!!! Lombardi Hill Consulting Group WHAT YOU NEED TO KNOW!! CMS (Medicare)! and! The Joint Commission CSC! Updates! Debbie Lombardi Hill, FAHA Dunedin, Florida w May 4, 2016 Lombardi Hill Consulting Group! FOCUSED STROKE CENTER STRATEGY Disclosures! ª Principal, Lombardi Hill Consulting Group ª Member, Gerson Lehman Healthcare Council ª Independent Contractor, American Heart Association/ American Stroke Association (AHA/ASA) May 4, 2016 1
THE JOINT COMMISSION! ª Comprehensive Stroke Center Measure Set (CSTK) CSTK Description 01 NIHSS Score Performed for Ischemic Stroke Patients 02 Modified Rankin Score (mrs at 90 days) 03 Severity Measurement Performed for SAH and ICH Patients (Overall Rate) 04 Procoagulant Reversal Agent Initiation for ICH 05 Hemorrhagic Transformation (Overall Rate) 06 Nimodipine Treatment Administered 07 Median Time to Revascularization (Retired 1/1/16) 08 Thrombolysis in Cerebral Infarction (TICI Post-Treatment Reperfusion Grade) 09 Arrival Time to Skin Puncture (Effective 1/1/17) CMS (Medicare)! ª Two Midnight Rule Observation Unit vs. Short Inpatient Stay The Recovery Audit Program s mission is to identify and correct Medicare improper payments through the efficient detection and collection of overpayments made on claims of health care services provided to Medicare beneficiaries RAC audits begin January 1, 2016 for short inpatient stays May 4, 2016 2
CMS (Medicare)! ª Medicare Outpatient Therapy Caps PT Capped at $1900 OT/ST Capped at $1900 Therapy cap exception process remains in effect until December 2017 Services provided to a patient whose medical or psychological problems require moderate to high-complexity medical decision-making during transitions from an inpatient setting (acute, rehab, LTC) or partial hospitalization (observation unit, SNF) to the patient s community setting (home, assisted living, etc.) Billed by physician, NP, PA, etc. Medicare payment rate is about $30-35 more than an regular office visit May 4, 2016 3
CPT Code 99495 (performed in a non-facility setting, i.e., physician office, stroke clinic) requires: Communication with the patient and/or caregiver within 2 business days of discharge. Medical decision making of at least moderate complexity during the service period, and Face-to-face visit within 14 calendar days of discharge CPT Code 99496 (performed in a non-facility setting, i.e., physician office, stroke clinic) requires: Communication with the patient and/or caregiver (direct contact, telephone, electronic) within 2 business days of discharge. Medical decision making of at high complexity during the service period, and Face-to-face visit within 7 calendar days of discharge May 4, 2016 4
Three Requirements During the 30 days beginning with the date of discharge: An interactive contact, Telephone, email, face-to-face Certain non-face-to-face services, and Obtain and review discharge information Review need for follow-up on pending diagnoses Interact with other health care professionals Provide education to patient, family, etc. Establish referrals with community providers Assist in scheduling follow-up with community providers A face-to-face visit May 4, 2016 5
National payment rates: 99495 $172.66 (moderate complexity) 99496 $243.60 (high complexity) Benefits: Better patient care Better outcomes Reduces risk of readmission Reduces physician office no show rates Enhanced billing At least 20 minutes of clinical staff time directed by a physician or other qualified health professional per calendar month Billed by physician, NP, PA, etc. NP, PA, etc. billed under general supervision of a physician or other appropriate practitioner CPT Code 99490 May 4, 2016 6
CPT Code 99490 requires: Multiple (2 or more) chronic conditions expected to last at least 12 months, or until death of the patient Chronic conditions place the patient at significant risk of death, acute exacerbation/decompensation or functional decline Comprehensive care plan established, implemented, revised or monitored Only one practitioner can furnish and be paid for the service during a calendar month Requires: Documentation of patient consent Billing practitioner must furnish a comprehensive evaluation and management (E/M) visit, annual wellness visit, or preventative physical exam (IPPE) prior to billing for CCM Must initiate the CCM service as part of the visit May 4, 2016 7
Requires (continued): Access to care 24/7 access to care management services Access to care management plan to address urgent chronic care needs Continuity of care with practitioner seeing patient Enhanced opportunities for patient and caregiver to communicate with the practitioner (HIPPA compliant) Telephone Secure messaging Secure internet Asynchronous non-face-to-face consultation methods, etc. National payment rates: 99490 ~ $30.00 Does require a patient co-pay (~$8.00) Patient must be informed and can opt out Benefits: Better patient care Better outcomes Reduces risk of readmission Reduces physician office no show rates Enhanced billing May 4, 2016 8
New ASA Guidelines! QUESTIONS?! Please feel free to contact me at: Debbie Hill Debbie@LombardiHill.com 407-222-6106 May 4, 2016 9