Third Party Archives - Tennessee Association of Optometric Physicians

From CMS: Open Payments System Reopens, Extends Physician Registration and Review Period

From CMS Press Release:

CMS announced today that the Open Payments system is once again available for physicians and teaching hospitals to register, review and, as needed, dispute financial payment information received from health care manufacturers. The system was taken offline on August 3 to resolve a technical issue. To account for system down time, CMS is extending the time for physicians and teaching hospitals to review their records to September 8, 2014. The public website will be available on September 30, 2014.

“CMS takes data integrity very seriously and took swift action after a physician reported a problem,” said CMS Deputy Administrator and Director of the Center for Program Integrity Shantanu Agrawal, M.D. “We have identified the root cause of the problem and have instituted a system fix to prevent similar errors. We strongly encourage physicians to review their records before the deadline and before the data are posted publically to identify any discrepancies.”

A full investigation into a physician complaint found that manufacturers and group purchasing organizations (GPOs) submitted intermingled data, such as the wrong state license number or national provider identifier (NPI), for physicians with the same last and first names. This erroneously linked physician data in the Open Payments system.

CMS has implemented system fixes to resolve the issue, and revalidated all data in the system to verify that the physician identifiers used by the applicable manufacturer or GPO are accurate, and that all payment records are attributed to a single physician. Incorrect payment transactions have been removed from the current review and dispute process and this data will not be published.

CMS remains committed to ensuring the data made public from the system is as accurate as possible and extended the time for review and dispute to provide physicians and teaching hospitals with a full 45 days.

New ICD-10 Compliance deadline established (again)

On Friday, CMS issued a final ruling establishing the new compliance deadline for the transition to ICD-10. The new deadline (as many had guessed/projected) is October 1, 2015. This should allow practices more than ample time to begin preparations (again). Be sure to begin by contacting your EHR vendor to learn about their preparedness and how they will assist in the transition. Read more here:

http://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-07-31.html

ICD-10 Basics: Unspecified Diagnosis Codes, CPT Codes, and Version 5010 Standards

The Department of Health & Human Services (HHS) expects to release a final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015. The new compliance date would give providers an extra year to prepare. Now is a great time to brush up on ICD-10 basics as you get ready for the transition.

If you missed the June 4 MLN Connects National Provider Call, More ICD-10 Coding Basics, a written transcript and audio recording are now available.

And for a quick refresher on a few ICD-10 basics where the Centers for Medicare & Medicaid Services (CMS) frequently receives questions, read on!

Unspecified Diagnosis Codes

In both ICD-9 and ICD-10, sign/symptom and “unspecified” diagnosis codes have acceptable, even necessary, uses. While specific diagnosis codes should be reported when they are supported by the available medical record documentation and clinical knowledge of the patient’s condition, there are instances when signs/symptoms or unspecified codes are the best choices for accurately reflecting the health care encounter. Each health care encounter should be coded to the level of certainty known for that encounter.

If a definitive diagnosis has not been established by the end of the encounter, it is appropriate to report codes for sign(s) and/or symptom(s) in lieu of a definitive diagnosis. When sufficient clinical information isn’t known or available about a particular health condition to assign a more specific code, it is acceptable to report the appropriate “unspecified” code (e.g., a diagnosis of pneumonia has been determined, but not the specific type). In fact, unspecified codes should be reported when they are the codes that most accurately reflect what is known about the patient’s condition at the time of that particular encounter. It would be inappropriate to select a specific code that is not supported by the medical record documentation or to conduct medically unnecessary diagnostic testing in order to determine a more specific code.

CPT Codes

The transition to ICD-10 does not affect Current Procedural Terminology (CPT) coding for outpatient procedures. Like ICD-9 procedure codes, ICD-10 procedure codes (ICD-10-PCS) are for hospital inpatient procedures only.

Version 5010

You must be using Version 5010 HIPAA standards in order to conduct electronic transactions with ICD-10. The earlier, Version 4010 HIPAA standards cannot accommodate the longer ICD-10 codes.

Most organizations began using Version 5010 in 2012, when compliance became mandatory under HIPAA. Any providers or organizations still using Version 4010 for electronic transactions are in violation of HIPAA.

If you are not certain whether you are Version 5010-compliant, check with your health IT professional or your clearinghouse or billing service.

Find Out More About the Basics in the Road to 10

To find out more about ICD-10 basics and beyond—including how to build an action plan, update your processes, and test your readiness—check out the Road to 10 resource for small medical practices, available at cms.gov/ICD-10.

Keep Up to Date on ICD-10

Visit the CMS ICD-10 website for the latest news and resources to help you prepare. Sign up for CMS ICD-10 Industry Email Updates and follow us on Twitter.

Report on PQRS measures now

If you haven't started participating in the Physician Quality Reporting System (PQRS) for 2014, time is running out to report on quality measures, earn a bonus and avoid penalties. The AOA encourages more ODs to participate in PQRS, which will likely be a key component of any future Medicare payment model.

Providers must report accurately on at least nine measures for 50 percent of their applicable patients to receive a 0.5 percent incentive payment in 2015. Those who don't participate at all face a 2 percent penalty in 2016. Reporting successfully on just three of the measures means you avoid the penalty-but won't earn a bonus.

The reporting period is for all of 2014, so there's no firm deadline to begin PQRS. However, most doctors should probably start reporting by the middle of the year if they haven't already—assuming they have a similar number of patients in the first half of the year and the second.

"It's important to begin now so that you can reach the 50 percent accuracy and cases required to meet the PQRS bonus goals," says Rebecca Wartman, O.D., member of the AOA Third Party Center Coding Committee. "If you wait until June but actually saw more Medicare patients between January and June who met the criteria to add PQRS codes, then you would not earn the 2015 bonus."

ODs have at least 10 PQRS measures to choose from:

Three for diabetic patients
Two for glaucoma patients
Two for macular degeneration patients
Tobacco use and counseling
Hypertension and follow-up, and
Medication listing

There is no sign-up required. ODs can immediately begin by reporting the quality data codes that correspond to the applicable quality measure on their Medicare claims.

OD reporting rates are on the rise

AOA research on 2012 PQRS statistics found that participation is on the rise, but there's room for growth:

OD participation rose from 28.6 percent in 2011 to 32 percent in 2012; by comparison, ophthalmology grew from 46.6 percent to 55 percent

ODs ranked 37th in participation rates out of 55 eligible specialties

Optometry was the fifth-highest non-MD/DO specialty participating in PQRS

ODs earned $1,810,832 in PQRS incentive bonuses, compared with ophthalmologists, who earned$15,921,621

Access the AOA's webinar on PQRS and other resources at eyelearn.aoa.org.

Congress approves one-year Medicare payment fix, extends ICD-10 deadline

Congress has issued a yearlong fix to Medicare's physician payment formula, but the fight for a permanent solution is far from over.

Medicare's sustainable growth rate formula has threatened automatic payment cuts to Medicare physicians for more than a decade. Congress on multiple occasions has approved temporary "patches" to prevent these reductions from taking effect. The most recent patch had been scheduled to expire on March 31.

Averting the cuts once again, House and Senate lawmakers approved legislation that provides a temporary solution for a year. The legislation replaces a 24 percent reduction to Medicare physicians with a 0.5 percent increase through Dec. 31, freezing Medicare payments until April 1, 2015.

It also pushes the implementation date for the International Classification of Diseases, Tenth Revision (ICD-10) back by a year to Oct. 1, 2015.

As expected, President Obama signed the bill into law on April 1.

"With the one-year patch in place, again the financial uncertainty is removed so Congress can work on the complete repeal of the SGR and put in place a long-term program that will work for all physicians," says Roger Jordan, O.D., who chairs the AOA Federal Relations Committee.

Advocacy for a long-term solution

As lawmakers continue to seek a permanent solution to Medicare's payment issues, the AOA urges members to attend its Congressional Advocacy Conference. The conference offers opportunities to meet directly with lawmakers to ensure any program changes fully recognize ODs as physicians and safeguard patient access to ODs.

"The AOA has made it clear to both House and Senate leaders that our full physician status in Medicare is non-negotiable," says AOA President Mitchell T. Munson, O.D.

"On several occasions, the AOA sought and won optometry-specific changes to advancing Medicare payment bills. It's clear that our profession is being heard loud and clear on Capitol Hill, thanks to the hard work of the AOA and optometry's army of grassroots advocates," Dr. Munson says.

Bill extends ICD-10 and other deadlines

The AOA and state affiliates had been working to help members prepare for the transition to ICD-10, originally scheduled for Oct. 1, 2014. Providers now have until Oct. 1, 2015, to prepare for ICD-10.

Many ODs had been wondering if their offices would be adequately trained in time to meet ICD-10's previous deadline for 2014, Dr. Jordan says. "We all were also concerned that the vendors could meet the deadline."

The bill also extends the 1.0 work floor on the Geographic Pricing Cost Index by a year. This provision "is crucial for those optometrists that practice in a less expensive region to keep their current reimbursement up," Dr. Jordan explains.

Lawmakers indicated they would continue to work on a long-term Medicare payment solution.

The yearlong patch "does not preclude any work from being done on the long-term fix in terms of how we pay doctors," U.S. House Speaker Rep. John Boehner (R-Ohio) said at a March 26 press conference. "I think we need to take this step first."

The AOA will monitor Congress' progress and voice any concerns on behalf of members, Dr. Jordan says. "We will not be left on the outside looking in on any programs. We are physicians and will continue to assure that status in Medicare."