Healthcare Coding & Documentation 2014 Update

Published: Apr 23, 2014
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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 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 Implementation
2013 OIG Work Plan – Physician, ASC and Hospital
2014 CPT Code Changes

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