Modifier 25 audits, 2018 fee schedule and QPP rule, IPAB, physician burnout, and AMA membership. View this email in your browser
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Dermatology World Weekly
November 8, 2017
 
Anthem to conduct modifier 25 audits

The American Academy of Dermatology Association (AADA) has confirmed that Anthem/Empire Blue Cross Blue Shield will begin conducting post-service reviews of claims billed with modifier 25 in California, Connecticut, Maine, New Hampshire, and New York. Providers deemed as outliers will be contacted for additional documentation related to the services, and if a billing discrepancy is identified, Anthem/Empire has indicated that it will be require “recoupments as appropriate.”

This announcement comes on the heels of news that starting with claims processed on or after Jan. 1, Anthem Blue Cross Blue Shield plans to reduce reimbursement for modifier 25 in California, Connecticut, Kentucky, Maine, Nevada, New Hampshire, Ohio, and Wisconsin. The Academy also recently learned that this policy will be instituted in Missouri effective Feb. 1. The Academy has developed a number of resources for members on appropriate usage and documentation of modifier 25. To sign up for updates on modifier 25 advocacy efforts, fill out the form here, or stay tuned to DWW.

Read more about insurer attempts to rein in modifier 25, and other payer policies, in Dermatology World.

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CMS releases final fee schedule, updates to QPP

The Centers for Medicare and Medicaid Services (CMS) has released the final 2018 Medicare Physician Fee Schedule. Overall, dermatology can expect a 1 percent increase in payments — depending on each physician’s individual mix of services. The rule stated that CMS will retroactively lower PQRS reporting requirements for 2016 from nine to six measures, and will reduce value-based modifier penalties for eligible providers that did not meet minimum reporting requirements in 2016, meaning some physicians will see smaller payment reductions than they may have anticipated in 2018 based on their 2016 quality reporting. Additionally, CMS updated the value of the existing photodynamic therapy (PDT) code and created two new PDT codes that involve physician work. The code values for acne surgery and photochemotherapy increased slightly.

CMS also issued its final rule that implements the second year of the Quality Payment Program (QPP) for 2018. CMS finalized major changes to MIPS for 2018, including recommendations made by the Academy. Specifically, CMS will increase the threshold for the MIPS exemption to include providers with less than $90,000 of allowed Medicare Part B charges, or those who see 200 or fewer unique Part B beneficiaries. In 2017, the exemption covers those with less than $30,000 in charges or 100 or fewer beneficiaries. Additionally, CMS will now count the ‘Cost’ section toward the total MIPS score. MIPS scoring for 2018 will consist of ‘Quality’ at 50 percent, ‘Cost’ at 10 percent; ‘Practice Improvement’ at 15 percent, and ‘Advancing Care Information’ (ACI) at 25 percent. The practice improvement and ACI activities will require a 90-day minimum performance period.

Read more about the 2018 Fee Schedule and updates to the QPP on AAD.org. Learn more about how to navigate these changes and the impact to your practice by attending the Coding & Practice Updates for 2018 Live Webinar on Dec. 7. This webinar is also available in one of the Academy's popular coding packs for 2018.

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U.S. House passes IPAB repeal

The U.S. House of Representatives has passed ― with a large bipartisan majority ― H.R. 849, the Protecting Seniors’ Access to Medicare Act, which would repeal the Independent Payment Advisory Board (IPAB). The legislation will now go to the Senate, but it is unclear when it will consider the bill. Send a letter urging your senators to support IPAB repeal through the AADA’s Advocacy Action Center.

The American Academy of Dermatology Association (AADA) and other members of the IPAB Repeal Coalition have been lobbying aggressively in support of IPAB repeal ― joining a number of medical organizations in support of the legislation, and signing on to a support letter to the lead sponsors of bills. Read more about the IPAB in Dermatology World.

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Administrative burden taking a toll on physicians

According to recent research conducted by the American Medical Association (AMA), the Mayo Clinic, and Stanford University, one in five physicians in the United States plans to reduce clinical work hours within the next year. Additionally, about one in 50 physicians is planning to change careers within the next two years. According to a press release issued by the AMA, “the research sheds light on a troubling correlation between the career plans of U.S. physicians and the growing problem of burnout, technology dissatisfaction and administrative fatigue among physicians.” Additionally, the paper highlights the effects physician burnout can have on patient access. “If just 30 percent of physicians follow through on their intention to leave medicine in the next two years, the study estimates approximately 4,759 physicians would leave the workforce ― a loss roughly equivalent to eliminating the graduating classes of 19 U.S. medical schools in each of the next two years.”

Dermatologists are no strangers to physician burnout. Read more about this trend — and take a quiz to assess your own burnout level — in Dermatology World.

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Support dermatology by joining the American Medical Association

The American Academy of Dermatology Association has four delegates and four alternate delegates in the American Medical Association (AMA) House of Delegates working to represent the interests of dermatology, help advance the profession and benefit patients. However, in order to maintain this representation in the AMA House of Delegates in 2018, more Academy members must join the AMA by Dec. 29, 2017. Without increasing membership in the AMA, the Academy stands to lose one delegate and one alternate delegate, a significant loss for the specialty. Help keep dermatology’s voice strong in medicine and in advocacy. To join the AMA, visit www.ama-assn.org/membership.

Dermatology has successfully collaborated with the AMA and the greater house of medicine on many issues such as truth in advertising, scope of practice, Medicare payment reform, and narrowed provider networks. Read more about dermatology’s fruitful alliances in Dermatology World.

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Links to this month's issue

Psoriasis goal setting
 
Expanding a practice
Comedic dermatology
 
Caring for LGB patients

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Copyright © 2017 by the American Academy of Dermatology and American Academy of Dermatology Association. "All rights reserved." Reproduction or republication strictly prohibited without prior written permission.

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