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1 1 Practice Revenue Enhancers Michael Fessenden, M.D., MBA Chief Medical Officer, Alegis Care.

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Presentation on theme: "1 1 Practice Revenue Enhancers Michael Fessenden, M.D., MBA Chief Medical Officer, Alegis Care."— Presentation transcript:

1 1 1 Practice Revenue Enhancers Michael Fessenden, M.D., MBA Chief Medical Officer, Alegis Care

2 2 2 3 General Categories to Evaluate What you are already doing; are you billing and getting paid appropriately? Payer opportunities (or penalties). Changing your practice; focus on a new “niche”.

3 3 3 Are You Paid for Everything You Do? How does your billing and coding distribution compare to national averages? – CMS publishes “averages” per specialty yearly – From my experience, most physicians “under code” as a general rule because they undervalue their medical decision making and don’t understand the components of determining the proper coding level. Are you billing for the time you spend addressing issues for patients receiving home health or post discharge care? – Post Hospitalization Transitional Codes – Care Plan Oversight

4 CMS FP New Patient Billing Distribution

5 CMS FP Established Patient Billing Distribution

6 6 6 Are You Paid for Everything You Do? Resources to Help – How to Analyze Your E/M Coding Profile by Betsy Nicoletti in the April 2007 Family Practice Management. – Kent Moore’s series of documentation guidelines from 2010 (Mar/Apr, May/Jun, Jul/Aug) Family Practice Management. – Systems/Statistics-Trends-and- Reports/MedicareFeeforSvcPartsAB/MedicareUtilizati onforPartB.html Systems/Statistics-Trends-and- Reports/MedicareFeeforSvcPartsAB/MedicareUtilizati onforPartB.html

7 7 7 Are You Paid for Everything You Do? New Codes for 2013; “Transitional Care” Code: Code Type:e/m Patient Status to the Practice:Est. Estimated RVU Work Value: Estimated Payment: Basic Requirements:1. F2F visits within 14 days of discharge1. F2F visit within 7 days of discharge 2. Direct contact with patient within 2 days of discharge 3. Moderate Level of Medical Decision Making3. High Level of Medical Decision Making 4. Includes non face to face activities 5. Office Level pays $ Office Level pays $152.48

8 8 8 Are You Paid for Everything You Do? Discussed doing a G code for non face-to-face time post discharge dedicated to a patient similarly to a Care Plan Oversight but this did not make the cut. Because the G code did not occur, you could perform Care Plan Oversights if post discharge home health was necessary and you document your time. Care Plan Oversights

9 9 9 Where to get more information AAFP PDF Regarding Transitional Codes AAFP PDF Regarding Transitional Codes – dule.Par.0001.File.dat/Final2013MPFS pdf dule.Par.0001.File.dat/Final2013MPFS pdf Pennsylvania Medical Society Regarding Transitional Codes – Rule-Care-Coordination.html Rule-Care-Coordination.html AAFP Care Plan Oversight Summary AAFP Care Plan Oversight Summary -

10 10 Payer Opportunities Medicare – EMR Meaningful Use To avoid payment penalties: If you demonstrated meaningful use in ‘11 or ‘12; you need to demonstrate it for all of ‘13. If demonstrating in ‘13; must be on for 90 days to avoid 2015 penalties. Money is available to help, I strongly recommend a “EMR partner” to help. Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/eh rincentiveprograms/ Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/eh rincentiveprograms/ – E-prescribing 2013: 0.5% incentive for successful prescribers or 1.5% penalty for non-successful electronic prescribers. This may be avoided if we achieve meaningful use during certain eRx payment adjustment reporting periods.

11 11 Payer Opportunities Medicare Continued – PQRI 2013: 0.5% incentive based on the practice’s total estimated Medicare Part B allowed charges for covered professional services furnished during the reporting period or 1.5% penalty on practices in 2015 that did not successfully participate in the 2013 PQRS. The hardest part is understanding what you need to do to qualify……and then waiting.

12 12 Payer Opportunities Medicare Advantage – Getting Paid for Annual Health Risk Assessments A complete history and physical Essentially the equivalent of a Welcome to Medicare Exam – Be proactive with the plans and ask them what you could do for them and be paid for doing it.

13 13 Payer Opportunities Medicaid – Paying at Medicare Rates in but then what happens? – Make sure that you are billing the secondary payer on your “dual eligible” patients.

14 14 Changing Your Practice Having a “niche” in your practice. Examples: – Cosmetics such as Botox and Fillers – Sports Medicine – Incorporating Home Visits – Adding Diagnostic Services such as lab and x-rays.

15 15 Summary Keys 1. Get paid for what you are already doing. 2. Take advantage of all “required” practice enhancements. 3. Evolve your practice based upon your enjoyment. Thanks. Questions?


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