Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities – UPDATE
As circulated by CMS on 7/31/15:
On July 6, 2015, the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) released a joint statement about their efforts to help the provider community get ready for ICD-10. This statement included guidance from CMS that allows for flexibility in the claims auditing and quality reporting processes.
In response to questions from the health care community, CMS has released “Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities,” which provides answers to the most commonly asked questions. Today CMS has reissued these Questions and Answers with revisions to questions 3 and 5.
Lytec® 2015 is ICD-10 ready, are you?
Waiting until October 1 could cause significant loss in productivity and revenue
Lytec 2015 can help you spend less time on administrative tasks and more time focusing on your patient. Lytec’s new Patient Intake Mobile application for iPad® and Android™automates the entire information-gathering process – giving you the ability to save valuable time and money.
The ICD-10 ready Lytec 2015 includes the following features that can help you meet ICD-10 requirements:
- (New) Lytec Mobile, a mobile application for iPad and Android tablets, allows you to view your schedule and transmit charges using a tablet.
- (New) Patient Intake form helps to provide patients with a seamless, automated check-in experience.
- Multiple filtering options to search for ICD-9 or ICD-10 codes.
- ICD-10 mapping tool to evaluate your existing ICD-9s and to help you create new ICD-10 codes mapped to ICD-9.
- CMS 1500 02-12 form to help meet regulator deadlines for the required paper claim.
- Wrong code set warning alerts you prior to sending claims that you have entered a Diagnosis code version that does not comply with the version the payer requires.
- Customized carrier setting to ICD-9 or ICD-10 to send the correct code version on your insurance claims and to alert you with Wrong Code set warning.
- Dual diagnosis list to help easily verify that you have mapped your codes and to easily search for either code version.
NOW is the time to upgrade to Lytec 2015. You can’t afford to wait until October.
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Medicare ICD-10 Provisions
A Word of Caution
Per the announcement made on July 6, 2015, CMS and AMA have instituted Medicare ICD-10 provisions to help providers with the transition. However, with the October 1st transition date less than 70 days away, practices would be remiss to rely on these provisions as rationale for stalling their preparation efforts.
While the changes do allow for some additional flexibility, it is important to recognize one rule that has not changed:
ICD-10 codes will be required on all claims beginning October 1, 2015.
In a letter recently sent to Medicare providers, CMS Acting Administrator reiterated this point by saying:
“Starting October 1, Medicare claims with a date of service on or after October 1, 2015 will only be accepted if they contain a valid ICD-10 code.The Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of service after September 30, 2015 or accept claims that contain both ICD-9 and ICD-10 codes.”
THE 1-YEAR ICD-10 TRANSITION PERIOD
The guidelines, in summary, allow for the following:
- Medicare claims will not be denied due solely to the specificity of the code, so long as an ICD-10 code from the correct family of codes is used. No ICD-9 codes will be accepted.
- Similarly, quality-reporting penalties will not be assessed based solely upon code specificity for PQRS, value-based payment modifiers or Meaningful Use.
- The plan also authorizes advances payments to physicians who are unable to process claims due to ICD-10 issues.
- An ICD-10 Ombudsman will be available as part of a communication and collaboration center to help address provider issues.
Check out the Medicare ICD-10 FAQs for more information on what will and will not be allowed during the transition period.
CMS Guidance on Meaningful Use Objectives
Source: CMS – EHR Incentive Programs
Review Updated Information on Reporting Menu Objectives
CMS has released updated guidance on the how eligible professionals should select menu objectives for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. We encourage you to stay informed by taking a few minutes to review the information below.
Guidance on Reporting Menu Objectives
Eligible professionals participating in Stage 1 of the EHR Incentive Programs are required to report on a total of 5 meaningful use objectives from the menu set of 9 objectives. When selecting five objectives from the menu set, eligible professionals must choose at least one option from the public health menu set.
If an eligible professional is able to meet the measure of one of the public health menu objectives but can be excluded from the other, the eligible professional should select and report on the public health menu objective he or she is able to meet.
If an eligible professional can be excluded from both public health menu objectives, the eligible professional may meet the menu requirement one of two ways:
- Claim an exclusion from only one public health objective and report on four additional menu objectives from outside the public health menu set.
- Report on five menu objectives from outside the public health menu set
Eligible professionals participating in Stage 2 are required to report 3 meaningful use objectives from the menu set of 6.
We encourage eligible professionals to select menu objectives that are relevant to their scope of practice, and claim an exclusion for a menu objective only in cases where there are no remaining menu objectives for which they qualify or if there are no remaining menu objectives that are relevant to their scope of practice.
For example, we hope that eligible professionals will report on 5 measures, if there are 5 measures that are relevant to their scope of practice and for which they can report data, even if they qualify for exclusions in the other objectives.
The Registration and Attestation System may prompt an eligible professional to report on additional measures if he or she claims an exclusion. This is because starting in 2014, the exclusion criteria will no longer count as reporting a meaningful use objective from the menu set. An eligible professional must meet the measure criteria for the objectives or report on all of the menu set objectives through a combination of meeting the exclusions and meeting the measures.
However, some eligible professionals who elect option 1 above may be asked to report on non-public health measures when they claim that exclusion in the Attestation System. These providers should document this issue for their records, and then claim the exclusion for the remaining measures in order to allow the system to accept their attestation.
5 Ways to Increase Payer Reimbursements for Your Medical Practice
Many medical practices are looking for ways to increase payer reimbursement as they adjust to the new health care industry landscape. You may have noticed that some of the latest trends (2013, 2014) have increased the financial pressures experienced by medical practices. The number of Medicaid patients has increased, but processing the claims for these patients is time consuming and Medicaid is known for rejecting claims at a higher-than-average rate. Higher deductibles and co-pays have also made the burden of collection more challenging.
The following are practical ways to increase payer reimbursements.
- Evaluate Your Situation
You will need to assess your payer reimbursements, looking for problem areas. This requires access to data and analytics, which can be best provided by practice management software or an EMR/EHR system tailored to your practice. At the very least, start with a spreadsheet comparing your top 10 payers and your 25 most common current procedural terminology (CPT) codes to see where you are losing money.
You will need to examine the data from the past couple years to identify where you can make improvements when it comes to reimbursements. Are you having problems with claims denial from a specific payer? Are there problems related to proper coding, or the performance of procedures that specific payers do not consider beneficial or necessary, and therefore are not covering?
- Address Internal Problems
Are the providers at your office administering services that aren’t covered? Are they coding improperly or in ways that are resulting in claim denials? Invest in software that checks procedures with policy coverage to limit claim denials. Also, make sure your staff is properly trained on optimal coding.
- Keep Current
It’s important to remain current with processing tools for record keeping, coding, billing and claims. If your software is outdated or no longer supported, you will need to invest in practice management software that communicates with payers and clearinghouses.
- Know Your Competition
Small practices don’t have much leverage with payers, since payers often say things like, “We know there are 75 other providers in your area who will take these patients if you don’t accept our reimbursement rates.” Find out how many competitors you really have, and keep track of your number of referrals, where they come from and what types of referrals you are getting. Keep data on which insurance plans they use.
Look for ways to prove your worth. If you have a reputation for quality service or are a unique practice that offers superior health care services, you need to find a way to document this so you have some sort of tangible proof to bring into payer negotiations. Survey patients and referral partners on satisfaction and quality of services provided, and collect and publish this information so you have some way to prove your worth in the market.
- Negotiate with Private Payers
You can negotiate better reimbursement rates from private payers if you can show your market worth and don’t just accept the first offer. Ask questions about changes in rates for specific codes.
Pay attention to contract expiration dates and make note of the deadlines for requested rate changes. Most payers want to set up evergreen contracts that renew automatically, making you think you can’t negotiate new rates. Read the fine print and find out when you need to initiate a meeting to renegotiate rates. Then ask for short term instead of long term contracts; it’s easier to ask for a small percentage increase in payments every year than to negotiate a 10 percent raise every six or seven years.
Look for areas of the contract to renegotiate that have previously been problematic. For example, you may need to ask for changes in the authorization for treatment process, or perhaps the amount of time allowed for appeal of a rejected claim. If your practice has lost money because of a specific problem, try to shore up against that problem when negotiating the terms of the contract.
Increasing Payer Reimbursements: How MediPro Inc. Can Help
If you want to keep up in this rapidly-changing industry, you need practice management software that will assess your office’s claims filing and processing for you. Talk to an expert at MediPro Inc. to find out what the best software is for this purpose. The payout will be well worth the investment.