an ICD10monitor contributor. Coding Report: Although the Centers for Medicare & Medicaid Services (CMS) has released the final rule on the 2019 Medicare Physician Fee Schedule (MPFS), Dr. Jeffrey Lehrman will report on one issue that CMS did not include in its extensive update.Tuesday Focus: Alarms are being sounded because of the clinical and privacy issues being raised as a result of offshore coding. Terry Fletcher, a nationally recognized professional physician coding consultant, educator and auditor, will report this developing story.TalkBack: Talk Ten Tuesdays co-host Erica Remer, MD, FACEP, CCDS, founder and president of Erica Remer, MD, Inc., will report on the recent decision by U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) to conduct DRG validation audits.

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The Enigma of Sepsis: Providers vs. Payers

Play Episode Listen Later Nov 13, 2018 28:46

When it comes to defining sepsis, who wins? Is it providers, who rely on the current definition of sepsis as “life-threatening organ dysfunction caused by a dysregulated host response to infection?” Or do payers prevail – the ones who control the reimbursement? And under what circumstances would you ever side with a carrier that has denied a claim of sepsis?Reporting our lead story during this edition of Talk Ten Tuesdays will be Roland Dale, responsible for denials prevention, for Hardin Medical Center, who shares his experience in these situations while offering important and timely advice.Other segments to be featured on the broadcast include:News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, anchors the Talk Ten Tuesdays News Desk.Dateline Washington: Talk Ten Tuesdays legislative analyst Rhonda Taller has the latest news coming out of Washington, D.C. Rhonda is a member of the HIMSS professional development committee.Tuesday Focus: The Centers for Medicaid & Medicare Services (CMS) last week released the final rule on the 2019 Medicare Physician Fee Schedule (MPFS) and the Quality Payment Program (QPP). Reporting this developing story is Dheeraj Mahajan, MD, president and CEO of Chicago Internal Medicine Practice and Research (CIMPAR, SC), who leads its affiliated group of companies.TalkBack: Talk Ten Tuesdays co-host Erica Remer, MD, FACEP, CCDS, founder and president of Erica Remer, MD, Inc., will report on the Global Leadership Initiative on Malnutrition (GLIM) during her popular TalkBack segment.

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Court Orders HHS to Clear Medicare Appeals Backlog

Play Episode Listen Later Nov 12, 2018 30:31

U.S. District Court Judge James E. Boasberg ruled last week that the U.S. Department of Health and Human Services (HHS) must eliminate the Medicare appeals backlog by the end of fiscal year 2022. Reporting our lead story during the next edition of Monitor Mondays will be healthcare attorney Andrew Wachler, managing partner of Wachler and Associates.In other news, the Centers for Medicare & Medicaid Services (CMS) released its 2019 Medicare Home Health final rule. Reporting on this major story will be William Dombi, president of the National Association for Home Care and Hospice.The broadcast rundown also will include:Death by Cyber, Part III: RACmonitor investigative reporter and New York attorney Edward Roche will report on how healthcare IT adds to the cost of healthcare, but without offering benefits.Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron will report on another example of a potentially troublesome issue that could pose a risk to your facility.Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, will return to report on all the latest hot topics.Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, will be making his Monday Rounds with another installment of his popular segment.

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Physician Burnout and PTSD: How Traumatic Events Impact Care

Play Episode Listen Later Nov 6, 2018 29:22

The tragic events that shocked the nation’s collective conscience on an otherwise peaceful recent Saturday morning call to mind the intersection of physician burnout and post-traumatic stress syndrome.With physician burnout reported to be widespread and suicides among physicians escalating at an alarming rate, do disasters – both natural and manmade – disproportionately impact the profession? Or are there other conflicts endemic to healthcare that tear at the emotional and mental health of physicians, thus creating a sense of helplessness?Reporting on our lead story during this edition of Talk Ten Tuesdays will be Dr. Tracy Sanson, a practicing emergency physician, consultant, and educator on leadership development and medical education. A national and international speaker, Dr. Sanson also serves as a core faculty member for the American College of Emergency Physicians.Other segments to be featured on the broadcast include:CDI Report: What does the future of clinical documentation integrity (CDI) look like? Mel Tully, vice president of clinical services and education for the healthcare division of Nuance Communication, reports on the evolution of CDI as an integrated, interdisciplinary function impacting patient care.News Desk: Timothy Powell, compliance expert and ICD10monitor national correspondent, anchors the Talk Ten Tuesday News Desk.Tuesday Focus: Julie Dooling, a director at the American Health Information Management Association (AHIMA), reports on health information management challenges and tips for hospitals and other healthcare organizations in the aftermath of a hurricane, specifically in light of the devastation recently brought by Hurricane Michael.RegWatch: Leading healthcare technology consultant Stanley Nachimson returns to the broadcast to report on the final rules for the Medicare Physician Fee Schedule and the Quality Payment Program (QPP) that were released by the Centers for Medicare & Medicaid Services (CMS) on Thursday. TalkBack: Talk Ten Tuesdays co-host Erica Remer, MD, FACEP, CCDS, founder and president of Erica Remer, MD, Inc., reports on an issue that recently caught her attention during her popular TalkBack segment.

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Last Chance to Take a Stand: Comment Period for Proposed E&M Changes Ends

Play Episode Listen Later Sep 9, 2018 30:28

Few proposals from the Centers for Medicare and Medicaid Services (CMS) have generated such a plethora of opposition from concerned stakeholders as the agency’s recent proposed evaluation and management (E and M) reimbursement changes in the 2019 Medicare Physician Fee Schedule. The outrage has been intense over the plan to reimburse new patient visits at a single flat rate for codes 99202-99205 (99201 would be paid at a lower rate), while a corresponding, lower flat rate would apply to established patient visit codes 99212-99215. Code 99211 would also be paid a lower rate. The level 1 codes don’t get the flat rate, because they don’t require the presence of a physician. Making a final stand in opposition to the proposed changes during this edition of Monitor Mondays will Dr. Steven J. Meyerson, board-certified in internal medicine and geriatrics, and Holly Louie, past president of the Healthcare Business and Management Association. The broadcast rundown also will include: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Monday Focus: Social Determinants of Health (SdoH) are coming into sharp focus, as Tropical Gordon impacted parts of the Central Gulf Coast this week. It brought with it memories of Hurricane Harvey and its impact that is still being experienced in Houston, especially among the poor, the unemployed, and the disenfranchised – those who are predisposed to SDoH. Reporting on the compliance issues surrounding SDoH will be nationally recognized topic authority Ellen Fink-Samnick. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest hot topics. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility. Monitor with us™

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Proposed E&M Changes: The Good, the Bad, and the Ugly

Play Episode Listen Later Aug 20, 2018 28:16

Backlash continues over the Centers for Medicare & Medicaid Services (CMS) proposed changes to evaluation and management (E&M) coding and reimbursement found inside the proposed 2019 Medicare Physician Fee Schedule. But it’s not all bad news. On this edition of Talk Ten Tuesdays, when Sally Streiber, president of Practical Coding Solutions, LLC, returns to the broadcast and launch part one of her two-part series reviewing the proposed changes. Sally will begin the first part of her series with the “ugly,” notably a 50 percent reduction of the less-expensive service when an E&M code and a procedure are billed on the same date of service. Sally will return on Aug. 28 with part two, reporting the good and the bad of other anticipated impacts. Other segments to be featured on the broadcast include: Talk Tuesdays News Desk: The NFL continues to make payouts for former players who have been diagnosed not only with chronic traumatic encephalopathy, but now Parkinson’s and amyotrophic lateral sclerosis (ALS), according to a recent news report by the Los Angeles Times. Senior healthcare consultant Laurie Johnson, an ICD10monitor contributor, reports on the clinical indicators of these two diagnoses in advance of the NFL season, which kicks off Sept. 6. Mental Health Report: Feeling the heat? With unseasonably hot weather plaguing most of the U.S., physicians are feeling another kind of burn; burnout. A recent study reports that 52 percent of physicians feel burned out regularly. Returns to report on this topic will be nationally renowned psychiatrist H. Steven Moffic, MD, the Talk Ten Tuesdays resident psychiatrist. TalkBack: Talk Ten Tuesdays co-host Erica Remer, MD, FACEP, CCDS, founder and president of Erica Remer, MD, Inc., reports on her personal role as a patient advocate for her ailing father. Joining the conversation will be Caitlin Donovan, director of outreach and public affairs for the National Patient Advocate Foundation. Talk Ten Tuesdays. More than just talk.™

CMS, Are You Listening? Podiatrists React Negatively to Proposed E&M Changes

Play Episode Listen Later Aug 19, 2018 30:25

“Podiatrists should not be discriminated against any further. E&M (evaluation and management) requirements are the same as (those for) other providers, and we should be reimbursed justly,” one podiatrist recently wrote, expressing his opposition to the Centers for Medicare & Medicaid Services’ (CMS’s) proposed E&M reimbursement changes in the recently posted 2019 Medicare Physician Fee Schedule. “If Medicare is going to change E&Ms to only two codes, then all specialists should be changed,” another opined. “All I have to ask is what about optometrists? Why aren't you focused on them as well?” Reported by RACmonitor, the controversy centers on the proposal by CMS to reimburse new patient visits at a single flat rate for codes 99202-99205 (99201 would be paid at a lower rate), while a corresponding, lower flat rate would apply to established patient visit codes 99212-99215. Code 99211 would also be paid a lower rate. The level 1 codes don’t get the flat rate, because they don’t require the presence of a physician. Reporting on this developing story on this edition of Monitor Mondays will be Jeffrey D. Lehrman, DPM, diplomate of the American Board of Foot and Ankle Surgery. The broadcast rundown also will include: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Monday Focus: The proposed E&M changes are expected to impact providers’ bottom lines. But by how much? Senior healthcare analyst Frank Cohen, director of business intelligence and analytics for DoctorsManagement, has done the math and shares his analysis. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility. False Claims Act Report: Nationally recognized whistleblower attorney Mary A. Inman, partner at Constantine Cannon’s London office, has an update on the $65 million settlement by Prime Healthcare to resolve allegations that its hospitals submitted false Medicare claims. Medicare Report: Monitor Mondays national correspondent J. Paul Spencer, a senior healthcare consultant for DoctorsManagement, continues to report on the vexing issue of Medicare compliance. Monitor with us™

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Controversy Continues to Swirl Around Proposed E&M Changes

Play Episode Listen Later Aug 12, 2018 30:27

The Centers for Medicare & Medicaid Services’ (CMS’s) proposed evaluation and management (E&M) code changes in the recently posted 2019 Medicare Physician Fee Schedule continue to generate controversy. The controversy centers around the proposal by CMS to reimburse new patient visits at a single flat rate for codes 99202-99205 (99201 would be paid at a lower rate), while a corresponding, lower flat rate would apply to established patient visit codes 99212-99215. Code 99211 would also be paid a lower rate. The level 1 codes don’t get the flat rate, because they don’t require the presence of a physician. Reporting this developing story during this edition of Monitor Mondays will be Shannon DeConda, founder and president of the National Alliance of Medical Auditing Specialists (NAMAS) as well as president of coding and billing services and a partner at DoctorsManagement, LLC. The broadcast rundown also will include: Monday Rounds: Ronald Hirsch, MD, vice president of R1 Physician Advisory Services, makes his Monday Rounds with another installment of his popular segment. Monday Focus: Lori O’Hara, the lead of the additional documentation request (ADR), appeals, and clinical review team for Ensign Services, a provider of skilled nursing and assisted living services, reports on the impact of the Inpatient Prospective Payment System (IPPS) final rule as it pertains to skilled nursing facilities. Hot Topics: Monitor Mondays senior correspondent Nancy Beckley, president and CEO of Nancy Beckley and Associates, reports on all the latest hot topics and present the Monitor Mondays Listener Survey. Risky Business: Healthcare attorney David Glaser with Fredrikson & Byron reports on another example of a potentially troublesome issue that could pose a risk to your facility. IRF Report: One of the nation’s most respected authorities on Inpatient Rehabilitation Facility (IRF) provider issues, Angela Phillips, president and chief executive officer for Images & Associates, reports on IRF provisions that will be impacted by the IPPS final rule. Monitor with us™

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2019 Medicare Physician Fee Schedule and the Outpatient Prospective Payment System: Analyzing the Impacts on Providers