CMS logoAre you an eligible professional or part of a group practice participating in PQRS this year? If so, you must satisfactorily report data on quality measures during 2014 to avoid the 2016 payment adjustment.

 CMS logoOn April 1, 2014, President Obama signed legislation that delays the scheduled Sustainable Growth Rate (SGR) cut to physician payments for one year (and delay ICD-10 implemetation!).

While fee-for-service is not going away anytime soon that we can see, many alternative payment models are in play impacting how physicians manage their patients, document the patient encounter and manage re-visits. Many factors are now being considered to determine the amount of reimbursement the provider receives as we see the shift to determine payment moving from volume to value.

The transition to ICD-10 is the biggest change to face our industry in decades. Essentially everything associated with coding a patient encounter and submitting that encounter for payment is going to have to change.  There is the potential for major disruption in operations, payment streams and productivity for those that don’t adequately prepare. So, how do you survive? For many practices, the best option will be to engage with a revenue cycle partner that has already made the investment in the tools, systems and training and can provide a turnkey solution for your practice.

The passage of the Affordable Care Act empowered CMS to encourage new payment models by changing reimbursement structures driving an evolution from pay for volume to pay for outcome.

If you thought it was difficult for your practice to field patient questions that start with “Do you accept?” in the past, health exchange plans have just made it more difficult to answer. Each plan participating in a state exchange has identified or created a network to service members and they vary widely. Look at the exchanges as another plan type as you would Medicare Advantage or a Managed Medicaid and improve the patient experience by having information available to answer their questions.

After years of pressure from consumer groups and new outlets, and with the AMA court injunction lifted, the Center for Medicare Services released data this week on what Medicare paid individual doctors in 2012. The historical release of data is the first time this information has been available to the public since the 1970s. It represents the first step in the Obama Administration’s efforts to make our health system more transparent, accountable and affordable.

Bundled payment programs have gotten much less attention than Medicare ACOs and commercial global capitation programs, but they offer an attractive risk and care management option that is designed more for specialists than for PCPs.  Typically bundled payment programs are initiated by a discrete clinical diagnosis or event, and cover all necessary care for a pre-determined period of time.  For example, the Medicare BPCI demonstration is initiated by a hospital admission and includes all medical services required for 30, 60, or 90 days post discharge, depending on the preference of the parti

Under the Protecting Access to Medicare Act of 2014 (the Act), Congress adopted a substantially different pathway for setting payments under the Medicare Clinical Laboratory Fee Schedule (CLFS). These reforms are intended to modernize the CLFS by moving away from a payment system based upon historical charge data that are now nearly 30 years old and moving to a market-based payment system intended to provide accurate, transparent and timely rate-setting determinations for clinical laboratory services.