Hot Topics in Medical Billing April 2015


Info Services Inc 2015 Hot Topics

Let’s continue our look at some of the 2015 hot topics in medical billing impacting health care providers. While some may be obstacles, others may become opportunities. Staying abreast of changes is now more important than ever- the financial health of your practice depends on it!

ICD-10-CM: 6 months and Counting! Are You Ready? 4 Steps to Success

Last year at this time, ICD-10 was surprisingly delayed yet again through a tiny language insertion into the SGR Patch Bill. This year SGR was repealed with a permanent fix and ICD-10 was nowhere in the bill.

What does that mean? It means ICD-10 is on for October 1, 2015! 6 Months and Counting- Are you ready? Have you begun to transition your practice to ICD-10? What should you do?

  1. Training Is Crucial. Your staff, including providers, should all be taught the differences in ICD-9 and ICD-10! Stop and realize that medical coding is the mechanism by which you get paid! What could be more important than having all clinic employees on the same page regarding the fastest, most efficient and legal way to get reimbursement! Info Services offers affordable classroom in May (OBGYN focus), June, July and August or specific topic based online training! Learn about it here.

  2. Practice. After your staff has been sufficiently trained, they should practice! Dual coding provides the opportunity to practice what they’ve learned with exposure to cases they encounter on a daily basis.

  3. Analyze. In addition to coding the daily charges into both ICD-9 and ICD-10, coders should pull listings of the top diagnoses used by the practice as well as the most-used and highest reimbursement non-office visit procedures performed by the clinic. MediSoft provides both a Diagnosis Ranking as well as Most Frequently Used Procedure Codes Report to assist in this exercise. Reviewing this information will allow you to isolate the procedures with the most dollar risk attached should the ICD-10 coding and documentation not be accurate. Using the CMS National Coverage Determination (typically labs) and Novitas’ Local Coverage Determinations (future), you can research the payable ICD-10 diagnosis codes and the required documentation for those procedures. This will reduce “not medically necessary” denial codes when you begin sending ICD-10 codes. Rank your diagnoses and procedures based on the last 12 months, last 6 months, 3 months, etc. to get a true picture of your risk. The non-office visit codes are reviewed because these are the procedures which would have medical necessity coverage information.

  4. Review Documentation. Assess the quality of your chart documentation including your superbill! Medical Coding is just an extension of medical record (chart) documentation. If it’s not documented- you cannot bill for it. While there are some changes in current terms and definitions, ICD-10 does not technically change the requirements of medical record documentation. There has always been the requirement to include the all the details and highest specificity information. ICD-10 just requires that specificity to be included in the code where ICD-9 did not. For example: if a provider performs cataract removal surgery on a patient’s right eye, he or she most likely has indicated “right eye” in the chart documentation. In ICD-10 “right eye” must be included in the code submitted for reimbursement. It is imperative that documentation be reviewed compared to ICD-10 requirements and for providers, coders and billers to communicate the new required details for each patient encounter to ensure successful coding. Here is an example of a worksheet that could be utilized to examine documentation for all procedures:

Meaningful Use- Modified Stage 2(and 1)

In April, CMS issued another proposal for “meaningful use” with the goal of aligning Stage 1 and Stage 2 objectives with the long-term proposals for Stage 3. The change from the original Stage 2 requirements are to reduce reporting requirements which would allow providers to focus on advanced use of EHR technology and quality improvements and better promote interoperability. The plan would not be issued as a final regulation until August of this year; however, it applies to MU for years 2015, 2016 and 2017. So in August of 2015, providers will receive the final rule affecting 2015.

The proposal reduces the number of MU objectives to focus on the advanced use of EHRs; removes measures that have become redundant or have reached wide-spread adoption; realigns the reporting period to a calendar year instead of fiscal year; and allows for a 90 day reporting period in 2015.

Modified objectives of particular interest are the patient electronic access and patient electronic messaging. The original MU measure was 5% while the modified MU is 1 patient for electronic access and a “functionality fully enabled” for electronic messaging.

If a provider is currently attempting Stage 1 MU, it also was modified for Stage 2 criteria, but with smaller less comprehensive measures.

Meaningful Use Stage 3 Released

The proposed rule for stage 3 of “meaningful use” EHR Incentive Program was also recently released. It contains 8 objectives focused on advanced use of EHRs. The rule proposed significant change to the structure of the program by establishing a single stage for MU (Stage 3) starting in 2018. This would require eligible professionals to comply with MU requirements by 2018, regardless of their prior participation in the program. It is predicted that the cost to purchase and implement a certified EHR would be $54,000 and $10,000 annually for maintenance. The patient engagement requirement jumps from 5% in the original stage 2 to 25% of patients in stage 3. Starting in 2018, CMS would require electronic quality reporting for providers who would need to implement 5 clinical decision support interventions related to four or more quality measures. CMS insists that stage 3 includes some flexibility to help providers successfully attest. By 2019, MU will be rolled into a consolidated program under Merit-Based Incentives.

PQRS, VBM, MU EHR and now MIPS- Alphabet Soup That Isn’t That Tasty! Act Now to Avoid Penalties!

By now, everyone should be aware that fee-for-service payment is on its way out and a value-based payment system is on its way. But all the program abbreviations being tossed around can be confusing! To read more about PQRS, VBM and MIPS see our Medicare Billing Boosters for April 2015.