What's New For the rest of 2014 and Beyond?

It seems like Risk Adjustment for Medicare Advantage is ever-evolving.   According to a Final Rule, published by CMS in the Federal Register on May 23, 2014, the one thing we can certainly expect more of is audits.

CMS will be introducing a Recovery Audit Contractor (RAC) for Part C, slated before the end of 2014.  RAC auditors use a combination of methods, including medical record review and automated edits, to identify improper payments.  Currently, there are RAC contractors in Part A, B and D--so the addition of a Part C RAC will mean that all of Medicare is under RAC audits.

We don't yet know what RAC audits for Part C will look like--but if you want to stay ahead of the curve, you should be looking at your data for any anomalies now.  Speaking at an America's Health Insurance Plans conference, Sonja Brown, a health insurance specialist in the Center for Program Integrity in CMS’s Division of Plan Oversight and Accountability,initial areas of review are end-stage renal disease (ESRD), hospice and Medicare as Secondary Payer (MSP).

In addition to the RAC, beginning in 2015, the OIG will be doing their own Risk Adjustment Data Validation Audits (RADV), which we assume will look just like a CMS RADV, but may be more targeted.

This means that with so many audits going on simultaneously, it will be the rare medical group that is not affected.  Medical groups should be doing their own internal chart reviews to determine where more physician education is needed.

We'll continue to keep you up to date on new and changing rules from CMS as we become aware of them.

ICD-10 Webcast for Internal Medicine and Family Practice Posted

This morning, CMS posted a new webcast, aimed at primary care physicians on their Roadto10.org website:  

An AHIMA-certified coder presents training focused on unique ICD-10 clinical documentation needs and hot topics for each medical specialty. The five webinars will follow the same outline and objectives catering to each medical specialty with specific examples.

• Physician Perspective/clinical impact of ICD-10
• Documentation requirements for certain conditions
• Documentation changes and new concepts
• Use of “unspecified” in ICD-10

This webcast features Dr. Maggie Gaglione, a board certified internist and bariatrics specialist, a physician in private practice in Virginia.  Per Dr. Gaglione:

“Comprehensive documentation is key to identifying and assigning the best diagnosis code. By doing our part, and focusing on how we document our patients’ condition we put the foundation in place to drive value based quality and improve the health of populations served.”

You can view this webcast here.

CMS Offers New ICD-10 Content

As part of their ongoing "Road to 10" series, CMS has posted a newly released webcast on ICD-10 documentation and coding concepts for cardiology.  You can access this webcast here, on the webcasts page of The Road to 10: The Small Physician Practice's Guide to ICD-10 website.


An AHIMA-certified coder presents on the webcast, which focuses on unique ICD-10 clinical documentation needs and hot topics for cardiology:

• • Physician perspective/clinical impact of ICD-10
• • Documentation requirements for certain conditions
• • Documentation changes and new concepts
• • Use of "unspecified" codes in ICD-10

In addition to the newly posted Cardiology webcast, you can find webcasts geared toward Orthopedic Surgery, OB/GYN and Pediatrics.   There will soon be a Family Practice/Internal Medicine webcast as well.  

In addition to these specialty geared webcasts, the website contains a wealth of ICD-10 related information, including a guide to building an action plan, and templates that you can use with that action plan.

We encourage you to visit the website for authoritative information on ICD-10-CM.