CMS Posts New ICD-10 Clinical Content

CMS continues to post clinical content, common ICD-10 codes and coding vignettes for providers.  The latest is OB/ GYN, and it can be viewed here. 

One problem with some of CMS content in the past--they assumed that physicians understand documentation requirements, and all content tells physicians what to code for what disease.   The site has been beefed up, and there are Clinical Documentation tips now

I strongly recommend this site for clinicians and coders alike--coders and physicians must follow the same rules when coding--and all of those rules are based on clinical documentation and the ICD-10 Official Guidelines for Coding and Reporting, available free of charge on the National Center for Health Statistics website.  All other ICD-10 content is there as well at www.cdc.gov/nchs.

Although the guidelines are long, physicians can read only those specialty specific guidelines that they normally treat, along with the section on Outpatient Coding (all physician coding uses the outpatient guidelines, regardless of where the services were rendered).

And remember, SCAN contracted providers can send coding questions to us at: Coding@scanhealthplan.com.

The SCAN Tools Team

SCAN Memo On Encounter Data Submission Deadlines

The SCAN Encounter Data Team has published the memo below, and sent it to all Encounter Data contacts.  We're reprinting the content here, to enable you to better support your Encounter Data staff in timely submissions.  As noted below, if you have questions regarding this memo, please email them to Encounters_Operation@scanhealthplan.com with the subject line ‘SCAN Dates for Submission of Risk Adjustment Data to CMS’.

______________________________________________________________________

To: All SCAN Provider Partners, including Groups, Hospitals and Ancillary Providers
CC: SCAN Encounter Data Team
From: SCAN Health Plan
Date: 7/2/2015
Re: *IMPORTANT* -- SCAN Dates for Submission of Risk Adjustment Data to CMS
Below are SCAN dates for the next five CMS Sweeps for risk adjustment data. Please note, in addition to the CMS deadline for Health Plans, SCAN has created two key submission dates for our Provider Partners: 1) SCAN Target Date and 2) SCAN Deadline.
SCAN Target Date
The “SCAN Target Date” (yellow in the below matrix) is the date after which any new data received is subjected to increased scrutiny and is at some risk of not being processed with CMS for that sweep. This date is approximately 4 weeks prior to each of the CMS deadlines, and has been set to ensure that SCAN has adequate time to complete processing prior to the cut-off by CMS. Again, any data received after this date will be subject to additional scrutiny which may include (but is not limited to) successfully passing a random chart validation. After the additional scrutiny is concluded, the data will be submitted to CMS but SCAN cannot guarantee that this will occur prior to the CMS deadline for Health Plans.
Note: If your organization uses a clearinghouse, all encounter data should be received by the clearinghouse well before the SCAN Target Date to ensure CMS processing. Any files that are submitted directly to SCAN (i.e. ICE files), must also be received by the SCAN Target Date.
SCAN Deadline
The “SCAN Deadline” (red in the below matrix) is the date after which any data received will NOT be processed for that sweep. This is an important change that SCAN is making for each CMS sweep period. This will be the final date SCAN will receive any data that may be sent to CMS prior to the Sweep Deadline for Health Plans.
Note: While the SCAN Deadline is the critical date for each sweep, it is especially so for the final CMS sweeps (highlighted in blue in the below matrix) for any given calendar year. Please mark your calendars now for 1/22/2016, the next SCAN Deadline prior to a final sweep!

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.