Healthcare unplug

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HEALTHCARE UNPLUG Taino Consultants Inc. Dr. Jose I. Delgado

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Healthcare UnplugTaino Consultants Inc.Dr. Jose I. Delgado

TopicsICD 10MACRAMeaningful Use AuditsChronic DiseaseHIPAA Non ComplianceACA & Employee Retention

ICD 10October 1st SignificanceUpdate of codes for FY 2017Specificity Grace Period Ends

Codes UpdateTotal codes approved 75,625New codes 3,651Good News/Bad news97% (3,549) of new codes are cardio codesRevised codes 487

Specificity grace PeriodOne year termCodes in the right family were payableICD-10 flexibilities were solely for the purpose of contractors performing medical review so that they would not deny claims solely for the specificity of theICD-10code as long as there is no evidence of fraud," CMS said.

ICD 10 and the Medical RecordICD-10 codes will require additional information in order to code the service and support the treatment plan. The patient record must include specific terminology and provide more detail in the documentation.Diagnoses codes are used for medical review, auditing, and coverage.

Medicare access and CHIP Reauthorization Act of 2015 (MACRA)Basic TerminologyConsolidation of ProgramsEligible CliniciansNew Options

Basic TerminologyCHIP - The Childrens Health Insurance Program (CHIP) provides health coverage to eligible childrenMIPS Merit-Based Incentive Payment SystemAPMs Advanced Alternative Payment Model

Basic OptionsMIPS Model that most eligible clinicians will selectFee for service with adjustments based on performanceAPMsHigh risk modelAcceptable ModelsCMS Innovation Center Model (other than a Health Care Innovation Award)Medicare Shared Savings Program Accountable Care Organizations (MSSP ACOs)Demonstration under the Health Care Quality Demonstration ProgramDemonstration required by federal law

MIPS Eligible CliniciansPhysicians Physician Assistants (PA)Nurse Practitioners (NP)Clinical Nurse SpecialistsCertified Registered Nurse Anesthetists (CRNA)Groups that include these clinicians

MIPS ConsolidationPhysician Quality Reporting System (PQRS)Value-Based Payment Modifier (VBPM)Electronic Health Record (EHR) IncentiveClinical practice improvement activities (CPIA)

Performance ParametersQuality (replaces PQRS and the VM). Year 1 (2019): 50%Year 2 (2020): 45% 2021 and beyond: 30%Advancing Care Information (formerly Meaningful Use [MU]). Year 1 (2019): 25%Year 2 (2020): 25% 2021 and beyond: 25%Clinical Practice Improvement Activities. Year 1 (2019): 15%Year 2 (2020): 15% 2021 and beyond: 15%Cost (replaces the VM). Year 1 (2019): 10%Year 2 (2020): 15% 2021 and beyond: 30%

Performance ParametersQuality (replaces PQRS and the VM). Six quality measures to report on Extensive list of options tailored to each specialty and practiceAdvancing Care Information (formerly Meaningful Use [MU]). Choose measures that reflect how technology best suits their day-to-day practice.No need to report on:Measures related to Clinical Decision Support (CDS) Computerized Physician Order Entry (CPOE).

Performance ParametersClinical Practice Improvement Activities. Care coordination, beneficiary engagement, and patient safetyMore than 90 reporting options are availableCredit for participating in APMs and Patient-Centered HomesCost (replaces the VM). Based on Medicare claims Does not require any additional reporting. More than 40 episode-specific measures.

New OptionsFirst Option: Test the Quality Payment Program. Submit some data to the Quality Payment ProgramSecond Option: Participate for part of the calendar year. Submit Quality Payment Program information for a reduced number of days. Potential to qualify for a small positive payment adjustment. May start after January 1, 2017 Third Option: Participate for the full calendar year. Submit Quality Payment Program information for a full year. Fourth Option: Participate in an Advanced Alternative Payment Model in 2017.

Chronic Conditions - DiabetesDiabetes Studies and costsWeight loss to be part of diabetes protocolsDiabetes Education and Medical NutritionImportance of Certification and Documentation

Electronic Health IncentiveAll Providers in Stage 2Single set of objectives and measuresReduced Patient engagement requirementsEligible professionals (EPs), there are 10 objectives, Eligible hospitals and critical access hospitals (CAHs), there are 9 objectives.

HITECH AuditsAudits will continue and potentially increaseMay go up to six years backAuditors learning curve and demands increasing

Lessons LearnedMonitor e-mailDont trust back-ups or reportsRecommend a book of evidenceKeep copies of attestation reports and support documents for six yearsConduct annual Security Risk AssessmentsNot all risk assessments are the sameSupport Documentation requiredFollow risk assessment with management plan

Affordable Care ActHealth Care MandateSmall business impactIndividual mandateRetention challengesOptions

ResourcesTaino Consultants [email protected]ic Centers for excellenceLavern DowellPeople Helping [email protected]