Happy Thanksgiving!

We would like to thank everyone who contributed to our Thanksgiving Food Drive. We were able to collect 152 lbs of food for the Connecticut Food Bank!

Please note, HMS will be closed Thursday, November 27 and Friday, November 28 in observance of the holiday. All of us at HMS Healthcare Management Solutions, Inc. wish you a safe and happy Thanksgiving!

Study: American Seniors With Medicare Coverage Face Health Gaps

According to a new study by the Commonwealth Fund, American seniors often have difficulty affording their healthcare despite receiving Medicare benefits. Beneficiaries with traditional Medicare end up spending more than $4,000 on average per year on out-of-pocket health costs, according to the report.

A Kaiser Health News report on the study also found that:

  • 87 percent of U.S. respondents 65 or older indicated having one chronic condition and 68 percent had two or more.
  • 19 percent of U.S. respondents reported costs as an obstacle in getting care last year.
  • 55 percent said it was “somewhat or very easy” to get care after hours.

Click here to read more.

ICD-10 Implementation Is Less Than A Year Away: What You Need To Do To Be Ready Part V

In the final installment of our ICD-10 Implementation Is Less Than A Year Away: What You Need To Do To Be Ready series, we’ll give you insights and tips on post-implementation follow-up.

Once you go live with ICD-10 on October 1, 2015, keep monitoring the impact on reimbursement, claims denials, rejections and coding productivity and accuracy. Identify any issues you may be having and take the necessary steps to address these issues. In addition to closely monitoring the impact of the implementation, staff should continue meeting regularly to share information regarding issues. Issues can include a high number of claim denials and rejections, unexpected coding backlogs, a lower-than-expected coding accuracy rate and system glitches. Work with your team to resolve any issues.

During this time, continue monitoring systems functionality and correct any errors or problems as quickly as possible. If you are having issues with coding accuracy or productivity, implement strategies to address these issues. Strategies include additional education on code sets, improving medical record documentation or even additional coding professionals to assist with the coding backlogs or to review claims denials and rejections.

Lastly, keep analyzing changes or issues that may arise and communicate with payers about anticipated changes. Approximately two to three months after you go live, begin analyzing data to evaluate the impact of the implementation. This way, you can identify trends and correct any issues you may be having.

This post wraps up our ICD-10 series! We hope you utilize these tips and strategies for a successful ICD-10 implementation. Good luck!

*HMS Healthcare Management Solutions, Inc. has an assessment package to help you prepare for ICD-10. Click here for more information.

CMS To Host A National Provider Call On New F2F Encounter Requirements

CMS announced a National Provider Call on the new F2F encounter requirements to be held on December 16, 2014. The National Provider Call will provide an overview of certifying patient eligibility for the Medicare home health benefit, including an overview of a new requirement for home health agencies to obtain documentation from the certifying physicians’s or the acute/post-acute facility’s medical record for the patient that serves as the basis for the certification of patient eligibility.

The new requirement was finalized in the Calendar Year 2015 Home Health Prospective Payment System final rule, effective for home health episodes beginning on or after January 1, 2015.

To register for this MLN Connects Call National Provider Call, click here.

Click here to read more.

ICD-10 Implementation Is Less Than A Year Away: What You Need To Do To Be Ready Part IV

In this installment of the ICD-10 Implementation Is Less Than A Year Away: What You Need To Do To Be Ready series, we’ll take a look at other key steps providers should take before the go-live date.

A few months before you go-live, confirm with system vendors that changes and upgrades have been completed. Determine the level of support you’ll need for go-live and who the main point of contact will be if issues arise. Also, finalize other changes that have not yet been completed. At this point, you should also conduct ICD-10 transaction testing and make modifications in response to the results of the systems testing.

Right before you go-live, provide intensive ICD-10 education to coding staff. Training should be conducted by an individual who has already become ICD-10 certified. Training can include classroom training, self-directed learning using printed or electronic materials, and audio or web-based programs. Remember not all coding staff will require the same type or amount of ICD-10 education. For example, coding staff working for a physician practice medical specialty area should focus on code categories most applicable to their particular patient mix. During this time, you should also continue assessing the quality of medical record documentation and implement document improvement strategies as needed.

Lastly, get ready to go live with ICD-10 for dates of service on or after October 1, 2015. Claims for services provided on or after this date must use ICD-10 for diagnoses. CMS has advised that there will be no extension or grace period and that noncompliant claims will be rejected.

We’ll post our final installment of our ICD-10 series tomorrow. Stay tuned!


HUSKY Health Primary Care Increased Payments Policy

Under the ACA, Medicaid has increased its payments to equal the 2013 and 2014 Medicare fee for certain primary codes when billed by an eligible primary care provider, who has submitted a valid attestation to the Department of Social Services. However, the ACA requirement ends with dates of service January 1, 2015 and forward. 

The Connecticut General Assembly has appropriated funding within the Medicaid biennial in order to continue increased primary care payments for dates of service beyond December 31, 2014. The Department is establishing a policy for primary care increased payments; this policy will be referred to as the HUSKY Health Primary Care Increased Payments Policy. The Department is also revising the list of codes eligible for an increased payment.

Click here for more information from the Connecticut Department of Social Services regarding the HUSKY Health Primary Care Increased Payments Policy.

Monday Morning Recap

The HMS Healthcare Management Solutions Monday Morning Recap reviews some of the top stories and healthcare highlights you may have missed last week.