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HEALTHCARE UNPLUG
Taino Consultants Inc.Dr. Jose I. Delgado
TOPICS ICD 10 MACRA Meaningful Use Audits Chronic Disease HIPAA Non Compliance ACA & Employee Retention
ICD 10 October 1st Significance
Update of codes for FY 2017 Specificity Grace Period Ends
CODES UPDATE Total codes approved 75,625 New codes 3,651
Good News/Bad news 97% (3,549) of new codes are cardio codes
Revised codes 487
SPECIFICITY GRACE PERIOD One year term Codes in the right family were payable
“ICD-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-10 code as long as there is no evidence of
fraud," CMS said.”
ICD 10 AND THE MEDICAL RECORD ICD-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 Terminology Consolidation of Programs Eligible Clinicians New Options
BASIC TERMINOLOGY CHIP - The Children’s Health Insurance
Program (CHIP) provides health coverage to eligible children
MIPS – Merit-Based Incentive Payment System
APMs – Advanced Alternative Payment Model
BASIC OPTIONS MIPS
Model that most eligible clinicians will select Fee for service with adjustments based on performance
APMs High risk model Acceptable Models
CMS 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 Program
Demonstration required by federal law
MIPS ELIGIBLE CLINICIANS Physicians Physician Assistants (PA) Nurse Practitioners (NP) Clinical Nurse Specialists Certified Registered Nurse Anesthetists
(CRNA) Groups that include these clinicians
MIPS CONSOLIDATION Physician Quality Reporting System
(PQRS) Value-Based Payment Modifier (VBPM) Electronic Health Record (EHR)
Incentive Clinical practice improvement activities
(CPIA)
PERFORMANCE PARAMETERS Quality (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 PARAMETERS Quality (replaces PQRS and the VM).
Six quality measures to report on Extensive list of options tailored to each specialty
and practice Advancing 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 PARAMETERS Clinical Practice Improvement Activities.
Care coordination, beneficiary engagement, and patient safety
More than 90 reporting options are available Credit for participating in APMs and Patient-
Centered Homes Cost (replaces the VM).
Based on Medicare claims Does not require any additional reporting. More than 40 episode-specific measures.
NEW OPTIONS First Option: Test the Quality Payment Program.
Submit some data to the Quality Payment Program Second 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 - DIABETES Diabetes Studies and costs
Weight loss to be part of diabetes protocols Diabetes Education and Medical
Nutrition Importance of Certification and
Documentation
ELECTRONIC HEALTH INCENTIVE All Providers in Stage 2 Single set of objectives and measures Reduced Patient engagement
requirements Eligible professionals (EPs), there are 10
objectives, Eligible hospitals and critical access
hospitals (CAHs), there are 9 objectives.
HITECH AUDITS Audits will continue and potentially
increase May go up to six years back Auditors learning curve and demands
increasing
LESSONS LEARNED Monitor e-mail Don’t trust back-ups or reports
Recommend a book of evidence Keep copies of attestation reports and
support documents for six years Conduct annual Security Risk Assessments
Not all risk assessments are the same Support Documentation required Follow risk assessment with management plan
AFFORDABLE CARE ACT Health Care Mandate
Small business impact Individual mandate Retention challenges
Options
RESOURCES Taino Consultants Inc.
www.tainoconsultants.com [email protected]
Diabetic Centers for excellence Lavern Dowell
People Helping People [email protected]
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