Medical Coding & Billing CMMI National Regulatory Changes Daniel - PowerPoint PPT Presentation

5/31/2016 Value alue ‐ Based Based Pay Payments Medical Coding & Billing CMMI National Regulatory Changes Daniel E. Buffington, PharmD, MBA, FAPhA CMS June 2, 2016 HHS, CM HHS, CMS, & CMMI MMI Tr Transition in in Pay Payment Model Models Alternate Alternate Center for Medicare & Medicaid Innovation Fee ‐ for ‐ Historical CMMI Payment Payment Service Models Models (APM) (APM) Pay ‐ for ‐ Recent Performance Patient ‐ Accountable Centered Care Medical Homes Organizations Value ‐ Based (PCMH) (ACO) Future Payment 1

5/31/2016 Al Alterna rnate Pay Payment Model Model Journe urney Payment MIPS & Coding Valuation Models MACRA AMA CPT AMA RUC CMS / CMMI Future Alternate Current Procedural Terminology Relative Value Scale (RVS) Healthcare Payment Payment Models (APM) Update Committee Modeling & Improvement Value ‐ Based Payment FFS & APM Product RUC Valuation Analysis Healthcare Reform Physician ‐ Focused or or Technical Advisory Committee Service Market Valued a) Market & Exchange b) Payment Models c) Quality & Safety Improvement HHS HHS Goals Goals Alternate Payment Models (APM) & Fee ‐ For ‐ Service (FFS) 2

5/31/2016 Opportunities Opportunities fo for In Integration In Into CMS & CM CM CMMI In Init itiatives Hospital Engagement Networks Transforming Clinical Practice Initiative Alternate Payment Models (HEN) (TCPI) (APM) 3