CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10 Frequently Asked Questions
CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10 Frequently Asked Questions
Q1. What if I run into a problem with the transition to ICD-10 on or after October 1st 2015?
A1. CMS understands that moving to ICD-10 is bringing significant changes to the provider community. CMS will set up a communication and collaboration center for monitoring the implementation of ICD-10. This center will quickly identify and initiate resolution of issues that arise as a result of the transition to ICD-10. As part of the center, CMS will have an ICD-10 Ombudsman to help receive and triage physician and provider issues. The Ombudsman will work closely with representatives in CMS’s regional offices to address physicians’ concerns. As we get closer to the October 1, 2015, compliance date, CMS will issue guidance about how to submit issues to the Ombudsman.
Q2. What happens if I use the wrong ICD-10 code, will my claim be denied?
A1. While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family. However, a valid ICD-10 code will be required on all claims starting on October 1, 2015. It is possible a claim could be chosen for review for reasons other than the specificity of the ICD-10 code and the claim would continue to be reviewed for these reasons. This policy will be adopted by the Medicare Administrative Contractors, the Recovery Audit Contractors, the Zone Program Integrity Contractors, and the Supplemental Medical Review Contractor.
Q3. What happens if I use the wrong ICD-10 code for quality reporting? Will Medicare deny an informal review request?
A3. For all quality reporting completed for program year 2015 Medicare clinical quality data review contractors will not subject physicians or other Eligible Professionals (EP) to the Physician Quality Reporting System (PQRS), Value Based Modifier (VBM), or Meaningful Use 2 (MU) penalty during primary source verification or auditing related to the additional specificity of the ICD-10 diagnosis code, as long as the physician/EP used a code from the correct family of codes. Furthermore, an EP will not be subjected to a penalty if CMS experiences difficulty calculating the quality scores for PQRS, VBM, or MU due to the transition to ICD-10 codes. CMS will not deny any informal review request based on 2015 quality measures if it is found that the EP submitted the requisite number/type of measures and appropriate domains on the specified number/percentage of patients, and the EP’s only error(s) is/are related to the specificity of the ICD-10 diagnosis code (as long as the physician/EP used a code from the correct family of codes). CMS will continue to monitor the implementation and adjust the timeframe if needed.
Q4. What is advanced payment and how can I access this if needed?
A4. When the Part B Medicare Contractors are unable to process claims within established time limits because of administrative problems, such as contractor system malfunction or implementation problems, an advance payment may be available. An advance payment is a conditional partial payment, which requires repayment, and may be issued when the conditions described in CMS regulations at 42 CFR Section 421.214 are met. To apply for an advance payment, the Medicare physician/supplier is required to submit the request to their appropriate Medicare Administrative Contractor (MAC). Should there be Medicare systems issues that interfere with claims processing, CMS and the MACs will post information on how to access advance payments. CMS does not have the authority to make advance payments in the case where a physician is unable to submit a valid claim for services rendered.
HIPAA Watchdog is Launched!
PRWeb News Release - June 10, 2015
HIPAA Watchdog’s comprehensive and affordable HIPAA compliance software delivered as a service, annual subscription provides round-the-clock, round-the-year protection and guaranteed HIPAA compliance. We offer a confidential approach for healthcare organizations to maintain and track all of their privacy and security efforts. Torrance, California (PRWEB)
June 10, 2015 -- Over 100 customers have already used HIPAA Watchdog with complete satisfaction. HIPAA Watchdog is the only HIPAA security compliance product that comprehensively addresses all of an organization’s privacy and security compliance needs from one portal. Here’s what a few of our customers are saying.
"It was a great tool to quickly point out where the work needs to done. The process was great." - Office Manager, Big Sur, CA Health Center
"HIPAA Watchdog offered an easy and straightforward way to meet our HIPAA goals. The website and initial assessment at the office were very helpful." - Office Manager, Saleem A. Waraich, M.D.
"I was very new to this. They were a great help, I recommended them to several offices in our area." - Office Manager, Indian River Surgery Center, Vero Beach, FL
Annual Subscription includes:
HIPAA Risk Assessments: HIPAA Watchdog allows a covered entity or business associate to conduct their own privacy and security assessments.
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Policies and Procedures: HIPAA Watchdog allows you to develop and maintain your health center’s Security Policies and Procedures.
HIPAA Compliance for Employees: Online Training and the ability to track employees’ completion of their annual HIPAA training is included in the Organizational Profile.
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Media Contact: Suzanne Patterson
Division of e2o Health
CA Orthopaedic Association Refers Orange County Specialists to e2o Health
TO: COA Members in Orange County
FROM: William Brien, M.D., President
CalOptima, who is affiliated with the Orange County Medical Association, has made us aware that they have approved funding to assist specialists in Orange County in implementing Electronic Health Records (EHR) and to meet the Centers for Medicare and Medicaid (CMS) Medicare Meaningful Use Requirements. Previously, the funding was earmarked only for primary care practices.
In 2015, CMS will be penalizing physician practices who do not meet the Meaningful Use Requirements. These penalties can be significant depending on the number of Medicare patients that you treat.
We would urge you to take advantage of this offer to work with the CalOptima Regional Extension Center if your practice is struggling with implementing EHR or meeting the Meaningful Use requirements. Questions should be directed to:
Notice from CalOptima
Subsidized Supports for Specialists to meet Meaningful Use Requirements
CalOptima’s Board of Directors has just approved funding for CalOptima Regional Extension Center (COREC) to implement a Specialists Program to assist specialists in EHR implementations and Meaningful Use (MU) achievements. The goal of the program is to ensure the providers are in compliance with MU requirements and able to obtain the incentive payments from the Medicare or Medicaid Incentive Programs.
E2o Health has been a consultant for COREC since the inception of the EHR Incentive program and has helped many providers in the community to implement an EHR and achieve MU. Our services to the providers are subsidized under COREC Specialist Program grant and can be provided at no-cost to the providers.
Meaningful Use requirements can be a difficult and time consuming process with constant regulatory changes. We are grateful for this opportunity to assist you during this process and hopeful that you will take advantage of the opportunity. Please note, enrollments in the program are limited and certain criteria need to be met for participation.
Thank you for your time and we are looking forward to hearing from you soon.
Diane Przepiorski | Executive Director
California Orthopaedic Association | “Keeping you Active”
1246 P Street | Sacramento, CA 95814
Fifth Annual Benchmark Study on Privacy and Security of Healthcare Data, May 2015
Fifth Annual Benchmark Study on Privacy and Security of Healthcare Data
Activity Monitoring must be part of a security footprint in healthcare organizations. For the first time, criminal attacks are the #1 cause of data breaches.This percentage is up 125% compared to five years ago.
Criminal activity is part of everyday business in healthcare: 65% of healthcare organizations and 87% of BA’s report electronic health data based security incidents in the past two years. Many healthcare organizations believe that they don’t have adequate funding to combat this.
Over the past five years, the most often reported root cause of breaches moved from stolen computers to criminal attacks, and employee negligence remains a top concern.
Trends in Privacy & Security – 2010 - 2015
Root Causes of Data Breaches in Healthcare Organizations
|Lost/stolen computer devices
|Unintentional employee action
|Technical System glitch
Assessing Risks after a Security Incident
50% of healthcare organizations assess risks following a security incident.
|Ad hoc process
|Automated process or software tool
|Incident response management platform
|Engage 3rd parties
10 Weeks to ICD-10 Hands-on Workshop Training - May 15th to July 17
10 Weeks to ICD-10 Hands-on Workshop Training
Starting May 15th, e2o Health will launch a paid 10 Weeks to ICD-10 Hands-on Workshop series. These workshops will help providers complete the tasks necessary to roll-out ICD-10 by October 1st, 2015. They provide:
- Action Oriented ICD-10 Planning through a Project Management tool
- A dedicated project manager assigned for 10 weeks of support for your ICD-10 transition effort
- 10 hours of consulting outside the 10 weeks of Hands-On workshops
- 5 hours for documentation impact assessment
- 5 hours of Project Management Support
First session May 15th to July 17th
The cost for EARLY BIRD SPECIAL is $2000 if you sign-up by May 15th.
To sign up for the 10 Weeks to ICD-10 Hands-on Workshop training, call (800) 409-0096 extension 102 or 212.
The 10 Workshop sessions are designed to complete ICD-10 implementation within 10 Weeks.
- Project Planning for ICD-10 Migration
- Monitoring Progress by surveys and assessments
- Impact Assessment
- Chart Auditing
- Create education flashcards and favorites lists for staff
- ICD-10 Hands-on Training
- Assistance in testing claims to payers and Clearinghouses
- Prepare you to lead the ICD-10 implementation
- Online subscription to ICD-9 to ICD-10 Conversion Tool
- Access to various Tools and Templates for ICD10 Transition
Five More Facts about ICD-10
Five More Facts about ICD-10
Last week, the Centers for Medicare & Medicaid Services (CMS) shared five facts dispelling misperceptions about the transition to ICD-10. Here are five more facts addressing common questions and concerns CMS has heard about ICD-10:
- If you cannot submit ICD-10 claims electronically, Medicare offers several options.
CMS encourages you to prepare for the transition and be ready to submit ICD-10 claims electronically for all services provided on or after October 1, 2015. But if you are not ready, Medicare has several options for providers who are unable to submit claims with ICD-10 diagnosis codes due to problems with the provider’s system. Each of these requires that the provider be able to code in ICD-10:
If you take this route, be sure to allot time for you or your staff to prepare and complete training on free billing software or portals before the compliance date.
- Free billing software that can be downloaded at any time from every Medicare Administrative Contractor (MAC)
- In about ½ of the MAC jurisdictions, Part B claims submission functionality on the MAC’s provider internet portal
- Submitting paper claims, if the Administrative Simplification Compliance Act waiver provisions are met
- Practices that do not prepare for ICD-10 will not be able to submit claims for services performed on or after October 1, 2015.
Unless your practice is able to submit ICD-10 claims, whether using the alternate methods described above or electronically, your claims will not be accepted. Only claims coded with ICD-10 can be accepted for services provided on or after October 1, 2015.
- Reimbursement for outpatient and physician office procedures will not be determined by ICD-10 codes.
Outpatient and physician office claims are not paid based on ICD-10 diagnosis codes but on CPT and HCPCS procedure codes, which are not changing. However, ICD-10-PCS codes will be used for hospital inpatient procedures, just as ICD-9 codes are used for such procedures today. Also, ICD diagnosis codes are sometimes used to determine medical necessity, regardless of care setting.
- Costs could be substantially lower than projected earlier.
Recent studies by 3M and the Professional Association of Health Care Office Management have found many EHR vendors are including ICD-10 in their systems or upgrades—at little or no cost to their customers. As a result, software and systems costs for ICD-10 could be minimal for many providers.
- It’s time to transition to ICD-10.
ICD-10 is foundational to modernizing health care and improving quality. ICD-10 serves as a building block that allows for greater specificity and standardized data that can:
- Improve coordination of a patient’s care across providers over time
- Advance public health research, public health surveillance, and emergency response through detection of disease outbreaks and adverse drug events
- Support innovative payment models that drive quality of care
- Enhance fraud detection efforts
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.
Delay of Flexibility Rule Implementation until after March 31, 2015
This blog is to make you aware of the Delay of the Flexibility Rule Implementation, announced March 19, 2015.
DHCS previously announced that on March 24, 2015 the State Level Registry (SLR) would be able to accept 2014 applications from professionals using the Flexibility Rule. However, DHCS now projects that the SLR will not be able to accept these applications until March 31, 2015. DHCS regrets this delay. The deadline for receipt of these applications will remain unchanged at May 31, 2015. Please visit the SLR home page at http://medi-cal.ehr.ca.gov/ for future information.
Please contact us if you have any questions at (800) 409-0096..
NEW Medicare & Physician Quality Reporting System (PQRS) Deadlines for 2014
March 20, 2015: New EHR Attestation Deadline for Medicare Eligible Professionals:
Eligible professionals now have until 11:59 pm ET on March 20, 2015, to attest to meaningful use for the Medicare Electronic Health Record (EHR) Incentive Program 2014 reporting year.
March 31, 2015: Medicare providers can submit PQRS data (only) to qualified registries until March 31, 2015.
Meaningful Use Timelines and Deadlines Update - 2015
Important Timeline and Deadline Changes
for Eligible Professionals
February 27, 2015
2014 Flexibility Rule MU Attestations
DHCS anticipates that the State Level Registry (SLR) will be able to accept 2014 meaningful use (MU) applications from eligible professionals wishing to use the Flexibility Rule beginning on March 24, 2015. Among other provisions, the Flexibility Rule allows professionals who were delayed in accessing 2014 CEHRT due to vendor issues to attest to 2013 Stage 1 objectives and measures in 2014 using CEHRT that was certified to 2011 standards.
The deadline for applying for 2014 MU has been extended to May 31, 2015 because of the delay in the ability of the SLR to accept 2014 MU applications under the Flexibility Rule.
2015 MU Attestations
The SLR will not begin accepting MU applications for 2015 until June 1, 2015 in order to prevent overlap of the MU applications periods for 2014 and 2015.
2015 Public Health Registration
The deadline for professionals to register with public health agencies for submitting Stage 2 public health objectives in 2015 is March 1, 2015. However, this deadline will not apply if CMS follows through with its announced intent to change from a full year to a 90-day reporting period in 2015. If this change is implemented the deadline to register with public health agencies will be 60 days after the first day of the 90-day reporting period chosen by the professional.
Switching Between Incentive Programs
The deadline for professionals to apply to CMS to switch between the Medicare and Medicaid EHR Incentive programs has been extended by CMS to March 20, 2015. Professionals will need to access their accounts in the National Level Registry at (https://ehrincentives.cms.gov/hitech/login.action) to initiate this one-time switch