CollaborateMD Blog

2013 Fee Schedule Information

Mon, 07 Jan 2013 11:39:29 +0000

Valued CMD Customers,On Wednesday, January 2, 2013, President Obama signed into law the American Taxpayer Relief Act of 2012. This new law prevents a scheduled payment cut for physicians and other practitioners who treat Medicare patients from taking effect on January 1, 2013. The new law provides for a zero percent update for claims with dates of service on or after January 1, 2013, through December 31, 2013.In order to allow sufficient time to develop, test, and implement the revised Medicare Physician Fee Schedule(MPFS), Medicare claims administration contractors may hold MPFS claims with January 2013 dates of service for up to 10 business days (i.e., through January 15, 2013).The Centers for Medicare & Medicaid Services, (CMS) expects these claims to be released into processing no later than January 16, 2013. The claim hold should have minimal impact on physician/practitioner cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 for paper claims) after the date of receipt. Claims with dates of service prior to January 1, 2013, are unaffected.CMS is currently revising the 2013 Medicare Physician Fee Schedule (MPFS) to reflect the new law's requirements and will be posting the MPFS payment rates on their websites no later than January 23, 2013. Once the new MPFS is available, we will send out a notification with an expected date it will be loaded into the CollaborateMD system.Further notification will be provided once the 2013 Medicare Physician Fee Schedule (MPFS) have been loaded and are available in CollaborateMD.Best Regards,Your CollaborateMD Team

Financing the Future of Healthcare; Impact Analyses

Fri, 07 Dec 2012 16:11:58 +0000

by Madeline Angela Meyer,Senior Healthcare ConsultantHe said, she said; even the Actuaries really cant say!How will the future of healthcare services be financed in the United States in 2013 and beyond? The medical care delivery cost equation has never been more challenging and ambiguous in its projections. Even the actuaries at the Centers for Medicare and Medicaid (CMS) cannot agree on what the future healthcare expenditures may be and how they will be paid for. In a May, 18, 2012 memorandum from the CMS Office of the Actuary, projections were presented to rectify the previous 2012 Annual Report of the Board of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds, which they felt was unrealistic. The memo stated that Medicares actual future costs are highly uncertain and are likely to exceed those shown by the current-law projections in the annual report (CMS, 2012).On the flip side the actuaries stated that under the current-law projections, physician expenditures were unrealistically high and would most likely be less than projected. In other words, total healthcare cost projections have been grossly understated, and physician and hospital cost projections have been overstated. In particular, the purpose of the memo was to present a rationale on how to minimize the impact to physicians and hospitals in regard to the fee cuts effective January 1, 2013. See: Projected Medicare ExpendituresAs of January 1, 2013, the cuts for Medicare Part B physician non-facility fees will decrease by -27% and non-facility fees will decrease by -28% based on the published CMS physician fee schedule files. See the comparative analysis prepared using the National 2012 Physicians Fees against the CMS 2013 Physician Fees (unadjusted for geographic location). See: Medicare Part B 2012/2013 Comparative Fee Analysis (Source: CMS Data, Model, Meyer, 2012).2013 Fee Schedule Impact AnalysesEvery medical provider and professional wants to quantify how the changes under the healthcare reforms and fiscal adjustments will impact them. These measurements may be done by downloading utilization and fee schedule reports from your medical billing system and using the primary source files of the Medicare Part B Physician Fee Schedule to perform similar analysis such as the following illustration impact model provided. What this model doesn't show are the many "other" factors that need to be taken into consideration in the impact analysis when you perform one that is specific to your medical practice. These will be discussed next. See: Example National Medicare Part B 2013/2012 Fee Schedule, Utilization Impact Analysis (Source: CMS Data, Model, Meyer, 2012).Other Fee Schedule ConsiderationsThere are many physicians and professional organizations that have documented that the CMS fee schedules are not accurate. However, relative value units (RVUs) are still the most quantitative data that we have to set practice fees by, quantify utilization, productivity, revenue and costs. The physicians and professional organizations continue to present errors in the Resource Based Relative Value Scale (RBRVS) even in 2012, which is 20 years after its implementation. Other example issues affecting physician reimbursement in 2013 and beyond are: Inaccurate Practice Expense Relative Value Units Misvalued Codes Under the Physician Fee Schedule Devalued Global Surgical Packages Inappropriate Multiple Procedure Payment Reduction Inaccurate Malpractice RVUs (reviewed only every 5 years) Geographic Practice Cost Indices (CMS does not include proposed GPCI changes for 2013 and will be updating them in 2014)Impact modeling should be performed each time there is a change in the CMS primary fee schedule files using the provider specific Geographic Price Cost Indices (GPCI's), and the current rules of coding and billing, e.g., the National Correction Coding Initiatives (NCCI). When errors are found, providers may submit a written request to the American Medical Association's CPT Editorial Panel to either fix and/or add a procedure code. See: CPT Coding Change Request Instructions For errors or adding a code related to HCPCS Level II, Durable Medical Equipment, Orthotics, Prosthetics and Supplies (DMEPOS), which are updated quarterly, providers may submit requests to CMS. See: HCPCS Level II Coding Process & CriteriaFinancing the Future of HealthcareRight about now, you may feel like the future financing of healthcare is coming off the backs of healthcare providers. This is understandable, but there are other factors at play that are contributing to paying for future costs, but the forecast does remains cloudy and here is why.The Accountable Care Act, 2010 (ACA) will provide insurance access to an estimated 30 million more Americans, it provides more mandatory paid prevention services, it prohibits denial for pre-existing conditions, it removes lifetime caps on insurance coverage payments, and it prohibits the cancellation of active insurance policies. So, who else is picking up the tab?There are no cookie cutter answers, but there are many reform scenarios being implemented that may help with the growing costs, e.g., Accountable Care Organizations (ACA) (premiums and taxes) The Theory of Eliminating Cost Shifting (leveling the playing fields) Accountable Care Organizations (ACO) and Medicare Shared Savings Program Pay-for-Performance Incentives and Quality Improvements Physician Compare and in Physician Quality Reporting System (PQRS) ACA creates medical loss ratios whereby a fixed portion (80-85%) of insurance companies revenues must go towards medical care for beneficiaries. Medicare Recovery Audit Contractors (RACS)recoupments Hospital, Physician and other Provider Fee Cuts Hospital Value-Based Purchasing Hospital Quality Improvement (HQI) Physician Value-Based Payment Modifier and other healthcare reform initiatives being implemented through 2015.SummaryHealth services delivery and reimbursement have never been more complex. If it is a challenge for the actuaries within the DHHS and CMS to provide accurate predictions of the future financing of healthcare, it is reasonable to say that it will continue to be a challenging feat for our providers in their attempts to quantify and predict the impact of the many reform changes to their practices in this very dynamic, often unpredictable era of healthcare reform.___________References:CMS. (2012). National Physician Fee Schedule and Relative Value Files. Read MoreCMS. (2012). Fact Sheets. Details for: CMS Issues Outpatient Policy and Payment Changes. Read More Federal Register. (2012) Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule, DME Face-to-Face Encounters, Elimination of the Requirement for Termination of Non-Random Prepayment Complex Medical Review and Other Revisions to Part B for CY 2013. Centers for Medicare & Medicaid Services on 11/16/2012. Read MoreShatto , John D. Clemens, M. Kent. (2012). Projected Medicare Expenditures under Illustrative Scenarios with Alternative Payment Updates to Medicare Providers. CMS. May 18, 2012. Read More

Not Just ICD-10-“CM”, but also “PCS”!

Thu, 01 Nov 2012 15:57:08 +0000

by Michael Alan Meyer, DO, CCS, CPC, CPCI, AHIMA ICD-10-CM/PCS Trainer and AmbassadorIn week ten of this article series, we will look at ICD-10-PCS (facility procedure coding). But, first, lets look at the ANSWER for last weeks ICD-10-CM challenge question.PCS; Not for EveryoneThe ICD-10-PCS (procedure) coding system was developed by CMS for inpatient hospital settings only. However, it is also used by some insurance companies that require the Universal Billing 2004 (UB 04) (CMS 1450) facility form for outpatient surgery center procedures. So, the PCS codes are used in selective outpatient procedure facility billing, but they are not used for Medicare and Medicaid outpatient billing, which is done on the CMS 1500 form.The new ICD-10-PCS uses 7 alpha or numeric digits. ICD-9-CM/PCS Volume III coding system uses 3 or 4 numeric digits. All ICD-10-PCS procedure codes are coded using the full seven (7) alphanumeric characters. Each character can be any of 34 possible values of the ten digits 0-9 and the 24 letters A-H, J-N and P-Z and may be used in each character location. This allows for a lot of expandability in coding procedures. Therefore, where in ICD-9-CM there are a little over 4,000 procedures, in ICD-10-CM there are over 72,000 procedures. It is important to note that the letters O and I are not used to avoid confusion with the numbers 0 and 1. There are no decimals in ICD-10-PCS, which can make the seven digit codes confusing. Much attention to detail is required. This is where your medical billing software system can really be a blessing by pre-loading the code combinations for your specific facility or departments most common procedures.The ICD-10-PCS index allows codes to be located based on an alphabetic lookup, just like in ICD-9, Volume III. Codes may be found in the index based on the general type of the procedure e.g., resection, transfusion, fluoroscopy, or a more commonly used terms e.g., Cholecystectomy, Appendectomy, Tonsillectomy. The code for percutaneous intraluminal dilation of the coronary arteries with an intraluminal device can be found in the index under dilation, or a synonym of dilation (e.g., angioplasty).Once the desired main term is located in the index, the index specifies the first three or four values of the code, followed by three or four periods (example: 027....), or directs the user to see another term. Each table also identifies the first three values of the code. Based on the first three values of the code obtained from the index, the corresponding table can be located. The table is then used to obtain the complete code by specifying the last four values of the procedure code.Attached is an introduction to ICD-10-PCS: See: ICD-10-PCS Presentation. Download the primary source files for PCS that are in the presentation and code some cases! See: ICD-10-PCS Practice Cases.WARNING: ICD-10-PCS is more complex than ICD-9-CM Volume III coding. Therefore, we have prepared a coding tool for you to use in your coding of procedures! See: ICD-10-PCS coding tool.___________References:CMS. (2012) Centers for Medicare & Medicaid Services (CMS) ICD-10 Website. https://www.cms.gov/Medicare/Coding/ICD10/index.html CMS. (2012) ICD-10-PCS Coding System, Mappings, and Related Training Manualhttp://www.cms.gov/ICD10/13_2010_ICD10PCS.asp CMS. (2012) ICD-10-CM Coding System, Mappings, and Guidelines. http://www.cms.gov/ICD10/12_2010_ICD_10_CM.aspCMS. (2012) Report on Use of Health Information Technology to Enhance and Expand Health Care Anti-Fraud Activities. http://www.hhs.gov/healthit/documents/ReportOnTheUse.pdf CMS. (2012) CMS-0013-PHIPAA Administrative Simplification: Modification to Medical Data Code Set Standards to Adopt ICD-10-CM and ICD-10-PCS. http://edocket.access.gpo.gov/2008/pdf/E8-19298.pdf

Dr. Lender’s Credit Policy!

Sun, 28 Oct 2012 08:52:50 +0000

by Madeline Angela Meyer and Michael Alan Meyer

Banks are not the only lending institutions; Physicians & Hospitals are too!

Lending InstitutionsMedical providers are lending institutions! Physicians and hospitals extend credit to tens of thousands of people every year. Therefore, it stands to reason that providers would have a comprehensive credit policy to guide both their staff and their patients in matters of finance. After all, all lending institutions provide loans, but no lending institution does it without communicating the terms. The patients perception of quality of medical care begins with their registration process and ends with their account resolution. No physician or hospital wants the satisfaction of their medical care to be determined by poor billing and collections activities and policies. It has long been recognized that accounts receivable issues are an unspoken denominator in many malpractice cases (Meyers, 1987). In an industry undergoing constant change, developing a good credit policy and keeping it current is critical to customer satisfaction and business success.Credit PoliciesThere is no cookie cutter credit policy, because how they are written will depend on the providers medical and managed care markets, the contracts that they have signed, and in an era of consolidation, the Accountable Care Organizations (ACOs), organizational structure. However, regardless of those key factors, there are important fundamentals that goes into any credit policy, e.g., the who, what, when, where, why and hows of the lender.Attached is an examplecredit policy template. The policy needs to be a living breathing, readable and user-friendly tool. Its core lending policies should be summarized in a patient brochure or document, which is provided to all new patients. When the policies are updated, established and new patients should be provided with a copy of the new policies. Any credit policy written and used by a medical facility should be reviewed and approved by both the accounting and law firms that provides consultation to your medical business. Your medical billing software vendor also can provide major insight and assistance in automating and documenting credit policies and streamlingthem into effective and efficient accounts receivable management processes.Click here for a comprehensive credit policy template: XYZ Clinic Credit Policy!___________ReferencesHuntington, BSN, MSN, JD, Beth. Kuhn, RN, BSPA, CPHRM, Nettie. (2003). Communication gaffes: a root cause of malpractice claims. Proceedings (Baylor University. Medical Center). 2003 Apr; 16(2)157-161Meyers, A.R. (1987). Lumping it: the hidden denominator of the medical malpractice crisis. American Journal of Public Health. 1987;77:15441548.Meyer, Michael A., Meyer, Madeline A. (2007-2012) Tier I. Module V. Medical Reimbursement. Medical Coding Preparatory 5^th Edition. eBook Self-Publication, 2012.

ICD-10-CM: Just in “Case-3”!

Wed, 24 Oct 2012 17:43:34 +0000

by Michael Alan Meyer, DO, CCS, CPC, CPCI, AHIMA ICD-10-CM/PCS Trainer and AmbassadorThis marks our 9th week in this ICD-10-CM/PCS article series, and this week we will code our 3rd case! For this weeks case, lets add Chapter 3, Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism to last weeks Chapter 2, Neoplasm... and mix it up a little! Click here for the case ANSWER for last week.Chapter 3: Diseases of the blood and blood-forming organsThere are no official guidelines in ICD-10-CM at this time regarding diseases of the blood and blood-forming organs. It is Reserved for future guideline expansion. However, there are differences in ICD-10-CM versus ICD-9-CM.Anemia and Neoplasm In ICD-9-CM, anemia due to antineoplastic chemotherapy and antineoplastic chemotherapy-induced anemia are considered synonymous. If a patient has a metastasis and is receiving chemotherapy and developed anemia we code report codes 199.1, Other malignant neoplasm of unspecified site and 285.22, Anemia in neoplastic disease. However, if the patient is being seen primarily to treat the anemia due to chemotherapy, then the anemia is coded as first and the cancer second, e.g., report 285.22 and 199.1.Important Difference Between ICD-9 CM and ICD-10 CM Neoplasm and Anemia;

Excludes1: anemia due to antineoplastic chemotherapy (D64.81)

In ICD-10-CM, when an encounter is for the management of an anemia associated with malignancy, the malignancy is sequenced as the principal or first-listed diagnosis because of an instructional note and there is a guideline that addresses this situation.The only time anemia would be coded first is if the patient is being treated primarily for anemia and it is not associated or not due to the neoplasm. ICD-10-CM tabular has an instructional notation under code D63.0, Anemia in neoplastic disease, to code first the neoplasm (C00 to D49).Armed with the ICD-10-CM Official Coding Guidelines, and the coding references, lets code a neoplasm case! See Anemia and Neoplasm Case.Always remember, the key to improved financial performance is high quality medical billing software. ___________References:CDC, (2012) International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). National Center for Health Statistics. http://www.cdc.gov/nchs/icd/icd10cm.htmCMS. (2012) Centers for Medicare & Medicaid Services (CMS) ICD-10 Website. https://www.cms.gov/Medicare/Coding/ICD10/index.html

Bottom Line…End-of-Year Priority!

Thu, 18 Oct 2012 13:17:33 +0000

by Madeline Angela Meyer and Michael Alan Meyer

Healthcare is a business and business is bottom line driven, the bottom line of healthcare is driven by the medical codes (Meyer, 2007).

Fee Schedules & Billing Forms:Never has it been so important to begin the end of year updates to your clinics fee schedules, superbills and hospital chargemasters timely. In 2013-2014 and beyond, in the wake of CMS quality initiatives, e.g., the Physician Quality Reporting System (PQRS), Hospital Quality Initiative (HQI), the Accountable Care Organization Pay-for-Performance (P4P), and with ICD-10-CM/PCS on the horizon updating fees, forms and your medical billing software by January 1 is critical to your bottom line. Tips for Optimizing:To avoid unnecessary denials, and potential payment errors, or missed quality reporting opportunities, all claims should be filed with current year CPT, ICD-9, and HCPCS codes, using current year coding and reporting conventions. There should be only one standard provider fee schedule for your business in your practice management software, which is effective January 1 of each year. Click here for a presentation of tips for optimizing your fee schedule for 2013 and beyond: The Birds, the Bees and Your Fees!___________References CMS. (2012) Physician Fees. Resource Based Relative Value Scale. http://www.cms.gov/apps/physician-fee-schedule/ CMS. (2012) Outpatient Perspective Payment System. Ambulatory Payment Classifications. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/index.html CMS (2012) Inpatient Perspective Payment System. Medical-Severity Diagnostic Related Groups. http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/ CMS. (2012). Roadmap for Quality Measurement in the Traditional Medicare Fee-for-Service Program. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Downloads/QualityMeasurementRoadmap_OEA1-16_508.pdf Meyer, Michael A., Meyer, Madeline A. (2007-2012) Tier I. Module V. Medical Reimbursement. Medical Coding Preparatory 5th Edication. eBook Self-Publication, 2012.

ICD-10-CM: Just in “Case-2”!

Tue, 16 Oct 2012 09:32:35 +0000

by Michael Alan Meyer, DO, CCS, CPC, CPCI, AHIMA ICD-10-CM/PCS Trainer and AmbassadorIn last weeks article, we began our case coding with ICD-10-CM/PCS focusing on infectious diseases, specifically, sepsis and septic shock. Click here for the case ANSWER. This week our case coding will address Chapter 2, neoplasm! Treatment: Primary or Secondary?In ICD-10-CM, Chapter 2, the rules are that we code the primary or the secondary neoplasm as the principal diagnosis when treatment directed at the malignancy designate the malignancy. Therefore, if treatment is for the primary, it is sequenced first. If it is for the secondary, then it is sequenced first. The exception is if a patient encounter is solely for the administration of chemotherapy, immunotherapy or radiation, then the coder must assign the appropriate Z51. as the principal diagnosis. Note that if treatment is directed toward the secondary site only, the secondary neoplasm is designated as the principal diagnosis even though the primary malignancy is still present.Neoplasm and Adverse Effects: Section I.C.2.c.2 of the ICD-10-CM Official Guidelines advises us to sequence first the appropriate adverse effect code when an admission is for management of anemia due to an adverse effect of chemotherapy, immunotherapy, or radiation therapy. The codes for the anemia and the neoplasm follow as secondary diagnoses. Sequencing the adverse effect code ahead of the anemia code is a change from sequencing guidelines in ICD-9-CM. Codes for adverse effects in ICD-10-CM are located in a column with the heading Adverse Effect, which is also new to the Table of Drugs and Chemicals for ICD-10-CM. Note that ICD-10-CM Official Guidelines Section I.C.19.e.1 directs us not to code directly from the Table of Drugs and Chemicals, but to always to refer back to the Tabular List.Armed with the ICD-10-CM Official Coding Guidelines, and the coding references, lets code a neoplasm case! See Neoplasm Case.___________References:CDC, (2012) International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). National Center for Health Statistics. http://www.cdc.gov/nchs/icd/icd10cm.htmCMS. (2012) Centers for Medicare & Medicaid Services (CMS) ICD-10 Website. https://www.cms.gov/Medicare/Coding/ICD10/index.html Always remember, the key to improved financial performance is high quality medical billing software.

ICD-10-CM: Just in “Case”!

Thu, 11 Oct 2012 13:00:48 +0000

by Michael Alan Meyer, DO, CCS, CPC, CPCI, AHIMA ICD-10-CM/PCS Trainer and AmbassadorCase Coding Starts Now!In last weeks article, I recommended that you download all of the primary source files that make up the ICD-10-CM/PCS code books and learn how to use them. This week we begin case coding with the source files, or if you prefer with your ICD-10-CM 2012 reference book. We will start with Chapter 1, infectious disease!Keys to coding Infectious Disease!Chapter 1 includes diseases generally recognized as communicable or transmissible. There is a new section called infections with a predominantly sexual mode of transmission (A50-A64). It is important to note that human immunodeficiency virus (HIV) disease is excluded from the range of infection codes.When coding sepsis or AIDS, it is important to review the Coding Guidelines for categories B90-B94. Codes are to be used to indicate conditions in categories A00-B89 as the cause of sequelae, which are themselves classified elsewhere. Code first the condition resulting from (sequelae), i.e., the infectious or parasitic disease. Bacterial and viral infectious agents (B95-B97) are provided for use as supplementary or additional codes to identify the infectious agent(s) in diseases classified elsewhere, e.g., Index--->, Infection---->, Organism ( ex. Streptococcus). Note that the provider and/or coder is to use additional code for any associated drug resistance (Z16).For this weeks ICD-10-CM case coding: See Sepsis Case.___________References:CDC, (2012) International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). National Center for Health Statistics. http://www.cdc.gov/nchs/icd/icd10cm.htmCMS. (2012) Centers for Medicare & Medicaid Services (CMS) ICD-10 Website. https://www.cms.gov/Medicare/Coding/ICD10/index.html Remember, quality Web medical billing software is the key to improved financial performance!

What’s in Your Plan!

Wed, 10 Oct 2012 13:01:03 +0000

by Madeline Angela Meyer and Michael Alan MeyerGeneral Healthcare Compliance Plans In last weeks article, we looked at what CMS and the RACS programs have to offer providers and other healthcare professionals in the way of training, continuing education and audit tools for maintaining healthcare compliance. Todays healthcare facility doesnt have just one overarching compliance plan, but rather volumes of plans, policies and procedures to meet many requirements under current laws.Healthcare Facility Compliance Plans are generally broken down into three (3) basic areas, e.g., 1) operational compliance, or regulatory compliance which involves everything related to patients, patient safety and human resources, 2) financial compliance, e.g., policies and processes related to the revenue cycle, contracting and all matters of finance, 3) health information management and technology compliance, which includes HIPAA and HITECH Acts.Compliance plans should follow the seven (7) the principles of the U.S. Sentencing Guidelines, to ensure that all areas of compliance have been adequately covered. The principles are:1. Standards and Procedures: Establishment of written compliance policies and procedures and distribution to employees.

o The Organizations Code of Conduct2. Oversight: Designation of a specific individual or individuals to monitor compliance.

o The Compliance Officer and/or Compliance Committee).3. Education and Training: Commitment to conducting formal, documented training and education programs.

o Ongoing training on the standards and procedures.4. Auditing and Monitoring: Development of internal system for communication of suspected compliance violations.

o Verifying compliance.5. Reporting: Commitment to auditing and monitoring to evaluate compliance and identify potential problematic areas.

o Reporting concerns and developing corrective plans.6. Enforcement and Discipline: Maintenance of disciplinary policies which are consistently enforced.

o Non-compliance policy enforcement consistent with appropriate disciplinary action.7. Response and Prevention: Development of process for investigation of suspected violations and reporting to the government and law enforcement authorities when necessary.

o Process for employees to voice their concerns.Healthcare Compliance TechnologyCompliance survival for any size medical facility today requires strong technological infrastructure in order to meet the challenges. Partnering with quality information system vendors and transforming health services and compliance through technology is an absolute necessity in 2012 and beyond.The attached presentation are some of the ways that healthcare facilities are achieving highly automated, integrated, and relational database technologies that communicate through their electronic medical billing systems in order to perform high level compliance monitoring and reporting.See: Technology Partnerships: Compliance Planning!___________ReferencesUnited States Sentences Commission. (2012) US Sentencing Guidelines. http://www.ussc.gov/DHHS. (2012) OIG Compliance Program for Individual and Small Group Physician Practices, 65 Fed. Reg. 59434 (Oct. 5, 2000).DHHS. (2012) Compliance Guidance. Office of the Inspector General. https://oig.hhs.gov/compliance/compliance-guidance/index.asp

Exclusive Interview with Secretary of Health and Human Services (HHS), Kathleen Sebelius

Tue, 09 Oct 2012 08:24:15 +0000

BC Advantage Magazine:

This Month, Read an Exclusive Interview with Secretary of Health and Human Services (HHS), Kathleen Sebelius.

You will only see this exclusive interview in the October/November issue of BC Advantage Magazine.

We ask about ICD-10, ICD-11, RAC and ZPIC programs, Medicare, Affordable Care Act, The HEAT (Joint effort program between DOJ, HHS, and CMS) Program and much more.

Read this exclusive article now online:http://www.billing-coding.com/detail_article.cfm?ArticleID=4669

BC Advantage 12 Month subscription includes access to CEUs, Webinars and more, all for less than $5.00 per month.

Visit: http://www.billing-coding.com/subscribe today

CMS & RAC: Too Good to be True!

Fri, 05 Oct 2012 05:09:56 +0000

by Madeline Angela Meyer and Michael Alan MeyerWe dont know about you, but we love Free Stuff, and the Centers for Medicare and Medicaid (CMS) and their Recovery Audit Contractors program provide it! Are you thinking this is too good to be true? Well, it isnt!Free CMS Web-Based Training Courses with CEUsCMS provides over 20 Web-based training courses, many that are online learning with certificates of completion and continuing education units (CEUs) that are accepted by the major healthcare professional organizations. The courses include such topics as payment systems, medical billing, fraud and abuse and many more. They range from quick 30 minute courses, to those over 1260 minutes (21 hours of study). Upon completing the Medicare Billing Certificate Program for Part A Providers and/or the Medicare Billing Certificate Program for Part B Providers the learner will have earned an official CMS Medical Billing Certificate. For the complete list of courses, click on: CMS Free Web-Based Training Courses Free CMS-RAC Stuff!What does the CMS Recovery Audit Contractors program have that you want you ask? They have great free stuff too! First, there are many useful free PowerPoint presentations to help train staff. Just click on this example on the August 2012, Recovery Auditor Prepayment Review Demonstration project. They give away the ship, sharing what states they are targeting and even what codes! They also provide helpful hints on billing with your medical office software correctly the first time to avoid unnecessary rebillings, duplicate billings and other billing errors. This is vital free stuff. There is even a Provider Compliance Group Interactive Map that access state-specific CMS contractor contact information. You may use this graphic website to access RAC contact information including emails, phone numbers and their individual websites!Training staff can get quite expensive. To help with training costs, and to ensure training is accurate and current, providers and their staff should take advantage of the primary resources given to us by CMS and the CMS RACS programs. Your Compliance Officer, or a designated internal compliance training assistant should register with their email address for all CMS listserves so that they may receive real time updates when they happen. Sign up for CMS Real-time Email Updates, CMS Twitter, or visit the CMS YouTube Video LibrarySee Top 5 CMS Links: Manuals, Medicare Coverage Database, CMS Forms, Transmittals, MLN Products___________ReferencesAmerican Health Information Management Association (AHIMA) (2009). AHIMA RACS ToolKit! http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_044065.pdf CMS. (2012) Recovery Audit Program Updates. http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/recovery-audit-program/index.html?redirect=/RAC/ CMS. (2012) Recovery Audit Program Providers Resources. http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Recovery-Audit-Program/Program-Providers-Resources.html

ICD-10-CM: Jump in and get your feet wet!

Tue, 02 Oct 2012 05:01:35 +0000

by Michael Alan Meyer, DO, CCS, CPC, CPCI, AHIMA ICD-10-CM/PCS Trainer and AmbassadorIn last weeks article, we looked why it is important to have a solid AP&PP foundation when coding with ICD-10-CM. We posted a challenge test to help you measure where you are at. How did you do? Grade yourself with the ANSWER KEY to last weeks Challenge Questions! Your Life Raft!The key to really learning ICD-10-CM/PCS is not memorizing codes, or being an expert at all-things in all specialities, but rather becoming expert on how to use the primary ICD resources. In ICD-10-CM/PCS, the primary resource files are found in two places; the CDC maintains ICD-10-CM (diagnoses) primary source files, and the CMS maintains the ICD-10-PCS (procedure) primary source files. They are the life raft when learning to use this new code set for medical professionals and for their medical billing software vendors.Primary Source Files! This weeks challenge isnt a question, but rather an activity. In this activity, you are to download the primary source files that you may use to learn ICD-10-CM/PCS. You will want to save the files in their Adobe Acrobat Reader.pdf format. You will be using the search function in the .pdf to learn the sections and coding conventions using "main terms". Create a 2013 ICD-10-CM folder to save the files in your "myDocuments". Note that these essential files are the entire ICD-10-CM/PCS reference books in sections and may take a few minutes to download per file. The file links are organized for you at: ICD-10 CM Diagnoses Source FilesStarting next week, we will use these primary resources files to code ICD-10-CM/PCS cases. See you next week!___________References:CDC, (2012) International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM). National Center for Health Statistics. http://www.cdc.gov/nchs/icd/icd10cm.htmCMS. (2012) Centers for Medicare & Medicaid Services (CMS) ICD-10 Website. https://www.cms.gov/Medicare/Coding/ICD10/index.html

ACA Facilitates Alternative Care Delivery Models!

Fri, 28 Sep 2012 06:01:11 +0000

by Madeline Angela Meyer and Michael Alan MeyerIncreases in DemandThere is no doubt when reading the myriad of reported public and private health agencies projections that the Affordable Care Act (ACA) increases access to health services, which in turn will increase the number of office visits, procedures and ancillary care services. According to the Association of American Medical Colleges (AAMC), 32 million Americans who will get insurance cards when the ACA is fully implemented, and 15 million more will become eligible for Medicare by 2015.Changes in DemandCouple these increases with our changing US population demographics, e.g., those who are over the age of 65 years in need of chronic disease prevention, treatment and management and there is a change in demand for primary care physicians, as well as, specialty care and services.Provider ShortagesAccording to the Association of American Medical Colleges 2011 Annual Physician Workforce Data, by the year 2025 the US will experience approximately 91,500 physician shortages in all specialties (AAMC, 2011). So, how will these changes impact physicians and patients?Alternative Care Delivery ModelsTo meet the increases in demand and changes in demographics, the US healthcare markets are experiencing increases in non-traditional delivery methods, both old and new. The overarching facilitator in care delivery changes is the Accountable Care Organizations (ACOs), discussed in our September 4, 2012 article. These massive integrated delivery systems are supported by increased telecommunications which includes more sophisticated medical billing software solutions, electronic health records and telemedicine technologies. Alternative delivery models that most likely will grow due to the changes discussed are presented in this weeks presentation on Alterative Care Delivery Models!___________ReferencesCherry, MS, Donald., Lucas, MPH, MSW, Christine., Decker, PhD, Sandra L. (2010) Population Aging and the Use of Office-based Physician Services. CDC, NCHS Data Brief. No. 41. August 2010.Association of American Medical Colleges. 2011 State Physician Workforce Data Release. Center for Workforce Studies. November 2011. https://www.aamc.org/download/263512/data/statedata2011.pdf

ICD-10-CM: Test your AP&PP for the next level of ICD!

Mon, 24 Sep 2012 05:50:25 +0000

by Michael Alan Meyer, DO, CCS, CPC, CPCI, AHIMA ICD-10-CM/PCS Trainer and AmbassadorIn last weeks article, we looked at ICD-10-CM coding conventions and what is new for medical coding, data analyses and their effect on medical billing software. Click on this link for the ANSWER to last weeks Challenge Question!More Codes with Higher SpecificityWith ICD-10-CM, there are more codes and more details in the code descriptions, which equates to higher medical code specificity. With higher specificity, the coder must be able to abstract the most appropriate medical terms from the patient record in order to accurately match code descriptions to the record. This isnt anything new that the coder doesnt do with ICD-9-CM, however, it is a slightly higher level of medical coding abstraction since code descriptions are more detailed in ICD-10-CM. For some coders, this may require a review of anatomy (structure), physiology (function), pathology (disease) and pathophysiology (disease function) (AP&PP).AP & PP ResourcesThere are many excellent free resources available on the Internet to brush up on your AP&PP. Resources are listed below in the reference list. Pathophysiology is often a challenge since it involves understanding the differences in disease cause versus its manifestations. You-tube videos produced by medical providers are often useful for focused areas where more in-depth understanding of diagnoses and treatments are needed. Many of the videos are 3-D and the enhanced graphics facilitates learning, such as these on hypertension; Effects of Hypertension, or Pheochromocytoma.Take the self-test below. If you are comfortable with your AP&PP foundation, then do no more, and begin to prepare and learn ICD10-CM/PCS for the October 1, 2014 implementation. However, if you identify a gap, then jump in and get your feet wet with a good AP&PP review!This weeks Challenge Questions #5: Self-Test for AP&PP ___________Resources:MedlinePlus (2012) Health Topics, Anatomy, Drugs, Supplements, Videos and Tools. National Institute of Health. http://www.nlm.nih.gov/medlineplus/anatomy.html Merk. (2012) The MERK Manuals Online for Healthcare Professionals. http://www.merckmanuals.com/professional/index.html The Inner Body. (2012) Anatomy. http://www.innerbody.com/htm/body.html

PQRS: An evolution in quality measures!

Wed, 19 Sep 2012 07:19:28 +0000

by Madeline Angela Meyer and Michael Alan Meyer, September 19, 2012PQRS Reporting & Incentives In 2007, the first year the physician quality reporting system (PQRS) was put into place, there were 74 quality measures. As of September, 2012, the program has over 300 measures. Rules, codes and process for PQRS have changed each year. They will continue to change as the program evolves. New measures come into play, old ones are retired, and incentive rates for participation adjust:

2010 = 2% incentive payments

2011 = 1% incentive payments

2012-2014 = 0.5%

2014 = 1.5% reduction in Medicare reimbursement for those who do not submit PQRI measures

2015 and Beyond = the penalty will be increased to 2% in subsequent yearsIncentives for the PQRS program are independent of participation in the other two CMS programs, e.g., electronic health record (EHR) and e-prescribe (eRx). It is very important that the qualified providers use the current year specifications for PQRS reporting. Therefore, medical computer system vendors, and reporting registries should work together with their providers to ensure reporting systems are kept current.Health Outcome MeasurementsCMS now publishes the Single Source Code File, This files contains 11,684 ICD-9-CM, HCPCS Level I (CPT) and Level II codes that are used in the 2012 Physician Quality Reporting System (Physician Quality Reporting) Quality-Data Code (QDC) Categories. The source file is also broken down into the categories of quality measure "groups" by disease type. The PQRS reporting manual has 655 pages, which includes all of the specific quality measure details (CMS, Manual, 2012).In 2012, there are three reporting methods available to eligible providers participating in PQRS, e.g., claims based reporting during your regular process of submitting Medicare Part B claims to CMS; registry based reporting through a qualified PQRS registries or; electronic health record (EHR) reporting through a qualified EHR product or vendor. What quality measures are reported depends on what method is being used.For a full picture of the how the new quality measures are reported, see the 2012 PQRS Decision Trees by type of submission process.______________References:CMS. (2010). 2011 2012 Physician Quality Reporting System. January 2012. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/downloads/2012PQRS_SatisfRprtng-Claims_Final508_1-13-2012.pdf ______________Resources: CMS Physician Quality Reporting website http://www.cms.gov/PQRS CMS 2012 PQRS Measure Specifications Manual for Claims and Registry Reporting of Individual Measures (655 pages) http://www.entnet.org/Practice/qualityimprovement/upload/2012_PhysQualRptg_MeasureSpecificationsManual_122311.pdf Medicare and Medicaid EHR Incentive Programs website http://www.cms.gov/EHRIncentivePrograms Eligible Professional List for PQRS http://www.cms.gov/PQRS/Downloads/Eligible_Professionals03-08-2011.pdf Eligibility for Medicare EHR Incentive Program http://www.cms.gov/EHRIncentivePrograms/15_Eligibility.asp#BOOKMARK1 2012 Qualified EHR Vendor List http://www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp 2012 EHR Documents for Eligible Professionals (PQRS Measure Specifications) http://www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp 2012 Physician Quality Reporting Decision Tree http://www.cms.gov/PQRS/20_AlternativeReportingMechanisms.asp 2012 PFS Final Rule http://www.gpo.gov/fdsys/pkg/FR-2011-07-19/pdf/2011-16972.pdf 2012 EHR Incentive Program Resources for Eligible Professionals http://www.cms.gov/EHRIncentivePrograms/55_EducationalMaterials.asp 2012 EHR Incentive Program Attestation module is available on the CMS website https://www.cms.gov/EHRIncentivePrograms/32_Attestation.asp