2018 payment outlook shows new opportunities, old challenges

What a difference a year makes. 

 

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Twelve months ago physicians were preoccupied with Medicare payment reform, which was just taking effect, and wondering how-or whether-to gather and submit the data the law requires to avoid a reduction in Medicare reimbursements in 2019.

Many practices are still coming to grips with the Medicare Access and CHIP Reauthorization Act (MACRA), the law that overhauls how doctors are reimbursed for treating Medicare beneficiaries. But the new year also brings fresh revenue-generating opportunities for primary care practices in the areas of chronic care management, telehealth and diabetes management, along with an expanded number of practices exempt from MACRA’s quality data reporting requirements. 

Even with these new possibilities for additional income, though, doctors should continue to look for ways to get the most out of their existing sources of revenue. They can do so, according to practice management experts, by regularly reviewing existing payer contracts, ensuring they are properly documenting and coding patient encounters, and demonstrating their value to payers.

 

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“One of the things I try to get practices to understand is the importance of developing partnerships with payers now,” says Pam Ballou-Nelson, RN, Ph.D., senior consultant with the Medical Group Management Association (MGMA). “They need to understand the insurance company’s objectives and ask themselves: ‘How do we as a practice match with those? What is the value proposition we bring to the table?’”

 

New revenue opportunities 

The new prospects for practice income are spelled out in the 2018 Medicare Physicians Fee Schedule Final Rule, which the Centers for Medicare & Medicaid Services’ (CMS) released in November. Among other provisions, the Rule:

• Creates a separate billing code for collecting and interpreting patient health data from remote monitoring devices;

• Creates new billing codes for telehealth services; and

• Expands Medicare’s existing Diabetes Prevention Program and creates a fee schedule for the program’s services.

In addition, the Rule exempts more practices from having to participate in the Merit-based Incentive Payment Program by raising the participation threshold to $90,000 in Medicare Part B allowed charges or 200 Medicare Part B patients. The 2017 threshold was $30,000 in charges and 100 patients.

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