Revenue Cycle Management

KPG Newsletter - MACRA-mania!
November 2016

Kathy Puziak PMP CMPE

by Kathy Puziak CMPE PMP

  The Medicare and Medicaid Access and CHIP Reauthorization Act of 2015 (MACRA) introduced a new Medicare value-based reimbursement system that will impact Medicare reimbursement amounts beginning in 2019. In October of 2016, the Centers for Medicare and Medicaid (CMS) released the final rule that sets the stage for implementation, beginning in January 2017.

Payment Alphabet Soup

The new system, the Quality Payment Program (QPP), repeals the Sustainable Growth Rate Formula (SGR) and is made up of two tracks for participation:
  • The Merit-Based Incentive Payment System (MIPS)
  • Advanced Alternative Payment Models (APMs)
As a physician billing under the Medicare Physician Fee Schedule, it is essential to understand the requirements and payment changes under MACRA because the payment adjustments that take place in 2019 will be based on action and performance starting January 1, 2017.

The Final Rule from CMS

The QPP begins January 1 2017, with a ramp-up period during which there will be less financial risk for eligible clinicians in at least the first two years of the program. The initial development period of the QPP implementation will allow clinicians to select their pace of participation for the QPP's first performance period that begins January 1, 2017. The final rule, as published by CMS, states: Clinicians can choose to report under MIPS for a full 90-day period or, ideally, the full year, and maximize the MIPS-eligible clinician's chances to qualify for a positive adjustment. In addition, MIPS-eligible clinicians who are exceptional performers in MIPS, as shown by the practice information they submit, are eligible for an additional positive adjustment for each year of the first 6 years of the program.

Clinicians can choose to report to MIPS for a period less than the full year performance period 2017 but for at least a minimum full 90-day period, and report more than one quality measure, more than one improvement activity, or more than the required measures in the advancing care information performance category to avoid a negative MIPS payment adjustment and to possibly receive a positive MIPS payment adjustment.

Clinicians can choose to report one measure in the quality performance category; one activity in the improvement activities performance category; or report the required measures of the advancing care information performance category and avoid a negative MIPS payment adjustment. Alternatively, if MIPS-eligible clinicians choose not to report even one measure or activity, they will receive the full negative 4 percent adjustment.

MIPS-eligible clinicians can participate in Advanced APMs, and if they receive a sufficient portion of their Medicare payments or see a sufficient portion of their Medicare patients through the Advanced APM, they will qualify for a 5 percent bonus incentive payment in 2019.

Are you ready for 2017 MACRA?

You need to be! The first measurement period for MACRA begins January 1, 2017 , with incentives and penalties increasing up to   ±9% of your Medicare FFS payments over the next few years.
KPG RCM can help you report for PQRS this year and move forward into MIPS and Advanced APM next year. Contact our specialists at

Additional Resources on MACRA:

Medicare Overpayments
by Kathy Puziak CMPE PMP
The Centers for Medicare & Medicaid Services(CMS) has spoken! In February of 2016, CMS published a final rule requiring Medicare Parts A and B healthcare providers and suppliers to report and return overpayments when an overpayment is identified.
The major provisions of the final rule that healthcare providers need to incorporate into their workflow:  
Meaning of Identification
Components of the final rule provide clarifications that resulted in more confusion since a separate final rule was published in the May 23, 2014 Federal Register (79 FR 29844) addressing Medicare Parts C and D overpayments.
The Affordable Care Act established new requirements for overpayments. Section 1128J(d) of the Act provides that "an overpayment must be reported and returned by the later of: (i) the date which is 60 days after the date on which the overpayment was identified; or (ii) the date any corresponding cost report is due, if applicable.  This final rule states that a person has identified an overpayment when the person has or should have, through the exercise of reasonable diligence, determined that the person has received an overpayment and quantified the amount of the overpayment." Identification established a standard that involved the healthcare providers and suppliers complying with the requirements and resolution of the self-identified overpayments.

Lookback Period

The final rule further identifies that overpayments must be reported and returned only if the provider or supplier identifies the overpayment within six years of the date the overpayment was received.

How to Report and Return Overpayments

The final rule provides that providers and suppliers must "use an applicable claims adjustment, credit balance, self-reported refund, or other appropriate process to satisfy the obligation to report and return overpayments."

What does Your Organization Use to Manage Overpayments?

If you are using GE Centricity Group Management © (IDX/GPMS/Groupcast), Task Management is the perfect module to help in the management of overpayments and credit balances. Combine Task Management with KPG RCM's Credit Balance Management tools to help you get your arms around the challenge of credit balances, refunds, and overpayments.


Notes in Group Management  
Part 3 in a Series on Notes
by Ellen Jakovich, 
Director of Training, KPG RCM  
Coded and Sticky Notes
This month we look at Coded Notes and Sticky Notes in Centricity Group Management (CGM). In addition to discussing the differences between the two, we encourage you to do an annual self-assessment on how well your Notes program is working for your practice.  Does it help or hinder your sort, search and reporting options? 

Patient Coded Notes

One reason to create a Patient Coded Note is to easily search or sort for similar notes on a patient. To keep this manageable, first create a list of notes your practice needs to store on a patient. Caution, don't go overboard building notes. If too many Note Codes are created, then users may become confused on the correct note to choose for a specific application. Just as you don't want to waste staff time sorting for the "best" note to use, you also don't want to overuse Miscellaneous Coded Notes, because that expends valuable staff time searching through every note to find the one needed. We suggest you create a table like the one below to govern the use of Coded Notes. List the areas for which notes are needed (Column 1); assign a Code for each note type (Column 2); and add a description for when to use it and the information to be stored in the free text field for each note (Column 3).
Type of Note
Example Code
Description of Information
Appointment Notes
APPT (Appointment info)
Information pertaining to the patient's appointments. For example: patient needs guardian with them; patient needs wheelchair, patient requires an appointment.
Billing Note
AR (Accounts Receivable)
BILL (Billing)
INSFU (Insurance Follow up)
ELIGIB (Eligibility)
Contains information on benefit plans specifics and limitations not documented in the insurance set. For example: information related to specific claims such as re-files; information related to a claim that needs to be corrected and researched.
Collection Notes
COLL (Collections)
All collection turnovers, financial discharges, bankruptcy and returned checks, correspondence related to collecting on balances, distribution of financial forms to patients related to payment arrangements. Can be copied from AC notes.
DSCLOSE (Disclosures of pt data)
WAIVER (Waiver needed)
Information related to HIPAA restrictions. For example: No phone calls at work; No messages; account access permissions.
Patient Notes
BADADD (Bad address)
DUPACCT (Dup account)
EXPIRED (Deceased pt)
LABTEST (Lab results)
CHART (Chart info)
PATNTS (Patient notes)
PHONE (Phone message)
PRNTS (Practice notes)
PTCARE (Patient care)
REFER (Referrals Notes)
REFILL (Prescription refill)
Information related to financial discharge, returned checks, bad addresses, etc.
  Many CGM customers create Excel scripts for use in Coded Notes. These can be copied and pasted in the note and the user simply answers the questions. For instance, for users who call insurance carriers to verify Patient eligibility, with incorrect policy #, an ELIGIB note could have a script like this:
            Reps Name:
            Reps Phone #:
            Incorrect ID#:
            Correct ID#:
Coded Notes can be added and appended (check security to ensure you're set up to append a note) for additional comments to facilitate tracking of a particular issue within one note (all are date/time/user stamped). This allows the user to choose and open one note and read the entire history from beginning to end.  With a Coded Note, stored patient information may need follow-up, but this is done without an alert. The Coded Notes tab is also found in Comments and is accessible in both Charge and Payment mini menus, Task Management and PM.
Patient Sticky Notes

These provide an alert function to staff in specified areas and appear every time the account is accessed. Sticky Notes should be read and appended, or ignored until the information can be obtained. Once the alert is addressed, the note should be changed from a Sticky Note to a Coded Note. For example, a BADADDR Sticky Note for a patient indicates a corrected address is needed to ensure patient statements and correspondence are received. Open the Sticky Note, use the free text area to summarize the changes made on the account (I.e., updated patient de mographics and included new address).  

Once the action is complete, m anually update the Sticky Note to a Coded Note, deleting the Sticky Note option. Why? Because overuse/abuse o f Stic ky Notes drives staff to ignore the message each tim e it pops up. If the action is complete, then there is no need for the alert to remain and all it will do is cause confusion and take staff time away from necessary task performance. 
Some of the Special Programs available for Coded Notes:
  • Loadcnote - allows the user to load a patient Coded Note in mass quantity. An input file with account number and note code will load one message to each patient in the text area or they can use an input file to specify a different message for each patient or a combination of the two messages
  • Chgsticky - changes a sticky note to a non-sticky note for one note code
  • Liststicky - lists all sticky notes that are not pended for deletion

We recommend you evaluate Coded Notes on an annual basis to assess whether they are helping or hindering practice efficiency and to seek areas for continual improvement. Sometimes your findings will indicate a need to update procedures and/or for staff training to optimize your results with Coded Notes.

For more on Notes, check the Resource Library at