2014 CODING & DOCUMENTATION UPDATE. Healthcare Services Group November 2013

Transcription

1 2014 CODING & DOCUMENTATION UPDATE Healthcare Services Group November 2013

2 Overview of Topics ICD-10 Implementation 2013 OIG Work Plan Physician, ASC and Hospital 2014 CPT Code Changes 2

3 ICD-10-CM & ICD-10-PCS ARE YOU READY? ICD-10-CM (Volumes 1 & 2) 69,000 Codes ICD-10-PCS (Volume 3) 72,000 Codes 3

4 Implementation-Phase I Implementation Phase I Identify business impact areas Educational session with key stakeholders Create steering committee and assign project manager Utilize internal and/or outsourced resources Establish Implementation Timeline Conduct the following assessments: Onsite impact assessment of all business impact areas» Identify all impacted people, processes and systems» System remediation and/or replacement» Education and training needs» Budgetary needs 4

5 Implementation-Phase I Implementation - Phase I Conduct the following assessments: IT Assessment Product upgrade timelines Hardware impact Testing timelines Costs associated with system remediation/replacement efforts ICD-9-CM to ICD-10/ICD-10 to ICD-9-CM translation methodology Inventory of Reports and Interfaces» Confirm number of reports and interfaces» Determine continued need/efficiencies that can be realized» Remediation effort 5

6 Implementation-Phase I Implementation - Phase I Conduct the following assessments: ICD-10 reimbursement and coding/documentation impact analysis What is the magnitude of the impact ICD-10 will have on your revenue» DRG weights - Hospital Deficiencies in coding/documentation for ICD-9 Education/training and Documentation Improvement 6

7 Implementation-Phase I Implementation - Phase I Clinical Data Quality Assessment Electronic Health Record (EHR) Review Physician documentation» Encounter» Procedure/Operative Reports» Pathology, Lab, Imaging Reports Encounter Forms Develop ICD-10 education and training approach ICD-10 workflow to readiness 7

8 Implementation-Phase I Implementation - Phase I Create Budget Software Modifications Software/Hardware Upgrades Staff Training/Materials Testing-Related Costs Temporary/Contract Staffing Consulting Services Development of New Reports Data Conversion 8

9 Implementation-Phase 2 Implementation - Phase 2 Project Governance Implement education and training program Staff and providers Policies and Procedures Software Upgrades ICD-10 CM Anatomy & Physiology Specificity Requirements Implement clinical documentation improvement program Technical resources 9

10 Implementation-Phase 2 Implementation - Phase 2 Testing, design and management Implement systems changes Internal/External Testing Operational and systematic workflow ICD-9-CM to ICD-10/ICD-10 to ICD-9-CM mapping and translation 10

11 Implementation Phase 3 Implementation - Phase 3 Go Live System Vendors Changes & Upgrades Are Completed Complete Internal Testing ICD-10 Transaction Testing Review/Test Contingency Plan for Continuing Operations Coding Staff Training Six months prior to Go Live Documentation Assessments 11

12 Implementation Phase 4 Implementation - Phase 4 Post Implementation Monitoring and Improvement End-state measurement and documentation Implement review and improve process Denials Coding/Documentation Accuracy Update compliance program 12

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14 2013 OIG Work Plan Physician Medical Review of Part A and Part B Claims Submitted by Top Error-Prone Providers Request Refunds on Projected Overpayments Anesthesia Services Payments for Personally Performed Services AA Modifier Anesthesia Services Personally Performed by an Anesthesiologist QK Modifier Medical Direction of 2, 3 or 4 Concurrent Anesthesia Procedures by an Anesthesiologist QK Modifier limits payment at 50% of the Medicare-allowed amount for personally performed services claimed with the AA modifier 14

15 2013 OIG Work Plan Physician Payments to Providers Subject to Debt Collection Existing overpayments that were reported to the Department of Treasury for failure to refund overpayments Ceasing to bill under one Medicare number and billing under another Medicare number Independent Therapists High Utilization of Outpatient Physical Therapy Services 15

16 2013 OIG Work Plan Physician Electrodiagnostic Testing Questionable Billing EMG s and Nerve Conduction Tests Use of Electrodiagnostic Testing for Financial Gain Noncompliance with Assignment Rules and Excessive Billing of Beneficiaries Place of Service Coding Errors Non-facility Setting vs. Facility Setting 16

17 2013 OIG Work Plan Ambulatory Surgery Centers (ASC) Payment System Review appropriateness of Medicare s methodology for setting ASC payment rates under the revised payment system Safety and Quality of Surgery and Procedures ASC and Hospital Outpatient Departments Care in preparation for and during surgeries Adverse events 17

18 2013 OIG Work Plan Hospital Diagnosis Related Group Window Outpatient services currently bundled up to 3 Days prior to admission OIG determined CMS could realize significant savings if DRG window was expanded to 14 days Compliance with Medicare s Transfer Policy Review discharges that should have been billed as transfers 18

19 2013 OIG Work Plan Hospital Payments for Discharges to Swing Beds in Other Hospitals Full DRG vs. Reduced Payment Payments for Canceled Surgical Procedures Payments for Mechanical Ventilation Did patients receive less than 96 hours of mechanical ventilation? 19

20 2014 CPT Code Changes Effective 1/1/ New Codes 107 Revised Codes 54 Deleted Codes *Per AMA 20

21 2014 CPT Code Changes Evaluation & Management 6 new codes Surgery 74 GI endoscopy procedures Radiology 5 new, revised or deleted codes Pathology/Laboratory 21 new, revised or deleted codes Medicine 12 new, revised or deleted codes 21

22 2014 CPT Code Changes Category II 7 new codes 1 revised code Category III 12 new codes 12 deleted codes

23 Contact Information Contact Information Michael McLafferty CPA, MBA, FACHE, FACMPE, CHFP EisnerAmper, LLP Partner, Healthcare Services Group Steven Bisciello, MBA, CMPE EisnerAmper, LLP, Manager, Healthcare Services Group Nancy Clark, CPC, CPB, CPMA, CPC-I EisnerAmper, LLP, Manager, Healthcare Services Group 23

24 EisnerAmper LLP is an independent member firm of PKF International Limited