CMS regulations and Physicians

September 22, 2017
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The dynamics of health IT are changing as we speak and there’s virtually nothing the community can do about it. Yes, the end of the grace period for ICD-10 codes is near and physicians are beginning to feel the impact already. The Workgroup’s survey for Electronic Data Interchange found the transition period to be relatively neutral, contrary to the expectations of many providers and analysts across the States. Results state that the productivity for responding providers was somewhat the same and had a neutral effect overall. Many respondents found costs to be in line with expectations, while some stated that the costs were relatively lower.

Here’s how to get through the transition;

•        Mitigate Risk of Unspecified ICD-10 Codes

Practices aware of the transition are already taking pro-active measures. This is how it can be done in three simple steps.

1.         Review (top) ICD-10 diagnosis codes reports and pay special attention to identifying unspecified codes.

2.         Conduct internal analysis: diagnosis codes assigned by physicians to identify trends in unspecified ICD-10-CM (diagnosis) coding.

3.         Review Clinical Documentation: It’s always important to identify the loopholes in the reporting department. In a case of misuse of codes or loss of documents themselves, educating the staff or coder will always come in handy. Get those documents filed, and make sure proper and precise codes are being used to avoid the slightest bit of hassle.

•        Hire a Credentialed Coding Professional

If you can’t do it right, hire a professional. Most practices across the States are getting a grip of the codes and doing it right. However, a lot of them are still deprived and are not able to manage coding due to reasons that may or may not be relatable. Regardless, it’s wise to hire a professional coder to do it for you and rid you of the long-term costs. Trained coding professionals evaluate electronic medical record (EMR) code assignments, identify software errors, and conduct advanced ICD-10 training for non-specific documentation and coding problem areas.

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•        Looking Ahead

Adapting a pro-active approach is what keeps you in the race. Well, at least in the HealthCare industry. With the new year almost on its way, practice providers must remain cognizant of the changes that they might have to prepare themselves for; the addition of nearly 2,000 new ICD-10-CM codes. Not all physician practices use all of the new codes, but it’s essential to carefully review the changes ahead, primarily focusing on the subset of codes applicable to their practice or patient population.

Nearly 300,000 eligible practice providers, looking away from meaningful use and the importance of certified EHR technology, are set to face reductions in their fee. This one percent loss would also include reductions in reimbursements for providers not compliant with Medicare’s Electronic Prescribing (eRx) Incentive Program and the Physician Quality Reporting System (PQRS).

Compliance with CMS’s new Value-Based Payment Modifier program is necessary. Unless practice providers wish to face penalties throughout the year, it’s best that they cooperate and make the most out of the opportunity. The program adds a few regulations but the reward is equally satisfying and is a step closer to improve healthcare altogether.

The American Medical Association has been consistent in demanding relief for the extremely pre-occupied doctors who are unable to cope up with the overwhelming amount of reporting requirements. But wait. There’s another side to the story. CMS has passed a rule to allow new procedural terminology (CPT) code, 99490, one that enables physicians to bill at a more efficient and convenient rate. The practice providers will now be able to bill $41.92 per month for provision of remote chronic care management to (qualifying) patients. Moreover, the states under Medicaid and commercial payers are now incorporating telemedicine into their reimbursement fee feature; therefore, helping practice providers bill for these services.