Getting Paid
Making the most of your payment options
As a practicing family physician, you make important decisions about patient care every day. When it comes to being appropriately paid for that care, you should be no less diligent in evaluating your options and choosing the path that’s right for you and your practice.
Whether you participate in Medicare, contract with private payers, or some combination of the two, accurate and appropriate coding and documentation are foundational to ensuring you’re properly compensated for the services you provide, so you want to be sure you’re up to date on the latest requirements.
In addition, the Medicare Access and CHIP Reauthorization Act (MACRA) set the stage for the creation of two tracks for Medicare payment: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (AAPMs). Although both programs are designed to reward physicians for providing higher quality care, performance and reporting requirements differ based on which track you participate in. Find out what you need to know to succeed in today’s evolving payment environment.
FPM Coding Topic Collection
Find answers to your coding and documentation questions
The FPM Topic Collection on Coding offers in-depth information to help you maximize payment and avoid stressful, time-consuming audits by billing correctly for these services.
Find articles on topics such as:
- The 2021 implementation of revised office visit evaluation and management (E/M) coding and documentation guidelines
- The 2023 updates on coding for E/M services provided in hospitals, nursing homes and other facilities
- Structured screening and assessment coding and documentation requirements
- Coding for Medicare wellness and care coordination services
- Specific patient care scenarios (e.g., performing a punch biopsy on a suspicious lesion)
Coding
Choosing the right codes for services you provide—and supporting them with proper documentation—is essential to billing correctly and avoiding an audit. Adhering to the latest coding requirements can be tricky, but it’s essential to maximizing your revenue. Learn about the basics of coding; understand the complexities of coding for evaluation and management (E/M) patient visits; and find out how to optimize fee-for-service (FFS) revenue, improve quality, and decrease costs by providing Medicare annual wellness visits and other care coordination services.
MACRA
MACRA established two Medicare payment tracks—MIPS and AAPMs—known collectively as the Quality Payment Program (QPP). As Medicare’s FFS, pay-for-performance program, MIPS assesses eligible clinicians on four categories: quality, cost, improvement activities, and promoting interoperability. MIPS aims to prepare your practice to transition to an APM by fostering the skills needed to succeed in value-based payment (VBP); AAPMs may be a better option if your practice already has experience in this environment. MIPS APMs can assist in transitioning to AAPMs for those participating in an APM who are not ready to assume sizable downside risk. QPP’s technical assistance programs can help you determine which program is best for you.
Medicare Options
When it comes to Medicare contracting, you basically have three choices. You can sign a participating (PAR) agreement and agree to accept Medicare's allowed charge as payment in full for your Medicare patients. If you elect to be a non-PAR physician, you may make assignment decisions on a case-by-case basis and bill patients for more than the Medicare allowance for unassigned claims up to a predetermined cutoff. Or you can become a private contracting physician, agreeing to bill patients directly and forgo all payments from Medicare. Review the options before you decide.
Private Payer Issues
Like other innovative payment models, those being promulgated by private payers are increasingly focused on boosting quality and reducing costs by moving physicians toward value- rather than volume-based payment arrangements. However, the wide range of actors in this space translates to a patchwork of different policies, procedures, and payment modalities that can add significant complexity to your medical practice. Discover what’s being done to promote administrative simplification, and find out how you can lessen the excessive burdens posed by prior authorizations.
2021 E/M Coding Reference Cards Support Practice Teams
Evaluation and management (E/M) codes are the family physician’s bread and butter. To maximize payment and reduce the chances of being audited, you need to understand how to properly code and document E/M services. Put the information you need at your fingertips—literally—with a comprehensive resource that reflects the 2021 office visit E/M guideline changes.
Updated coding reference cards based on the revised E/M guidelines are designed to support physicians and their practice team members in selecting the appropriate codes for every practice scenario and documenting those choices. Find out how to purchase your card set.
HCC Coding Risk Adjustment Helps Predict Care Utilization
Hierarchical condition category (HCC) coding is a prospective risk-adjustment model designed to convey the full picture of patient complexity and help estimate future health care costs. HCC coding uses ICD-10 diagnostic codes to assign patient risk scores. Payers combine those risk scores with demographic data to assign risk adjustment factor (RAF) scores, which, in turn, help predict care utilization and related costs. RAF scores are also used to risk adjust quality and cost measures.
Learn how your practice can use team-based strategies to optimize coding for risk adjustment in this Family Medicine Practice Hack.