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Healthcare Coding & Documentation 2014 Update

Healthcare Coding & Documentation 2014 Presentation Overview

The health care market is constantly changing. Staying abreast of the latest information is essential to today's health care professional. For the fourteenth consecutive year, the Heath Care Services Group of EisnerAmper LLP has provided free seminars covering coding updates and the latest regulatory changes. A comprehensive overview of the Office of Inspector General Work Plan and an overview of ICD-10 implementation are included to assist professionals in strategic planning. Our presentations are created specifically to educate and advise all types of health care professionals. Our seminars deliver practical knowledge on the latest information, updates and respective changes impacting the health care industry for providers, staff, attorneys and outside professionals. Attendees will explore the latest advances in health care reform, compliance, and coding and documentation. This information enables the healthcare professional to make informed decisions in a challenging business environment.

Following are highlights from our Health Care Group's 2014 Healthcare Coding & Documentation presentation.

Sections

ICD-10-CM & ICD-10-PCS: ARE YOU READY?

  • 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
       
     
  • 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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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
    • 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?

2014 CPT Code Changes

Effective 1/1/14

175 New Codes
107 Revised Codes
54 Deleted Codes
(*Per AMA)

Evaluation & Management

  • 6 new codes

Surgery

  • 74 GI endoscopy procedures

Radiology

  • 5 new, revised or deleted codes

Pathology/Laboratory

  • 21 new, revised or deleted codes

Medicine

  • 12 new, revised or deleted codes

Category II

  • 7 new codes
  • 1 revised code

Category III

  • 12 new codes
  • 12 deleted codes
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