12/02/2016

CAC PIAC Meeting Update

NYSPMA Executive Director Mike Borden and board members Nicholas D’Angelo and Daniel Keating attended the APMA CAC-PIAC meeting November 4-5 in Baltimore.

MIPS - Kate Goodrich, MD, Director for Clinical Standards and Quality at CMS provided an update on Medicare Quality Payment Programs, in particular the Merit Based Incentive Payment System (MIPS).

Only Part B clinicians with allowable billing more than $30,000 based on 2015-2016 billings and more than 100 Medicare patients are included in the MIPS program. These would include Podiatrists, MDs, DOs, physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists. Within these providers, new clinicians in their first year are excluded from reporting.

The program begins January 2017 and payments/penalties begin in 2019. Eligible providers can opt for full or partial participation.

Partial Participation: CMS has agreed to do a “test run” of the program. Eligible providers can submit some data by January 1 and receive no penalty or a small positive payment adjustment. Providers can send in one improvement activity or one quality measure.

Eligible providers can report for a 90 day period between January and October 2, 2017 with submission sent by March 2018 to receive a small positive payment adjustment and still remain eligible to earn the max adjustment.

Full Participation: Eligible providers can submit a full year of data for 2017 to receive a modest positive payment adjustment. Groups with 15 or fewer participants, non-patient facing clinicians, and rural or health care shortage areas, can attest to two activities for full participation. Participants in certified patient centered medical homes automatically get full credit.

Members are encouraged to ask APMA advice on “what you need to do” and vendor advice on “how you can do it”.  A webinar is available free to members.

Medicare Policy - Marjorie Kanoff with Health Policy Alternatives provided an update on Medicare policy issues. She reported the Physician Fee Schedule for Medicare conversion factor is $35.8043 for 2016 and $35.8887 for 2017. Medicare fee schedule will have 0.5% increase each of the next four years.

Beginning in January 2017, there will be a 20 percent payment reduction for x-ray imaging submitted on film.   When submitting for payment, the FX modifier should be used to document use of film, rather than digital. 
Kanoff stressed that physicians are required to perform internal audits and independent 3^rd party audits to locate overpayments by insurers and return monies in a timely manner.

Statistics - David Freeman, DPM provided Medicare Part B Reimbursement Statistics. Among the highlights:

1. Amputations have decreased significantly from 2014 to 2015.
2. Diabetic shoes dispensing has also decreased by 36%.
3. New York is the 3^rd highest user of CPT codes 11305-11307 (must have pathology report).
4. New York is the 4^th highest user of CPT code 11755 (must have pathology report for nail unit.
5. 11721 with modifier 59 is 2^nd highest utilized.
6. 11100 with modifier 59 is highest utilized.
7. CPT Code 99201 – should rarely be used.
8. L4361 is CPT code to be used for pneumatic walking boot.

New bunion codes for ICD-10 change in October were reported, but they are not to replace hallux valgus diagnostic codes.  M21611 R, M21612 L for bunions and M21621 R, M21622 L for bunionette 5^th Metatarsal.

These new bunion codes are not meant to replace the existing bunion codes. They are meant to further clarify the diagnostic codes.  If the bunion diagnosis is a complex one, with the presence of symptoms, then use the old codes. If it is non-complex, cosmetic diagnosis, use the new codes.

APMA UPDATE - APMA President Dan Davis announced he will be addressing the Medicare/Medicaid dual eligible issue at the AMA House of Delegates with the intent of partnering to address this legislatively.   An APMA webinar on dual eligible issues will take place December 6.

David also announced APMA’s development of a Qualified Clinical Data Registry. APMA is developing the registry with vendor partner Prometheus and will make application to CMS for approval in 2017.