What is a Rural Health Clinic? by HC120831204824

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									      Medicare Incentives and the RHC


                           Charles A. James, Jr.
                            President and CEO
              North American Healthcare Management Services




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      Session Objectives
      Learn the various Medicare incentive
      opportunities.
      Learn how each Medicare incentive is
      calculated and services on which they are
      based.
      Learn how each of the incentives relate to
      the Rural Health Clinic program.

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      Medicare Incentive Programs
      Electronic Health Record Incentives
      HPSA - Health Professional Shortage
      Incentive
      Primary Care Incentive (PCIP)
      Physician Quality Reporting (PQRI)
      eRx (e-prescribing) Incentive


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      American Recovery and
      Reinvestment Act (ARRA)
      Signed into law 2.17.2009.
      $767 billion in new spending and tax cuts.
      $17 billion for adopting ‘meaningful use’ of
      HIT in hospitals and physician practices.
      Stipulates Medicare and Medicaid payment
      incentives including EHR, Primary Care, and
      HPSA.

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      Medicare EHR Incentive -
      Eligible Professionals
      Doctors of medicine or osteopathy
      Doctors of dental surgery or dental
      medicine
      Doctors of podiatry
      Doctors of optometry
      Chiropractors


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      Medicare Incentive Payment Structure
      CMS will make Medicare Part B incentive
      payments to physicians who have
      demonstrated that they are "meaningful"
      EHR users.
      Eligible providers will be paid up to $44,000
      for meaningful adoption.
      Payments will be based on an amount
      equal to 75 percent of allowable charges.
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      Medicare Incentive Amounts




   “An Introduction to the Medicare EHR Incentive Program for Eligible
   Professionals” Centers for Medicare and Medicaid Services


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       Medicare EHR Payment Limitations




  “An Introduction to the Medicare EHR Incentive Program for Eligible
  Professionals” Centers for Medicare and Medicaid Services



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       Medicare/Medicaid




    “An Introduction to the Medicare EHR Incentive Program for Eligible
    Professionals” Centers for Medicare and Medicaid Services

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      EHR Incentive and the RHC
      To maximize the Medicare EHR incentive,
      EPs must receive $24,000 or more in Fee
      Schedule payments annually.
      The Medicare incentive program does not
      recognize NP/PA or RHCs.
      Typically, the Medicaid incentive is most
      appropriate for RHCs.

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      HPSA Incentive
      The HPSA bonus is a 10 percent incentive payment to
      physicians who provide covered professional services in a
      geographic HPSA.
      The incentive is 10 percent of the amount paid, not the
      approved amount.
      Incentive eligibility is determined by the location where
      the service was actually performed. Despite where the
      physician’s office is located, the HPSA bonus is
      determined by where the physician treated the patient.


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      HPSA Incentive Payment
      The incentive is 10 percent of the amount paid,
      not the allowed amount.
      HPSA incentive checks are issued quarterly. If the
      physician provided HPSA eligible services from
      January – March, the incentive payment will be
      received in April.
      Incentive payments are taxable and will be
      reported to the Internal Revenue Service (IRS)
      through the IRS 1099 process.
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      HPSA Incentive
      HPSA Incentive: 10% Medicare Payments
        Must be located in Geographic HPSA
        Should get these for hospital claims

   Both PCIP and HPSA are payable together.



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      HPSA Incentive RHC Ramifications
      Hospital payments should receive the HPSA
      bonus.
      An area which has RHCs does not
      necessarily qualify for the HPSA bonus.




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      Primary Care Incentive
   Beginning in CY 2011, primary care practitioners will
   be identified based on their primary specialty of
   enrollment in Medicare and percentage of allowed
   charges for primary care services that equals or
   exceeds the 60 percent threshold from Medicare
   claims data 2 years prior to the bonus payment
   year. A provision to accommodate newly enrolled
   Medicare providers will be released in 2011.


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      Primary Care Incentive Payments
      Primary Care (PCIP): 10% Medicare Pmts
         Eligible for Primary Care docs
         FP/IM/Peds/Geriatric
         99201-99215; 99304-99340; 99341-
         99350 are:
         At least 60% of all allowable Fee
         Schedule services.
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      PCIP Services Defined
      99201 through 99215 for new and established patient
      office or other outpatient Evaluation and Management
      (E/M) visits;
      99304 through 99340 for initial, subsequent, discharge,
      and other nursing facility E/M services; new and
      established patient domiciliary, rest home (e.g., boarding
      home), or custodial care E/M services; and domiciliary,
      rest home (e.g., assisted living facility), or home care plan
      oversight services;
      99341 through 99350 for new and established patient
      home E/M visits.
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      RHCs and PCIP
      60% of the allowable codes must be paid
      on the Medicare Physician Fee Schedule
      (1500).
      MOST of the allowable CPT codes for PCIP
      will never be billed on a 1500.



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      PQRI
   Eligible professionals who satisfactorily report
   quality-measures data for services furnished during
   a Physician Quality Reporting System reporting
   period are eligible to earn an incentive payment
   equal to a percentage of the eligible professional's
   estimated total allowed charges for covered
   Medicare Part B Physician Fee Schedule (PFS)
   services provided during the reporting period.


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      But…
   Services payable under fee schedules or methodologies
   other than the PFS are not included in Physician Quality
   Reporting (for example, services provided in federally
   qualified health centers, independent diagnostic testing
   facilities, independent laboratories, hospitals [including
   method I critical access hospitals], rural health clinics,
   ambulance providers, and ambulatory
   surgery center facilities).
   http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-
   Instruments/PQRS/Downloads/Eligible_Professionals03-08-2011.pdf


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      E-Prescribing Incentive
   The program provides an incentive payment to
   practices with eligible professionals (identified on
   claims by their individual National Provider
   Identifier [NPI] and Tax Identification Number [TIN])
   who successfully e-prescribe for covered Physician
   Fee Schedule (PFS) services furnished to Medicare
   Part B Fee-for-Service (FFS) beneficiaries (including
   Railroad Retirement Board and Medicare Secondary
   Payer).
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      E-Prescribing
   Beginning in 2012, the program also applies a
   payment adjustment to those eligible
   professionals who are not successful
   electronic prescribers on their Medicare Part
   B services.




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      E-Prescribing
      An eligible professional must have and use
      a qualified eRx system and report on his or
      her adoption and use of the eRx system.
      …the eligible professional must meet the
      criteria for a successful electronic
      prescriber specified by CMS for a particular
      reporting period.

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      E-Prescribing
   Finally, at least 10% of a successful electronic
   prescriber's Medicare Part B covered services
   must be made up of codes that appear in the
   denominator of the eRx measure.




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      eRx Denominator Codes
   Patient visit during the reporting period (CPT or
   HCPCS): 90801, 90802, 90804, 90805, 90806,
   90807, 90808, 90809, 90862, 92002, 92004, 92012,
   92014, 96150, 96151, 96152, 99201, 99202, 99203,
   99204, 99205, 99211, 99212, 99213, 99214, 99215,
   99304, 99305, 99306, 99307, 99308, 99309, 99310,
   99315, 99316, 99324, 99325, 99326, 99327, 99328,
   99334, 99335, 99336, 99337, 99341, 99342, 99343,
   99344, 99345, 99347, 99348, 99349, 99350, G0101,
   G0108, G0109
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      Eligible but not able to participate:
   Services payable under fee schedules or
   methodologies other than the PFS are not included
   in Physician Quality Reporting (for example, services
   provided in federally qualified health centers,
   independent diagnostic testing facilities,
   independent laboratories, hospitals [including
   method I critical access hospitals], rural health
   clinics, ambulance providers, and ambulatory
   surgery center facilities).
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      Filing a Hardship
      Many practices are erroneously having the
      payment reduction applied.
      Contact the QualityNet Helpdesk
      QualityNet Help Desk
      Monday – Friday from 7 a.m. – 7 p.m. CT
      (866) 288-8912
      qnetsupport@sdps.org
   https://www.qualitynet.org/portal/server.pt/community/co
   mmunications_support_system/234

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      Presentation Resources
   “An Introduction to the Medicare EHR Incentive
   Program for Eligible Professionals.” Centers for
   Medicare and Medicaid Services.
   https://www.cms.gov/Regulations-and
   Guidance/Legislation/EHRIncentivePrograms/downloads/Beginners_Guide.pdf


   eRx and PQRS Eligible Professionals
   http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-
   Instruments/ERxIncentive/Eligible-Professionals.html




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      Presentation Resources
   Trailblazer’s Overview of 2012 Medicare
   Incentives
   http://www.trailblazerhealth.com/Education
   /Documents/WBT/Overviewofthe2012Medic
   areIncentivePrograms03-21-12.pdf



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      MLN Articles
   SE1107 - 2011 Electronic Prescribing (eRx) Incentive
   Program Update – Future Payment Adjustments
   MM6514 - Coding and Reporting Principles for the
   Physician Quality Reporting Initiative (PQRI) and the
   Electronic Prescribing (E-Prescribing) Incentive
   Programs.
   SE1206 - 2012 Electronic Prescribing (eRx) Incentive
   Program: Future Payment Adjustments

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      CMS and Medicare Resources
   CMS Rural Health Center – www.cms.gov/center/rural.asp

   Online Manuals -
     www.cms.gov/Manuals/IOM/list.asp?listpage=1

   Trailblazer’s Rural Health Clinic Manual
   www.trailblazerhealth.com/Publications/Training%20Manual/rhcmanual.pdf


   Cahaba – www.cahabagba.com


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      More CMS Resources
   Medicare Claims Processing Manual – UB04 Completion
           www.cms.gov/manuals/downloads/clm104c25.pdf


   Medicare Claims Processing Manual – Chapter 9 RHC/FQHC
     Coverage Issues
           www.cms.gov/manuals/downloads/clm104c09.pdf


   MedLearn Catalog
           www.cms.gov/MLNProducts/downloads/MLNCatalog.pdf



www.northamericanhms.com                                  888.968.0076
      Contact Information
   Charles A. James, Jr.
   North American Healthcare Management Services
   President and CEO
   888.968.0076
   cjamesjr@narhsinc.com
   www.northamericanhms.com




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