Updates!

With the ICD-10 implementation date just around the corner, we at SCAN, and you as our Provider partners are working very hard.  There's so much information to filter through, it sometimes seems impossible to keep up with.

CMS has posted their DRAFT CPT/HCPCS filtering list.  What is on the list is not hugely problematic, but what's missing (Modifiers) is.  As you know, modifiers alter the meaning of the CPT/HCPC codes, and inclusion of some of those modifiers may be important.  Health Plans have until August 21st to comment.  You can rest assured that we're studying the list, and will make comments to CMS in a timely manner.

CMS also posted another important file: The updated CMS-HCC and Rx-HCC files.  As you know, CMS posted a draft file a little over a month ago--they've now taken it down and replaced it.  They are not calling this the final ICD-10 mapping, so we'll be sure to monitor the CMS website and post updates here.

We've posted a number of new Q and As on the Ask-a-coder page.   In addition, we've completely new Helpful Links page.  All of the links are now categorized, making it easier for you to find exactly what you're looking for.

Just as an FYI--when we have special or time sensitive posts to HCCUniversity.com, we usually send out an email blast.  These are sent infrequently, and usually no more often  than once a month.  If you'd like to be added to our growing list of HCCUniversity readers, please send your name and email address to coding@scanhealtplan.com, and we'll be sure to add you.

That's it for today.  As we get closer to ICD-10, we 're sure to hear things from CMS that are of importance to you. We'll pass them along here, on HCCUniversity.com and through our email blasts.


Stacey Hernandez, CCS-P          

Opportunity for *FREE* CMEs and CEUs

CMS is offering a new training course which will allow physicians and nurses to obtain free CMEs, and a new MedLearn training course that will allow coders (check with your accrediting body) to obtain CEUs!

First, CMS is offering a new article on Improving Care through Care Coordination via MedScape. Gain credits from this CME article on Improving Quality of Care Through Care Coordination. The article focuses on:
 • CMS programs aimed at improving care coordination and transitions
• Helpful, evidence-based strategies for providers to improve patient care coordination, including upcoming changes to billing and processes To view the articles, you must be a registered Medscape user. There is no cost to join. Links to CMEs are also available through the CMS Earn Credit web page!

For coders, CMS is offereing free CEUs for a new Medlearn Web Based Training Course (WBT) on the Home Health Benefit.  Many of CMS' web based training courses offer CEUs approved by the AAPC.  Check out all of the  WBTs here.

Check back here frequently for new information to help you navigate Medicare.

New Documents Posted to HCC University--and a Request

With the ICD-10 implementation date looming, we're increasing our focus on ICD-10 documentation and coding issues.  October 1 is very close!

We have recently posted a new link to the American Health Information Management's (AHIMA) ICD-10 superbill for primary care.

In addition, we've posted the full text of the Official ICD-10 Coding Guidelines and the 2015 ICD-10 Alphabetical Index, and the 2015 ICD-10 Tabular Listing of Diseases.

On our Presentations page, we have a Diabetes Coding in ICD-10 presentation.

We're currently creating a set of single page documentation tips for common coding situations.

But we know there's more we can give you to help you with this transition. We'd like you to send us suggestions for the following:

• Specific disease categories that you feel could benefit from a tip sheet
• Specific body system or disease states you feel you need presentations for you to use with your physicians, or for yourselves.

While we can't promise we'll be able to fill all requests, we'll do our very best.

Please send your suggestions to coding@scanhealthplan.com.  As always, we appreciate your feedback and help.

Thanks so much!

SCAN HCC Tools Team

ICD-10 Clinical Documentation Improvement Document

For those of you tasked with training and/or coding in ICD-10, there's an excellent resource on the American Health Information Management Association (AHIMA) website.  It's a 72 page document on clinical documentation improvement for ICD-10.  In other words, it's a guide to helping both coders and clinicians understand the documentation requirements for a number of ICD-10 codes.

While encoders and crosswalks may be able to point you in the right direction, all coding is done based on the documentation in the medical record.  This guide can help you understand the documentation requirements for a number of diagnoses and services.

The document is accessible to both AHIMA members and non-members in their body of knowledge, and can be downloaed here.

Advance Notice of 2016 Medicare Advantage and Part D Rates Released

On Friday, February 20, CMS released the proposed rules for Medicare Advantage Payment for 2016.

Comments to the proposed rule are due to CMS on March 6, 2015.  You can download the proposed rule on the CMS website.

The final rule will be released on April 6, 2015 in accordance with the law, and you'll be able to download it on the Announcements and Documents Page.

For an easy to read summary of the notice, you can download the CMS Press Release.

CMS plans to completely phase in the new CMS-HCC model, with no blend.

In addition, CMS is proposing that they will calculate 2016 MA and Part D risk scores by blending two separate risk scores.  One risk score would be calculated using 2015 diagnoses from the Risk Adjustment Processing System (RAPS) and Fee-For-Service (FFS) data, and another separate risk score would be calculated using 2015 diagnoses from the Encounter Data System (EDS) and FFS.  CMS would then blend these two risk scores, weighting the risk score from RAPS and FFS by 90% and weighting the risk score from EDS and FFS by 10%.  This will make the subission of all encounter data more important than ever before.

CMS has decided not to disallow services performed in the home setting, but health plans still must report services performed in the home.

We suggest you review the CMS documents, and download the final rule, which will likely be released late in the afternoon of April 6, 2015.

Can You Code From a Problem List?

Today we posted a collections of documents from CMS. These documents were Questions and Answers from a series of CMS Risk Adjustment  User Group Calls.  Among the answers is a question we get very frequently--Is it okay to code from a problem list?  To find out, check out the CMS User Group Q and A's on HCC University.

Medicare Fee-for-Service Update: Chronic Care Management

In the 2015 Medicare Physician Fee Schedule Final Rule, CMS approved Chronic Care Management.  This is not a capitated service, or automatically payable for any patient with 2 or more chronic conditions that are likely to decompensate  and cause hospitalization or death in the next 12 calendar months.

As mentioned, these are not automatic or capitated payments, and there are 5 important capabilities a provider must have in order to bill for these services.   In addition, they must have authorization from the beneficiary to communicate electronically with other providers to coordinate this care.  The beneficiary must be informed they can revoke this authorization at any time.

The five capabilities include: (1) Use a certified EHR for specified purposes in the rule;

(2) Maintain an electronic care plan and provide 24/7 access to it (3) Ensure beneficiary access to care; (4) Facilitate transitions of care; and (5) Coordinate care.

When a provider submits a claim for CCM, the provider is attesting to the fact the provider has met each of these capabilities in full, and there are many provisions to fulfill for each one.

Importantly, only one physician can bill for these services in a calendar month. While there is no speciality requirement, CMS seems to think that the PCP will be the one billing for the CCM. So, what qualifies a beneficiary for this service?

Those qualifications are laid out in CPT code 99487:

Complex chronic care management services, with the following required

elements:

• Multiple (two or more) chronic conditions expected to last at least 12

months, or until the death of the patient;

• Chronic conditions place the patient at significant risk of death, acute

exacerbation/decompensation, or functional decline;

• Establishment or substantial revision of a comprehensive care plan;

• Moderate or high complexity medical decision making;

• 60 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month

No physician or physician extender (NP, PA, CNS) should bill for Chronic Care Management without reviewing the 14 or so pages dedicated to it in the 2015 Medicare Physician Fee Schedule Final Rule.  If you don’t want to do that, you’ll need to wait for the billing instructions from your Medicare Administrative Contractor to ensure you’re following all the rules. 

While the code itself speaks about “staff time” it also speaks about complex medical decision making—physician staff cannot perform any portion of it that requires medical decision making—this is reserved for clinicians who can make a diagnosis.  So, this is not merely a staff activity.  Medicare envisions this as a component to the overall care of chronically ill patients, and not a replacement to that care.