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:
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