Healthcare Coding & Documentation 2013 Update

Presentation Overview

EisnerAmper Healthcare Coding & Documentation 2013 Update

Today’s healthcare marketplace is a complex and consistently changing entity. Staying ahead of the curve with the latest information on reforms is critically important to today’s healthcare professional.

For the thirteenth consecutive year, the Healthcare Services Group of EisnerAmper LLP is providing free seminars documenting the latest regulatory and coding updates. Our presentations are created and presented specifically to advise, educate and mentor all types of healthcare professionals. Our seminars deliver knowledge on the latest information, updates and respective changes impacting the healthcare industry for healthcare providers, staff members, attorneys and outside professionals. Attendees will examine the latest developments and changes in healthcare reform, compliance, and coding and documentation. This information enables the healthcare professional to make informed decisions in a challenging business environment.

What follows is the highlights from our Healthcare Group's 2013 Healthcare Coding & Documentation presentation.


2013 CPT Code Changes  

2013 OIG Work Plan – Physician, ASC and Hospital  

ICD-10 Implementation 


2013 CPT Code Changes

    Effective 1/1/13 216 New Codes

    • Pathology & Laboratory - 116 Codes
      • Molecular Basis of Disease Remaining CPT Codes
    • Category II and III Codes
    • Cardiovascular
    • Medicine
      • Immunizations
      • Psychotherapy
      • Cardiovascular
      • Nerve Conduction Studies

2013 OIG Work Plan: Physician

  • Medical Review of Part A and Part B Claims Submitted by Top Error-Prone Providers
    • Request Refunds on Projected Overpayments
  • Anesthesia Services - Payments for Personally Performed Services
    • AA Modifier - Anesthesia Services Personally Performed by an Anesthesiologist
    • QK Modifier - Medical Direction of 2, 3 or 4 Concurrent Anesthesia Procedures by an Anesthesiologist
      • QK Modifier limits payment at 50% of the Medicare-allowed amount for personally performed services claimed with the AA modifier
  • Payments to Providers Subject to Debt Collection
    • Existing overpayments that were reported to the Department of Treasury for failure to refund overpayments
    • Ceasing to bill under one Medicare number and billing under another Medicare number
  • Independent Therapists
    • High Utilization of Outpatient Physical Therapy Services
  • Electrodiagnostic Testing – Questionable Billing
    • EMG's and Nerve Conduction Tests
    • Use of Electrodiagnostic Testing for Financial Gain
  • Noncompliance with Assignment Rules and Excessive Billing of Beneficiaries
  • Place of Service Coding Errors
    • Non-facility Setting vs. Facility Setting

2013 OIG Work Plan: Ambulatory Surgery Centers (ASC)

  • Payment System
    • Review appropriateness of Medicare's methodology for setting ASC payment rates under the revised payment system
  • Safety and Quality of Surgery and Procedures
    • ASC and Hospital Outpatient Departments
    • Scheduled for 2013
      • Care in preparation for and during surgeries
      • Adverse events

2013 OIG Work Plan: Hospital

  • Diagnosis Related Group Window
    • Outpatient services currently bundled up to 3 Days prior to admission
    • OIG determined CMS could realize significant savings if DRG window was expanded to 14 days
  • Compliance with Medicare's Transfer Policy
    • Review discharges that should have been billed as transfers
  • Payments for Discharges to Swing Beds in Other Hospitals
    • Full DRG vs. Reduced Payment
  • Payments for Canceled Surgical Procedures
  • Payments for Mechanical Ventilation
    • Did patients receive less than 96 hours of mechanical ventilation?


  • ICD-10-CM (Volumes 1 & 2) - 69,000 Codes
  • ICD-10-PCS (Volume 3) - 72,000 Codes 

Implementation - Phase I 

  • Identify business impact areas
    • Educational session with key stakeholders
    • Create steering committee and assign project manager
      • Utilize internal and/or outsourced resources
      • Establish Implementation Timeline
  • Conduct the following assessments:
    • Onsite impact assessment of all business impact areas
      • Identify all impacted people, processes and systems
      • System remediation and/or replacement
      • Education and training needs
      • Budgetary needs
  • Conduct the following assessments:
    • IT Assessment
      • Product upgrade timelines
      • Hardware impact
      • Testing timelines
      • Costs associated with system remediation/replacement efforts
      • ICD-9-CM to ICD-10/ICD-10 to ICD-9-CM translation methodology
      • Inventory of Reports and Interfaces
        • Confirm number of reports and interfaces
        • Determine continued need/efficiencies that can be realized
        • Remediation effort
  • Conduct the following assessments:
    • ICD-10 reimbursement and coding/documentation impact analysis
      • What is the magnitude of the impact ICD-10 will have on your revenue
        • DRG weights - Hospital
      • Deficiencies in coding/documentation for ICD-9
      • Education/training and Documentation Improvement
  • Clinical Data Quality Assessment
    • Electronic Health Record (EHR) Review
      • Physician documentation
        • Encounter
        • Procedure/Operative Reports
        • Pathology, Lab, Imaging Reports
    • Encounter Forms
    • Develop
      • ICD-10 education and training approach
      • ICD-10 workflow to readiness
    • Create Budget
      • Software Modifications
      • Software/Hardware Upgrades
      • Staff Training/Materials
      • Testing-Related Costs
      • Temporary/Contract Staffing
      • Consulting Services
      • Development of New Reports
      • Data Conversion

Implementation - Phase 2 

  • Project Governance
  • Implement education and training program
    • Staff and providers
    • Policies and Procedures
    • Software Upgrades
    • ICD-10 CM
      • Anatomy & Physiology
      • Specificity Requirements
  • Implement clinical documentation improvement program
  • Technical resources
  • Testing, design and management
    • Implement systems changes
    • Internal/External Testing
  • Operational and systematic workflow
  • ICD-9-CM to ICD-10/ICD-10 to ICD-9-CM mapping and translation

Implementation - Phase 3 - "Go Live"

  • System Vendors
    • Changes & Upgrades Are Completed
  • Complete Internal Testing
  • ICD-10 Transaction Testing
  • Review/Test Contingency Plan for Continuing Operations
  • Coding Staff Training
    • Six months prior to "Go Live"
  • Documentation Assessments

Implementation - Phase 4 - Post Implementation

  • Monitoring and Improvement
    • End-state measurement and documentation
    • Implement review and improve process
      • Denials
      • Coding/Documentation Accuracy
  • Update compliance program



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