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

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Medical Coding & Billing

National Regulatory Changes

Daniel E. Buffington, PharmD, MBA, FAPhA June 2, 2016

Value alue‐Based Based Pay Payments CMS CMMI HHS, HHS, CM CMS, & CMMI MMI

Center for Medicare & Medicaid Innovation

CMMI

Tr Transition in in Pay Payment Model Models

Fee‐for‐ Service Pay‐for‐ Performance Value‐Based Payment Alternate Payment Models (APM) Alternate Payment Models (APM) Historical Recent Future

Patient‐ Centered Medical Homes (PCMH) Accountable Care Organizations (ACO)

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Al Alterna rnate Pay Payment Model Model Journe urney

Coding Valuation Payment Models MIPS & MACRA

AMA CPT

Current Procedural Terminology Product

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Service

AMA RUC

Relative Value Scale (RVS) Update Committee

CMS / CMMI

Healthcare Payment Modeling & Improvement

Future Alternate Payment Models (APM)

Value‐Based Payment FFS & APM RUC Valuation Analysis

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Market Valued Healthcare Reform a) Market & Exchange b) Payment Models c) Quality & Safety Improvement Physician‐Focused Technical Advisory Committee

HHS HHS Goals Goals

Alternate Payment Models (APM) & Fee‐For‐Service (FFS)

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Opportunities Opportunities fo for In Integration In Into CM CMS & CM CMMI In Init itiatives

Hospital Engagement Networks (HEN) Transforming Clinical Practice Initiative (TCPI) Alternate Payment Models (APM)