Medicare Physician Fee Schedule(MPFS) using the RBRVS (Resource Based Relative Value Scale) as the main vehicle for implementing the fee schedule. Each year CMS proposes changes to MPFS and then at the beginning of the calendar year implements the changes. The relative value units (RVUs) are almost continuously updated from year-to-year based on special studies. Additionally, changes to policy issues such as the anticipated E/M payment and documentation changes along with the Global Surgical Package (GSP) are discussed in the Federal Register. CMS is now in the process of doing away with the Sustainable Growth Rate (SGR) and replacing it with value-based or merit-based payment mechanisms as require through MACRA 2015.
- How does CMS go about making changes in the RVUs?
- Are there incorrectly valued RVUs?
- Why is the conversion factor for MPFS so controversial?
- Are changes being made to telehealth services?
- Do ambulance services have anything to do with MPFS?
- What is happening with anesthesia payments?
- What is happening with chronic care management services?
- How can I assess the impact of the MPFS changes on our clinic?
- Will radiation therapy centers and radiation oncology experience decreases in reimbursement?
- How is health information technology being integrated in MPFS?
- What about physician quality reporting?
- Is CMS really going to change the GSP?
- How will MIPS ad APM through MACRA 2015 affect physicians?
- To briefly review the main components of MPFS.
- To discuss the broad range of changes being made to MPFS including technical RVU changes as well as policy changes.
- To understand the changes in E/M payment and documentation requirements for CY2021.
- To appreciate the changes being made relative to the Sustainable Growth Rate (SGR), such as MIPS and APM incentives.
- To review proposed changes in the RVUs for selected physician specialties.
- To briefly review changes in CPT and HCPCs coding.
- To discuss the proposed change in the Global Surgical Package (GSP),
- To briefly discuss associated policy areas such as physician quality reporting and the physician compare website.
- To review changes in associated payment systems and services such as telehealth, anesthesia and the ambulance fee schedule (AFS).
- To discuss non-physician practitioners (NPPs) special changes that are being made relative to NPPs.
- To review the possible impact of the proposed changes on different specialty areas.
- To discuss related issues such a provider-based clinics and special services such as observation services.
- Review of MPFS and RBRVS
- Use of Relative Value Unit
- Work Component
- Practice Expense Component
- Malpractice Component
- Conversion Factor and SGR
- Updating of RVUs
- Geographic Adjustments for MPFS
- Non-Physician Practitioner Involvement
- Major Policy Areas for the MPFS
- Other Areas Affected by the MPFS
- Use of Relative Value Unit
- Review Code Set Changes
- EM Payment and Documentation Changes for CY2021
- Changes Being Made to MPFS/RBRVS for CY2019
- RVU Changes
- Conversion Factor and SGR
- Site-of-Service Consideration
- Changes in GPCIs
- Facility vs. Non-Facility Practice Expense RVUs
- Radiation Oncology
- Future Changes and Trends
- Global Service Changes(GSP)
- GSP Basics
- Problem Areas for Physicians to Report Correctly
- Discontinuing 10-Day and 90-Day Global Periods
- Possibly Impacts on Physicians and Clinics
- Commenting to the Proposed Changes
- MACRA 2015
- MIPS – Merit-Based Incentive Payment System
- APM – Alternative Payment Model
- Timing of Changes
- Payment Impacts
- Associated Areas of Concern
- Ambulance Fee Schedule
- Anesthesia Fee Schedule
- Non-Physician Practitioner
- Health Information Technology
- Physician Quality Reporting
- Provider-Based Clinics
- The Future of MPFS and RBRVS
- Clinic Managers
- Clinic Administrators
- Coding Personnel
- Billing and Claims Transaction Personnel
- Nursing Staff
- Clinical Service Area Personnel
- Chargemaster Coordinators
- Financial Analysts
- Compliance Personnel
- Non-Physician Practitioners
- Healthcare Auditors
- 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.
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