Presented by Evan M. Gwilliam, MBA DC CPC CCPC NCICS CCCPC CPC I MCS P CPMA. Vice President

Transcription

1 Hot Topics in Chiropractic Reimbursement 2015 Presented by Evan M. Gwilliam, MBA DC CPC CCPC NCICS CCCPC CPC I MCS P CPMA Vice President 1

2 Tbl Table of Contents t ICD 10 PQRS (bonus: VBM!) EHR/Meaningful Use HIPAA Security Compliance 2

3 Education Introduction ti Bachelor s of Science, Accounting Brigham Young University Master s of Business Administration Broadview University Doctor of Chiropractic, Valedictorian Vldit i Pl Palmer College of Chiropractic Certifications Certified Professional Coder (CPC) AAPC Nationally Certified Insurance Coding Specialist (NCICS) NCCT Certified Chiropractic Professional Coder (CCPC) AAPC ChiroCode Certified Chiropractic Professional Coder (CCCPC) ChiroCode Certified Professional Coder Instructor (CPC I) AAPC Medical Compliance Specialist Physician (MCS P) MCS Certified Professional Medical Auditor (CPMA) AAPC, NAMAS 3

4 Introduction ti Affiliations / Experience Chiropractic Practice in Washington and Utah Vice President ChiroCode Institute Editorial Board Member ICD10Monitor.com Speaker/Instructor Cross Country Education, ChiroCode, AAPC, multiple state associations and other groups Contributor Chiropractic Economics, ACANews, AAPC Cutting Edge, The American Chiropractor, Dynamic Chiropractic Board member Council on Chiropractic Guidance and Practice Parameters 4

5 The Landscape 5

6 The Landscape 6

7 The Landscape 7

8 ICD 10 ICD 9 14,000 codes ICD 10 68,000 codes 8

9 ICD 10 Issues Issue Code set education Solution Live seminars Live/recorded webinars Coding manuals In office training Office meetings Trade journals ICD10Monitor.com Personalized crosswalk

10 ICD 10 Issues Issue Budgeting Solution Line of credit Documentation Provider training plan Consultants if necessary Software Delays Ask vendors the right questions Who knows?

11 ICD 10 resources Medicare: free training ChiroCode.com: books, free alerts and webinars, more training, memberships, and chart audits, coding tools FindACode.com: Crosswalks and other advanced tools ICD10Monitor.com: free articles AAPC.com and AHIMA.org

12 ICD 10 implementation

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14 PQRS Measures Three measures 131: Pain Assessment and Follow up 182: Functional Outcome Assessment 317: Screening for High Blood Pressure and Follow up documented d ****focus on patient outcomes is the trend for all payers, not just for Medicare 14

15 PQRS Measures CMT to 1-2 spinal regions AT PA & follow-up G8730 FOA w/in last 30 days G

16 PQRS Penalties Penalties: 1.5% 15%in 2015 based on 2013 performance 2.0% in 2016 based on 2014 performance For providers who accept assignment, CMS will take the penalty out of the allowed amount For providers who do not accept assignment, they must reduce the amount collected from the patient. 16

17 PQRS Resources ChiroCode C 2015 DeskBook, section D Free Webinars Medicare: American Chiropractic Association: Note that PQRS gets updated in December or January, so subscribe to ChiroCode or ACA s to keep current 17

18 Value based Payment Modifier CMS is moving toward physician reimbursement that rewards value rather than volume. The transformation of Medicare from a passive payer to an active purchaser of higher quality, more efficient health care

19 Value based Payment Modifier Low cost Avg cost High cost High quality +2.0x +1.0x +0% Average quality +1.0x +0% 0.5% Low quality +0% 0.5% 1.0% Compared to your peers, how does your practice rate on quality and costs? ****focus on patient outcomes is the trend for all payers, not just for Medicare

20 EHR/Meaningful Use Reporting 1 st or 2 nd year? Stage 1 Reporting 3 rd year (in 2015)? Stage 2, unless you don t want to due to trouble getting certified software ****focus on patient outcomes is the trend for all payers, not just for Medicare 20

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22 EHR/Meaningful Use Penalties: 22

23 EHR/Meaningful Use Penalties: 1.0% 10%in 2015 if Provider did not report in 2013 OR Attest for 2014 by Oct. 1, 2014 OR Complete the hardship exemption by Nov. 30, 2014 More on penalties: For providers who accept assignment, CMS will take the penalty out of the allowed amount For providers who do not accept assignment, they must reduce the amount collected from the patient. Providers cannot expect Medicare beneficiaries to pick up the slack for penalties assessed to the practice fro non compliance. 23

24 HIPAA/MU To qualify for Meaningful Use, you must o Complete a Risk Analysis o Correct identified security deficiencies o Attest that you have done so Risk Analysis is o Required by HIPAA o Good business practices

25 HIPAA: Security Risk Analysis 1. Gather data about where and how ephi is used 2. Identify and document potential threats and vulnerabilities Threats: Human, natural, environmental (floods, power loss) Vulnerabilities: Weaknesses in security controls (i.e. unencrypted lap tops) p) 3. Assess Current Security measures: Administrative, physical and technical

26 HIPAA: Security Risk Analysis 4. Evaluate likelihood and impact of risks to ephi

27 HIPAA: Security Risk Analysis Implement security measures in response Document which corrective actions are taken o i.e new policies, more locks, better passwords Maintain continuous, reasonable, and appropriate security protections Conduct analysis annually Solution: risk assessment

28 Medicare/OIG e/oig Compliance The Affordable Care Act signed dinto law March 23, 2010 makes a Compliance Plan required for participation in federal programs. Elements e of a Compliance Plan were outlined by the OIG in 2000 as a suggestion. /physician.pdf 28

29 Medicare/OIG Compliance The seven e elements: e 1. Conduct internal monitoring and auditing 2. Implement compliance and practice standards 3. Designate a compliance officer 4. Conduct appropriate p training and education 5. Respond appropriately to detected offenses 6. Develop open lines of communication 7. Enforce disciplinary standards through wellpublicized guidelines 8. Check employees against the exclusion database 29

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