Brief presentation regarding key topics in the USA healthcare industry. Some of the basic topics include: MACRA, ICD 10, Meaningful Use and a very brief comment about diabetes as a chronic condition.
3. ICD 10
October 1st Significance
Update of codes for FY 2017
Specificity Grace Period Ends
4. 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
5. 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.”
6. 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.
7. MEDICARE ACCESS AND CHIP
REAUTHORIZATION ACT OF 2015 (MACRA)
Basic Terminology
Consolidation of Programs
Eligible Clinicians
New Options
8. 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
9. 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
10. MIPS ELIGIBLE CLINICIANS
Physicians
Physician Assistants (PA)
Nurse Practitioners (NP)
Clinical Nurse Specialists
Certified Registered Nurse Anesthetists
(CRNA)
Groups that include these clinicians
11. MIPS CONSOLIDATION
Physician Quality Reporting System (PQRS)
Value-Based Payment Modifier (VBPM)
Electronic Health Record (EHR) Incentive
Clinical practice improvement activities
(CPIA)
12. 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%
13. 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).
14. 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.
15. 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.
16. 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
17. 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.
18. HITECH AUDITS
Audits will continue and potentially increase
May go up to six years back
Auditors learning curve and demands
increasing
19. 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
20. AFFORDABLE CARE ACT
Health Care Mandate
Small business impact
Individual mandate
Retention challenges
Options
21. RESOURCES
Taino Consultants Inc.
www.tainoconsultants.com
Drdelgado@tainoconsultants.com
Diabetic Centers for excellence
Lavern Dowell
People Helping People
josedelgado@tainoconsultants.com