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February 2016 Client Newsletter

Just a reminder that Annual Deductibles start on January 1, including Medicare. As mentioned in previous CMB Client Newsletters, Medicare's deductible in 2016 is $162. Every year this is a significant decrease in cash flow in January and February and it begins to pick up in March.
If you have sufficient cash reserves, you have the option to delay billing Medicare patients during that timeframe. If you missed the email sent out in late December offering that option, we can still do that if you are interested. That allows patients to see other providers and "hit" the deductible with them. There is no legal requirement to bill for your services, or when to bill for them, other than timely filing deadlines. Medicare is 365 days.
209,000 EPs to receive
Meaningful Use penalties in 2016
CMS announced that there will be 209,000 eligible professionals (EPs) subject to a 2016 penalty under Medicare for failing to demonstrate Meaningful Use in 2014. In addition, there are 44,579 EPs who did not submit physician claims to Medicare. CMS projects that, based on the estimated Medicare claims volume, the majority of EPs will be subject to a penalty that is less than $1,000. CMS published the following breakdown of EPs and their expected penalties:
  • 13,900 EPs will receive a penalty of less than $100
  • 103,000 EPs will receive a penalty of $100- $1,000
  • 30,400 EPs will receive a penalty of $1,000 - $5,000
  • 56,000 EPs will receive a penalty of $5,000 - $10,000
  • 5,700 EPs will receive a penalty of $10,000 or more
This just refers to the loss of revenue in one year, not subsequent years or add onto previous penalties.
Just a reminder that providers are absolutely allowed to bill BOTH a SICK visit and a WELL visit on the same day.  There is nothing inappropriate about that - as long as both services are performed and properly documented. 
Some patient education may be necessary to explain why it is reasonable for you to provide services, but you are entitled to be paid for those services.
The following services are covered by Medicare and other insurers as indicated below:
  • Annual Well Visits - covered by all Medicare plans and many other insurers.  Very common with HMO's, less so for other plans.  No deductible or co-insurance applied.  Medicare allows:  G0402 = $179.74, G0438 = $185.38, G0439 = $125.90).
  • Transitional Care  (99495 = $177.69, 99496 = $250.42)
  • Chronic Care ($43.71 ~ per 20 minutes).   You can contract out or hire an LPN /RN to handle the majority of this work. 
  • Advance Care Planning/End-of Life (new with Medicare effective 1/1/16).  99497 = $91.24 for the first 30 minutes.  99498 = $79.10 for each additional 30 minutes).  These can be added onto office and facility (hospital and nursing home) visits. 
Your staff can use your EHR, NaviNet, or the HealthPac Scheduler to verify benefits in advance.
Office providers not taking advantage of the above programs may want to consider looking at very carefully.  In many case, you are likely already providing all or part of these additional services to your patients - for free. 
Feel free to call us with any questions.  We can provide the requirements to bill each of the above services. 
2016 is a critical reporting year for groups and eligible professionals (EPs) to report successfully for PQRS to avoid duplicative penalties in the Value-Based Payment Modifier (VBPM). Based on 2016 performance, smaller practices with nine or fewer EPs now face potential 2% penalties based on cost and quality performance, while practices of ten or more EPs face the same four percent maximum amount of Medicare reimbursement at risk as last year. 2016 performance will impact payments in 2018. The VBPM expands to cover certain non-physician practitioners including physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists for the first time.
If you would like more information, MGMA has updated its member-benefit resource for 2016, the VBPM: How to Prepare Your Practice, which outlines the critical connection between PQRS and the VBPM. Don't get stuck with these penalties; arm your practice with the information it needs! If you are a CMB client, email Rich for a copy.
NJ Medicaid selectively increased some fees effective January 1, 2016: E&M codes and some preventive services. If you are interested in specific CPT codes, send an email to Rich.
2016 Client Newsletter Archive