10/20/2020

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Copyright © 2019 AAPC

Industry Trends that Effect AAPC Members

Objectives

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• Discuss regulatory guidelines

• Review payment model shifts

• Discuss technology advancements

• Answer your questions

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CY 2021 PFS Proposed Conversion Factor

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• CY 2021 PFS conversion factor: $32.26

•Currently $36.09

Medicare Telehealth Services – Category 1

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•HCPCS code GPC1X: Visit complexity inherent to evaluation and management associated with primary medical care services that serve as the continuing focal point for all needed health care services (Add-on code, list separately in addition to an evaluation and management visit)

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Medicare Telehealth Services – Category 1

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•99417: Prolonged office or other outpatient evaluation and management service(s) (beyond the total time of the primary procedure which has been selected using total time), requiring total time with or without direct patient contact beyond the usual service, on the date of the primary service; each 15 minutes (List separately in addition to codes 99205, 99215 for office or other outpatient Evaluation and Management services)

Medicare Telehealth Services – Category 1

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•90853: Group psychotherapy (other than of a multiple-family group)

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Medicare Telehealth Services – Category 1

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•96121: Neurobehavioral status exam (clinical assessment of thinking, reasoning and judgment, [eg, acquired knowledge, attention, language, memory, planning and problem solving, and visual spatial abilities]), by physician or other qualified health care professional, both face-to-face time with the patient and time interpreting test results and preparing the report; each additional hour (List separately in addition to code for primary procedure)

Medicare Telehealth Services – Category 1

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•99483: Care Planning for Patients with Cognitive Impairment

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Medicare Telehealth Services – Category 1

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•99334: Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 15 minutes are spent with the patient and/or family or caregiver.

Medicare Telehealth Services – Category 1

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•99335: Domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent with the patient and/or family or caregiver.

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Medicare Telehealth Services – Category 1

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•99347: Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self-limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family.

Medicare Telehealth Services – Category 1

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•99348: Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 25 minutes are spent face-to-face with the patient and/or family.

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Medicare Telehealth Services

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•Add new Category 3 telemedicine codes

•Calendar year the PHE ends

Medicare Telehealth Services – Category 3

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Service Codes

Domiciliary, Rest Home, or Custodial Care services, Established patients

99336, 99337

Home Visits, Established Patient 99349, 99350

Emergency Department Visits 99281, 99282, 99283

Nursing facilities discharge day management

99215, 99316

Psychological and Neuropsychological Testing

96130, 96131, 96132, 96133

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Medicare Telehealth Services

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•Challenges being faced• Technology

• Providers• Patients

• Documentation• Regulations

• Accept the AMA new and established E/M changes effective January 1, 2021

• New and established codes selected based on a new defined MDM or Time

• Remove history and exam as key components –medically

• Elimination of 99201

Evaluation and Management

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Current 2021 Proposed wRVU % increase99201 0.48 Deleted99202 0.93 0.93 0%99203 1.42 1.6 13%99204 2.43 2.6 7%99205 3.17 3.5 10%

Current 2021 Proposed wRVU % increase99211 0.18 0.18 0%99212 0.48 0.7 46%99213 0.97 1.3 34%99214 1.5 1.92 28%99215 2.11 2.8 33%

Evaluation and Management

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• Post PHE for the COVID-19 pandemic – an established patient-physician relationship is required• Allow auxiliary personnel to furnish CPT codes 99453 and 99454 services under a physician’s supervision. • Medical device supplied to a patient as part of CPT code 99454 must be a medical device as defined by

Section 201(h) of the Federal Food, Drug, and Cosmetic Act, that the device must be reliable and valid, and that the data must be electronically (i.e., automatically) collected and transmitted rather than self-reported.

• Post PHE for COVID-19, require 16 days of data each 30 days must be collected and transmitted to meet the requirements to bill CPT codes 99453 and 99454.

• RPM services are considered to be evaluation and management (E/M) services.• Only physicians and NPPs who are eligible to furnish E/M services may bill RPM services.• CPT codes 99457 and 99458, an “interactive communication” is a conversation that occurs in real-time and

includes synchronous, two-way interactions that can be enhanced with video or other kinds of data

Remote Physiologic Monitoring Services

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Direct supervision - real-time, interactive audio and video technology (excluding telephone that does not also include video) through December 31, 2021.

Direct Supervision

Pharmacists fall within the regulatory definition of auxiliary personnel under “incident to” regulations.

Pharmacists

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Therapy students, and students of other disciplines, working under a physician or practitioner, may document in the record. It must be reviewed and verified (signed and dated) by the billing physician, practitioner, or therapist.

Medical Record Documentation

https://innovation.cms.gov/innovation-modehttps://innovation.cms.gov/innovation-models#views=modelsls#views=models

Innovative Payment ModelsACO Episode Based Primary Care

Transformation Focused on Medicaid and CHIP

New Payment and Service Delivery

Adoption of Best Practices

Next Generation ACO Model

Comprehensive Care for Joint Replacement Model

Comprehensive Primary Care Plus

Medicaid Innovation Accelerator Program

Artificial Intelligence (AI) Health Outcomes Challenge

Historically Black Colleges and Universities (HBCU) Research

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• Use of Medicare Telehealth Services During the COVID-19 Pandemic

• Audit of Medicare Payments for Inpatient Discharges Billed by Hospitals for Beneficiaries Diagnosed With COVID-19

• Opioid Use in Medicare Part D in 2020• Medicare Part B Payments to Physicians for Co-Surgery

Procedures

OIG Workplan

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Healthcare Now the Largest U.S. Employer

Tho

usan

ds o

f per

sons

Manufacturing Retail Trade Healthcare

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Hospital Outpatient Revenue will Overtake Inpatient

Shift to Non-Traditional Healthcare Consumption

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2020 Headwinds are Here

• COVID-19• Global Economic Downturn• U.S. Elections• Political and Cultural Polarization• Technology Automation• Transition to Virtual/Remote• Outsourcing• Healthcare Payment Model Evolution• Role Consolidation• Stuck at home with kids until…….

What AAPC is Doing

• Remote Staff - 400 AAPC Employees transitioned to work from home• Virtual HEALTHCON/Regional Conf• Local Chapters – Shifted meetings to virtual• Exams – Extended vouchers, postponed live, and proctoring online• Students – Extending 2019/2020 courses and awarding scholarships• AAPC Coder – Extended free trial through June• Education – Free webinars, courses, CEUs• Fees/Payments – Leniency, extensions, and payment plans• Member Outreach – Staff, Boards, and Officers reaching out

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What AAPC is Doing

• Exam Inventory – remains one of our greatest risks for Q3/Q4. We administered ~14,000 exams in Q2 2019. This year, ~1,700 in the same period (live and online combined). The demand is there, the inventory is not – creating a huge challenge for the last two quarters of 2020 when even in normal years we regularly deal with exam capacity issues.

• Q2 pent up demand of more than 12,000 exams• Q3 exam locations still not up to full capacity (and in a quarter where we normally

do 18,000 exams)• 20,000 free courses (CIC, COC, CPB) given away to members who may want to sit

for an exam in Q3/Q4• We’ll be encouraging chapters to hold exams where possible, reserving additional

locations, and recommending all prospective CPCs go the online route (where outcomes are better – averaging nearly an hour less time to complete, improved scores, split into two so less a test of endurance, etc)

What AAPC is Doing

• Local Chapters • Attendance is up 100% with virtual chapter meetings remaining more popular than their in-person counterparts

(87%/13% split currently). • Unfortunately, 20% of chapters haven’t held any meetings (in-person or virtual) since April (restrictions limiting in-

person and they’re fearful of the technology requirements of virtual).

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What AAPC is Doing

What AAPC is Doing

• Customer Service Swamped• Thanks to everyone for their patience with our customer care team. They’ve

been overwhelmed as we try to keep up with demand • AAPC hired 10 new representatives. • Increased demand based on inquiries related to our virtual events, online

exams, cancelled exams, #FREEAAPC, and an influx of new members to AAPC)• Calls up 40%• Chats up 100%• Emails up 150%

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Certification: History

• CPC 1989• COC (formerly CPC-H) 1992• Specialties (coding) 2006• CPMA (auditing)CPMA 2009• CPCO (compliance) 2011• CPPM (practice mgmt) 2012• CPB (billing) 2013• CIC(inpatient) 2014• CRC (risk adjustment) 2015• CDEO (documentation) 2016

AAPC Exams

• 46% average pass rate overall• 27% pass rate – third party training• 83% pass rate – AAPC training • Online proctored exams

• Currently, CPC only. Online exam results (so far) show reduced completion time and better outcomes.

• Plan is to continue to transition to on-line exams for all credentials• New certifications on the horizon with role emergence/evolution

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AAPC Curriculum

• Revised and updated MACRA certificate course• Home health coding course• Physical medicine and rehabilitation coding course• Advanced neurology and neurosurgery coding course• Skilled nursing facility coding course• EHR/EMR training • Pathophysiology course to support the coming E/M changes• E/M training (courses, workshops, live boot camps) in preparation for 2021• Expanded approved instructor program• High school curriculum for business of healthcare

Reference Guides

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AAPC Coder

AAPC Diversity

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Gender

Female, 84%

Male, 16%

Roles

0% 10% 20% 30% 40%

Coding/Coding Management

Billing/Billing Management

Auditing

Compliance

Practice Management

Other

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Age

0% 10% 20% 30% 40%

21-30

31-40

41-50

51-60

61-70

Organization

0% 5% 10% 15% 20%

Large Group Practice (50+)

Health System

Medium Group Practice (11-49)

Hospital (inpatient)

Solo Practice

Other

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What are your AUDITORS' productivity standards?

37%

26% 28%

6% 3%0%

5%

10%

15%

20%

25%

30%

35%

40%

<5 5-7 8-10 11-15 >15Cases perhour

What are your CODERS' productivity standards?

14%21% 21%

29%

15%

0%

5%

10%

15%

20%

25%

30%

35%

<5 5-7 8-10 11-15 >15Cases perhour

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AAPC International

35,000 members in 39 countries

Please rate your challenges at workLearning advanced coding skills 1Getting definitive coding answers 2Obtaining management skills 3Understanding the reimbursement process 4Finding reliable workplace resources 5Communicating with providers 6Managing time 7Using technology (e.g., EHR, computer-assisted coding, electronic code lookup tools) 8

Member Survey - Challenges at Work

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10 Ways to Future Proof Your Career

1. Learn Your Business (not just your role)2. Solve Your Employers Challenges (not just your own)3. Embrace Technology4. Grow Your Network5. Stay in Growing Industry Sectors6. Learn to be Virtual7. Be Prepared to Go Solo8. Accept Change and Overcome Adversity9. Stay in the Know10. Level Up (push your limits)

Resources

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https://innovation.cms.gov/innovation-models#views=models

https://www.cms.gov/medicaremedicare-fee-service-paymentphysicianfeeschedpfs-federal-regulation-notices/cms-1734-p

https://oig.hhs.gov/reports-and-publications/workplan/active-item-table.asp

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