1. 5 th Annual Lourdes Cardiology Services Symposium: Cardiology for Primary Care

2. 1,194,161 *Source: CMS.gov / research One Year NJ Part B Enrollments 2012*

3. 19662014 19.1 Million 54.0 Million *Source: CMS.gov / research 183% 2013 $747.7 Billion Net Federal Outlays-CMS Programs 21.6% of the Federal Budget

4. “Welcome to Medicare” AWV (Annual Well Visit) AWV (Annual Well Visit) TCM (Transitional Care Management) TCM (Transitional Care Management) AWV (Subsequent) AWV (Subsequent)

5.  110 Physicians (22 PCP / IM)  27 Physician Extenders

6.  Leverage new Medicare population health initiatives to deliver better healthcare and optimize revenue.  Be conscious of cost and resources available.  Is there an ROI, what is the potential revenue?

7. Medicare Regulatory Interpreter Wanted: Rocket Scientist Experience Required!

8. "Welcome to Medicare“ only within the first 12 months of receiving Part B.

9.  Review medical and social history  Counseling about preventive services  Height, weight, and blood pressure  BMI  A simple vision test  A review of potential risk for depression  An offer to talk about creating advance directive  A written plan regarding screenings, shots, and other preventive services as needed

10. $168.89 (G0402 ) Note: During the first year a patient has enrolled with Medicare, he or she is eligible for the “Welcome to Medicare” Visit or Initial Preventative Physical Exam (IPPE). (M/C Allowable, NJ Area 99) “Welcome to Medicare”

11.  Developing or updating a list of current providers and prescriptions  Height, weight, blood pressure, and other routine measurements  Detection of any cognitive impairment  Review risk factors and treatment options  Review questionnaire - “Health Risk Assessment”

12. $174.28 (G0438) Note: Annual wellness Visit, including a personalized prevention plan of service (PPPS), first visit. (M/C Allowable, NJ Area 99) AWV (Annual Well Visit)

13. $117.86 (G0439) Note: Annual Well Visit, including a Personalized Prevention Plan of Service (PPPS), subsequent visit. AWV (Subsequent) (M/C Allowable, NJ Area 99)

14.  Assign a project lead  Identify patients turning 65 within your PM system through reporting  Send letters to patients reminding them of the benefit  Emphasis placed on “no cost to you” when speaking with the patient

15.  Schedule the AWV during a sick visit  Review scheduled patients prior to visit for opportunity for AWV and Welcome to Medicare  Place visits at the end of your schedule  Dedicate a Saturday

17. From  Inpatient Acute Care Hospital  Inpatient Psychiatric Hospital  Long Term Care Hospital  Skilled Nursing Facility  Inpatient Rehabilitation Facility  Hospital outpatient observation or partial hospitalization  Partial hospitalization at a Community Mental Health Center. To His or her home; His or her domiciliary; A rest home; or Assisted living.

18. Communication with patient/caregiver within 2 business days  Medication Reconciliation  Hospitalization Reason  Review Discharge Instructions  Schedule face-to-face visit within 7 to14 days based on clinical complexity

19. Licensed Clinical Staff Support  Communicate with agencies and community services used by the beneficiary  Provide education to the beneficiary, family, guardian, and/or caretaker to support self-management, independent living, and activities of daily living  Assess and support treatment regimen adherence and medication management  Identify available community and health resources

20.  Review discharge information (for example, discharge summary or continuity of care documents)  Review need for or follow-up on pending diagnostic tests  Refer to specialists as needed  Provide education to the beneficiary, family, guardian, and/or caregiver  Establish or re-establish referrals and arrange for needed community resources Services Furnished by Physicians or NPPs

21. $233.57 (99496) Note: Medical decision making of high complexity during the service period. Face-to-face visit within 7 calendar days of discharge. The codes cannot be used with G0181 (home health care plan oversight) or G0182 (hospice care plan oversight) because the services are duplicative. (M/C Allowable, NJ Area 99) TCM -7 Day Follow up

22. $166.37 (99495) Note: Medical decision making of at least moderate complexity during the service period. Face-to-face visit within 14 calendar days of discharge. The codes cannot be used with G0181 (home health care plan oversight) or G0182 (hospice care plan oversight) because the services are duplicative. (M/C Allowable, NJ Area 99) TCM 14 Day Follow-up

23. CPT CodeDescription Total Payment Amount Distinct Patient Count 99495TCM 14 Day$ 63,530475 99496TCM 7 Day$ 41,494237 G0402“Welcome to MC”$ 4,69449 G0438AWV$ 110,059785 G0439AWV (Subsequent) $ 29,745511 Total 2015 $249,5222525

24.  Improved Revenue  Enhanced Quality: Identify clinical issues early  Preventive Medicine  Improved Cost of Care

25. Data extraction  Not all systems have reports needed  “Welcome to Medicare” based on approaching Medicare enrollment year or one year after Medicare enrollment Patient outreach  Can be a burden on existing staff  Better to call during evening hours  Explanation of the programs can be very time consuming  Patient’s lack of interest in the program

26.  Office visit capacity  Increasing Administrative Burden on Physicians  (TCM) Hospital reports  Tracking TCM billing. Can not submit a claim before 30 days post visit. If patient is readmitted TCM claim will be denied.  Patients too sick to travel / Transportation issues

28. CPT CodeAllowableCPTAllowableDifferential G0402 Welcome to Medicare $168.8999213$73.30$95.59 G0438 AWV $174.2899214$108.88$65.40 G0439 AWV Subsequent $117.869921373.30$44.56 99496 (TCM) 233.5799215146.97$86.60 99495 (TCM) $166.3799214$108.88$57.49 (M/C Allowable, NJ Area 99)

29. AWV Two/Week $16k TCM One/Week $10K

30. Call Center Project Leads Auditing Services Analytical Support

31.  Q&A  Thank You Pierre Scott Vice President Revenue Cycle Management Pierre.Scott@lmanet.com