CMS: No ICD-10 Audit Claims for Specificity in Year One

For one year after implementation of ICD-10, CMS will not deny or audit claims just for specificity, as long as the code is from the appropriate family of ICD-10 codes. Similarly, physicians will not be penalized for the value-based payment modifier or Meaningful Use due to specificity of diagnoses.

After a vigorous, last-ditch push by the AMA for a two-year transition period after implementation to protect physicians from all ICD-CM coding errors and mistakes, CMS and AMA made a joint announcement that appears to signal a burying of the hatchet.

Steven Stack, MD, AMA's president, touts the changes in a post that begins with a concession his group has resisted stating for years: "Implementation of the ICD-10 code set is just around the corner, with a hard deadline of Oct. 1."

To gain that admission from the AMA, CMS agreed to a variety of policies involving claim denials, quality reporting, payment disruptions, and navigating the transition.

For one year after implementation, CMS will not deny or audit claims just for specificity, as long as the code is from the appropriate family of ICD-10 codes.  Even though the use of unspecified codes is allowed according to the ICD-10-CM Official Guidelines for Coding and Reporting, this clarification makes a lot more sense than absolving physicians of all coding errors and mistakes.

Similarly, CMS will not penalize physicians for the Physician Quality Reporting System, the value-based payment modifier, or meaningful use to due specificity of diagnoses as long as the provider reports a code from the appropriate family.

CMS has also authorized advance payments to physicians if Medicare contractors can't process claims due to problems related to ICD-10.

CMS will continue to offer resources to aid practices with a new ICD-10 communications and coordination center headed by an ombudsman to resolve outstanding questions about implementation.

For more information, see CMS' guidance on the changes.

The biggest benefit to the healthcare community is that the announcement has finally removed the biggest barrier to implementation: uncertainty. You can now talk to physicians confidently about the ICD-10 deadline and work with them throughout the yearlong transition to improve their documentation for you to choose the most appropriate, and specific, code.

You can forget about delays, waiting for ICD-11, and any other excuses you've heard about pushing off training for the transition. With the AMA and CMS working together, ICD-10 is certainly coming in just 86 days.

Steven Andrews is editor of Briefings on APCs and outpatient editor of JustCoding.com.

http://www.healthleadersmedia.com/content/TEC-318237/CMS-No-ICD10-Audit-Claims-for-Specificity-in-Year-One.html

Patient enrollment, use, and satisfaction with patient portals

Many physicians are adopting patient portals in response to governmental incentives for meaningful use (MU), but the stage 2 requirements for portal use may be particularly challenging for newer electronic health record (EHR) users. This study examines enrollment, use based on MU requirements, and satisfaction in a recently-adopting fee-for-service multispecialty system. The Centers for Medicare and Medicaid Services (CMS) financial incentives for meaningful use (MU)1 likely will persuade many reluctant doctors to adopt electronic health records (EHRs). However, there are strong concerns about whether most physicians will be able to adopt and utilize these EHRs to meet MU standards.

The study team examined data from 2010 to 2012 of users of a available patient portal linked to the EHR of a multispecialty academic group practice and 10 affiliated community primary care clinics. Patient portals linked to commercial EHRs are likely to offer the most commercially practical way for new EHR users to meet CMS MU patient access regulations. The results indicate that even some large centers with patient portals will have difficulty with some of their physicians' enrollment targets.

The study suggests that patients at later-adopting centers are moving quickly to embrace online programs, and that primary care, but not specialty physicians, can satisfy many of their expectations even without large redesigns of care.

http://www.medicalnewstoday.com/releases/274538.php

Tavenner: No ICD-10 Delay, But Expect Some MU Relief

Lena J. Weiner, for HealthLeaders Media , February 27, 2014

CMS Administrator Marilyn Tavenner has announced that the ICD-10 deadline will not be delayed, but she is offering relief to providers, payers, and health information technology vendors struggling to meet Meaningful Use Stage 2 requirements.

Two announcements from Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner at the HIMSS 2014 conference in Orlando Thursday will have wide-ranging implications for healthcare providers, insurers, and vendors.

The deadline for implementing the ICD-10 diagnostic coding set, which had already been delayed one year to October 1, 2014, will not be delayed again, Tavenner said.

And while the Stage 2 Meaningful Use deadline will also not be delayed, Tavenner said that providers and vendors struggling to meet the incentive program's requirements will see some flexibility.

During the keynote presentation Thursday morning at HIMSS 14 in Orlando, Tavenner announced a partial reprieve for physicians and medical systems finding it difficult to adjust to Meaningful Use guidelines—but urged professionals to come up to speed quickly.

"We have decided to permit flexibility on how hardship exemptions will be granted," Tavenner said. "I must stress we expect all providers to meet requirements in 2015. I urge you to meet the requirements this year." Scattered applause broke from members of the crowd as Tavenner made the announcement.

"We certainly have experienced… difficulties, and I can personally relate to the challenges of new systems, relationships with vendors, and charting a course through previously unnavigated waters," Tavenner said, referring to the well-documented difficulties with thehealthcare.gov website.

When confronted by a question regarding patient safety during the Q & A session after the keynote, National Coordinator for Health Information Technology, Karen DeSalvo, said, "We are exploring our options to help you… we want to make sure you are not penalized for doing the right thing."

These comments come at a time when many within the healthcare industry are expressing concerns regarding the ability to adopt the Meaningful Use standards as specified in the HITECH act. On the Friday before HIMSS, more than 40 healthcare industry groups penned a letter to Health and Human Services Secretary Kathleen Sebelius seeking more time for Meaningful Use attestation, and citing concerns over patient safety and lack of vendor support.

On Thursday, in an exclusive interview with HealthLeaders Media, Intermountain Healthcare CIO Marc Probst disclosed that his organization is unready to seek MU Stage 2 attestation and will forgo incentive payments and trigger penalties.

'It's Time to Move On'While concerns from within the industry are being taken seriously, there will be no turning back. While CMS will be offering exemptions on a case-by-case basis, "Now is not the time for us to stop moving forward," Tavenner said. She was especially unyielding regarding the new ICD-10 coding system.

"Let's face it guys; it's time to move on," Tavenner said. "There will be no change in the deadline for ICD-10. CMS began installing and testing systems for ICD-10 in 2011. All fee for service systems at CMS are ready."

Earlier this month, in response to concerns raised by providers and a group of U.S. senators, CMS agreed to perform end-to-end ICD-10 testing with a small sample group of providers selected to represent "a broad cross-section of provider types, claims types, and submitter types."

The College of Healthcare Information Management Executives (CHIME) responded to Tavenner's comments at HIMSS in a statement released shortly after the keynote speech.

"[CHIME] welcomes CMS Administrator Marilyn Tavenner's announcement this morning, acknowledging the need to provide relief for our nation's providers. Such relief is vitally important for the future success of Meaningful Use, as ICD-10 deadlines and continued shifts in payment policies demand an ever-increasing amount of IT and workforce resources," the statement read.

In the event that expansion of the Hardship Expectations provides the "kind of relief the industry desperately needs," CHIME will pledge to assist CMS "in every way possible," the statement continued. "It will be CHIME's highest policy priority to ensure that providers receive the kind of relief they need in order to deliver quality care."

http://www.healthleadersmedia.com/print/TEC-301496/Tavenner-No-ICD10-Delay-But-Expect-Some-MU-Relief

Meaningful use incentive payments top $19 billion, 88% of hospitals included

Nearly 88% of eligible hospitals have received a payment for participating in the EHR incentive program, as noted in data shared at a recent Health IT Policy Committee meeting. The payments were either given to providers who could attest to having fully installed and were using EHRs according to meaningful use criteria, or those who had yet to achieve meaningful use but were in the adopt/implement/upgrade phase with their EHR system. Through 2013, more than $19 billion in meaningful use incentive payments had been distributed to eligible professionals and hospitals.

In a meeting held last April, the Health IT Policy Committee laid down some ideas for the continued development of the meaningful use incentive program. Goals for stage 3 of the program — including whether to shift compliance requirements more toward effective use of data and away from technology adoption — was among the topics covered by the committee. For providers who have attested to previous stages of meaningful use, stage 3 compliance could depend more on patient outcomes and disease prevention.

CMS continues to adjust their deadlines to allow for greater participation in the meaningful use program. The agency recently extended both the stage 2 deadline and the reporting period for providers to receive incentive payments for 2013. The decision to prolong stage 2 was due to stakeholder concern that insufficient data would be available to fully assess its effectiveness before moving on to the third stage.

Extending stage 2 will not only give more providers a chance to receive incentive payments while transitioning to the ICD-10 codes, but it will also help define the next stage in the meaningful use process. Specifically, it will allow the policymakers more time to determine reasonable benchmarks to set for stage 3. It also grants vendors additional time to create and adjust their products to better suit providers’ needs.

http://searchhealthit.techtarget.com/healthitexchange/healthitpulse/meaningful-use-incentive-payments-top-19-billion-88-of-hospitals-included/

Consider the Value of Engaging Patients through Fun and Interactive Games...

Are you a physician looking for fun new ways to engage your patients and help them take control of their own health? Are you a patient who has just been diagnosed with diabetes?

What if we could game our way to better health? I believe we can.

Consider "Diabetes Space Race" a quick fun interactive game, that patients can play in the waiting room or while in the exam room waiting to be seen.

With inexpensive games we can fill this "dead time" with meaningful fun!

These 5 minute games can not only teach, but also track and measure the experiences of your patients.

Easily make them available from any device for use outside of the office as well.

All on a complete HIPPA secure server!

To play "Diabetes Space Race" click the picture below:

 

 

 

If you are interested in offering this game or others to your patients, please email: Kameron Gifford