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14th Annual Joint National Podiatric CAC-PIAC Representatives’ Meeting 14TH ANNUAL CAC-PIAC November 7-8, 2014 Washington, DC.

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Presentation on theme: "14th Annual Joint National Podiatric CAC-PIAC Representatives’ Meeting 14TH ANNUAL CAC-PIAC November 7-8, 2014 Washington, DC."— Presentation transcript:

1 14th Annual Joint National Podiatric CAC-PIAC Representatives’ Meeting 14TH ANNUAL CAC-PIAC November 7-8, 2014 Washington, DC

2 14TH ANNUAL CAC-PIAC  Located on the APMA CAC-PIAC page:  Available to all APMA and state component members Meeting Materials

3 14TH ANNUAL CAC-PIAC  Important Takeaways: Kathy Bryant, JD, CMS, HHS Medicare Physician Fee Schedule final rule, unveiled on October 31, to be published in the Federal Register on November 13. Conversion of 10- and 90-day global surgical services to 0-day global services by CY 2017 and CY 2018, respectively, fraught with challenges. For misvalued codes, if reductions do not meet 0.5%, CMS will have to start reduce across the board to meet the 0.5% threshold (congressional mandate). CMS initiatives may not currently offer opportunities for podiatry but could in the future. Update on Medicare Physician Fee Schedule for CY 2015 and Physician Payment

4 14TH ANNUAL CAC-PIAC  Important Takeaways: Henry Desmarais, MD, MPA, Health Policy Alternatives DPMs will see no change on average to total allowed charges. Conversion to 0-day global services may not impact podiatrists as negatively as other specialties. Value-based modifier: for CY 2017, 10+ group practice (positive, negative, neutral impact), solo practitioners and 2+ group practice (positive, neutral impact). Must satisfy PQRS requirements to avoid decrease. Continuing medical education (CME)-related changes affecting the Open Payments/Sunshine Act reporting requirements restore a level playing field for CME programs in podiatry. DPMs (and all other physicians) need to start paying far more attention to the Quality and Resource Use Reports (QRURs) made available by CMS. Medicare Policy Issues for DPMs

5 14TH ANNUAL CAC-PIAC  Important Takeaways: Erika D. Williams, MPA, NSC Know, review, and comply with the supplier standards. If physician–supplier has hours posted, PECOS/CMS-855S must reflect posted hours (unannounced site inspections may occur at any time). To report system/navigation issues with PECOS, contact the External User Services (EUS) Help Desk at Contact the NSC for general enrollment questions. Beneficiaries are serviced must have billing privileges. 42 CFR requires every supplier to revalidate every 3 years (revalidation materials sent in a yellow envelope). CMS Revalidation List notifies suppliers if revalidation has been mailed. Understanding Physician Supplier Enrollment and Related Issues

6 14TH ANNUAL CAC-PIAC  Important Takeaways: William Rogers, MD, CMS Stressed the ever increasing cost of health care in the US. Trend of increasing enrollment in Medicare Advantage plans. Congressional focus on audit programs (RACs, ZPICs), which bring money back. Physician Regulatory Issues

7 14TH ANNUAL CAC-PIAC  Important Takeaways: Jim Christina, DPM, APMA 2014 is last year where participating in PQRS and meaningful use is not mandatory. For PQRS in 2015, no more incentive payments so participation is required to avoid the 2017 payment reduction (2% of all Medicare Part B FFS payments). In the future, becoming increasingly difficult to participate in PQRS without an EHR. New CMS guidance on when to complete a security risk analysis: Must be conducted/review during each program year for Stage 1 and 2. Hardship exception applications to avoid the 2015 Medicare payment adjustment due November 30. PQRS and Meaningful Use

8 14TH ANNUAL CAC-PIAC  Important Takeaways: Kelli Back, Esq. Consider the pros and cons of participating in Medicare Advantage Organizations. Stay tuned for updates on federal agency guidance on the ACA provider non-discrimination provision. Be aware of your rights in regards to provider terminations. Be aware of your rights and responsibilities when acting as an authorized representative. Template letter located in the APMA Private Insurance Resource Guide (PIRG), Emerging Issues in Private Insurance

9 14TH ANNUAL CAC-PIAC  Important Takeaways: J. Kevin West, Esq. To avoid audits, investigations and big overpayments, DPMs should: implement and follow a written corporate compliance plan Available at have competent, well-trained billing staff or billing service; and use all available resources to stay informed. E.g., APMA Coding Resource Center, Examples of most commonly audited codes Current audit environment Leading Sources of Audits and How to Protect Your Practice

10 14TH ANNUAL CAC-PIAC  APMA Federal Legislative Update  APMA Health Policy and Practice Initiatives  Coding Update (ICD-10, modifier 59)  BMAD  DME Panel  CAC Breakout Session  PIAC Breakout Session Additional Highlights


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