and Coding Updates Agenda ICD 10 Preparation CPT Code Changes Medicare Updates Other Presented by: Mark Painter December 3, 2013

Transcription

1 214 Urology Medicare and Coding Updates Presented by: Mark Painter December 3, 213 ICD 1 Preparation CPT Code Changes Medicare Updates Other Agenda 2 1

2 Objectives Understand the implications of the impending transition from ICD 9 to ICD 1 and develop a plan to implement the new ICD 1 system Identify CPT changes that effect Urology Evaluate many of the Medicare final rule changes for Urology practices in relation to SGR PQRS RVU changes 3 ICD 1 Overview ICD 1 CM/PCS implementation date October 1, 214 (last Industrialized nation to implement system) CM version developed by NCHS under agreement from WHO HIPAA covered Payers for dates of service on or after Oct. 1, 214 will no longer accept medical diagnosis (ICD 9 CM diagnosis codes) inpatient procedures (ICD 9 procedure codes) 4 2

3 Planning for Implementation Clinical Establish clear list of clinical personnel Analyze Technology relationships EMR PM Paper Communication Assess current ICD 9 knowledge 5 Execution Strategies Tools Analyze best available on line or print materials and acquire ( January April) Modify current paper tools (January February) Cheat Sheets for LCDs etc. (January September) Common CPT codes ICD 9 and ICD 1 6 3

4 Execution Strategies Training Who/when CodingInstruction (April) Common Codes, Nomenclature and Guidelines Use of indices and tools GEMS what to use and what to avoid CPT to ICD 1 commonly used System Instruction (July August) How to locate ICD 1 What about ICD 9 Assigning Dx to Procedure Practice (August September) Designated test dates Scenarios of increasing difficulty Code ICD 1 as well as ICD 9 for practice (Do not Submit) 7 Execution Strategies Build cash reserves or obtain access to financing to run practice for up to 6 months (October 213 October 214) Monitor Timelines and maintain compliance (Now ) 8 4

5 CPT Code Changes 214 Added CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH LITHOTRIPSY INCLUDING INSERTION OF INDWELLING URETERAL STENT (EG, GIBBONS OR DOUBLE J TYPE) Deleted 521 Drainage of perirenal or renal abscess; percutaneous 9 Medicare Updates SGR Proposal lfrom house and senate would fix SGR Hold current payments for 1 years Provide opportunity for increased revenue for APM Will it pass this year? 24% drop in fees January 1 Retroactive fix To collect and bill or not? 1 5

6 Medicare Updates PQRS Must submit to qualify in 213 or cuts in 215 Path hlfi left is Registry On going required to avoid cuts in future years Physician Compare ( PQRS Data, PECOS data and Claims Data used Designed to allow patients to select physicians Update PECOS Data Indicators indicating successful reporting under PQRS, ERx and EHR meaningful use Consumer Assessment for groups of 1 or more will be posted as early as 214 (25 99 will be added in 215) Expanded reporting for Groups and ACOs in 215 for PQRS measures 11 Medicare Updates PQRS (.5% bonus for 214 and avoid penalty in 216) Group reporting notification deadline moved up from October to September 3 (GPRO) Groups of 25 or more can elect to submit patient assessments in 214 through the web. Added requirements for reporting CG CAHPS (Clinician and Group Consumer Assessment of Health Care Providers and Systems) for ACOs and Groups using GPRO reporting of PQRS (groups under 1 optional) Certified Vendor Claims based or Registry reporting Measures required to report for satisfaction of PQRS increased from 3 to 9 measures with 3 NQS measures. MAV (adjustment for volume) allowed report on as many as possible for success. Success still defined at 5% of eligible patients for each measure 12 6

7 Medicare Updates PQRS EHRbased reporting unchanged from 213 requirements Data registry reporting can avoid 216 payment adjustment if reporting 3 measures on 8% of eligible patients 1 NQS measure included (MAV will applied if applicable). New Option for a CMS approved Clinical Data Registry Must be able to submit data to CMS demonstrating PQRS participation Must be able to submit to CMS PQRS data for multiple payers Provide timely feedback to individually eligible professionals at least 4 times a year Possess benchmarking capacity for individual professionals Must report on 9 measures including 3 NQS measures and 1 outcome measure (no MAV allowed) for bonus; 3 measures for 5% of eligible patients to avoid 216 penalty. 13 Medicare Updates RBRVS Proposed adjustment to PE RVUS to make payments in the OPPS or ASC if available and Non facility (office) setting equal Proposal was opposed by many including the AUA. CMS elected not to implement this change this year but will continue to explore options as they believe that values should be aligned in some way. Likely will be revised and proposed for next year. 14 7

8 Medicare Updates RBRVS Mis valued Codes Identified by CMS and others based on multiple potential criteria and identified as potentially misvalued Will be subject to review 15 RBRVS Big Losers Office CPT 1 / HCPCS Mod Description Non- Facility Decrease Perc cryo ablate renal tum 8% Simple cystometrogram 7% Simple cystometrogram 2% Simple cystometrogram 1% Complex cystometrogram 7% Complex cystometrogram 1% Complex cystometrogram 9% Cystometrogram w/up 7% Cystometrogram w/up 2% Cystometrogram w/up 1% Cystometrogram w/vp 6% Cystometrogram w/vp 1% Cystometrogram w/vp 9% 16 8

9 RBRVS Big Losers Office CPT 1 / HCPCS Mod Description Non- Facility Decrease Cystometrogram w/vp&up 7% Cystometrogram w/vp&up 2% Cystometrogram w/vp&up 1% Urine flow measurement 4% Urine flow measurement % Urine flow measurement 1% Electro-uroflowmetry first 4% Electro-uroflowmetry first % Electro-uroflowmetry first 9% Anal/urinary muscle study 6% Anal/urinary muscle study 1% Anal/urinary muscle study 9% Anal/urinary muscle study 6% Anal/urinary muscle study 2% Anal/urinary muscle study 8% 17 RBRVS Big Losers Office CPT 1 / HCPCS Mod Description Non- Facility Decrease Urinary reflex study 7% Urinary reflex study 1% Urinary reflex study 9% Intraabdominal pressure test 7% Intraabdominal pressure test 2% Intraabdominal pressure test 1% Us urine capacity measure 9% Cystoscopy and treatment 1% Insert prost urethral stent 8% Transurethral rf treatment 9% Cryosurgery penis lesion(s) 8% Penis study 4% Penis study 1% Penis study 8% 18 9

10 RBRVS Big Losers Office CPT 1 / Mod Description Non- Facility Decrease HCPCS 5425 Penis study 2% 5425 Penis study 1% 5425 Penis study 9% Cryoablate prostate 8% Us exam abdo back wall lim 43% Us exam abdo back wall lim % Us exam abdo back wall lim 58% Us exam pelvic complete 6% Us exam pelvic complete % Us exam pelvic complete 8% Us exam pelvic limited 47% Us exam pelvic limited 2% Us exam pelvic limited 58% 7687 Us exam scrotum 44% 7687 Us exam scrotum % 7687 Us exam scrotum 58% 19 RBRVS Big Losers Office CPT 1 / HCPCS Mod Description Non- Facility Decrease Echograp trans r pros study 5% Echograp trans r pros study % Echograp trans r pros study 8% Us xtr non-vasc complete 8% Echo guide for biopsy 66% Echo guide for biopsy 1% Echo guide for biopsy 78% Tissue exam by pathologist 4% Tissue exam by ypathologist 1% Tissue exam by pathologist 8% 2 1

11 RBRVS Big Winners Office CPT 1 / HCPCS Mod Description Non- Facility Decrease Change of bladder tube 31% Us transrectal 21% Us transrectal % Us transrectal 39% 21 RBRVS Big Losers Facility CPT 1 / HCPCS Mod Description Non- Facility Decrease Explore and drain kidney 8% Transplantation of kidney 1% Reimplant ureter in bladder 16% Incision of urethra 12% Repair penis 15% 22 11

12 Medicare Updates Value based Payment Proposed py payment modifier tied to quality y( (PQRS)and cost (Claims) Will be implemented for some groups(1+) in 215 Will be implemented for physician groups larger than 1 in 216 No downward adjustment for this period for groups 1 99 if in Category 1 Groups will be broken into categories based on PQRS success Category 2 groups are subject to automatic decrease of 2.% CY 216 Cost/Quality Low quality Average quality High quality Low cost +.% +1.x* +2.x* Average cost -1.% +.% +1.x* High cost -2.% -1.% +.% 23 Medicare Updates Medicare Advantage Plans Preparing for Pt. Satisfaction based scoring Monitor contracts and requirements Narrowing networks Increased management and Oversight 24 12

13 Other Embrace the EMR Use Extenders to collect and enter data. Improve your templates Data mining requires accurate Data Think about ICD-1 Change is not easy but necessary 25 Other Integrate Compliance Conform to Business plan. Include or Reference job descriptions and responsibilities Goal is to charge accurately for all services. Audit of charts and processes part of business model. Non-Compliance will cost you money do not tolerate it. 13

14 Thank You Questions? Mark Painter PRS Network markp@prsdata.com 27 14