Thursday, November 16, 2017

AHRQ and HealthIT.Gov Post EMR Information

The Agency for Healthcare Research and Quality (AHRQ) has posted an Electronic Health Record (EHR)  primer for physicians and hospitals.  This primer provides guidance for providers in the use of EMRs.  The AHRQ’s mission:
The Agency for Healthcare Research and Quality's (AHRQ) mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used.

The AHRQ primer references the Safety Assurance Factors for EHR Resilience (SAFER) guides, developed by HealthIT.gov, the official site for Health IT Information.  Because certified EHRs are part of CMS’ quality programs in FFS Medicare, the guides were developed to aid providers in the implementation and use of them.   
The SAFER guides provide  an additional resource for providers seeking information on EHRs.  The following SAFER guides are available:
·         High Priority Practice
·         Contingency Planning
·         System Interfaces
·         Clinician Communication
·         System Configuration
·         Patient Identification

Finally, AHRQ has developed free CME (1 CME unit for American Board of Internal Medicine) and Medical Knowledge/Patient Safety credit (up to 45 MOC points).   There is a related CME program, The Hazards of Distraction: Ticking All the EHR Boxes available on the AHRQ site (registration required).

We hope this information is helpful.

Monday, August 7, 2017

Encounter Data Updates

In addition to the reminder from our Encounter Data Team (below) regarding sweep dates, we have several important updates posted to HCC University to help make your Encounter Data Submission more successful.  These three files have been posted to the Encounter Data/ICD-10 page on HCC U:

Encounter Data Processing

Duplicate Logic

Last Updated: 8/7/2017 222 KB
One page guide to assist encounter data staff submit compliant encounters for CMS processing, and avoid duplicate line/encounter rejects.

Swing Bed SNF Conditions Not Met

Last Updated: 8/7/2017 183 KB
One page guide to assist encounter data staff submit compliant SNF swing bed encounters for CMS processing.

Occurrence Code 55 and DOD Required

Last Updated: 8/7/2017 184 KB
One page guide to assist encounter data staff submit compliant encounters when the discharge status code is 20 (expired), 40 (expired at home), 41 (expired in a medical facility), or 42 (expired – place unknown) for CMS processing.



---------------------------------------------------------------

UPDATE On Sweep Dates
*IMPORTANT* -- SCAN Dates for Upcoming September 2017 Encounter Data CMS Sweep
Hello SCAN Provider Partners,

The September CMS Encounter Data Sweep is approaching. We are 1 weeks away from SCAN’s Target Date! This is the INITIAL CMS sweep impacting 2017 DOS (2018 payment) and requires the submission of encounters for DOS range:
  • 07/01/2016 à 06/30/2017

SCAN has two dates for you to manage towards:
Ø  SCAN Target Date for Provider Partners: EOB Friday, August 11, 2017
o   This target date ensures that SCAN has adequate time to complete processing prior to the health plan cut-off date by CMS

Ø  SCAN Deadline for Provider Partners: EOB Friday, September 1, 2017
o   After this deadline, SCAN will NOT process any files received for the September CMS sweep


7 STEPS YOU CAN TAKE TO PREPARE:
  1. Review your SCAN monthly Encounter Submission Reports
    1. June reports were uploaded to the SCAN Encounter Data Portal on 06/13/2017. The next ESRs will be uploaded the first week of July 2017.

2.       Review your SCAN Encounter HCC Reconciliation Reports
    1. This report is available to you monthly. If you would like to utilize this report for the September Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.
b.      Reports with dates specific to the September CMS sweep dates 07/01/2016 à 06/30/2017 will be uploaded before end of week 07/14/17.
  
  1. Review your SCAN All DX Reconciliation Reports
    1. This report is available to you monthly. If you would like to utilize this report for the September Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.
§ QUESTION: What is the All Diagnoses (DX) Reconciliation report?
§ ANSWER: A report containing all diagnosis codes received from your group for dates of service 07/01/2016 à 06/30/2017.
    1. This report can be leveraged along with the HCC Reconciliation report to match up to your database and ensure all of your encounter data has been sent to SCAN.

  1. Review your SCAN PCN Reconciliation Reports
    1. This report is available to you monthly. If you would like to utilize this report for the September Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.
§  QUESTION: What is the Patient Control Number (PCN) Reconciliation report?
§  ANSWER: A report containing a list of all the PCNs received from your group for dates of service 07/01/2016 à 06/30/2017. The PCN field provides you with the ID received from you for each encounter (a.k.a. claim ID). You may reconcile the list of PCNs against your system to ensure that SCAN has received all of your PCNs. If any are missing on our list that exist in your system, then you can identify those as needing to be submitted to SCAN immediately
    1. If you are already reconciling against the PCN report, then continue to do so and provide an update on results as soon as available.

*The above reports are designed to help you ensure that all possible encounter data for SCAN members has been sent to SCAN to meet the CMS health plan cut-off date of September 8, 2017.

Additional Steps:
  1. Work your clearinghouse rejections via OfficeAlly, Ability Network, or Change Healthcare

  1. Upload all ICE alternative submission files to SCAN via the Encounter Data Portal (providerportal.scanhealthplan.com) using the File Transmission link
    1. It is your responsibility to ensure that the file uploaded is processed successfully. Due to the larger number of files received during sweep timeframes, it becomes very difficult to provide 1:1 attention on these files. Please refer to the SCAN ICE file specifications located on the SCAN Encounter Data portal or you may email me to request the documents to ensure the success of your file upload.
    2. Send these files sooner than later; please do not to wait until September 1, 2017 to upload your files.
    3. ICE files should only be used to submit additional DX codes or deletes of DX codes.
§ SCAN expects to receive all original encounter data records via your normal clearinghouse workflow.

  1. Follow up on additional cleanup requests (contact your respective encounter data representative with your direct questions)
    1. Provider Name Mismatch (PNM) rejection reports
    2. Rendering Provider/Entity (RPX) rejection reports
    3. EDS Full Encounter Data rejection reports

What are the Timelines?
  1. Submit all 07/01/2016 à 06/30/2017 DOS encounters to your Clearinghouse: 08/11/2017
  2. Last day for ICE file submissions of additions/deletions of DX codes for 07/01/2016 à 06/30/2017 to SCAN: 08/11/2017
  3. CMS Sweep deadline for SCAN: 09/08/2017

* Remember: SCAN has two dates for provider partners to manage towards:
Ø  SCAN Target Date for Provider Partners: EOB Friday, August 11, 2017
o   This target date ensures that SCAN has adequate time to complete processing prior to the health plan cut-off date by CMS

Ø  SCAN Deadline for Provider Partners: EOB Friday, September 1, 2017
o   After this deadline, SCAN will NOT process any files received for the September CMS sweep

Please be prepared for continued communication from SCAN. We look forward to supporting and working with you during this upcoming sweep period!
  
If you have any questions or concerns, please feel free to contact me directly or reach out to your assigned SCAN HCI Project Representative:
o   Michelle Nguyen: MNguyen3@scanhealthplan.com

Best regards,

Christina Cabiltes
Supervisor, HCI Projects

Tuesday, July 25, 2017

Updated Reminder from our Encounter Team

Hello SCAN Provider Partners,

The September CMS Encounter Data Sweep is approaching. We are 3 weeks away from SCAN’s Target Date! This is the INITIAL CMS sweep impacting 2017 DOS (2018 payment) and requires the submission of encounters for DOS range:
  • 07/01/2016 à 06/30/2017

SCAN has two dates for you to manage towards:
Ø  SCAN Target Date for Provider Partners: EOB Friday, August 11, 2017
o   This target date ensures that SCAN has adequate time to complete processing prior to the health plan cut-off date by CMS

Ø  SCAN Deadline for Provider Partners: EOB Friday, September 1, 2017
o   After this deadline, SCAN will NOT process any files received for the September CMS sweep


7 STEPS YOU CAN TAKE TO PREPARE:
  1. Review your SCAN monthly Encounter Submission Reports
    1. June reports were uploaded to the SCAN Encounter Data Portal on 06/13/2017. The next ESRs will be uploaded the first week of July 2017.

2.       Review your SCAN Encounter HCC Reconciliation Reports
    1. This report is available to you monthly. If you would like to utilize this report for the September Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.
b.      Reports with dates specific to the September CMS sweep dates 07/01/2016 à 06/30/2017 will be uploaded before end of week 07/14/17.
  
  1. Review your SCAN All DX Reconciliation Reports
    1. This report is available to you monthly. If you would like to utilize this report for the September Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.
§ QUESTION: What is the All Diagnoses (DX) Reconciliation report?
§ ANSWER: A report containing all diagnosis codes received from your group for dates of service 07/01/2016 à 06/30/2017.
    1. This report can be leveraged along with the HCC Reconciliation report to match up to your database and ensure all of your encounter data has been sent to SCAN.

  1. Review your SCAN PCN Reconciliation Reports
    1. This report is available to you monthly. If you would like to utilize this report for the September Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.
§  QUESTION: What is the Patient Control Number (PCN) Reconciliation report?
§  ANSWER: A report containing a list of all the PCNs received from your group for dates of service 07/01/2016 à 06/30/2017. The PCN field provides you with the ID received from you for each encounter (a.k.a. claim ID). You may reconcile the list of PCNs against your system to ensure that SCAN has received all of your PCNs. If any are missing on our list that exist in your system, then you can identify those as needing to be submitted to SCAN immediately
    1. If you are already reconciling against the PCN report, then continue to do so and provide an update on results as soon as available.

*The above reports are designed to help you ensure that all possible encounter data for SCAN members has been sent to SCAN to meet the CMS health plan cut-off date of September 8, 2017.

Additional Steps:
  1. Work your clearinghouse rejections via OfficeAlly, Ability Network, or Change Healthcare

  1. Upload all ICE alternative submission files to SCAN via the Encounter Data Portal (providerportal.scanhealthplan.com) using the File Transmission link
    1. It is your responsibility to ensure that the file uploaded is processed successfully. Due to the larger number of files received during sweep timeframes, it becomes very difficult to provide 1:1 attention on these files. Please refer to the SCAN ICE file specifications located on the SCAN Encounter Data portal or you may email me to request the documents to ensure the success of your file upload.
    2. Send these files sooner than later; please do not to wait until September 1, 2017 to upload your files.
    3. ICE files should only be used to submit additional DX codes or deletes of DX codes.
§ SCAN expects to receive all original encounter data records via your normal clearinghouse workflow.

  1. Follow up on additional cleanup requests (contact your respective encounter data representative with your direct questions)
    1. Provider Name Mismatch (PNM) rejection reports
    2. Rendering Provider/Entity (RPX) rejection reports
    3. EDS Full Encounter Data rejection reports

What are the Timelines?
  1. Submit all 07/01/2016 à 06/30/2017 DOS encounters to your Clearinghouse: 08/11/2017
  2. Last day for ICE file submissions of additions/deletions of DX codes for 07/01/2016 à 06/30/2017 to SCAN: 08/11/2017
  3. CMS Sweep deadline for SCAN: 09/08/2017

* Remember: SCAN has two dates for provider partners to manage towards:
Ø  SCAN Target Date for Provider Partners: EOB Friday, August 11, 2017
o   This target date ensures that SCAN has adequate time to complete processing prior to the health plan cut-off date by CMS

Ø  SCAN Deadline for Provider Partners: EOB Friday, September 1, 2017
o   After this deadline, SCAN will NOT process any files received for the September CMS sweep

Please be prepared for continued communication from SCAN. We look forward to supporting and working with you during this upcoming sweep period!
  
If you have any questions or concerns, please feel free to contact me directly or reach out to SCAN’s Encounter Data Specialist:
o   Steve Vo: svo@scanhealthplan.com

Best regards,

Christina Cabiltes
Supervisor, HCI Projects

Monday, July 17, 2017

*IMPORTANT* -- SCAN Dates for Upcoming September 2017 Encounter Data CMS Sweep

Special Notice to SCAN Providers


Hello SCAN Provider Partners,

The September CMS Encounter Data Sweep is approaching. We are 4 weeks away from SCAN’s Target Date! This is the INITIAL CMS sweep impacting 2017 DOS (2018 payment) and requires the submission of encounters for DOS range:
  • 07/01/2016 à 06/30/2017

SCAN has two dates for you to manage towards:
Ø  SCAN Target Date for Provider Partners: EOB Friday, August 11, 2017
o   This target date ensures that SCAN has adequate time to complete processing prior to the health plan cut-off date by CMS

Ø  SCAN Deadline for Provider Partners: EOB Friday, September 1, 2017
o   After this deadline, SCAN will NOT process any files received for the September CMS sweep


7 STEPS YOU CAN TAKE TO PREPARE:
  1. Review your SCAN monthly Encounter Submission Reports
    1. June reports were uploaded to the SCAN Encounter Data Portal on 06/13/2017. The next ESRs will be uploaded the first week of July 2017.

2.       Review your SCAN Encounter HCC Reconciliation Reports
    1. This report is available to you monthly. If you would like to utilize this report for the September Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.
b.      Reports with dates specific to the September CMS sweep dates 07/01/2016 à 06/30/2017 will be uploaded before end of week 07/14/17.
  
  1. Review your SCAN All DX Reconciliation Reports
    1. This report is available to you monthly. If you would like to utilize this report for the September Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.
§ QUESTION: What is the All Diagnoses (DX) Reconciliation report?
§ ANSWER: A report containing all diagnosis codes received from your group for dates of service 07/01/2016 à 06/30/2017.
    1. This report can be leveraged along with the HCC Reconciliation report to match up to your database and ensure all of your encounter data has been sent to SCAN.

  1. Review your SCAN PCN Reconciliation Reports
    1. This report is available to you monthly. If you would like to utilize this report for the September Sweep, please access the EDP SCAN Documents tab -> HCCs and Encounters.
§  QUESTION: What is the Patient Control Number (PCN) Reconciliation report?
§  ANSWER: A report containing a list of all the PCNs received from your group for dates of service 07/01/2016 à 06/30/2017. The PCN field provides you with the ID received from you for each encounter (a.k.a. claim ID). You may reconcile the list of PCNs against your system to ensure that SCAN has received all of your PCNs. If any are missing on our list that exist in your system, then you can identify those as needing to be submitted to SCAN immediately
    1. If you are already reconciling against the PCN report, then continue to do so and provide an update on results as soon as available.

*The above reports are designed to help you ensure that all possible encounter data for SCAN members has been sent to SCAN to meet the CMS health plan cut-off date of September 8, 2017.

Additional Steps:
  1. Work your clearinghouse rejections via OfficeAlly, Ability Network, or Change Healthcare

  1. Upload all ICE alternative submission files to SCAN via the Encounter Data Portal (providerportal.scanhealthplan.com) using the File Transmission link
    1. It is your responsibility to ensure that the file uploaded is processed successfully. Due to the larger number of files received during sweep timeframes, it becomes very difficult to provide 1:1 attention on these files. Please refer to the SCAN ICE file specifications located on the SCAN Encounter Data portal or you may email me to request the documents to ensure the success of your file upload.
    2. Send these files sooner than later; please do not to wait until September 1, 2017 to upload your files.
    3. ICE files should only be used to submit additional DX codes or deletes of DX codes.
§ SCAN expects to receive all original encounter data records via your normal clearinghouse workflow.

  1. Follow up on additional cleanup requests (contact your respective encounter data representative with your direct questions)
    1. Provider Name Mismatch (PNM) rejection reports
    2. Rendering Provider/Entity (RPX) rejection reports
    3. EDS Full Encounter Data rejection reports

What are the Timelines?
  1. Submit all 07/01/2016 à 06/30/2017 DOS encounters to your Clearinghouse: 08/11/2017
  2. Last day for ICE file submissions of additions/deletions of DX codes for 07/01/2016 à 06/30/2017 to SCAN: 08/11/2017
  3. CMS Sweep deadline for SCAN: 09/08/2017

* Remember: SCAN has two dates for provider partners to manage towards:
Ø  SCAN Target Date for Provider Partners: EOB Friday, August 11, 2017
o   This target date ensures that SCAN has adequate time to complete processing prior to the health plan cut-off date by CMS

Ø  SCAN Deadline for Provider Partners: EOB Friday, September 1, 2017
o   After this deadline, SCAN will NOT process any files received for the September CMS sweep

Please be prepared for continued communication from SCAN. We look forward to supporting and working with you during this upcoming sweep period!
  
If you have any questions or concerns, please feel free to contact me directly or reach out to SCAN’s Encounter Data Specialist:
o   Steve Vo: svo@scanhealthplan.com

Best regards,

Christina Cabiltes

Supervisor, HCI Projects
CCabiltes@scanhealthplan.com

Monday, April 17, 2017

Free Continuing Education From the CDC

The Centers for Disease control is offering free CEUs to the following:  Physicians, Physician Assistants, Nurse Practitioners, Registered Nurses, Health Educators, Pharmacists, Pharmacy Technicians, Medical Residents, Epidemiologists, Laboratorians, and Administrators.

The topic of the webinar is:
Webinar:       Lessons from an Outbreak Investigation: Improving Medication Preparation, Use, and Other Infection Control Practices in Outpatient Oncology Clinics
Date:
Tuesday, April 18, 2017 Time:         2:00–3:00 p.m. EDT
Sign up:
View webinar invitation and pre-register (at no cost) HERE



Please share this valuable information with your physician, pharmacist and other colleagues.

Tuesday, September 13, 2016

Changes to Diabetes Coding Rules Create Challenges

In Q1 2016, Coding Clinic published a question and answer about "Diabetes with Associated Conditions".

On the surface, this new rule seems great--here's an excerpt from AHA's Coding Clinic:


Question:

"The ICD-10-CM Alphabetic Index entry for 'Diabetes with' includes listings for conditions associated with diabetes...Does the provider need to document a relationship between the two conditions or should the coder assume a causal relationship?"

Answer:

"... the term "with" means "associated with" or "due to," when it appears in a code title, the Alphabetic Index, or an instructional note in the Tabular List,... The classification assumes a cause-and-effect relationship between diabetes and certain diseases of the kidneys, nerves, and circulatory system....

It is not required that two conditions be listed together in the health record. However, the provider needs to document the linkage, except for situations where the classification assumes an association ...When the provider establishes a linkage or relationship between the two conditions, they should be coded as such. .... The fact that a patient has two conditions that commonly occur together does not necessarily mean they are related...."

All of this sounds like it should make things easier for both physicians and coders.  However, the opposite can be true.

As coders, it's our job to educate physicians on coding rules.  But I think this Coding Clinic ruling, and other similar ones, as potential minefields.  Physicians, by the very nature of their jobs, have to keep current with a large amount of very complex information.  Educating physicians on a rule like this has the potential to backfire.

The physician is unlikely to go to the ICD-10 and check the code title, then to the Alphabetic Index, and  continue on to search for instructional notes in the Tabular list to determine if the term "with" is present.  That may lead them to assume that the rule applies in cases where it doesn't.

There is no harm in documenting the association between two diseases, but there can be tremendous harm (in an audit situation) in failing to document that association if the rule does not apply.

So, how can we best educate our physicians?  I think that explaining that there are some limited cases where a causal relationship is assumed is a good approach.  But with that explanation, physicians must also be told that the majority of the time, a  causal relationship is NOT assumed, and that trying to remember which is which is difficult for coders who do this all day long.  The safest approach is to state the causal relationship, which ensures that coders can code what the physician actually means.  Give them examples--and make sure those examples demonstrate how this can be done without significantly increasing their workload.  By simply adding a few words, the physician can convey their clinical judgement that one disease cause another--for example "CKD 4 2DM2" clearly shows the physician's diagnosis that type 2 diabetes mellitus caused the patient's stage 4 kidney disease.  And it means that doctors don't have one more thing to remember.

While telling our physicians about these rules in detail may seem like a good idea, it can increase the likelihood of errors.


What coding and educational challenges do you face?  Do you have ideas for helping providers navigate documentation issues?  Be sure to leave us a comment, or send ideas you would like to share to coding@scanhealthplan.com.


Tuesday, July 19, 2016

Encounter Data Filtering Logic Updates

As you probably know, CMS has provided guidance regarding the filtering of encounter data for risk adjustment purposes.  This doesn't mean that either Medical Groups or Health Plans should not submit certain encounters- CMS requires that ALL encounter data must be submitted to them.

Currently, encounter data represents 25% of the calculation of risk scores.  CMS plans to increase the weighting of encounter data-based risk scores over the next couple of years by moving to a risk score incorporating 50% of the encounter data/FFS-based risk score in 2018, a risk score incorporating 75% of the encounter data/FFS-based risk score for 2019, and a risk score of 100% encounter data/FFS-based risk score in 2020,

The logic that they use to determine what encounters are included is laid out in this 2015 memo from CMS to health plans.  At the same time, CMS released a list of procedure codes that would be used for filtering professional and outpatient hospital encounters.  

Recently, CMS released the list of 2015 codes and preliminary 2016 codes to be used for encounter data filtering.

When determining which encounters may be used in calculating risk scores, health plans and provider groups should refer to these documents, as well as reports received from CMS and health plans.  As CMS moves forward with using only encounter data for risk score calculation it will become more important than ever that your encounter data be accepted by the health plan and ultimately by CMS.  We will continue to provide you as much information as possible on our Encounter Data/ICD-10 Page.  CMS is currently hosting teleconferences with health plans, to keep them informed about changes to encounter data processing.  We'll post webinar slides like these, on duplicate record and demographic data fields processing, so you can stay up to date as well.

What other tools would be helpful to you?  Remember, if you have suggestions for HCC University, or the blog, you can contact us at coding@scanhealthplan.com.