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Stay current on all the news that matters to you with our blog: MRA Alerts and Updates

Empirical Risk
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Are you looking for the best education available in risk adjustment? Good News - You have found it! Join us for a day of risk adjustment, catch up with colleagues over lunch, and get the best tools in the industry for FREE! Do you need CMEs or CEUs? We have that too! All Workshops are approved by the American Medical Association, American Academy of Family Practice and the American Academy of Professional Coders. Register your team ( 3 or more) today to save 10% on Tampa and Ft. Lauderdale. Take advantage of Early Bird pricing and Save $100! Improve the Accuracy of your Risk Scores... Overview: What is changing for risk adjustment in 2019? New ICD-10 codes and HCC categories are coming. What should your team be doing now to prepare? Review the different risk adjustment models and their impact on medical practice management for 2019 and beyond. Discuss the impact of shifting from RAPS to EDS. What does this mean for office based claims? Take a deep dive into HCC Coding and Documentation. Review real documentation examples to see what validates, what doesn’t, and why.  Learn how to leverage frontline staff to be successful in the world of risk adjustment and value-based payments. Download the Agenda Here Who Should Attend? Medical Coders and Billers Providers, Managers and Frontline Staff CDI Specialists Executive Leaders ACO, MSO and IPA Teams Rural Health Centers Health Alliance Members Medicare, Medicaid and Commercial Plans REGISTER BELOW: Tampa,Florida HILTON GARDEN INN TAMPA RIVERVIEW 4328 Garden Vista Drive, Riverview, FL 34747 Wednesday - October 24, 2018 10:00 AM - 4:00 PM Early Bird Pricing $100 Register Here Fort Lauderdale, Florida CYPRESS CREEK EXECUTIVE CENTER 1451 W. Cypress Creek Road, Fort Lauderdale, FL, 33309 Thursday November 8, 2018 9:20 AM - 3:30 PM Early Bird Pricing $100 Register Here Visit for more details
Empirical Risk
Is your organization currently taking on risk or participating in value-based payment models?  If so, we can help!  ERM Consulting will work with your team to develop an internal risk adjustment program.  Services Included: Remote Auditing and Monitoring - Review of 25 encounters per provider, per month, with detailed monthly reports to track error trends and validation rates.  Development of Custom Education - Custom education for providers and coders, every quarter, to reinforce positive changes and educate on new opportunities.  Onsite Meetings (One week on-site per Quarter) - 1:1 meetings with providers, coders and leadership to review current audit results and discuss opportunities for improvement.  Oversight and Guidance - ERM will provide oversight and guidance to assist with the development of development of internal team and processes needed to manage new payment models.  Strategic Considerations: Who will be part of the team and what role will they play?  What new processes need to be added or adjusted? How will the team communicate and measure success? Who is On-boarding, Training and Managing your Coders? ERM also offers remote on-boarding, training and management of coders and billing teams.  Visit ERM online or email for more information. Contract during the month of September and receive a 25% Discount – on all HCC Coding Tools by ERM – visit our online store at to see a complete list.
Empirical Risk
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Evaluation and management (E/M) coding and documentation burden could lighten in 2019 under CMS proposed rule The rule also proposes a single payment rate for level 2 through level 5 office visits. The July/August issue of FPM addressed strategies for distinguishing between 99213 and 99214 office visit codes. That distinction may soon become easier to document but essentially irrelevant to payment. On July 12, the Centers for Medicare & Medicaid Services (CMS) released its proposed changes to the Medicare Physician Fee Schedule for 2019( The proposed rule contains, among other updates, significant revisions to the coding and documentation of office visit evaluation and management (E/M) services (see page 331 of the proposed rule( While Medicare is only proposing changes to the Office and Other Outpatient Services category of codes (99201-99215) for 2019, Medicare indicates it intends to use a stepwise approach and expand its finalized policy to other E/M code categories (see pages 331-332 of the proposed rule). The changes follow years of auditing from Medicare contractors and widespread concerns from the medical community that existing E/M documentation guidelines no longer reflect current practices and result in unnecessarily burdensome documentation requirements. New time reporting option In selecting a level of service for office or other outpatient services, beginning Jan. 1, 2019, physicians would have increased options available. In addition to using the current 1995 and 1997 documentation guidelines, physicians could select the level of service based on time or by using medical decision-making alone, regardless of the level of history or physical exam performed (see page 335 of the proposed rule). The option to select a level of service based on the duration of the visit relaxes existing requirements. Currently, selecting a visit based on time requires documentation of the duration of face-to-face time with the patient and greater than 50 percent of the visit must be spent in counseling or coordination of care. Medicare’s proposal would eliminate this second requirement, simply allowing physicians to select a code based on the total length of the visit even if counseling did not dominate the service time. (see page 338 of the proposed rule). Medical decision making as the driving factor Especially for new patient visits, which currently require meeting requirements for all three key components of history, examination, and medical decision-making, satisfying requirements for higher levels of service can be difficult. Physicians have long complained that the points system for history and examination components result in unnecessary documentation that does not contribute to patient care. As a result, Medicare proposes to allow physicians to select their level of service for both new and established patient office visits using only the medical decision-making component. The requirements for medical decision making would remain the same. Reducing unnecessary requirements Recognizing several common E/M documentation guideline complaints, Medicare proposes to no longer require physicians to re-record information regarding the chief complaint and history of present illness previously documented by ancillary staff (see pages 343-345 of the proposed rule). Single payment rate The method of supporting your level of service, in some respects, may be a distinction without a difference under the proposed rule. Level 2 through level 5 new and established office visits, respectively, would have a single payment rate regardless of the code reported (see page 349 of the proposed rule). New patients (99202-99205) would be paid at approximately the midpoint between a 99203 and 99204 (see page 349 of the proposed rule), assigning 1.9 work RVUs to new patient visit codes. (Compare that to the 2018 rates for 99203 at 1.42 work RVUs and 99204 at 2.43 work RVUs, with a midpoint of 1.925.) Established patient visits (99212-99215) would be paid just under the midpoint between 99213 and 99214 (see page 349 of the proposed rule), assigning 1.22 work RVUs to established patient visit codes. (Compare that to 2018 rates for 99213 at 0.97 work RVUs and 99214 at 1.5 work RVUs, with a midpoint of 1.235.) The following tables from the proposed rule illustrate the potential financial impact using 2018 work RVU and conversion factor values. Primary care payment bump Visits with a focus on primary care can receive a bump in payment by reporting a new add-on code (specific code to be determined), with a proposed work RVU of 0.07. Impact to physicians Physicians should note that these modifications, if finalized, would only apply to office visit codes and only for Medicare. As a result, the existing 1995 and 1997 E/M guidelines will continue to apply for other services such as hospital visits, and for commercial payers. Note: The release is scheduled for official publication in the Federal Register July 27, 2018. Page references are subject to change upon publication of the Proposed Rule in the Federal Register. – Richelle Marting, JD, an attorney practicing with Forbes Law Group in Overland Park, Kan., where she focuses on regulatory compliance and health care reimbursement



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