Wednesday, September 28, 2011

Don't limit risk-adjustment training to your hospital's IT staff

Don't limit risk-adjustment training to your hospital's IT staff:
With upcoming changes under health reform and pressures to gain revenue, healthcare institutions must make risk-adjustment training a must for all stakeholders, according to Joy Ridlehuber, senior clinical training specialist at Fort Worth-based Leprechaun, LLC, which outsources hierarchical condition category (HCC) management solutions for Medicare advantage plans.
"You really must have a training program no matter what type of organization you are," Ridlehuber said at the Opal Events' Medicare Advantage Strategic Business Symposium in Arlington (Va.) on Tuesday. Risk-adjustment training applies to the small practice all the way up to the large institution, she added.
In addition, training shouldn't be isolated to only staff in coding, health information management, or IT; it must be expanded to providers, care management, client services, and vendors, as well. For example, Ridlehuber said, an IT professional might not have a healthcare background, or vice versa.
"Risk adjustment translates to higher reimbursement with more specific documentation," Ridlehuber said. "You don't want to leave money on the table when you need that to care for members," she added.
In addition, Medicare Advantage members will increasingly play a role in reimbursement as they provide feedback for the 5-star quality rating system mandated in 2010. With ICD-10 pressures and EMR transitions coming down the pike, education seems to be an absolute necessity.

Among the key points to include in risk-adjustment training:
  • "Every year, CMS wipes the slate clean on Jan. 1," Ridlehuber said. That means, that organizations must submit diagnosis at least once every year for chronic condition patients.
  • Documentation must reflect face-to-face visits for claims to be substantiated.
  • On every page of documentation, it must have a patient identifier (e.g., name, ID number), date of encounter, valid signature (written or electronic but not stamped), providers' credentials to distinguish (for example, who is a physician versus a nurse practitioner), and date of signature.
  • If signatures are electronic, then the documentation must include the proper regulation-approved language surrounding electronic signatures.
  • Providers are reimbursed on CPT codes, and Medicare Advantage reimburses on diagnosis codes
Training can take many forms--in the classroom, online, or self-study. The important takeaway is that the training happens, Ridlehuber said.

Thursday, September 15, 2011

Who will be the final 30 ACO Pioneers?

Who will be the final 30 ACO Pioneers?:
With accountable care organization (ACO) Pioneers to launch before the year's end, Centers for Medicare & Medicaid Services (CMS) announced this week, the industry is waiting to hear who the final 30 ACO Pioneers will be. To some surprise, it wasn't Mayo Clinic, Cleveland Clinic, Geisinger Health System, and Intermountain Healthcare, who were among the most likely candidates to join the ACO experiment. The leading health systems, along with others in the industry, complained the draft CMS rules were too burdensome and didn't offer enough incentive to join the Shared Savings or Pioneer program.

"When the poster boys ask that the posters be taken down, you have a problem," said Michael Millenson, president of Health Quality Advisors LLC, in a Kaiser Health News-Politico Pro article.

The no-thanks approach that Mayo, Cleveland, Geisinger, and Intermountain took signaled similar doubts from physician organizations, such as the American College of Physicians, the American Academy of Family Physicians, the Medical Group Management Association, the American Medical Group Association, and the American Medical Association, who generally gave a thumbs down to the ACO Medicare Shared Savings Program draft rules, the program that will proceed the Pioneer program.
However, even with circulating skepticism around ACOs, anywhere between 30 to 50 organizations have applied to the Pioneer program, according to the Advisory Board Company, reports Kaiser-Politico. Among the applicants are Tucson Medical Center in Arizona, Monarch HealthCare in California, Norton Healthcare in Kentucky, Banner Health in multiple states, Mountain States Health Alliance (multiple states), Hackensack University Medical Center in New Jersey, and Montefiore Medical Center in New York.

For more information:
read the Kaiser Health News-Politico Pro article

Related Articles
ACO Pioneers to launch by year's end?
Leaked Pioneer ACO draft proposal released
ACO buzz kill: Micromanagement, bureaucracy
Doc groups stuff ACO suggestion box with complaints
CMS clarifies Pioneer ACO model, extends application dates

Thursday, September 1, 2011

CMS releases final eRx rule

CMS releases final eRx rule:
The Centers for Medicare & Medicaid Services (CMS) on Wednesday announced changes to the Medicare Electronic Prescribing (eRx) Incentive Program for calendar year 2011.
CMS received public comments raising concerns that the Medicare eRx Incentive program did not better align with the Medicare or Medicaid EHR Incentive Program also about the need for additional significant hardship exemption categories.
Among individuals and organizations submitting comments was the American Medical Association.


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