RheumWATCH Archives

”RheumWatch

Read the RheumWATCH archives on topics such as rheumatology advocacy, policy updates, insurance advocacy, and practice management.

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ICD-TEN Act Introduced – Goal to Mitigate Transition Risks; Have You See Your QRUR?

ICD-TEN Act Introduced! Goal to Mitigate Risks of Transition

The transition to ICD-10 presents significant administrative burdens and cost risks to physicians. Yet there will be no further delays in ICD-10 implementation—that’s the message congressional leaders have been sending. Given the near certainty that another delay is not possible, the ACR has been working with leading members of Congress on solutions to mitigate risks to physician practices presented by the transition on Oct. 1, 2015. On May 12, Rep. Diane Black (R-TN) introduced H.R. 2247, the ICD-TEN Act. It is critical that you ask your member of Congress for their support now. Ask them by visiting the ACR’s Legislative Action Center.

During the ICD-10 transition period, it is essential for CMS to ensure a fully functioning payment system and institute safeguards that prevent physicians from being unfairly penalized due to coding errors.

H.R. 2247 - ICD-TEN Act

  • Requires that CMS conduct full end-to-end testing and certify to Congress that the Medicare fee-for-service claims processing system based on the ICD-10 standard is fully functioning.
  • Implements an 18-month “safe harbor” period after Oct. 1, 2015, designed to protect providers who make minor mistakes in diagnosis coding due to the proliferation of subcodes.
  • Prevents rejection of claims and denial of payment based on subcoding specificity during the implementation period.
  • Prevents recovery of payments made during the implementation period based on use of inaccurate or unspecified subcodes.

If this bill does not move forward, it is possible ICD-10 will be implemented with no safe harbor provisions protecting rheumatology practices, potentially inadequate testing, and no certification that the claim remittance system will be fully functional. Please make your voice heard now by using the ACR’s Legislative Action Center to request that your lawmaker support this crucial effort.

Your representative in Congress can co-sponsor this legislation by contacting the office of the lead sponsor, Rep. Diane Black. Please ask them to act now by using the ACR’s Legislative Action Center.

Have You Seen Your QRUR (Quality Resource and Use Report)?

All rheumatologists should view their QRURs to know how they are doing with patient outcomes and cost information that will be used to calculate the 2016 Value-Based Modifier adjustment. CMS recently updated its How to Obtain a QRUR page to provide clear instructions for how to access reports for a solo provider or group.

Last month CMS released mid-year quality reports that can give you a glimpse of how you or your group is doing with quality and payment adjustments. These QRURs examine patient outcomes and cost information that will be used to calculate the 2016 Value-Based Modifier adjustment. The available reports reflect measurements of performance of care provided July 1, 2013 through June 30, 2014, and therefore only part of this information will count toward the Value-Based Modifier adjustment. CMS believes this mid-year report is an opportunity for you or your group to assess how you’re doing and adjust where quality or efficiency improvements are needed.

Refer to this CMS guide on how to use your mid-year QRUR, and contact ACR staff at mgueye@rheumatology.org with questions or if you need assistance.

ICD-10: Ready, Set, Go

 

Full implementation of ICD-10 will go live on Oct. 1, 2015, and congressional leaders have confirmed there will be no further delays. The transition to ICD-10 is not just a simple update; it is a major revamping of diagnosis coding. With the complexity of coding using the ICD-10 system and the high risk of disruptions of workflow and reimbursement, robust education and widespread testing on all aspects of ICD-10 are needed to facilitate a seamless transition. With only four months left to prepare, here are the steps you need to take.

Every healthcare stakeholder will be affected by the transition to the expanded ICD-10 code sets, as these changes will impact medical coding operations, software systems, reporting, administration, registration, and more. ICD-10 implementation requires a methodical approach consisting, in part, of the following steps:

  • Evaluate all clinical, financial, and business systems that currently use ICD-9 codes. This includes your practice management system, EMR, and encounter forms/superbills. Keep in mind that wherever ICD-9 is used currently in your practice, ICD-10 codes will take its place.
  • Collaborate with practice management vendors, billing services, and payers to ensure that ICD-10 implementation is a priority for them and discuss implementation plans to ensure a smooth transition.
  • Draft a budget that adequately covers changes to business processes, changes to software systems, and staff training. It is important to assess staff training needs, as coding and guideline changes in ICD-10-CM for rheumatic conditions may require coders to learn new terms and look for additional information in documentation to reach the highest level of specificity in the code set.
  • Identify potential changes to workflow and business processes. Consider changes to existing processes, including clinical documentation, encounter forms, and other requirements for quality health reporting.

ICD-10 education should be a major area of focus between now and the compliance date to minimize coding errors after implementation. Issues related to inconsistent, missing, conflicting, or unclear documentation must still be resolved now under ICD-9, as well as in the future with ICD-10-CM, to improve coding and documentation practices.

In The Cost of Implementing ICD-10 for Physician Practices, the authors indicate that training clinical and administrative staff to use the new ICD-10 code set may require up to 16 hours for coding staff, 8 hours for administrative staff, and 12 hours for providers.1

In response to this assessment, the ACR created rheumatology-specific training with targeted learning for physicians, coders, billers, and administrators. The training session includes a concentrated focus on clinical documentation improvement to reach the highest level of ICD-10 specificity, by accurately pinpointing elements such as severity of illness, laterality, complications, and symptom etiology.

You can join us for our next full day of training on June 26, 2015 in Atlanta. This day-long in-depth workshop will provide you and your staff with comprehensive training on ICD-10 and actionable steps necessary for transition. To register for this course, contact Melesia Tillman at mtillman@rheumatology.org or 404-633-3777 x820.

For questions on ICD-10 or more information on training opportunities, contact Antanya Chung at achung@rheumatology.org or 404-633-3777 x818.

Reference

1. Hartley, C., Nachimson, S. The Cost of Implementing ICD‐10 for Physician Practices – Updating the 2008 Nachimson Advisors Study. A Report to the American Medical Association. February 12, 2014.

Message from the ACR President

The ACR developed the Rheumatology Informatics System for Effectiveness (RISE) Registry to be a best-in-class resource to help the rheumatology community manage patient populations, improve patient care, and navigate the ever-changing healthcare environment. It is designed to simplify the jobs of health professionals and enable systematic data collection without the burden of added data entry.

RISE is an enhanced version of the Rheumatology Clinical Registry (RCR) that automatically syncs with electronic health records. In the brief time since launch, RISE has captured data on more than 50,000 patients with rheumatoid arthritis (RA) and already stands among the largest rheumatology patient registries in the nation.

RISE can identify performance gaps and facilitate better clinical decision-making because of the knowledge it imparts about a provider’s practice. RISE provides real-time access to data, allowing customized quality improvement queries and reports. Data from this registry also help the ACR identify and quantify the value of rheumatology care, which is vital when advocating to influencers and policymakers.

As the dependence on patient data grows in our evolving healthcare system, rheumatologists and other rheumatology healthcare providers will need increasing access to data collection tools and analytics that enable the documentation of quality of care. By signing up to participate in RISE, you can join the growing number of rheumatologists who recognize the value of membership in a national patient registry.

Benefits

RISE will allow the rheumatology provider to more easily:

  • Optimize practice performance and patient care;
  • Meet federal reporting requirements;
  • Demonstrate value of rheumatology to key influencers (e.g., lawmakers, CMS, insurance sector); and
  • Make new discoveries that advance rheumatology care and create solutions for more efficient healthcare delivery.

Continuing Success

We’ve come a long way in the past year, but we have a lot more work to do. This year, we aim to sign up at least 140 practices to contribute data to RISE. As of April, we had reached almost half our goal, with 69 practices connected—both private and academic—and 33 practices already contributing. If we continue at the pace of the first quarter, we will not only reach our goal for the year, but exceed it.

The power of RISE will increase with expanded data sets from a large number of member practices and rheumatologists across the country. A rich source of patient data will enable the ACR to bring added resources to the table and more effectively advocate on behalf of rheumatology. It will also allow the registry to develop more quality measures, which are critical to improving patient outcomes and advancing the field of rheumatology.

Dr. Charles King II, rheumatologist at IMA-Tupelo Rheumatology & Osteoporosis Center, began contributing data to RISE and immediately saw a benefit. “With RISE, I was able to quickly and easily assess my performance and discovered patient care gaps,” says Dr. King. “Because our patients are our No. 1 priority, we quickly acted to fill the gap to improve patient care and improve patient outcomes.”

Dr. Salahuddin Kazi, chair of the ACR’s Registries & Health Information Technology Committee, said, “RISE is a tool designed by rheumatologists, for rheumatologists. I would encourage everyone to give it a try, watch our demo and learn about our results. We now have over 900,000 patient encounters, and the growth of the registry has been amazing. With your participation it will develop into a powerhouse of knowledge. It’s so much easier than you imagine, and it’s worth it to you and your patients.”

Innovative tools, such as RISE, help us focus on what matters the most—the patients. Our raison d’êtra is the patient, and our mantra is the commitment to improve their health and serve their welfare. We are also fortunate to have the support of the ACR in this endeavor as dedicated volunteers and staff work tirelessly to promote high-quality care through innovation. Truly, we are working together to discover solutions and transform care in rheumatology.

I encourage you to get your practice started with RISE. You can do this by contacting the ACR registry staff at RISE@rheumatology.org.

E. William St.Clair, MD

President, American College of Rheumatology

This content is a modified version of a forthcoming article from the June 2015 issue of The Rheumatologist.