Saturday, February 29, 2020

2020 ICD-10 to HCC Mappings



CMS-HCC and Rx HCC Mappings

(Complete ICD-10 Mappings for 2020)

NEW Model V24 with 86 HCC Categories

This is a must have for every coder and clinician on your team!

218 Pages (8 ½ x 11)

Includes a complete list of ICD-10 codes included in the CMS-HCC and Rx-HCC Models for PY 2020

That is 9,700 ICD-10 codes in V24 (HCC) and 4,347 ICD-10 codes in V05 (Rx-HCC)
  • Have you ever wondered if a specific ICD-10 code had a "weight" or risk adjustment factor?
  • Have you wondered what other ICD-10 codes are risk adjusted?
If so, then you will love this book!

If your organization is looking to improve, this tool will help ensure accurate risk scores for your population.

Includes all of the following:
  • 2020 CMS-HCC ICD-10 Codes for V22, V24 and V05 (Rx-HCCs)
  • 2020 CMS-HCC Demographic Factors for New and Continued Enrollees
  • 2020 Medicaid and Disabled Factors
  • 2020 CMS-HCC Disease Factors for Non-Dual and Dual
  • 2020 CMS-HCC Trump Chart
  • 2020 Payment Count Factors
  • 2020 Interaction Factors
Give your team the tools to succeed this risk adjustment season!
  • Medicare Advantage Plans
  • Accountable Care Organizations
  • Value Based Payment Model Participants
  • PCMH, CPC+ and Primary Care First Participants
  • FQHCs and Community Health Centers
  • Academic Medical Centers and Integrated Health Systems
  • MSOs and IPAs
  • Physicians, Nurses, Auditors, Coders, CDI Specialists, Scibes and more...


FREE Shipping within the US!
Please allow 3 - 6 days for delivery.

Visit https://erm.ecwid.com/ to see a complete list of Risk Adjustment tools!





Friday, February 28, 2020

New Workshop Added in Fort Lauderdale



Join us on Tuesday, May 12th in Fort Lauderdale

Advanced Risk Management - Improve the accuracy of your risk scores!

Are you looking for the best education available in risk adjustment, value-based payments and/or CDI?
Good News - You have found it!

Join us for a day of risk adjustment, catch up with colleagues over lunch, and get the best tools in the industry for FREE!

Do you need CMEs or CEUs? We have that too!
All Workshops are approved by the American Medical Association, American Academy of Family Practice and the American Academy of Professional Coders.
Register your team ( 3 or more) today to save 10% on any 2020 Workshop!
Take advantage of Early Bird pricing and Save $100!

Overview:
Vast changes are coming to risk adjustment in 2020. What should your team be doing now to prepare? What are the potential impacts to revenue?
Discuss the importance of managing HCCs year over year. What resources are available from CMS to help? 
Discuss the impact of shifting from RAPS to EDS. What does this mean for office based claims?
Take a deep dive into HCC Coding and Documentation.
Review NEW HCCs for 2020 and see what documentation is needed to validate payment.
Learn how to leverage frontline staff to be successful in the world of risk adjustment and value-based payments.


Who Should Attend?
-Providers - MDs, DOs, PAs, and NPs
-Medical Directors - Medicare Advantage, ACOs, CPC+ and Medicaid
-Hospitals and Academic Medical Centers
-Medical Coders, Billers and CDI Specialists
-Executive Leaders, Administrators, Directors and Managers
-MSO and IPA Teams
-Rural Health Centers, FQHCs and Community Health Centers
-Health Alliance Members and Medical Society Members
-Medicare, Medicare Advantage, Medicaid and Commercial Plans

REGISTER BELOW:




Each Attendee will Receive ($130):
 - Color copy of the presentation
 - 2020 CMS-HCC Quick Coder
 - Laminated HCC and CDI Tools
 - CME from AAFP and AMA
 - CEU from AAPC

To SPONSOR an EVENT
Please email Kameron Gifford

Early Bird Pricing and Group Discounts
Register NOW to save $100 with Early Bird Pricing!

Bring the WHOLE TEAM!
 Register 3 and save 10% on your order!



Thursday, February 27, 2020

COVID-19: New ICD-10-CM Code and Interim Coding Guidance


ICD-10-CM Official Coding Guidelines - 

Coding encounters related to COVID-19 Coronavirus Outbreak 


Effective: February 20, 2020

Introduction  The purpose of this document is to provide official diagnosis coding guidance for health care encounters and deaths related to the 2019 novel coronavirus (COVID-19) previously named 2019-nCoV.

The COVID-19 caused an outbreak of respiratory illness, and was first identified in 2019 in Wuhan, Hubei Province, China. Since then, thousands of cases have been confirmed in China, and COVID-19 has also spread internationally, including in the United States. Investigations are ongoing. The most recent situation updates are available from the CDC web page, About 2019 Novel Coronavirus (COVID-19).  https://www.cdc.gov/coronavirus/2019-ncov/index.html

The confirmed COVID-19 infections can cause a range of illness, from little to no symptoms, to those affected being severely ill and even dying. Symptoms can include fever, cough, and shortness of breath. Symptoms may appear from 2 to 14 days after exposure, based on the incubation period for other coronaviruses, such as the MERS (Middle East Respiratory Syndrome) viruses. https://www.cdc.gov/coronavirus/2019-ncov/about/symptoms.html

This guidance is intended to be used in conjunction with the current ICD-10-CM classification and the ICD-10-CM Official Guidelines for Coding and Reporting (effective October 1, 2019) and will be updated to reflect new clinical information as it becomes available. https://www.cdc.gov/nchs/data/icd/10cmguidelines-FY2020_final.pdf.

The ICD-10-CM codes provided in this document are intended to provide information on the coding of encounters related to coronavirus. Other codes for conditions unrelated to coronavirus may be required to fully code these scenarios in accordance with the ICD-10-CM Official Guidelines for Coding and Reporting. A hyphen is used at the end of a code to indicate that additional characters are required.

General Guidance  

Pneumonia
For a pneumonia case confirmed as due to the 2019 novel coronavirus (COVID-19), assign codes J12.89, Other viral pneumonia, and B97.29, Other coronavirus as the cause of diseases classified elsewhere.

Acute Bronchitis
For a patient with acute bronchitis confirmed as due to COVID-19, assign codes J20.8, Acute bronchitis due to other specified organisms, and B97.29, Other coronavirus as the cause of diseases classified elsewhere. Bronchitis not otherwise specified (NOS) due to the COVID-19 should be coded using code J40, Bronchitis, not specified as acute or chronic; along with code B97.29, Other coronavirus as the cause of diseases classified elsewhere.

Lower Respiratory Infection
If the COVID-19 is documented as being associated with a lower respiratory infection, not otherwise specified (NOS), or an acute respiratory infection, NOS, this should be assigned with code J22, Unspecified acute lower respiratory infection, with code B97.29, Other coronavirus as the cause of diseases classified elsewhere. If the COVID-19 is documented as being associated with a respiratory infection, NOS, it would be appropriate to assign code J98.8, Other specified respiratory disorders, with code B97.29, Other coronavirus as the cause of diseases classified elsewhere.

ARDS Acute respiratory distress syndrome 
ARDS may develop in with the COVID-19, according to the Interim Clinical Guidance for Management of Patients with Confirmed 2019 Novel Coronavirus (COVID-19) Infection.  https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-management-patients.html

Cases with ARDS due to COVID-19 should be assigned the codes J80, Acute respiratory distress syndrome, and B97.29, Other coronavirus as the cause of diseases classified elsewhere.

Exposure to COVID-19 
For cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation, it would be appropriate to assign the code Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out.

For cases where there is an actual exposure to someone who is confirmed to have COVID-19, it would be appropriate to assign the code Z20.828, Contact with and (suspected) exposure to other viral communicable diseases.

Signs and Symptoms  

For patients presenting with any signs/symptoms (such as fever, etc.) and where a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as:  • R05 Cough • R06.02 Shortness of breath  • R50.9 Fever, unspecified

Note:  Diagnosis code B34.2, Coronavirus infection, unspecified, would in generally not be appropriate for the COVID-19, because the cases have universally been respiratory in nature, so the site would not be “unspecified.

If the provider documents “suspected”, “possible” or “probable” COVID-19, do not assign code B97.29. Assign a code(s) explaining the reason for encounter (such as fever, or Z20.828).

This coding guidance has been developed by CDC and approved by the four organizations that make up the Cooperating Parties: the National Center for Health Statistics, the American Health Information Management Association, the American Hospital Association, and the Centers for Medicare & Medicaid Services.

Reference: COVID-10 clinical presentation:
https://www.cdc.gov/coronavirus/2019-nCoV/hcp/clinical-criteria.html

https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf


Monday, February 24, 2020

2020 HCC Coding Essentials


2020 HCC Coding Essentials


- All NEW for the V24 Model

Prepare your team for victory this risk adjustment season with the CMS-HCC Coding Essentials Pack. Includes all of the following:
  1. 2020 CMS-HCC Disease Factors – includes RAF for both Non-Dual and Dual members.
  2. 2020 CMS-HCC Trump Chart – Is your practice limited in the number of diagnoses you can submit per claim? This chart is a valuable resource to assist you in working smarter, not harder!
  3. 2020 CMS New and Continuing Enrollee Factors - for both Aged and Disabled members, plus Medicaid and Disabled Factors.
  4. 2020 Interaction Factors - CMS adds these factors to offset the additional resources needed to care for patients with certain co-existing conditions.
  5. 2020 Payment Count Factors - Additional factors will be added to the risk score when a patient has at least 4 payment HCCs.
  6. EHR Guide - Reduce keystrokes and choices when searching for diagnoses in your EHR. This double sided guide includes the most common ICD-10 codes. Post one by every workstation. 
  7. Top Missed HCCs - Great education piece. A provider favorite! 
- All Printed on extra thick 14 pt. cardstock to last all year.





Click here to learn more or place your order! 

Saturday, February 15, 2020

Primary Care First Model

Is your organization participating?
Primary Care First Model Options is a set of voluntary five-year payment options that reward value and quality by offering an innovative payment structure to support delivery of advanced primary care. Primary Care First is based on the underlying principles of the existing CPC+ model design: prioritizing the doctor-patient relationship; enhancing care for patients with complex chronic needs and high need, seriously ill patients, reducing administrative burden, and focusing financial rewards on improved health outcomes. 

Primary Care First Model Options will be offered in 26 regions for a 2021 start date: Alaska (statewide), Arkansas (statewide), California (statewide), Colorado (statewide), Delaware (statewide), Florida (statewide), Greater Buffalo region (New York), Greater Kansas City region (Kansas and Missouri), Greater Philadelphia region (Pennsylvania), Hawaii (statewide), Louisiana (statewide), Maine (statewide), Massachusetts (statewide), Michigan (statewide), Montana (statewide), Nebraska (statewide), New Hampshire (statewide), New Jersey (statewide), North Dakota (statewide), North Hudson-Capital region (New York), Ohio and Northern Kentucky region (statewide in Ohio and partial state in Kentucky), Oklahoma (statewide), Oregon (statewide), Rhode Island (statewide), Tennessee (statewide), and Virginia (statewide).




The PCF model includes professional population-based payments and flat primary care visit fees to help practices improve access to care and transition from FFS to population-based payments. 


If your practice is located in one of the 26 regions and has at least 800 FFS Medicare patients, you should strongly consider particpating in the PCF model.  

  • Primary Care First practices may also participate in ACOs in the Medicare Shared Savings Program (Shared Savings Program).
  • Primary Care First practices may not participate in the Next Generation ACO Model or the Comprehensive End Stage Renal Disease (ESRD) Care Model. 

If you have any questions or need additional guidance navigating the Primary Care First Model, ERM Consulting can help!


Todd Gifford, MBA, CRC 
772-267-8156

Kameron Gifford, CPC
772-267-9453


Tuesday, February 4, 2020

2020 HCC Quick Coders



2020 HCC Quick Coders are ready for shipping!



Completely updated for 2020 - Version 24

This 40 page guide contains everything you need to calculate a risk score in one place!

Includes 200+ of the most common HCC codes in the Medicare (CMS-HCC) model.

This guide was designed for providers, with codes sorted alphabetically rather than by code.


Includes:
  • List of ICD-10 Guidelines
  • 270 ICD-10 Codes (Rx and HCCs)
  • Quality CPT II codes for MIPS / MACRA
  • 2020 CMS-HCC Factors (includes demographic, disease and interaction)
  • 2020 Trump Chart

Orders of 100 or more can be white labeled with your logo at no charge. Please email logo to orders@ermconsultinginc.com after purchase.




Visit https://erm.ecwid.com/ to see learn more and place your order.


Sunday, February 2, 2020

Advance Notice of Changes for Calendar Year (CY) 2021

CMS published the Advance Notice on January 6th 2020


NOTE TO: Medicare Advantage Organizations, Prescription Drug Plan Sponsors, and Other Interested Parties

SUBJECT: Advance Notice of Methodological Changes for Calendar Year (CY) 2021 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies – Part I, CMS-HCC Risk Adjustment Model

Medicare Advantage has been successful in providing Medicare beneficiaries with options so
that they can choose the healthcare that best fits their individual health needs. The Medicare
Advantage program demonstrates bringing the value of private sector innovation and creativity
to a government program, and CMS is committed to continuing to strengthen Medicare
Advantage by promoting greater innovation, transparency, flexibility, and program
simplification.

A key element in the success of Medicare Advantage is ensuring that payments to plans reflect
the relative risk of the people who enroll. A critical tool that CMS uses to accomplish that goal is
the risk adjustment models that adjust payments based on the characteristics and health
conditions of each plan’s enrollees.

Summary of Proposal for CY 2021 


For CY 2021 CMS is proposing to continue using the CMS-HCC model that was implemented in CY 2020 (i.e., 2020 CMS-HCC model). CMS is proposing to continue using the 2020 CMSHCC model to calculate encounter data-based scores and the 2017 CMS-HCC model to calculate RAPS-based scores. Under this proposal, 75% of the risk score would be calculated with the 2020 CMS-HCC model and 25% of the risk score would be calculated with the 2017 CMS-HCC model.


Proposal for 2021 and Three-year Phase-in 2019 - 2022 


The 21st Century Cures Act requires that any changes to risk adjusted payments under section 1853(a)(1)(C)(i) resulting from the implementation of section 1853(a)(1)(I) must be phased in over a three-year period, beginning with 2019, with such changes being fully implemented for 2022 and subsequent years. The statute thus requires a three-year phase-in over a four-year period. In the CY 2019 Advance Notice, we explained how we interpreted the statute’s direction to mean that the proposed changes to the risk adjustment model under section 1853(a)(1)(C)(i) could be implemented in 2019 without all the required provisions from section 1853(a)(1)(I), and could be further modified and implemented fully consistent with provisions from section

1853(a)(1)(I) for 2020. The model finalized for 2020 included modifications to meet all of the provisions from section 1853(a)(1)(I), and will be phased in over three years such that 100% of risk adjusted payments to MA organizations and certain demonstrations for 2022 are based on a risk adjustment model that complies with the statutory requirements in section 1853(a)(1)(I) of the Act. In order to phase in a model that meets the statutory requirements, risk score calculation for payment to MA organizations and certain demonstrations during the phase-in period reflects the transtion as follows:

For Payment Year 2019, we are calculating risk scores using the sum of:

  • 25% of the risk score calculated with the 2019 CMS-HCC model and 
  • 75% of the risk score calculated with the 2017 CMS-HCC model. 

For Payment Year 2020, we are calculating risk scores using the sum of:

  • 50% of the risk score calculated with the 2020 CMS-HCC model and 
  • 50% of the risk score calculated with the 2017 CMS-HCC model. 


For Payment Year 2021, we propose to continue the phase in of the changes to the model by calculating risk scores using the sum of:


  • 75% of the risk score calculated with the 2020 CMS-HCC model and 
  • 25% of the risk score calculated with the 2017 CMS-HCC model. 


For PACE organizations, we propose to continue to use the 2017 CMS-HCC model to calculate risk scores in CY 2021, as described in the CY 2020 Advance Notice Part II and CY 2020 Rate Announcement.


Encounter Data as a Diagnosis Source for 2021 


For CY 2020, CMS is calculating risk scores for payment to MA organizations and certain demonstrations by adding 50% of the risk score calculated using risk adjustment eligible diagnoses identified from encounter data, FFS claims, and RAPS inpatient records with 50% of the risk score calculated using risk adjustment eligible diagnoses identified from RAPS data and FFS claims.

For CY 2021, CMS proposes to calculate risk scores for payment to MA organizations and certain demonstrations by adding 75% of the risk score calculated using risk adjustment eligible diagnoses identified from encounter data, FFS claims, and RAPS inpatient records with 25% of the risk score calculated with risk adjustment eligible diagnoses identified from all RAPS data and FFS claims.

Specifically, we propose to calculate the encounter data-based risk scores as follows:


  • With the 2020 CMS-HCC model, 
  • Using risk adjustment eligible diagnoses from encounter data, FFS claims, and RAPS inpatient records. 


RAPS-based risk scores would be calculated as follows:


  • With the 2017 CMS-HCC model, 
  • Using risk adjustment eligible diagnoses from RAPS data and FFS claims


Thus, as proposed, encounter data-based risk scores would only be calculated with the 2020 CMS-HCC model.

For PACE organizations for CY 2021, we propose to continue the same method of calculating risk scores that we have been using since CY 2015, which is to pool risk adjustment-eligible diagnoses from the following sources to calculate a single risk score (with no weighting): (1) encounter data, (2) RAPS data, and (3) FFS claims



Read the entire advance notice here



The Final Rate Announcement

For CY 2021, CMS will announce the Medicare Advantage capitation rates and final payment
policies no later than Monday, April 6, 2020, in accordance with the timetable established in
section 1853(b)(2), as amended by the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA) (Pub. L. 108-173) and the Securing Fairness in Regulatory
Timing Act of 2015 (SFRTA) (Pub. L. 114-106).


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