According to a recent report by Genworth Financial, the cost of long-term care is rising. The findings show the daily cost of a private room in a nursing home at $230 a day compared to $115 a day at an assisted-living facility. Those able to receive home care homes will pay an average of $19 an hour for a licensed home health aide.
ICD-10 implementation will alter the way coding is currently done and will require a significant effort to execute. Below is an overview of the people that will be impacted by ICD-10 implementation and the potential effect it will have on your practice.
- Physicians: Physicians will have to familiarize themselves with thousands of new codes as code sets will increase fivefold. Physicians will also be required to provide more specific documentation to patient records.
- Nurses: Nurses will need to revise order forms to comply with ICD-10 coding, as well as modify prior authorization documents. Like physicians, nurses will need to provide more specific documentation to patient records.
- Clinical Staff: Clinical staff will need to develop new policies and forms, rework superbills and reformat Advanced Beneficiary Notices (ABNs). Create several superbills for different types of visits depending on the volume of codes ICD-10 will introduce to the practice.
- Practice Managers: Practice managers will need to establish new policies and procedures in conjunction with ICD-10. In addition, software upgrades should be performed and vendor contracts amended.
- Coding Specialists: Coders will need to become familiar with revised codebooks and thousands of new codes. Coders should also be prepared to increase their clinical knowledge and be prepared for simultaneous billing of ICD-9 and ICD-10 code sets.
- Billing: Billing staff should learn new code set and software modifiers and revised payer policies.
- Lab: Labs will need to understand more specific documentation requirements as well as reporting provisions.
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The Centers for Medicare & Medicaid Services (CMS) has revised the State Operations Manual’s Hospital Appendix A, Interpretive Guidelines for Hospitals, Condition of Participation to clarify the discharge planning requirements for hospitals.
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Studies show without encouragement, hospital workers wash their hands as little as 30% of the time that they interact with patients. And with hospital-acquired infections costing $30 billion and leading to nearly 100,000 patient deaths a year, hospitals are willing to try almost anything, including video monitoring, to reduce the risk of transmission.
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While the Patient Protection & Affordable Care Act (PPACA) has garnered attention for providing coverage to tens of millions of uninsured Americans, workers with employer-paid health insurance are being impacted. Companies hoping to avoid the Cadillac Tax, which penalizes companies that offer high-end health care plans to their employees, are beginning to scale back traditionally offered health benefits in an effort to bring down the overall cost of care.
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The U.S. Department of Health and Human Services (HHS) has mandated the use of ICD-10 code sets to report health care diagnoses and procedures effective October 1, 2014. Implementation of ICD-10 code sets will alter the way coding is currently done and will require a significant effort to execute.
- The ICD-10 compliance deadline is October 1, 2014.
- All HIPAA covered entities must use ICD-10 starting October 1, 2014.
- Claims that do not use ICD-10 diagnosis and inpatient procedure codes after October 1, 2014 cannot be processed.
- CMS will not be able to process ICD-10 claims until the October 1 compliance date.
- There are approximately 71,000 ICD-10 code sets compared to 16,000 ICD-9.
- Procedural coding will require increased knowledge of physiology, anatomy, medical terms, surgical devices and implants to name a few.
- Clinical documentation must support new codes.
- ICD-10 codes were developed with significant clinical input.
- Coders will need to be certified for ICD-10.
- Some specialties will have more assigned codes, resulting in greater “drill downs”
A new Senate bill, the Medicare Audit Improvement Act, a bipartisan companion bill to the House version that aims to reform Medicare Recovery Auditor Contractors (RACs) and address provider concerns over the Medicare audit process. The bill includes measures to rein in auditors and improve audit quality by imposing financial penalties and improving transparency.
- Establish a consolidated limit for medical record requests
- Improve auditor performance by implementing financial penalties and by requiring medical necessity audits to focus on widespread payment errors
- Improve recovery auditor transparency
- Assure due process appeals for claims reopenings
- Allow accurate payment for rebilled claims
- Require physician review for Medicare denials
Click here to read the bill in its entirety.
Time is running out to avoid a Medicare pay cut. The Centers for Medicare & Medicaid Services (CMS) is requesting data on quality indicators for several distinct conditions. Providers only have until the end of the year to participate in Physician Quality Payment Reporting (PQRS) and avoid a 1.5% pay reduction.
Here are some tips to prevent the payment decrease.
- Report: Send a valid quality measure code at least once in 2013 to prevent the penalty from kicking in.
- Opt In: CMS will perform a voluntary analysis and produce the data required for quality reporting. This option is only available until October 15.
- Education: CMS is working with physicians and organized medicine groups to educate them about what is required and encourage reporting before penalties are assessed.
- Reporting: Recently passed tax legislation with a provision allowing physicians to meet PQRS requirements when they satisfactorily participate in qualified clinical data registries through specialty or regional performance programs. Beginning in 2014, such registries are to be viewed as the same as those successfully submitting PQRS measures.
Remember, federal law mandates Medicare to begin levying penalties for noncompliance in PQRS. Avoid payment reductions by participating today. For more information, contact HMS Healthcare Management Solutions.