Duane C. Abbey

CMS New Medicare Physician Payment Models

Presenter :Duane C. Abbey, PhD.
Duration :90 minutes



Product 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 from 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?

Learning Objectives:

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

Areas Covered in the Session:

  1. MPFS
    1. RBRVS
    2. Relative Values
    3. Global Surgical Percentages
    4. Conversion Factor and the SGR
  2. MACRA 2015
    1. MIPS
    2. CMS Innovation Center
  3. Direct Contracting Model
    1. Intent of the Model
    2. How the Model Works
  4. Primary Care First Model
    1. Intent of the Model
    2. How the Model Works
  5. E/M Coding Changes
    1. Payment Considerations
    2. Documentation Considerations
  6. Elimination of the GSP
    1. Why the GSP Is Not Working
    2. Data Gathering Process for Global Percentages
  7. Provider-Based Clinics
    1. Brief Review
    2. Update Relative to Payment
  8. Telehealth
    1. Brief Review
    2. Update Relative to Payment
  9. Sources for Further Information
  10. Live Q&A Session
Related Courses:

Suggested Attendees:

  • 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

About the Presenter:

Duane C. Abbey, PhD, CFP, is a management consultant and president of Abbey & Abbey Consultants, Inc., a consulting firm specializing in healthcare and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. Dr. Abbey works extensively in all areas relating to compliance reviews, coding, billing and reimbursement with particular emphasis on the chargemaster and outpatient payment. His consulting activities include hospitals and physicians based clinics.

In addition to his consulting practice, Dr. Abbey also teaches workshops and makes presentations on a regular basis. He has taught at the University level and speaks nationally. He is a regular presenter for hospital associations, medical societies, Boards of Trustees and various other organizations and groups. In addition, professional societies such as HFMA use Dr. Abbey’s services to present seminars and workshops.

Dr. Abbey is a nationally recognized expert in payment systems. A special area of expertise includes APGs/APCs. He is recognized as the leading expert in the nation in APGs/APCs by the thousands who have attended his seminars, read his publications and/or contracted for his services. Attendees at these seminars over the years have included personnel from hospitals, clinics, integrated delivery systems and multiple consulting firms.

Dr. Abbey is also the author of numerous articles and books including: Compliance for Coding, Billing & Reimbursement, Outpatient Services: Designing, Organizing & Managing Outpatient Resources, ChargeMaster: Review Strategies for Improved Billing and Reimbursement, Ambulatory Patient Group Operations Manual, published by McGraw-Hill and Non-Physician Providers: Guide to Coding, Billing & Reimbursement, Chargemasters: Strategies to Ensure Accurate Reimbursement and Compliance, and Emergency Department Coding & Billing: A Guide to Reimbursement & Compliance published.

After Registration

You will receive an email with login information and handouts (presentation slides) 1 day before the live webcast that you can print and share to all participants at your location.

System Requirement

Operating System: Windows any version preferably above Windows Vista & Mac any version above OS X 10.6
Internet Speed: Preferably above 1 MBPS
Headset: Any decent headset and microphone which can be used to talk and hear clearly

Can’t Listen Live?
No problem. You can get access to On-Demand webinar. Use it as a training tool at your convenience.

For more information you can reach out to below contact:
Toll-Free No: 1-302-444-0162

You can also use the order form for making orders. Click here to download.