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To Quality and Beyond: Recent Developments in Medicare Reimbursement - By AtoZ Compliance
Key Take Away:
This webinar discusses changes in the physician payment landscape arising from several of physician quality reporting system, with particular focus on the Medicare changes resulting from the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). And, addresses the shift in Medicare away from traditional fee for service payment models, towards more value- and quality-based payment by examining the reporting requirements and new compliance difficulties that physicians and physician practices will need to understand.
This webinar discusses the history of Medicare's physician quality and value initiatives and recent changes in Medicare reimbursement and Medicare insurance.
Why Should You Attend:
Medicare currently operates several interconnected quality reporting systems. These are:
(1) the Physician Quality Reporting System (PQRS);
(2) the “Meaningful Use” program; and
(3) the Value-based Payment Modifier.
These programs will be incorporated into Medicare’s forthcoming Merit-based Incentive Payment System (MIPS). Data reported today will determine whether physicians receive upward or downward payment adjustments to their compensation in the future.
Currently, physicians face a range of upward and downward payment adjustments to the entire universe of their Medicare Physician Fee Schedule payments; under MIPS, this amount will eventually be +/- 9%. Improper reporting may require repayment of money to Medicare, and may result in exposure under the Federal False Claims Act, which recently had its penalties nearly doubled.
Given the complexity of these systems, and the potential risk associated with improper reporting, physicians must develop effective compliance strategies to minimize their risks.
Areas Covered In This Webinar:
In recent years Medicare has increased the number of programs which track physician-reported data. These programs, which include PQRS, EHR Meaningful Use, and the Value-based Payment Modifier, each bind Medicare physician fee schedule (MPFS) patients to the reporting of data.
The process of reporting such data, however, is complex. Physicians must choose which reporting mechanism is most appropriate for them, and different mechanisms require the reporting of different data. Physicians who fail to report properly may face reductions in MPFS payments.
In addition, there is often a delay of up to two years between when the data is reported and when payment adjustments are applied. Moreover, improper reporting that avoids a payment reduction could result in an overpayment, which could become a false claim under the federal False Claims Act. The Merit-based Incentive Payment System (MIPS) will consolidate much of the current reporting, but will ultimately increase the range of upward or downward payment adjustments for physicians.
• Examine the three physician reporting programs currently in use by Medicare: PQRS, Meaningful Use, and the Value-based Payment Modifier
• Get a brief background for each program, and discuss common problems and areas of overlap between them
• Know MIPS, and how the current systems relate to it
• Understand the False Claims Act liability inherent in both the current systems and in MIPS, and how improper reporting under these systems can potentially result in overpayments
• Learn proactive steps that physician practices can take to help ensure compliance with these systems to avoid such liability
Who Will Benefit:
• Physician Practice Managers
• Compliance Officers for Health Care Providers
• Medical Staff
• Allied Health Professionals
DANIEL F. SHAY is an attorney with Alice G. Gosfield and Associates, P.C. His practice is restricted to health law and health care regulation focusing primarily on physician representation, fraud and abuse compliance, Medicare Part B reimbursement, and HIPAA compliance in the physician context. He also has a keen interest in intellectual property issues, including copyright, trademark, data control, and confidentiality.
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If the To Quality and Beyond: Recent Developments in Medicare Reimbursement - By AtoZ Compliance is important to your business, act now and make the appropriate connections. See the contact information below.
Physician Practice Managers
Compliance Officers for Health Care Providers
Allied Health Professionals
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