Medicare 101. Lisa Satterfield, ASHA director, health care regulatory advocacy Neela Swanson, ASHA director, health care coding policy
|
|
- Jonas Fox
- 6 years ago
- Views:
Transcription
1 Medicare 101 Lisa Satterfield, ASHA director, health care regulatory advocacy Neela Swanson, ASHA director, health care coding policy
2 Neela Swanson Director, Health Care Coding Policy, ASHA Disclosure Financial ASHA employee Nonfinancial Contributor to multiple for-sale ASHA products on the topics of health plan payments, coding, and payer advocacy; receives no compensation for product sales 2
3 Lisa Satterfield, MS, CCC-A Director, Health Care Regulatory Advocacy, ASHA Disclosure Financial ASHA employee Nonfinancial Contributor to multiple for-sale ASHA products on the topics of health plan payments, coding, and payer advocacy; receives no compensation for product sales 3
4 Agenda Medicare Basics Medicare Part A Medicare Part B Documentation Coding and Billing Near Future Medicare
5 Foundational Rules Understanding the patients and the providers of Medicare services
6 Medicare Patients Age 65 or older US citizen or permanent resident Person or spouse has 40 credits of Social Security (appx 10 years) Government employee Under 65 Entitled to Social Security disability at least 24 months ALS Permanent kidney failure requiring dialysis
7 Medicare Providers Licensed or registered in the state Have completed the required degree in the related field Master s for SLPs and audiologists prior to 2007 AuD for audiologists after 2007 Registered for National Provider Identifier (NPI)
8 NPI First step for billing ANY insurance Required by federal law (HIPAA) for providers healthcare services Completed online in minutes
9 Enroll in Medicare Medicare requires audiologists and SLPs who provide services Medicare patients to be enrolled! It is against federal law to bill any Medicare patient privately NPI is NOT Medicare enrollment Enroll online at You will need to coordinate with employers
10 Medicare Benefits Medicare Part A Hospital Insurance Automatic benefit No monthly premium (if minimum Medicare employment is met) Medicare Part B Supplemental for outpatient services Optional benefit Monthly premium 20% co-pay for services Medicare Part C Medicare Advantage Medicare benefits managed by private insurance company Requires enrollment Plans vary by company Medicare Part D Prescription Drug benefit
11 Medicare Part A Hospitals, Skilled Nursing Facilities, Home Health
12 Prospective Payment Systems (PPS) Bundled payment systems based on patient severity and projected costs Includes inpatient costs and services provided while in a qualified stay Different systems and calculation methodologies based on the facility type
13 Hospital Acute Care Inpatient Patient must be officially admitted by a physician Audiology and SLP services included in any daily rate Patients not formally admitted may be under Observation Status: This means they are considered outpatients!!!
14 Long-Term Care Hospital (LTCH) Average length of stay is greater than 25 days Typically clinically complex, less stable Head trauma Cancer treatment Pain management Payment is under daily rate, similar to acute inpatient
15 Inpatient Rehabilitation Facility (IRF) Intensive rehab services for complex patients Requires Active and ongoing intervention for multiple therapies one must be PT or OT 3 hours a therapy a day 5 days a week Rehabilitation physician face-to-face visits 3 days a week Tracking is completed through the IRF-PAI
16 Skilled Nursing Facilities (SNF) Qualifying inpatient hospital stay of at least 3 days Transferred to the SNF within 30 days of discharge from the qualifying stay Required skilled care (nursing and/or therapy) on a daily basis Treatment must be for a condition treated in the inpatient hospital stay or acquired in the SNF Tracking is completed through Minimum Data Set (MDS)
17 Home Health 60-day episodes that cover Skilled nursing Home health aid PT, OT, SLP Medical social services Excludes equipment If a patient is under a Home Health payment, services cannot be billed separately.
18 Medicare Part B Fee-For-Service
19 Fee-For-Services Individual services are paid using Current Procedural Terminology Codes Encourages high volume paid more for the more provided Includes services performed in Private/Group practice University clinics Outpatient skilled nursing Outpatient hospital clinics (therapy services only)* * Outpatient audiology services in hospitals are paid via the Outpatient Prospective Payment System.
20 Codes Back to the Basics Procedure codes Current Procedural Terminology (CPT) Managed by the American Medical Association Used by all insurers Device codes Healthcare Common Procedure Coding System (HCPCS) Managed by the Centers for Medicare and Medicaid Services (CMS) Includes devices, prosthetics, hearing aids, temporary codes, and few procedures Diagnosis codes - International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Managed internationally by the World Health Organization Clinical Modification (CM) managed by CMS and the National Center for Health Statistics (NCHS)
21 CPT Codes hedule/ Audiology Procedures (vestibular test bundled) (caloric testing) (audiometric testing) (tympanometry) (ABR) (OAE) (Cochlear implant programming) (Tinnitus eval) (Aural Rehab eval) SLP Procedure (SLP treatment) (Fluency eval) (Motor speech eval) (Speech & Lang eval) (Voice eval) (Swallowing eval) (Aphasia eval) (Cognitive eval) (Cognitive treatment)
22 HCPCS Codes Audiology Devices Cochlear Implants L8614 L8629 Osseointegrated Implants L8690 L8699 Hearing Aids V5030 V5298 SLP Devices Tracheostoma supplies A7503 A7509 Speech-Generating Devices E2500 E2599 Artificial larynx, TEP, Voice amplifier L8500 L8515
23 While we re talking about coding ICD-10 started October 1, Used by all providers in every health care setting Used by all/most? payers: Medicare, Medicaid, and commercial payers. Significantly expands selection of codes ASHA s ICD-10 website includes: 1. ICD-9 to ICD-10 Mapping Tool 2. ICD-9 to ICD-10 Mapping Spreadsheets 3. ICD-10-CM Code Lists imbursement/coding/icd -10/
24 Medicare Part B Rules Audiology Recognized in Medicare for hearing and balance diagnostic services only Must have physician order prior to testing for coverage Testing must be to diagnosis a conditions or due to new symptoms Hearing aids are not covered Speech-Language Pathology Under the rehabilitation benefit with PT and OT Requires a plan of care signed by a physician Therapy services must be medically indicated and require the skills of a professional The broad definition allows coverage in theory of most services
25 Therapy Cap is a misnomer Cap on SLP and PT services combined Amount updated annually. HOWEVER exceptions process allows above cap Only requires KX modifier on the claim attesting that the services provided meet Medicare requirements of medical necessity Skilled services are needed for the improvement, maintenance, or the prevention of deterioration of a condition. Therapy cap cannot be used as a reason to stop services or bill the patient directly
26 Therapy Functional Reporting Requirements Congress requires Medicare to collect functional data on the claim form G-codes with severity modifiers for current status, projected goal, discharge status Swallowing Motor speech Spoken language comprehension Spoken language expression Attention Memory Voice
27 Physician Quality Reporting System Quality reporting system for audiologists and SLPs to avoid deductions applied to all claims 2016 Measures include Recording medication in the medical record Smoking cessation counseling Pain assessment Screen for depression Falls risk Referral for dizziness
28 Local Coverage Determinations (LCDs) Medicare Administrative Contractors (MACs) delineate policies regionally 12 geographic regions, 8 contractors LCDs define the CPT codes/icd-10 codes used in the claims processing systems Every region is a little bit different Administrative-Contractor-Resources/
29 Medicare Documentation
30 Why document? Audits Medicare Administrative Contractors (MACs) Recovery Audit Contractors (RACs) Office of the Inspector General The services that are billed must be justified The services must meet coverage requirements Skilled services necessary to improvement, maintain, or prevent the deterioration of a condition Identification of a condition to inform a plan of care
31 Evaluation documentation Physician order Reason for the test Qualifications of the provider Justification of the procedures billed Recommendations and projected prognosis
32 SOAP Note Subjective findings Current condition, patient complaints, history Behavioral evaluations Objective findings Not influenced by patient input Tympanometry, ABR Instrumental evaluations Assessment Incorporation of the results Plan Recommendations and prognosis
33 Therapy Plan of Care Diagnosis or diagnoses Long-term goals Functional (G-code) reporting Type, amount, frequency, duration of therapy Certification - dated signature of physician within 30 days of the patient s first visit Recertification (signed by physician) every 90 days
34 Daily Note Justifies the billing code for the date of service Date of service Procedure(s) performed The amount of time for each procedure Signature and professional identification of provider
35 Therapy Progress Report/Discharge Note Required every 10 th treatment day Assessment of improvement/progress towards goals Continued treatment or treatment plan revisions Any changes to long or short term goals Functional (G-code) reporting Distinction between rehabilitative therapy and maintenance therapy
36 Rehab or Maintenance? Rehab = potential to improve Reasonable expectations that improvement is attainable Maintenance = prevent or slow deterioration of a functional status To be billed to Medicare, the services requires skills of a professional for the safty and effective deliverty Services that can be performed by caregiver/unskilled personnel are not covered
37 Documenting Skilled Services Select appropriate tools and explain logic for that particular selection Explain conclusions/recommendations using professional language and/or technical terminology Document patient engagement, education and counseling Include ongoing assessment and clinical judgement For maintenance, distinguish between the skilled services and the unskilled exercises that will be performed by the patient.
38 Medicare Supervision Requirments Students and CFs
39 Levels of supervision General Physician s overall management of the patient Direct Physician is immediately available ; on campus Personal Supervisor is in the room, fully engaged, while procedures are performed Audiologists and SLPs can only provide personal supervision in the Medicare program
40 Incident to Physician Places responsibility of the service on the physician Integral, though incidental, to physician services Commonly furnished in a office setting Provided under direct supervision of a physician Hearing and balance services provided by audiologists are prohibited from incident to billing: the audiologist must enroll Speech services may be performed incident to however there is no financial advantage, and the physician must be in the office at the time the service is performed
41 Medicare Rules: Supervision Students require personal supervision 4 th AuD students without a Master s degree and license require personal supervision Clinical Fellows without state issued licensure/certification/registration require personal supervision Colorado, Connecticut, DC, Hawaii, Massachusetts, New York, Pennsylvania??Nevada, North Dakota, Virginia
42 Personal Supervision Only skilled services of a licensed professional may be billed to Medicare Professional must be in the room directing the session with the student/cf Takes on full responsibility of the services provided Services must be equivalent to those performed by a skilled, licensed professional
43 Supervision in Skilled Nursing Facilities Student does not have to be in line-of-sight BUT Supervisor cannot be treating another resident for billing of individual therapy If the supervisor is treating another resident, it must be in the same room and it is considered concurrent therapy and should be documented as such
44 Medicare in the Future Medicare Access and CHIP Reauthorization Act
45 MACRA Deleted the Sustainable Growth Rate (SGR) formula that caused a potential 25% reduction in Medicare payment every year Established the MIPS program to transition payment from fee-forservice to payment based on quality, outcomes, and efficiency
46 What does MIPS do? Creates a scoring system to compare and rank providers the same category/discipline Higher performing providers will get bump in payment, lower will receive penalties for 2019, 4 percent for 2020, 5 percent; for 2021, 7 percent; for 2022 and subsequent years, 9 percent. Providers who participate in Alternative Payment Models receive highest composite scores
47 What does this mean? u Audiologists and SLPs must report quality and outcomes through CMS-approved mechanisms u PQRS u Qualified Clinical Data Registry u Allows professional societies to develop and collect clinically relevant measures, benchmark and risk-adjust the measures u The QCDR must include all payers, not just Medicare u The providers must report on 50% of all of their patients, not just Medicare
48 Public Reporting and Payment Scores are compared within provider group Audiologists to audiologists/slps to SLPs Composite score is given to provider Scores will be published on the Physician Compare website to assist consumer s with provider choices
49 Look for the Medicare Survivor Guide for purchase product in July, 2016 Register to receive ASHA Headlines Read the Bottom Line articles in the ASHA Leader Keep informed with your state association and your State Advocate for Medicare Policy (StAMP) What do I do now? Contact ASHA Healthcare Advocacy and Economics Team (HEAT) at: reimbursement@asha.org
Agenda. Disclosure 5/5/2014. Financial ASHA Employee. Non financial Ex Officio to ASHA s Health Care Economics Committee
Health Reform & Reimbursement Update Tim Nanof, MSW ASHA Director of Health Care Policy and Advocacy CSAP Meeting Milwaukee, Wisconsin Saturday May 17 th, 2014 9:00 11:00 AM Disclosure Financial ASHA Employee
More informationUNIVERSITY SPEECH AND HEARING CLINICS MEDICARE REQUIREMENTS SLP CPT CODES WITH PROFESSIONAL WORK VALUE
MEDICARE IMPROVEMENTS FOR PATIENTS AND PROVIDERS ACT OF 2008 (MIPPA) UNIVERSITY SPEECH AND HEARING CLINICS MEDICARE REQUIREMENTS Dee Adams Nikjeh, PhD ASHA Health Care Economics Committee, Co-Chair AMA
More informationRegulatory Compliance Risks. September 2009
Rehabilitation Regulatory Compliance Risks September 2009 1 Agenda - Rehabilitation Compliance Risks Understand the basic requirements for Inpatient Rehabilitation Facilities (IRFs) and Outpatient Rehabilitation
More informationMedicare Part A Update
Medicare Part A Update Jennifer Bogenrief, JD Manager, Regulatory Affairs AOTA AOTA Specialty Conference: Effective Documentation Friday, September 12, 2014 1 Topics Medicare Therapy Documentation Requirements
More informationCouncil of State Association Presidents
Council of State Association Presidents In This Issue Reimbursement Resources Educational Opportunities for Reimbursement Prospective Payment Medicare Perspective REIMBURSEMENT ISSUES: Resources and Solutions
More informationMedicaid Update. Disclosure
Medicaid Update Molly Thompson, ASHA Fellow Owner, Pediatric Speech-Language Services Chair, ASHA Medicaid Committee Laurie Alban Havens, Director Private Health Plans and Medicaid Advocacy ASHA Disclosure
More informationDivision C: Increasing Choice, Access, and Quality in Health Care for Americans TITLE XV: Provisions Relating to Medicare Part A
Division C: Increasing Choice, Access, and Quality in Health Care for Americans TITLE XV: Provisions Relating to Medicare Part A Sec. 15001. Development of Medicare study for HCPCS versions of MS-DRG codes
More informationOutpatient Hospital Facilities
Outpatient Hospital Facilities Chapter 6 Chapter Outline Introduce students to 1. Different outpatient facilities 2. Different departments involved in the reimbursement process 3. The Chargemaster 4. Terminology
More informationTherapies (e.g., physical, occupational and speech) Medical social worker (MSW) 3328ALL0118-F 1
1. Q: Why is Humana implementing this utilization management (UM) program? A: Humana is implementing this program to help coordinate home health care for its Medicare Advantage members in Oklahoma and
More informationLong Term Care Hospital Clinical Coverage Policy No: 2A-2 Services (LTCH) Amended Date: October 1, Table of Contents
Long Term Care Hospital Clinical Coverage Policy No: 2A-2 Services (LTCH) Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 2.0 Eligibility Requirements...
More informationSummary of U.S. Senate Finance Committee Health Reform Bill
Summary of U.S. Senate Finance Committee Health Reform Bill September 2009 The following is a summary of the major hospital and health system provisions included in the Finance Committee bill, the America
More informationDepartment of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 2859 Date: January 17, 2014
CMS Manual System Pub 100-04 Medicare Claims Processing Department of Health & Human Services (DHHS) Centers for Medicare & Medicaid Services (CMS) Transmittal 2859 Date: January 17, 2014 Change Request
More informationChapter 13 Section 2. Billing And Coding Of Services Under Ambulatory Payment Classifications (APC) Groups
Outpatient Prospective Payment System (OPPS)-Ambulatory Payment Classification (APC) Chapter 13 Section 2 Billing And Coding Of Services Under Ambulatory Payment Classifications (APC) Groups Issue Date:
More informationCoding Guidelines for Certain Respiratory Care Services January 2018 (updates in red)
Coding Guidelines for Certain Respiratory Care Services (updates in red) Overview From time to time the AARC receives inquiries about respiratory-related coding and coverage issues through its Help Line
More informationCODING, DOCUMENTATION & REIMBURSEMENT FOR SLPS LEARN THE BASICS FROM THE EXPERTS (#1011) ASHA Health Care Economics Committee 2015 ASHA Convention
CODING, DOCUMENTATION & REIMBURSEMENT FOR SLPS LEARN THE BASICS FROM THE EXPERTS (#1011) ASHA Health Care Economics Committee 2015 ASHA Convention 1 SPEAKER DISCLOSURES Financial None Non-Financial Solicited
More informationIs your Home Health Agency ready for the Final Rule to the Conditions of Participation?
Is your Home Health Agency ready for the Final Rule to the Conditions of Participation? Medicare-certified home health agencies have almost doubled from 6,461 in 1990 to 12,268 in 2014 due to longer life
More informationThe Pain or the Gain?
The Pain or the Gain? Comprehensive Care Joint Replacement (CJR) Model DRG 469 (Major joint replacement with major complications) DRG 470 (Major joint without major complications or comorbidities) Actual
More informationThird Party Payer Days. IMGMA February 25, 2015
Third Party Payer Days IMGMA February 25, 2015 Agenda 2015 Medicare Physician Fee Schedule Medicare Physician Fee Schedule Database Transitional Care Management - Reminder Medicare - Coverage Guidelines
More informationComparison of Bundled Payment Models. Model 1 Model 2 Model 3 Model 4. hospitals, physicians, and post-acute care where
Comparison of Bundled Payment Models General Description Eligible awardees Retrospective bundled Retrospective bundled payment models for payment models for hospitals, physicians, and post-acute care where
More informationHere is what we know. Here is what you can do. Here is what we are doing.
With the repeal of the sustainable growth rate (SGR) behind us, we are moving into a new era of Medicare physician payment under the Medicare Access and CHIP Reauthorization Act (MACRA). Introducing the
More informationHealth care economics: what got us into this mess?
Overview Climate Change Impact of Health Care Economics on CSD Education and University Clinics Dee Adams Nikjeh, PhD, CCC-SLP Robert C. Fifer, PhD, CCC-A Margaret Rogers, PhD, CCC-SLP Health Care Economics
More informationTable of Contents. Speech, Language, and
Table of Contents 1. Section Modifications... 1 2.... 4 2.1. Introduction... 4 2.2. Independent Speech-Language Pathologist... 4 2.2.1. Overview... 4 2.2.2. Independent Therapist Qualifications... 4 2.3.
More informationMPTA Spring Meeting 2017: Medicare Outpatient Documentation: Clearing Up the Myths
Medicare Outpatient Documentation: Clearing Up the Myths MPTA Spring Meeting April 2017 Presenters Michael Gorman, PhD, PT, DMT, FAAOMPT CEO-St. Louis Physical Therapy Jennifer Schnieders, DPT CEO-Outbound
More informationMedicare Part A SNF Payment System Reform: Introduction to Resident Classification System - I
Medicare Part A SNF Payment System Reform: Introduction to Resident Classification System - I Introduction to the Resident Classification System - I Concepts Structure Implications RCS is NOT the Unified
More informationThe President s and Other Bipartisan Proposals to Reform Medicare: Post-Acute Care (PAC) Reform. Summary
Current Law The President s and Other Bipartisan Proposals to Reform Medicare: Post-Acute Care (PAC) Reform Summary Home Health Agencies Under current law, beneficiaries who are generally restricted to
More information310-V PRESCRIPTION MEDICATIONS/PHARMACY SERVICES
MEDICAL POLICY FOR AHCCCS 310-V PRESCRIPTION MEDICATIONS/PHARMACY SERVICES REVISION DATES: 01/01/16, 02/01/15, 08/01/14, 03/01/14, 01/01/13, 10/01/12, 04/01/12, 08/01/11, 10/01/10, 10/01/09, 04/01/06,
More informationCore Services Provided in Federally Clinical Coverage Policy No: 1D-4 Qualified Health Centers and Amended Date: October 1, 2015 Rural Health Clinics
Qualified Health Centers and Amended Date: October 1, 2015 Rural Health Clinics Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Federally Qualified Health Centers... 1
More informationDiabetes Outpatient Clinical Coverage Policy No: 1A-24 Self-Management Education Amended Date: October 1, Table of Contents
Table of Contents 1.0 Description of the Procedure, Product, or Service... 1 1.1 Definitions... 1 2.0 Eligibility Requirements... 1 2.1 Provisions... 1 2.1.1 General... 1 2.1.2 Specific... 2 2.2 Special
More informationOptima Health Provider Manual
Optima Health Provider Manual Supplemental Information For Ohio Facilities and Ancillaries This supplement of the Optima Health Ohio Provider Manual provides information of specific interest to Participating
More informationNavigating Therapy Compliance Requirements Across The Continuum. Objectives. Therapy is Occurring Everywhere!
Navigating Therapy Compliance Requirements Across The Continuum Kay Hashagen, PT, MBA, RAC-CT Senior Consultant LW Consulting, Inc. Catherine Gill, MS, PT, MHA Director of Quality and Support Services;
More informationPatient Driven Payment Model (PDPM) and the MDS: A Total Evolution of the SNF Payment Model
Patient Driven Payment Model (PDPM) and the MDS: A Total Evolution of the SNF Payment Model By Devin Kassi, PT, DPT, and Melissa Keiter, RN, RAC-CT, DNS-CT, DON Centers for Medicare & Medicaid Services
More informationMedicare Part A SNF Payment System Reform: Introduction to Resident Classification System - I ZIMMET HEALTHCARE 2018
Medicare Part A SNF Payment System Reform: Introduction to Resident Classification System - I Introduction to the Resident Classification System - I Concepts Structure Implications RCS is NOT the Unified
More informationOutcomes Measurement in Long-Term Care (LTC)
ASHA Short Course Outcomes Measurement in Long-Term Care (LTC) Bill Goulding, MS/CCC-SLP November 19, 2012 How Do We Show Value? Easy to measure! Not so easy! V $$$ A L Impact? Cost U Benefit E What do
More informationUpdates to the erehabdata PAS Tool & Referrals Outcomes Reports
Updates to the erehabdata PAS Tool & Referrals Outcomes Reports Teresa Hayes Management Consultant Melissa Berkoff erehabdata Project Manager Pre-Admission Screening Why do we conduct a pre-admission screening?
More informationChapter 13 Section 2. Billing And Coding Of Services Under Ambulatory Payment Classifications (APC) Groups
Outpatient Prospective Payment System (OPPS)-Ambulatory Payment Classification (APC) Chapter 13 Section 2 Billing And Coding Of Services Under Ambulatory Payment Classifications (APC) Groups Issue Date:
More informationSection 4 - Referrals and Authorizations: UM Department
Section 4 - Referrals and Authorizations: UM Department Primary Care Referral Process 1 Referrals to In-Network Specialists 1 Referrals to Out-Of-Network Specialists 2 Consultation Referral Forms 2 Consultation
More informationInpatient Psychiatric Facility (IPF) Coverage & Documentation. Presented by Palmetto GBA JM A/B MAC Provider Outreach and Education September 7, 2016
Inpatient Psychiatric Facility (IPF) Coverage & Documentation Presented by Palmetto GBA JM A/B MAC Provider Outreach and Education September 7, 2016 1 Disclaimer This information is current as of August
More informationQuestions and Answers on the CMS Comprehensive Care for Joint Replacement Model
Questions and Answers on the CMS Comprehensive Care for Joint Replacement Model MEGGAN BUSHEE, ESQ. 704.343.2360 mbushee@mcguirewoods.com 201 North Tryon Street, Suite 3000 Charlotte, North Carolina 28202-2146
More informationHOW TO SUBMIT OWCP-04 BILLS TO ACS
HOW TO SUBMIT OWCP-04 BILLS TO ACS The following services should be billed on the OWCP-04 Form: General Hospital Hospice Nursing Home Rehabilitation Centers As a provider you have the option of sending
More informationMLN Matters Number: MM6699 Related Change Request (CR) #: 6699
News Flash Medicare will cover immunizations for H1N1 influenza also called the "swine flu." There will be no coinsurance or copayment applied to this benefit, and beneficiaries will not have to meet their
More informationFor any new proposals presented to the Committee, ASHA respectfully requests the inclusion of the following principles:
American Speech-Language-Hearing Association Statement for the Record for the Health Subcommittee of the Energy and Commerce Committee Examining Bipartisan Legislation to Improve the Medicare Program I,
More informationObservation Care Evaluation and Management Codes Policy
Policy Number Observation Care Evaluation and Management Codes Policy 2017R0115A Annual Approval Date 3/8/2017 Approved By Reimbursement Policy Oversight Committee IMPORTANT NOTE ABOUT THIS You are responsible
More informationMEDICARE COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL (CCJR) Preparing for Risk-Based Outcomes of Bundled Care 8/12/2015.
MEDICARE COMPREHENSIVE CARE FOR JOINT REPLACEMENT MODEL (CCJR) Preparing for Risk-Based Outcomes of Bundled Care August 13, 2015 Eric M. Rogers MEd RT(R) Managing Consultant erogers@bkd.com Jeff Bond President
More informationCURRENT OIG ENFORCEMENT INITIATIVES: A ROAD MAP FOR HIGH RISK COMPLIANCE AREAS
10 th Annual HCCA Compliance Institute Session Las Vegas, NV April 25, 2006 CURRENT OIG ENFORCEMENT INITIATIVES: A ROAD MAP FOR HIGH RISK COMPLIANCE AREAS MARK HARDIMAN HOOPER, LUNDY & BOOKMAN, INC. 1875
More informationUsing Education Codes Effectively and Legally in Clinical Sleep Education
SOUTHERN SLEEP SOCIETY 39 TH ANNUAL MEETING SOUTHERN SLEEP SOCIETY TECHNOLOGIST COURSE - 2017 Using Education Codes Effectively and Legally in Clinical Sleep Education Jayme R. Matchinski March 23, 2017
More informationHere is what we know. Here is what you can do. Here is what we are doing.
With the repeal of the sustainable growth rate (SGR) behind us, we are moving into a new era of Medicare physician payment under the Medicare Access and CHIP Reauthorization Act (MACRA). Introducing the
More informationEmergency Department Update 2010 Outpatient Payment System
Emergency Department Update 2010 Outpatient Payment System ED Facility Level Guidelines: Still No National Guidelines Triage Only Services Critical Care Requires CMS Documentation E/M Physician of Payment
More informationCigna Medical Coverage Policy
Cigna Medical Coverage Policy Subject Observation Care Table of Contents Coverage Policy... 1 General Background... 2 Coding/Billing Information... 4 References... 5 Effective Date... 10/15/2014 Next Review
More informationMedicare s Proposed CY 2016 Physician Fee Schedule
Issue Brief Medicare s Proposed CY 2016 Physician Fee Schedule Background On July 15, 2015, the Centers for Medicare and Medicaid Services (CMS) published in the Federal Register the proposed CY 2016 Medicare
More informationKANSAS MEDICAL ASSISTANCE PROGRAM. Fee-for-Service Provider Manual. Local Education Agency
Fee-for-Service Provider Manual Local Education Agency Updated 07.2018 Introduction PART II Section Page 7000 Local Education Agency Billing Instructions............ 7-1 7010 Local Education Agency Billing
More informationObjectives 9/18/2018. Patient Driven Payment Model(PDPM) Janine Finck Boyle, MBA/HCA, LNHA Vice President of Regulatory Affairs Fall 2018
Patient Driven Payment Model(PDPM) Janine Finck Boyle, MBA/HCA, LNHA Vice President of Regulatory Affairs Fall 2018 Mission: The trusted voice for aging. Objectives List the five(5) case mix components
More informationPROVIDER POLICIES & PROCEDURES
PROVIDER POLICIES & PROCEDURES EXTENDED NURSING SERVICES The purpose of this document is to provide guidance to providers enrolled in the Connecticut Medical Assistance Program (CMAP) on the requirements
More informationOverview of Quality Payment Program
Overview of Quality Payment Program Policies for 2017 & 2018 Performance Years The Medicare program has transformed how it reimburses psychiatrists and other clinicians for providing services, under the
More informationThe Evolving Landscape of Healthcare Payment: Incentive Programs and ACO Model Optimization. Quality Forum August 19, 2015
The Evolving Landscape of Healthcare Payment: Incentive Programs and ACO Model Optimization Quality Forum August 19, 2015 Ross Manson rmanson@eidebailly.com 701.239.8634 Barb Pritchard bpritchard@eidebailly.com
More informationComplete Home Health Icd-9-cm Diagnosis Coding Manual 2012
Complete Home Health Icd-9-cm Diagnosis Coding Manual 2012 Download PDF ICD 9 CM 2015 for Physicians Volumes 1 and 2 Professional Complete Home. Time to Update your ICD-10-CM Implementation Plan by Teresa
More informationUsing the New Home Health Agency (HHA) PEPPER to Support Auditing and Monitoring Efforts
Using the New Home Health Agency (HHA) PEPPER to Support Auditing and Monitoring Efforts July 30, 2015 Kimberly Hrehor 2 Agenda History and basics of PEPPER HHA PEPPER target areas Percents, rates and
More informationLESSONS LEARNED FROM THE PROBE AND EDUCATE AUDIT K. CHEYENNE SANTIAGO, RN
LESSONS LEARNED FROM THE PROBE AND EDUCATE AUDIT K. CHEYENNE SANTIAGO, RN Created on 6/2/2014 DISCLAIMER DISCLAIMER: WPS Medicare has produced this material as an informational reference. Every reasonable
More informationMACRA for Critical Access Hospitals. Tuesday, July 26, 2016 Webinar
MACRA for Critical Access Hospitals Tuesday, July 26, 2016 Webinar MACRA presenters Harold D. Miller, President & CEO CHQPR Claudia Sanders, Sr. Vice President, Policy Development Andrew Busz, Policy Director,
More informationCMS Proposed SNF Payment System -- Resident Classification System: Version I (RCS-1)
CMS Proposed SNF Payment System -- Resident Classification System: Version I (RCS-1) Ohio Health Care Association Mike Cheek, Senior Vice President, Reimbursement Policy October 3, 2017 Background 1 FY18
More informationEmerging Issues in Post Acute Care Trends
Emerging Issues in Post Acute Care Trends Lavonne Elston, PT Senior Director of Operations & Strategic Initiatives Skilled Nursing & Rehabilitation Kingston HealthCare Company April 28, 2016 Disclosures
More informationCognitive Emotional Social Behavioral functioning
TIP SHEET Health and Behavior Assessment and Intervention (HBAI) Services Coverage of Chronic Disease Self-Management Education Medicare and Medicare Advantage Purpose: The HBAI services are used to identify
More informationTips for Completing the UB04 (CMS-1450) Claim Form
Tips for Completing the UB04 (CMS-1450) Claim Form As a Beacon facility partner, we value the services you provide and it is important to us that you are reimbursed for the work you do. To assure your
More informationHospital-Based Ambulatory Care
C H A P T E R 2 Hospital-Based Ambulatory Care ANSWERS TO KNOWLEDGE-BASED QUESTIONS 1. What has been the trend in the utilization of hospital-based services? What factors help to account for this trend?
More information2016 PQRS and VBM for Anesthesia and Pain Management
2016 PQRS and VBM for Anesthesia and Pain Management 2016 PQRS and VBM for Anesthesia and Pain Management 1 Table of Contents PQRS 1 Definitions 2 PQRS Basics 2 MAV 3 Claims-based vs. Registry-based Reporting
More informationThe Future of Healthcare Delivery; Are we ready?
The Future of Healthcare Delivery; Are we ready? Lisa K. Saladin, PT, PhD, FAPTA Dean and Professor Medical University of South Carolina copyright LisaSaladin 2016 Objectives 1. Discuss 5 of the projected
More informationMACRA Quality Payment Program
The American College of Surgeons Resources for the New Medicare Physician System Table of Contents Understanding the... 3 Navigating MIPS in 2017... 4 MIPS Reporting: Individuals or Groups... 6 2017: The
More informationUsing Clinical Criteria for Evaluating Short Stays and Beyond
Using Clinical Criteria for Evaluating Short Stays and Beyond Georgeann Edford I. History A. Social Security Act Medical Necessity and Utilization Review 1. Items or services necessary for the diagnosis
More informationAAPC Webinar 3/28/2016
Short Stays for the Coder Where Are We Now? Heather Greene, MBA, RHIA, CPC, CPMA AHIMA Approved ICD-10 CM/PCS Trainer Copyright 2016 AAPC Agenda The Two-Midnight Rule Supportive documentation Observation
More informationCourse Module Objectives
Course Module Objectives CM100-18: Scope of Services, Practice, and Education CM200-18: The Professional Case Manager Case Management History, Regulations and Practice Settings Case Management Scope of
More informationSNF proposed rule revisions to case-mix methodology
SNF proposed rule revisions to case-mix methodology Comments due: August 25, 2017 CMS intent to propose case-mix refinements in the FY 2019 SNF PPS proposed rule Summary of changes Goals of the change:
More informationFlorida Medicaid. Medicaid School Based Services Coverage Policy. Agency for Health Care Administration. Draft Rule
Florida Medicaid Medicaid School Based Services Coverage Policy Agency for Health Care Administration Draft Rule Table of Contents 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1 1.3
More informationSWING BED (SWB) Rural Hospitals under 100 Beds and Critical Access Hospitals
SWING BED (SWB) Rural Hospitals under 100 Beds and Critical Access Hospitals Federal Regulations Hospitals under 100 Beds Critical Access Hospitals CMS State Operations Manual Appendix T Regulations and
More informationFlorida Medicaid. Outpatient Hospital Services Coverage Policy. Agency for Health Care Administration. Draft Rule
Florida Medicaid Agency for Health Care Administration Draft Rule Table of Contents Florida Medicaid 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1 1.3 Definitions... 1 2.0 Eligible
More informationKate Goodrich, MD MHS. Director, Center for Clinical Standards & Quality. Center for Medicare and Medicaid Services (CMS) May 6, 2016
Kate Goodrich, MD MHS Director, Center for Clinical Standards & Quality Center for Medicare and Medicaid Services (CMS) May 6, 2016 THE MEDICARE ACCESS & CHIP REAUTHORIZATION ACT OF 2015 Quality Payment
More informationWakeMed Rehab Hospital Stroke Rehabilitation Scope of Service
WakeMed Rehab Hospital Stroke Rehabilitation Scope of Service WakeMed Rehab Hospital provides an integrated, comprehensive delivery of rehabilitation services utilizing evidenced-based practice directed
More informationMEDICARE By Peter G. Pan
Wendell K. Kimura Acting Director Research (808) 587-0666 Revisor (808) 587-0670 Fax (808) 587-0681 LEGISLATIVE REFERENCE BUREAU State of Hawaii State Capitol Honolulu, Hawaii 96813 No. 02-13 October 7,
More information1st Annual CRRN Review Course October 2-3, 2014
Overview of Rehabilitation Legislative Issues, Rehab Nursing Beth Hudson MS, RN, CRRN, Chief Nurse Executive for BIR JV What is the role of rehabilitation nursing within the regulatory environment The
More informationEPSDT HEALTH AND IDEA RELATED SERVICES
EPSDT HEALTH AND IDEA RELATED SERVICES Chapter Twenty of the Medicaid Services Manual Issued March 01, 2013 State of Louisiana Bureau of Health Services Financing LOUISIANA MEDICAID PROGRAM ISSUED: 08/18/17
More informationProcedural andpr Diagnostic Coding. Copyright 2012 Delmar, Cengage Learning. All rights reserved.
Procedural andpr Diagnostic Coding What is Coding? Converting descriptions of disease, injury, procedures, and services into numeric or alphanumeric descriptors Accurate coding maximizes reimbursement
More informationRural Health Clinic Overview
TrailBlazer Health Enterprises Rural Health Clinic Overview Steven W. Mildward Published March 2012 108724 2012 TrailBlazer Health Enterprises /TrailBlazer. All rights reserved. Important The information
More informationIMAGES & ASSOCIATES O UR S ERVICES OPERATIONAL REVIEW AND ENHANCEMENT
O UR S ERVICES OPERATIONAL REVIEW AND ENHANCEMENT The Prospective Payment System (PPS) for Inpatient Rehabilitation Facilities creates both opportunities and challenges for facilities that provide comprehensive
More informationShared and Incident To Billing of E/M Services in Radiation Oncology Updated November 2017
ASTRO Guidance on Shared and Incident To Billing of Evaluation and Management Services in Radiation Oncology The Centers for Medicare and Medicaid Services (CMS) establishes Medicare policy for the payment
More informationRegulatory Advisor Volume Eight
Regulatory Advisor Volume Eight 2018 Final Inpatient Prospective Payment System (IPPS) Rule Focused on Quality by Steve Kowske WEALTH ADVISORY OUTSOURCING AUDIT, TAX, AND CONSULTING 2017 CliftonLarsonAllen
More informationEmergency Department Update 2009 Outpatient Payment System
Emergency Department Update 2009 Outpatient Payment System ED Facility Level Guidelines Critical Care Composite APCs and No Diagnosis Limitations OPPS Facility Conversion Factor Update Hospital Outpatient
More informationQuality Payment Program MIPS. Advanced APMs. Quality Payment Program
Proposed Rule: Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models The Department
More informationA Nurse Leader s guide to a successful Restorative Nursing Program PRESENTER: AMY FRANKLIN RN, DNS MT, QCP MT, RAC MT
A Nurse Leader s guide to a successful Restorative Nursing Program PRESENTER: AMY FRANKLIN RN, DNS MT, QCP MT, RAC MT Requirements for Successful Completion 1. 2.0 contact hours will be awarded for this
More informationFebruary Jean C. Russell, MS, RHIT Richard Cooley, BA, CCS
February 2013 Jean C. Russell, MS, RHIT jrussell@epochhealth.com Richard Cooley, BA, CCS rcooley@epochhealth.com 518-430-1144 2 2013 E/M Codes Deleted Codes New Codes Changed Codes Agenda Documentation
More informationHOSPICE TARGETED PROBE & EDUCATE Melinda A. Gaboury, COS C Healthcare Provider Solutions, Inc.
HOSPICE TARGETED PROBE & EDUCATE Melinda A. Gaboury, COS C Healthcare Provider Solutions, Inc. www.targetedprobe&educate.com Targeted Probe and Educate October 1, 2017 Targets providers based on data Can
More informationIs Audiology effected by the Changes or will it be?
Is Audiology effected by the Changes or will it be? The basic problem The U.S. has the highest absolute medical expenditures and highest per capita medical expenditures of any nation. The U.S. also has
More information2017/2018. KPN Health, Inc. Quality Payment Program Solutions Guide. KPN Health, Inc. A CMS Qualified Clinical Data Registry (QCDR) KPN Health, Inc.
2017/2018 KPN Health, Inc. Quality Payment Program Solutions Guide KPN Health, Inc. A CMS Qualified Clinical Data Registry (QCDR) KPN Health, Inc. 214-591-6990 info@kpnhealth.com www.kpnhealth.com 2017/2018
More informationWound Care Reimbursement. Things Are A-Changing!
Wound Care Reimbursement Things Are A-Changing! Kathleen D. Schaum, MS President Kathleen D. Schaum & Assoc., Inc. kathleendschaum@bellsouth.net 561-964-2470 Disclosure No relevant financial relationships
More informationClinical Utilization Management Guideline
Clinical Utilization Management Guideline Subject: Therapeutic Behavioral On-Site Services for Recipients Under the Age of 21 Years Status: New Current Effective Date: January 2018 Description Last Review
More informationFIDA. Care Management for ALL
Care Management for ALL In 2011, Governor Andrew M. Cuomo established a Medicaid Redesign Team (MRT), which initiated significant reforms to the state s Medicaid program. This included a critical initiative
More informationMedicare General Information, Eligibility, and Entitlement
Medicare General Information, Eligibility, and Entitlement Chapter 4 - Physician Certification and Recertification of Services Transmittals for Chapter 4 Table of Contents (Rev. 50, 12-21-07) 10 - Certification
More informationMedicare Fee-For Service Provider Utilization & Payment Data Inpatient Public Use File: A Methodological Overview
Medicare Fee-For Service Provider Utilization & Payment Data Inpatient Public Use File: A Methodological Overview May 30, 2014 Prepared by: The Centers for Medicare and Medicaid Services, Office of Information
More informationJoint Statement on Ambulance Reform
Joint Statement on Ambulance Reform Policymakers Should Examine Short- and Intermediate-Term Policies to Promote Innovation in the Delivery of Emergency and Non- Emergency Care Provided by Ambulance Services
More informationSubject: Updated UB-04 Paper Claim Form Requirements
INDIANA HEALTH COVERAGE PROGRAMS P R O V I D E R B U L L E T I N B T 2 0 0 7 0 2 J A N U A R Y 3 0, 2 0 0 7 To: All Providers Subject: Updated UB-04 Paper Claim Form Requirements Overview The following
More informationABOUT FLORIDA MEDICAID
Section I Introduction About eqhealth Solutions ABOUT FLORIDA MEDICAID THE FLORIDA AGENCY FOR HEALTH CARE ADMINISTRATION The Florida Agency for Health Care Administration (AHCA or Agency) is the single
More informationCenters for Medicare and Medicaid CMS Updates. Christol Green, Anthem Inc.
Centers for Medicare and Medicaid CMS 2016-2017 Updates Christol Green, Anthem Inc. Agenda Topic Page Payment Models - BPCI 3 Sequestration 5 CPC+ Initiative 7 What is MACRA? 12 CMS Social Security Number
More informationObjectives. Assisted Living. O 2 : Opportunities & Outcomes in Assisted Living. Presented by: Chief Clinical Officer
O 2 : Opportunities & Outcomes in Assisted Living Presented by: Leigh Ann Frick, PT, MBA Chief Clinical Officer Melissa Moffitt, MS, CCC-SLP Senior Vice President of Senior Living Objectives Identify the
More information