As a practicing family physician, you make important decisions about patient care every day. When it comes to being appropriately paid for that care, you should be no less diligent in evaluating your options and choosing the path that’s right for you and your practice.
Whether you participate in Medicare, contract with private payers, or some combination of the two, accurate and appropriate coding and documentation are foundational to ensuring you’re properly compensated for the services you provide, so you want to be sure you’re up to date on the latest requirements.
In addition, the Medicare Access and CHIP Reauthorization Act (MACRA) set the stage for the creation of two tracks for Medicare payment: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (AAPMs). Although both programs are designed to reward physicians for providing higher quality care, performance and reporting requirements differ based on which track you participate in. Find out what you need to know to succeed in today’s evolving payment environment.
Although 2022 won’t usher in the same raft of CPT changes we saw in 2021, you can expect some notable updates—many of them welcome.
They’re laid out in the current issue of FPM, which focuses on payment and coding and can help ensure you reap the benefits of your hard work.
The issue’s lead article, for example, outlines clarifications to last year’s wholesale changes to coding and documentation for evaluation and management (E/M) services and describes new codes for principal care management services, remote monitoring and treatment, and more.
Other article topics include payment and policy highlights from the 2022 Medicare physician fee schedule regarding telehealth services, vaccine administration, chronic care management, and certain E/M services.
Finally, you’ll learn about the latest changes to CMS’ Quality Payment Program, which include revisions to the Merit-based Incentive Payment System (MIPS) and the Medicare Shared Savings Program (MSSP).
Choosing the right codes for the services you provide—and supporting them with appropriate documentation—is essential to billing correctly for those services and helping you avoid an audit. Understanding and adhering to the latest coding requirements can be tricky, but it’s essential to maximizing your revenue. Learn about the basics of coding; understand the complexities of coding for evaluation and management (E/M) patient visits; and find out how you can optimize fee-for-service (FFS) revenue, improve quality, and decrease total cost of care by providing Medicare annual wellness visits and other care coordination services.
The two tracks MACRA established for Medicare payment—MIPS and AAPMs—are known collectively as the Quality Payment Program (QPP). As Medicare’s FFS, pay-for-performance program, MIPS assesses eligible clinicians on four categories: quality, cost, improvement activities, and promoting interoperability. Whereas MIPS aims to prepare your practice to transition to an APM by helping you develop the skills you need to succeed in value-based payment (VBP), AAPMs may be a better option if you and your practice already have experience in this environment. MIPS APMs can also serve as a transition path to AAPMs for those who are participating in an APM but are not quite ready to assume significant downside risk. QPP’s technical assistance programs can help you determine which program best meets your needs.
When it comes to Medicare contracting, you basically have three choices. You can sign a participating (PAR) agreement and agree to accept Medicare's allowed charge as payment in full for all your Medicare patients. You may elect to be a non-PAR physician, which allows you to make assignment decisions on a case-by-case basis and bill patients for more than the Medicare allowance for unassigned claims up to a predetermined cutoff. Or you can become a private contracting physician, agreeing to bill patients directly and forgo any payments from Medicare to you or your patients. Review the options before making your decision.
Like other innovative payment models, those being promulgated by private payers are increasingly focused on boosting quality and reducing costs by moving physicians toward value- rather than volume-based payment arrangements. Still, as might be expected, the wide range of actors in this space translates to a patchwork of different policies, procedures, and payment modalities that can add significant complexity to your medical practice. Discover what’s being done to promote administrative simplification, and find out how you can lessen the excessive burdens posed by prior authorizations.
Evaluation and management (E/M) codes are the family physician’s bread and butter. To maximize payment and reduce the chances of being audited, you need to understand how to properly code and document E/M services. Put the information you need at your fingertips—literally—with a comprehensive resource that reflects the 2021 office visit E/M guideline changes.
Updated coding reference cards based on the revised E/M guidelines are designed to support physicians and their practice team members in selecting the appropriate codes for every practice scenario and documenting those choices. Find out how to purchase your card set.
Hierarchical condition category (HCC) coding is a prospective risk-adjustment model designed to convey the full picture of patient complexity and help estimate future health care costs. HCC coding uses ICD-10 diagnostic codes to assign patient risk scores. Payers combine those risk scores with demographic data to assign risk adjustment factor (RAF) scores, which, in turn, help predict care utilization and related costs. RAF scores are also used to risk adjust quality and cost measures.
Learn how your practice can use team-based strategies to optimize coding for risk adjustment in this Family Medicine Practice Hack.