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I know that many have already started the planning process for next year’s business priorities and therefore I remain hopeful that time was taken to reflect on the success stories already achieved to provide the foundation for next year’s business goals.
What is key, is that one recognizes that the planning process must begin this year to kickstart next year’s work soon after the holidays are over. This planning process should lay out the framework from which to assign the work so it’s part of the business operations wherein goals can be established and ultimately achieved.
As we move into a new decade the evolution of medicine and specifically gastroenterology hasn’t stopped. The question is, have you set yourself (and your practice) up for success in 2020? In the ever-changing world of the gastroenterology practice you don’t want to be left behind this year. Here are the top things you need to know for a productive and successful new year!
1. Use the new Medicare Beneficiary Identifier (MBI). Starting January 1, 2020, if you want to get paid by Medicare you must use the MBI when billing Medicare regardless of the date of service. Claims submitted without MBIs will be rejected, with some exceptions. The MBI replaces the social security number–based Health Insurance Claim Numbers (HICNs) from Medicare cards and is now used for Medicare transactions like billing, eligibility status, and claim status.
2. Prepare for Evaluation and Management (E/M) changes. Did you know that E/M coding and guidelines are about to undergo the most significant changes since their implementation? The changes to guidelines and coding for new and established office/outpatient visits (CPT codes 99202-99205, 99211-99215) won’t officially take place until January 1, 2021, but they are so significant that the American Medical Association has already released a preview of the CPT 2021 changes. Don’t miss out on the preview – https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf. Sit down with your coders or contact your medical billing company and create a plan for training physicians and staff for the changes for a smooth transition on Jan. 1, 2021. With changes this big, you may find you need all of 2020 to prepare.
3. Review your quality reporting under the Merit-Based Incentive System (MIPS). There have been several changes to the weights of quality and cost performance categories under MIPS for the 2020 performance year. These will go into effect January 1st and will impact your 2022 Medicare payments.
4. Evaluate your clinician participation level if you’re reporting under MIPS as a group. During the 2020 performance year, the threshold for clinician participation is increasing. At least 50% of clinicians from the group must participate in or perform an activity for the same continuous 90-day period to earn credit for that improvement activity.
5. Don’t forget to report under MIPS for 2019. Those not in an Advanced Alternative Payment Model (APM), a Medicare Accountable Care Organization (ACO) or other MIPS alternative must report the required data under the program or face payment cuts in 2021. The submission window for your 2019 data opens on January 2, 2020 and closes on March 31st!
6. Review your commercial contracts. With reimbursement decreasing each year, protect yourself by renegotiating multi-year contract rates now with payers based on the 2019 fee schedule. Review all your commercial contracts and focus on the ones with the lowest rates first. Prepare a case to justify higher rates by creating a value proposition and don’t forget to involve your coders; they are often aware of payer-specific reimbursement problems. Not comfortable negotiating with payers? Be open to looking for outside help, like a contract attorney.
7. Mark your calendars! Here’s a list of dates that you will want to put on your calendar for 2020!
December 2019
December 31 - MIPS Performance Year 2019 Ends
December 31 - Quality Payment Program Exception Applications Window Closes
December 31 - Fourth snapshot date for full TIN APMs (Medicare Shared Savings Program) for determining which eligible clinicians are participating in a MIPS APM for purposes of the APM scoring standard.
January 2020
January 1 - MIPS Performance Year 2019 Begins
January 2 - Submission Window Opens for MIPS Performance Year 2019
March 2020
March 31 - Submission Window Closes for MIPS Performance Year 2019
July 2020
• CMS publishes proposed reimbursement values for the E/M codes in the 2021 MPFS proposed rule
• CMS “Targeted Review” opens once CMS makes your MIPS payment adjustment available
• July 1 - MIPS Performance Feedback Available. CMS will provide you with performance feedback based on the data you submitted for Performance Year 2019. You can use this feedback to improve your care and optimize the payments you receive from CMS.
August 2020
August 31 - Targeted Review period closes (appeals process)
September 2020
AMA releases CPT 2021 book with new E/M coding guidelines and new coding for new patient office/outpatient visits (99202-99205)
October 2020
October 1, 2020 – Final day to start QPP activities to meet 90-day minimum.
November 2020
CMS finalizes reimbursement values for the E/M codes in the MPFS final rule
December 2020
December 31, 2020 - Quality Payment Program Exception Applications Window Closes
December 31, 2020 – MIPS Performance year 2020 ends
Stress to your team that proper planning is the norm and not the exception, and that seeking improvement in all facets of your medical practice is critical to achieving long-term success. Be sure to write your plans in the future tense and to include timelines in your final work product, as well as delegate accountability to accomplish those goals.
Use the planning process as an opportunity to build your team so that everyone is focused on the future and stress that their participation is important to achieve the success required to remain an independent medical group.
Mr. Turner is chief executive officer, Indianapolis Gastroenterology and Hepatology, Indianapolis. jturner@indygastro.com
I know that many have already started the planning process for next year’s business priorities and therefore I remain hopeful that time was taken to reflect on the success stories already achieved to provide the foundation for next year’s business goals.
What is key, is that one recognizes that the planning process must begin this year to kickstart next year’s work soon after the holidays are over. This planning process should lay out the framework from which to assign the work so it’s part of the business operations wherein goals can be established and ultimately achieved.
As we move into a new decade the evolution of medicine and specifically gastroenterology hasn’t stopped. The question is, have you set yourself (and your practice) up for success in 2020? In the ever-changing world of the gastroenterology practice you don’t want to be left behind this year. Here are the top things you need to know for a productive and successful new year!
1. Use the new Medicare Beneficiary Identifier (MBI). Starting January 1, 2020, if you want to get paid by Medicare you must use the MBI when billing Medicare regardless of the date of service. Claims submitted without MBIs will be rejected, with some exceptions. The MBI replaces the social security number–based Health Insurance Claim Numbers (HICNs) from Medicare cards and is now used for Medicare transactions like billing, eligibility status, and claim status.
2. Prepare for Evaluation and Management (E/M) changes. Did you know that E/M coding and guidelines are about to undergo the most significant changes since their implementation? The changes to guidelines and coding for new and established office/outpatient visits (CPT codes 99202-99205, 99211-99215) won’t officially take place until January 1, 2021, but they are so significant that the American Medical Association has already released a preview of the CPT 2021 changes. Don’t miss out on the preview – https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf. Sit down with your coders or contact your medical billing company and create a plan for training physicians and staff for the changes for a smooth transition on Jan. 1, 2021. With changes this big, you may find you need all of 2020 to prepare.
3. Review your quality reporting under the Merit-Based Incentive System (MIPS). There have been several changes to the weights of quality and cost performance categories under MIPS for the 2020 performance year. These will go into effect January 1st and will impact your 2022 Medicare payments.
4. Evaluate your clinician participation level if you’re reporting under MIPS as a group. During the 2020 performance year, the threshold for clinician participation is increasing. At least 50% of clinicians from the group must participate in or perform an activity for the same continuous 90-day period to earn credit for that improvement activity.
5. Don’t forget to report under MIPS for 2019. Those not in an Advanced Alternative Payment Model (APM), a Medicare Accountable Care Organization (ACO) or other MIPS alternative must report the required data under the program or face payment cuts in 2021. The submission window for your 2019 data opens on January 2, 2020 and closes on March 31st!
6. Review your commercial contracts. With reimbursement decreasing each year, protect yourself by renegotiating multi-year contract rates now with payers based on the 2019 fee schedule. Review all your commercial contracts and focus on the ones with the lowest rates first. Prepare a case to justify higher rates by creating a value proposition and don’t forget to involve your coders; they are often aware of payer-specific reimbursement problems. Not comfortable negotiating with payers? Be open to looking for outside help, like a contract attorney.
7. Mark your calendars! Here’s a list of dates that you will want to put on your calendar for 2020!
December 2019
December 31 - MIPS Performance Year 2019 Ends
December 31 - Quality Payment Program Exception Applications Window Closes
December 31 - Fourth snapshot date for full TIN APMs (Medicare Shared Savings Program) for determining which eligible clinicians are participating in a MIPS APM for purposes of the APM scoring standard.
January 2020
January 1 - MIPS Performance Year 2019 Begins
January 2 - Submission Window Opens for MIPS Performance Year 2019
March 2020
March 31 - Submission Window Closes for MIPS Performance Year 2019
July 2020
• CMS publishes proposed reimbursement values for the E/M codes in the 2021 MPFS proposed rule
• CMS “Targeted Review” opens once CMS makes your MIPS payment adjustment available
• July 1 - MIPS Performance Feedback Available. CMS will provide you with performance feedback based on the data you submitted for Performance Year 2019. You can use this feedback to improve your care and optimize the payments you receive from CMS.
August 2020
August 31 - Targeted Review period closes (appeals process)
September 2020
AMA releases CPT 2021 book with new E/M coding guidelines and new coding for new patient office/outpatient visits (99202-99205)
October 2020
October 1, 2020 – Final day to start QPP activities to meet 90-day minimum.
November 2020
CMS finalizes reimbursement values for the E/M codes in the MPFS final rule
December 2020
December 31, 2020 - Quality Payment Program Exception Applications Window Closes
December 31, 2020 – MIPS Performance year 2020 ends
Stress to your team that proper planning is the norm and not the exception, and that seeking improvement in all facets of your medical practice is critical to achieving long-term success. Be sure to write your plans in the future tense and to include timelines in your final work product, as well as delegate accountability to accomplish those goals.
Use the planning process as an opportunity to build your team so that everyone is focused on the future and stress that their participation is important to achieve the success required to remain an independent medical group.
Mr. Turner is chief executive officer, Indianapolis Gastroenterology and Hepatology, Indianapolis. jturner@indygastro.com
I know that many have already started the planning process for next year’s business priorities and therefore I remain hopeful that time was taken to reflect on the success stories already achieved to provide the foundation for next year’s business goals.
What is key, is that one recognizes that the planning process must begin this year to kickstart next year’s work soon after the holidays are over. This planning process should lay out the framework from which to assign the work so it’s part of the business operations wherein goals can be established and ultimately achieved.
As we move into a new decade the evolution of medicine and specifically gastroenterology hasn’t stopped. The question is, have you set yourself (and your practice) up for success in 2020? In the ever-changing world of the gastroenterology practice you don’t want to be left behind this year. Here are the top things you need to know for a productive and successful new year!
1. Use the new Medicare Beneficiary Identifier (MBI). Starting January 1, 2020, if you want to get paid by Medicare you must use the MBI when billing Medicare regardless of the date of service. Claims submitted without MBIs will be rejected, with some exceptions. The MBI replaces the social security number–based Health Insurance Claim Numbers (HICNs) from Medicare cards and is now used for Medicare transactions like billing, eligibility status, and claim status.
2. Prepare for Evaluation and Management (E/M) changes. Did you know that E/M coding and guidelines are about to undergo the most significant changes since their implementation? The changes to guidelines and coding for new and established office/outpatient visits (CPT codes 99202-99205, 99211-99215) won’t officially take place until January 1, 2021, but they are so significant that the American Medical Association has already released a preview of the CPT 2021 changes. Don’t miss out on the preview – https://www.ama-assn.org/system/files/2019-06/cpt-office-prolonged-svs-code-changes.pdf. Sit down with your coders or contact your medical billing company and create a plan for training physicians and staff for the changes for a smooth transition on Jan. 1, 2021. With changes this big, you may find you need all of 2020 to prepare.
3. Review your quality reporting under the Merit-Based Incentive System (MIPS). There have been several changes to the weights of quality and cost performance categories under MIPS for the 2020 performance year. These will go into effect January 1st and will impact your 2022 Medicare payments.
4. Evaluate your clinician participation level if you’re reporting under MIPS as a group. During the 2020 performance year, the threshold for clinician participation is increasing. At least 50% of clinicians from the group must participate in or perform an activity for the same continuous 90-day period to earn credit for that improvement activity.
5. Don’t forget to report under MIPS for 2019. Those not in an Advanced Alternative Payment Model (APM), a Medicare Accountable Care Organization (ACO) or other MIPS alternative must report the required data under the program or face payment cuts in 2021. The submission window for your 2019 data opens on January 2, 2020 and closes on March 31st!
6. Review your commercial contracts. With reimbursement decreasing each year, protect yourself by renegotiating multi-year contract rates now with payers based on the 2019 fee schedule. Review all your commercial contracts and focus on the ones with the lowest rates first. Prepare a case to justify higher rates by creating a value proposition and don’t forget to involve your coders; they are often aware of payer-specific reimbursement problems. Not comfortable negotiating with payers? Be open to looking for outside help, like a contract attorney.
7. Mark your calendars! Here’s a list of dates that you will want to put on your calendar for 2020!
December 2019
December 31 - MIPS Performance Year 2019 Ends
December 31 - Quality Payment Program Exception Applications Window Closes
December 31 - Fourth snapshot date for full TIN APMs (Medicare Shared Savings Program) for determining which eligible clinicians are participating in a MIPS APM for purposes of the APM scoring standard.
January 2020
January 1 - MIPS Performance Year 2019 Begins
January 2 - Submission Window Opens for MIPS Performance Year 2019
March 2020
March 31 - Submission Window Closes for MIPS Performance Year 2019
July 2020
• CMS publishes proposed reimbursement values for the E/M codes in the 2021 MPFS proposed rule
• CMS “Targeted Review” opens once CMS makes your MIPS payment adjustment available
• July 1 - MIPS Performance Feedback Available. CMS will provide you with performance feedback based on the data you submitted for Performance Year 2019. You can use this feedback to improve your care and optimize the payments you receive from CMS.
August 2020
August 31 - Targeted Review period closes (appeals process)
September 2020
AMA releases CPT 2021 book with new E/M coding guidelines and new coding for new patient office/outpatient visits (99202-99205)
October 2020
October 1, 2020 – Final day to start QPP activities to meet 90-day minimum.
November 2020
CMS finalizes reimbursement values for the E/M codes in the MPFS final rule
December 2020
December 31, 2020 - Quality Payment Program Exception Applications Window Closes
December 31, 2020 – MIPS Performance year 2020 ends
Stress to your team that proper planning is the norm and not the exception, and that seeking improvement in all facets of your medical practice is critical to achieving long-term success. Be sure to write your plans in the future tense and to include timelines in your final work product, as well as delegate accountability to accomplish those goals.
Use the planning process as an opportunity to build your team so that everyone is focused on the future and stress that their participation is important to achieve the success required to remain an independent medical group.
Mr. Turner is chief executive officer, Indianapolis Gastroenterology and Hepatology, Indianapolis. jturner@indygastro.com