Government Incentives for Medical Practices: Tips and Tools to Qualify, Participate and Get Paid #1

Kathy McCoy, MBA May 10th, 2012

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IIn this webinar on Government Incentives for Medical Practices: Tips and Tools to Qualify, Participate and Get Paid,  Elizabeth Woodcock, MBA, FACMPE, CPC provided ways practitioners can earn additional reimbursement through the affordable care act and “voluntary” incentive programs.

In a grim reimbursement environment where payors always seem to be ratcheting down their contracted allowable payments, any new opportunities for extra cash flow are welcome. In a recent webinar sponsored by Kareo entitled Government Incentives for Medical Practices: Tips and Tools to Qualify, Participate and Get Paid,  leading practice management expert and author Elizabeth Woodcock, MBA, FACMPE, CPC provided just that: ways practitioners can earn additional reimbursement through the affordable care act and “voluntary” incentive programs.

This post will highlight the information Elizabeth presented on reimbursement opportunities under the Affordable Care Act.  Check back soon for her important and timely summary on “voluntary” incentive programs, and how you might actually be penalized if you do not participate.

Under the Affordable Care Act’s Primary Care Incentive Program (PCIP), certain practitioners are being paid a quarterly bonus of 10% of payments for selected codes by Medicare. As the name indicates, it primarily benefits primary care practitioners from specialties such as internal medicine, family practice, and geriatrics as well as nurse practitioners, physician assistants and clinical nurse specialists for whom primary care services account for at least 60% of allowed charges. The program runs from 2011-2016 and most practices would have received their first payment around April of last year. These payments are being made automatically and starting in the first quarter of 2012, will come as a “special incentive remittance” to more easily identify them. If you feel you qualify but have not received any payments, you can check your Medicare carrier’s website to see if your primary care provider is listed under the “PCIP Lookup Tool.”  If not, you have the right to appeal in order to be included in the PCIP.

Under the Affordable Care Act’s Primary Care Incentive Program (PCIP), certain practitioners are being paid a quarterly bonus of 10% of payments for selected codes

General surgeons in Healthcare Professional Shortage Areas are also receiving an extra payment for performing major surgical procedures. The program, the HPSA Surgical Incentive Payment (HSIP), also runs from 2011 to 2016. Then in 2013, a new program is being introduced: Medicare/Medicaid Rate Parity. For 24 months, primary care providers accepting Medicaid for evaluation and management services and vaccines are guaranteed to be paid at or equal to Medicare’s current rates. This will be a boon for many primary care practitioners who in the past, may have been paid as little as one-third of Medicare rates for the same service. Overall, the current ratio of Medicaid to Medicare is .66, so many primary care physicians will benefit when this program begins in 2013.

And finally, Elizabeth presented an overview of preventive services now being paid for by Medicare. Annual wellness visits are now covered, and they must include a health risk assessment as of January 2012. Other wellness services that are covered include an annual face-to-face obesity screening, annual screening and brief-face-to-face behavioral counseling for alcohol misuse, an annual depression screening, and bi-annual intensive behavioral therapy for cardiovascular disease.  We recently covered these services and accompanying codes in a previous webinar entitled Optimizing Office Visits for Preventive Services.

You can view all of our archived webinars to find more topics of interest to you. To receive notification of upcoming informative webinars such as this one, subscribe to our newsletter list. You can also register now for our upcoming webinar on Using RVUs to Improve Your Bottom Line.

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