End of the ICD-10 Grace Period how to ensure proper claims reimbursement

1. End of the ICD-10 Grace Periodhow to ensure proper claims reimbursement Steve Adams, MCS, COC, CPC, CPMA, CPC-I, PCS, FCS, COA email: steve.adams@inhealthps.com web: thecodingeducator.com

2. thecodingeducator.com

3. DiscussionPoints • 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). Medicare Beneficiary Summary Files.

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