Medicare Advantage

Changes to the Medicare and Medicaid EHR Incentive Programs

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The Centers for Medicare and Medicaid Services (CMS) has released a long list of changes for the Hospital Outpatient Prospective Payment System (OPPS) that are intended to streamline certain systems and encourage quality health care by hospitals and their off-campus affiliate locations. Changes deal primarily with streamlining billing processes, creating more transparency for the patient and increasing compensation for hospitals and other qualifying medical treatment facilities.

Items and Services

The CMS had initially sought to change the types of items and services an off-campus facility could charge for under the OPPS and break everything down based on the type of treatment or procedure each item belonged to. When hospitals and other medical facilities indicated that this change would create an administrative nightmare, the CMS backed off this change. Instead, research is now being done on more efficient ways to bill for the excepted items on the new list.

Packaged Services

The CMS has also taken huge strides in cutting down administrative processes and costs associated with packaged services. Instead of billing based on the treatment date, the new OPPS will allow hospitals to bill based on the claim needs. This allows hospitals to bill for items and services as a group that used to be broken down into component parts. Laboratory billing has also been altered to make it more in line with the treatments that are being offered, and the L1 billing modifier – which created several bills for one lab test – has been discontinued.

Raising Payment Levels

To encourage quality care, the CMS has announced that the payment rate to hospitals is increasing by 1.7 percent in 2017. The CMS also changed the way that hospitals bill through its Partial Hospitalization Program (PHP), which enables hospitals to more accurately bill for specific types of treatment, as opposed to giving a limited number of categories for hospitals to choose from.

All of these changes mean more money for hospitals and less administrative red tape. By helping hospitals to focus less on filing claims and more on treating patients, the CMS expects an increase in the quality of care that is offered.

Changes to the Medicare and Medicaid EHR Incentive Programs

The Electronic Health Records (EHR) incentive programs were designed to create a more meaningful exchange of information between patients and clinicians, while giving incentives to medical practices to upgrade their technology. The changes laid out for 2017 (referred to as Stage 2) are designed to streamline the information exchange process and make information readily available to physicians who need it.

Quality Payment Program

A significant part of the Stage 2 changes to the EHR include the Quality Payment Program (QPP). This program rewards medical practices for continuing to update their technology, and provides financial incentives for clinicians to utilize a payment system based on the quality of care given as opposed to charging a flat rate for each procedure. By 2022, medical practices will be able to earn payment bonuses of up to 9 percent for updating their technology and becoming more active in the development of the EHR system.

A Centralized Storage System

Another key component of Stage 2 is the creation of a centralized storage area for all medical data that can be quickly accessed by medical practices and organizations throughout the country. The CMS is encouraging all qualified hospitals, off-campus providers and technicians to apply for access to the system so they can be prepared when the program is ready to go online.

The CMS is looking to the future and mandating that medical practices and organizations around the country work towards developing an effective medical records storage system. This system is going to make access to medical records easier and faster, which will be a huge benefit to clinicians and patients.

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