Description

Physician payment for the Medicare program continues to evolve.  For many years the MPFS (Medicare Physician Fee Schedule) used RBRVS (Resource-Based Relative Value Scale) along with annually adjusted conversion factor to determine payment for physicians.  Today there are many changes occurring in different directions.  The sustainable growth factor (SGF) is being replaced by various directives in MACRA (Medicare Access and CHIP Reauthorization Act) including MIPS (Merit-Based Incentive Payment System).  While the new approaches (models) emphasize value of services, CMS is also doing away with the GSP (Global Surgical Package) and making changes for payment and documentation of certain E/M (Evaluation and Management) codes.  Throw into the mix the changes that are occurring with telehealth and provider-based clinics and it is little wonder that the whole are of physician payment for the Medicare program can be confusing.

• What is RBRVS?
• What are these relative values and surgical percentages?
• What is the SGF and how is it used?
• Is CMS having difficulty doing away with the GSP?
• What is the overall intent of MACRA?
• How is MIPS supposed to work?
• What are all these physician payment models?
• What is the purpose of the Direct Contracting Model Option?
• What is different in the Primary Care First Model Option?
• Where to provider-based clinics fit into these optional payment models?
• How does telehealth fit into these processes?

Teleconference/Webinar Objectives:-

• To review RBRVS, the relative values, and surgical percentages.
• To appreciate the role of the conversion factor and the SGF.
• To understand Congress’s intent in passage of MACRA.
• To appreciate the various approaches that CMS is taking in order to implement MIPS.
• To examine the Direct Contracting and Primary Care First Models.
• To explore the process of unbundling for the GSP.
• To appreciate the changes being made in clinic payment for the E/M levels.
• To understand how provider-based clinics and telehealth affect and are affected by the various changes that are taking place.

Teleconference/Webinar Outline/Agenda:-

• MPFS
  • RBRVS
  • Relative Values
  • Global Surgical Percentages
  • Conversion Factor and the SGR
• MACRA 2015
  • MIPS
  • CMS Innovation Center
• Direct Contracting Model
  • Intent of the Model
  • How the Model Works
• Primary Care First Model
  • Intent of the Model
  • How the Model Works
• E/M Coding Changes
  • Payment Considerations
  • Documentation Considerations
• Elimination of the GSP
  • Why the GSP Is Not Working
  • Data Gathering Process for Global Percentages
• Provider-Based Clinics
  • Brief Review
  • Update Relative to Payment
• Telehealth
  • Brief Review
  • Update Relative to Payment
• Sources for Further Information

Prerequisites for Participating:- 

General knowledge of coding billing and reimbursement.

Who Will Benefit? 

• Physician Coding Personnel
• Billing and Claims Transaction Personnel
• Chargemaster Coordinators
• Utilization Review Personnel
• Financial Analysts
• Compliance Personnel
• Physicians
• Internal Auditing Staff and
• Other Interested Personnel