Preparing for 2016
New for 2016
ICD-10 Transition Moves Forward
On October 1,
2015 health systems across the country transitioned to the International
Classification of Diseases, 10th Revision – ICD-10. This change will enable
providers to capture more details about the health status of their patients to
improve patient care and public health surveillance.
CMS has been
carefully monitoring the transition and is pleased to report that claims are
processing normally. Generally speaking, Medicare claims take several days to
be processed and, once processed, Medicare must– by law – wait two weeks before
issuing a payment.
Keep in mind that CMS has
not monitored specificity, correct grouping or other potential flags.
2017 PQRS
Payment Adjustments Based on 2015 Reporting
- There
is no PQRS incentive in 2015 and beyond. Also, the additional incentive
for Maintenance of Certification is no longer available.
- The
2017 automatic downward adjustment for not successfully reporting PQRS in
2015 is -2.0%. This penalty amount applies to all eligible professionals
(EPs).
CMS proposes to
make changes to the PQRS measure set to add measures where gaps exist, as well
as to eliminate measures that are topped out, duplicative, or are being
replaced with a more robust measure. If all measure proposals are
finalized, there will be 300 measures in the PQRS measure set for 2016.
2016 HEDIS
New HEDIS technical
specifications include six new measures, retirement of one measure and one
HEDIS guideline, and changes to three existing measures and two guidelines.
2016 OIG’s
2016 Work Plan
The U.S
Department of Health and Human Services (HHS) Office of Inspector General (OIG)
Work Plan for fiscal year (FY) 2016 sums up new and ongoing activities that OIG
plans to pursue during the fiscal year and beyond.
2016 Quality Measures
Performance
measurement — if done right — can be a core activity to move the health care
system to higher value for the American public, while rewarding health
professionals and health care institutions for doing the right thing for their
patients. Yet, policy makers, private and public, have a duty to the public,
patients, and providers to get it right — to measure and report accurately and
meaningfully.
New CPT
Codes for 2016
Every year on
January 1st, the CPT is updated with new, revised and deleted codes. Your staff
will need to be ready to implement these changes when coding records as well as
updating the superbill. A number of new radiology and radiation oncology codes
are anticipated for 2016. A total of 40 new codes will impact radiology.
CMS show increasing support for value-based care
The shift from fee-for-service to fee-for-value necessitates
that providers optimize their operations and align costs with clinical outcomes.
Let’s improve Coding
& Reimbursement Now
Since 1983 we have been helping physicians to operate practices as a
business, over 500 Medicare and Medicaid audits have given us the knowledge to
develop the AccuChecker Product Line including Claims Scrubbers and for the 10
years we have been involved in HMOs Risk Management and have developed the MCAR
Reports – Managed Care Reports.
For more details, call us, and see how AccuChecker can assist you.
FOR MORE INFORMATION
HPP Management Group, Corp.
5201 Blue Lagoon, Suite 800
Miami, FL 33126
Phone: (305) 227-2383 or 1877-938-9311
Email: psilben@hppcorp.com
