Download presentation
Presentation is loading. Please wait.
Published byJanel Short Modified over 6 years ago
1
End of the ICD-10 Grace Period how to ensure proper claims reimbursement
Steve Adams, MCS, COC, CPC, CPMA, CPC-I, PCS, FCS, COA web: thecodingeducator.com
2
thecodingeducator.com
3
Discussion Points 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
4
Merit Based Payment
5
Medicare Access and CHIP Reauthorization (MACRA)
Act of 2015
7
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
8
What is Measured?
9
Percentages
11
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.
12
Sequencing
13
Other & Unspecified
14
What’s The Difference Other – you’ve documented something so specific there’s no code for the disease. Unspecified – your documentation is weak
15
Excludes 1 & 2
16
What? Excludes 1 – never billed with the primary code
Excludes 2 – a patient may have both conditions at the same time
17
Code First
18
Code Also
19
Signs and Symptoms
20
Signs and Symptoms
21
2017 ICD-10CM Changes
22
2017 ICD-10CM Changes
23
2017 ICD-10CM Changes
24
2017 ICD-10CM Changes
25
2017 ICD-10CM Changes
26
2017 ICD-10CM Changes
27
2017 ICD-10CM Changes
28
2017 ICD-10CM Changes
29
2017 ICD-10CM Changes
30
ICD-10CM, HCC and Risk
31
SOURCE: Chronic Condition Data Warehouse (CCW)
SOURCE: Chronic Condition Data Warehouse (CCW). Medicare Beneficiary Summary Files. Description: The conditions with the highest period prevalence rates are hypertension (57%) and hyperlipidemia (47%). Nearly one-third of the population has been treated for rheumatoid/osteo-arthritis (30%), ischemic heart disease (29%), and diabetes (28%). Technical notes: Period prevalence is calculated for these rates. Beneficiaries with full or nearly full fee-for-service (FFS) coverage during the year who received treatment for the condition within the condition-specified look back period. Chronic conditions have a 1 to 3 year look-back time period. Please refer to the CCW Chronic Condition Categories for algorithm criteria. Denominator is all who were enrolled in Medicare on or after January 1, 2013 and had full or nearly full FFS coverage (i.e., 11 or 12 months of Medicare Part A and B [or coverage until time of death] and one month or less of HMO coverage). Only females are included in the denominator for endometrial and female breast cancer; only males are included for prostate cancer and benign prostatic hyperplasia. Beneficiaries may be counted in more than one chronic condition category.
32
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
33
HCC
47
Code all Coexisting Conditions
48
Codes Can Be
49
Look at the Sheet Afib & Flutter Asthma COPD Diabetes Heart Failure
HTN Hyperlipidemia Other Cardiovascular Diagnosis Codes Psychiatric Rheumatoid Tobacco Medication Non-compliance
58
Heart failure often develops because you have (or had) a medical condition, such as coronary artery disease, a heart attack or high blood pressure, which has damaged or put extra workload on your heart.
67
Tools for ICD-10
68
IPhone
69
I-phone/Android Application
70
Intelligent Medical Object (IMO)
76
QRUR Information on performance is provided to participants in the form of Physician Quality & Resource Use Reports (QRURs). These reports are used to monitor the potential value modifier adjustment, and to improve performance.
78
What Do I Do?
79
What Do I Do?
80
Discussion Points 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
81
Questions?
82
Any Questions Direct: 706-483-4728 E-Fax: 770-709-3698
Web: Facebook: facebook.com/kingofcoders
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.