Advance Care Planning

CMS started paying for voluntary Advance Care Planning (ACP) from January 1, 2016.

ACP helps Medicare patients decide the plan of care that they would like to get when they are unable to take such decisions themselves.

Voluntary ACP is a face-to-face service between a physician (or other qualified health care  professional) and a patient discussing advance directives with or without completing relevant legal forms. An advance directive is a document in which a patient appoints an agent and/or records the  wishes of a patient pertaining to their medical treatment at a future time if they cannot decide for themselves at that time.

There are no limits on the number of times you can report ACP for a given patient in a given time period. When billing the service multiple times for a given patient, document the change in the patient's health status and/or wishes regarding their end-of-life care.

There are no place-of-service limitations on ACP services. You can appropriately furnish ACP services in facility and non-facility settings. ACP services are not limited to a 
particular physician specialty.

CMS requires no specific diagnosis to bill the ACP codes.

CPT 99497                
Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; first  30 minutes, face-to-face with the patient, family member(s), and/or surrogate

CPT 99498      
Advance care planning including the explanation and discussion of advance directives such as standard forms (with completion of such forms, when performed), by the physician or other qualified health care professional; each additional 30 minutes (List separately in addition to code for primary procedure)

Retrieved from https://www.medicare.gov/coverage/advance-care-planning.html

For more information refer the following link :  https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/AdvanceCarePlanning.pdf

Are you Eligible for MIPS in 2018 ?

You are eligible and are required to submit data for MIPS 2018, if you are a,

• Physician (including doctors of medicine, doctors of osteopathy, osteopathic practitioners, doctors of dental surgery, doctors of dental medicine, doctors of podiatric medicine, doctors of optometry, and chiropractors)
• Physician Assistant
• Nurse Practitioner
• Clinical Nurse Specialist
• Certified Registered Nurse Anesthetist

OR

if you see more than 200 Medicare patients annually

OR

if you bill Medicare more than $90,000 in Allowed charges annually.


You are exempt from MIPS 2018, if you,

• do not meet any of the criteria above
• enroll in Medicare for the first time in 2018
• participate in an advanced APM wherein you receive 25% of the Medicare payments or see 20% of the Medicare patients from an advanced APM

You can also know your MIPS 2018 eligibility by clicking this link  https://qpp.cms.gov/participation-lookup  and entering your 10-digit National Provider Identifier (NPI) number to view your MIPS participation status.

Abdomen X-ray coding in 2018

Abdomen X-ray codes have changed, the old Abdomen X-ray codes 74000, 74020 are being deleted and are being replaced by 74018, 74019 and 74021.

As the new Abdomen X-ray codes are coded based on the number of views, from a documentation compliance standpoint it is imperative for the practice to ensure that the number of views are appropriately documented.

The new Abdomen X-ray codes are,

• 74018 Radiologic examination, abdomen; single view
• 74019 Radiologic examination, abdomen; two views
• 74021 Radiologic examination, abdomen; three or more views

Chest X-ray coding in 2018

Chest X-ray coding has become simpler in 2018, the chest x-ray codes are some of the most frequently used imaging codes in healthcare.

Previously Chest X-ray codes used nine different codes, now these nine codes have been replaced with four codes that are simply determined by the number of views.

As  the new Chest X-ray codes are coded based on the number of views, from a documentation compliance standpoint it is imperative for the practice to ensure that the different types / number of views are appropriately documented.

The new Chest X-ray codes are,

• 71045 Radiologic examination, chest; single view
• 71046 Radiologic examination, chest; 2 views
• 71047 Radiologic examination, chest; 3 views
• 71048 Radiologic examination, chest; 4 or more views

Merit-Based Incentive Payment System (MIPS)

MACRA replaced three Medicare reporting programs with MIPS (Medicare Meaningful Use, the Physician Quality Reporting System, and the Value-Based Payment Modifier).

Under the combination of the previous programs, you would have faced a negative payment adjustment as high as 9% total in 2019, but the MACRA ended those programs, reduced the potential negative payment adjustments in the early years, and streamlined the overall requirements. While these three programs will end in 2018, if you have participated in these programs in the past, then you will have an advantage in MIPS because many of the requirements should be familiar.

To check if you need to submit data to MIPS, enter your 10-digit National Provider Identifier (NPI) number in the link below,

https://qpp.cms.gov/participation-lookup

MACRA defined four performance categories for MIPS, linked by their connection to quality and value of patient care.

Quality : Replaces the Physician Quality Reporting System (PQRS)

Most participants: Report up to 6 quality measures, including an outcome measure, for a minimum of 90 days.

Groups using the web interface: Report 15 quality measures for a full year. To submit data as a group through the CMS Web Interface, you must register your group between April 1, 2017 and June 30, 2017.

Groups in APMs qualifying for special scoring under MIPS, such as Shared Savings Track 1 APM or the Oncology Care Model one-sided risk APM: Report quality measures through your APM. You do not need to do anything additional for MIPS quality.

Advancing Care Information : Replaces the Medicare EHR Incentive Program, also known as Meaningful Use

Fulfill the required measures for a minimum of 90 days:

    Security Risk Analysis

    e-Prescribing

    Provide Patient Access

    Send Summary of Care

    Request/Accept Summary of Care

Choose to submit up to 9 measures for a minimum of 90 days for additional credit.

For bonus credit, you can:

    Report Public Health and Clinical Data Registry Reporting measures

    Use certified EHR technology to complete certain improvement activities in the improvement activities performance category

OR

You may not need to submit advancing care information if these measures do not apply to you.

Improvement Activities : New category

Most participants: Attest that you completed up to 4 improvement activities for a minimum of 90 days.

Groups with fewer than 15 participants or if you are in a rural or health professional shortage area: Attest that you completed up to 2 activities for a minimum of 90 days.

Participants in certified patient-centered medical homes, comparable specialty practices, or an APM designated as a Medical Home Model: You will automatically earn full credit.

Participants in certain APMs under the APM scoring standard, such as Shared Savings Program Track 1 or OCM: You will automatically receive points based on the requirements of participating in the APM. For all current APMs under the APM scoring standard, this assigned score will be full credit. For all future APMs under the APM scoring standard, the assigned score will be at least half credit.

Cost : Replaces Value-Based Modifier

No data submission required. Calculated from adjudicated claims.

Retrieved from https://qpp.cms.gov/