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Understand the impact of the end of the ICD-10 grace period on Medicare practices. Learn how to effectively sequence ICD-10 codes and capture multiple codes for patient encounters. Explore the top codes for MIPS and Value Modifier as we move towards P4P.
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End of the ICD-10 Grace Periodhow to ensure proper claims reimbursement Steve Adams, MCS, COC, CPC, CPMA, CPC-I, PCS, FCS, COA email: steve.adams@inhealthps.com web: thecodingeducator.com
DiscussionPoints • Understanding MIPS, MACRA and Risk • What the end of the ICD-10 grace period means to every Medicare practice in the country • How to show your providers and billing staff why sequencing is critical for ICD-10 and how to accomplish this task • The top ICD-10 Codes for MIPS and Value Modifier as we me toward P4P • When to capture multiple ICD-10 codes for a patient encounter • QRUR
Medicare Access and CHIP Reauthorization (MACRA) Act of 2015
Merit-Based Incentive Payment System (MIPS) The MIPS is a new program that combines parts of the Physician Quality Reporting System (PQRS), the Value Modifier (VM or Value-based Payment Modifier), and the Medicare Electronic Health Record (EHR) incentive program into one single program in which Eligible Professionals (EPs) will be measured on: • Quality • Cost • Improvement Activities • Advancing Care Information
ICD-10CM Fall from Grace October 1, 2016, will mark the end of a one-year “grace period” that allowed unspecified ICD-10-CM & Improperly Sequenced codes on certain physician Medicare claims to be reimbursed. The grace period was a joint initiative between the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association, created to help ease the transition from ICD-9 to ICD-10 for physician practices.
What’s The Difference • Other – you’ve documented something so specific there’s no code for the disease. • Unspecified – your documentation is weak
What? • Excludes 1 – never billed with the primary code • Excludes 2 – a patient may have both conditions at the same time
SOURCE: Chronic Condition Data Warehouse (CCW). Medicare Beneficiary Summary Files.
Risk Adjustment Factor The purpose for the Centers for Medicare and Medicaid Services (CMS) to conduct Risk Adjustment Factors is to pay plans for the risk of the beneficiaries they enroll, instead of calculating an average amount of Medicare/Medicare Advantage beneficiaries
Look at the Sheet • Afib & Flutter • Asthma • COPD • Diabetes • Heart Failure • HTN • Hyperlipidemia • Other Cardiovascular Diagnosis Codes • Psychiatric • Rheumatoid • Tobacco • Medication • Non-compliance