ICD-10 is a New Era

By Dr. Robert (Bob) Day, Jr., Broadway Eye Center, Garland, TXdr_bob_day_web

When I started learning ICD coding, my dad, Dr. Robert Day, Sr., was President of the American Optometric Association (AOA), and they had just published the first Current Optometric Information and Terminology (COIT) book in June 1974.  It was optometry’s first attempt to participate in the new medical trend of systematically classifying diseases.  Optometry was just beginning to become more than simply prescribing a pair of glasses to help patients realize improved vision.

Learning ICD-9 versus ICD-10 is very much like comparing learning multiplication tables to learning calculus.  I can’t remember a time when I didn’t know my multiplication tables, but I remember struggling to learn calculus all too well.  I probably learned multiplication in the second or third grade. It was a straightforward process where one problem produces only one answer.  For example, 2×2 can only equal 4—easy enough, right? Then you advance to calculus (particularly differential) where one problem can produce multiple possible answers.  The learning process is far more complex, and the answers, at least initially, are far less obvious. But it can be done; you just need to spend the time to identify your best resource and to understand your goal.

Even now, I calculate simple multiplication in my head, but for calculus I need the help of technology (a calculator) to do calculus.  Likewise, ICD-9 is committed to memory, but for ICD-10, I will depend on technology in the form of my electronic health record system to handle most of the ICD-10 coding.

Speculation abounds, but it’s reasonable to assume that ICD-10 will mark the end of the paper super-bill and coding from memory. Under ICD-10, the AOA’s Express Mapping Card alone is four pages with almost 300 codes.  ICD-10 is clearly more complex, and trying to manage it without the help of technology will drastically add time and expense to your coding.

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CMS Extends Medicare EHR Attestation Deadline

announcementIn a surprise announcement this morning, CMS extended the 2014 attestation deadline for the EHR Incentive Program, popularly known as “meaningful use.” The submission deadline is now March 20, 2015, at 11:59pm (ET).

This extension gives providers a chance to breathe and a little more time to gather their meaningful use data from 2014 and attest. This is fantastic news for all participating providers who want to avoid Medicare payment adjustments in 2016. This is particularly good news to those who are attesting to meaningful use for the first time, since this is their last chance to receive any incentive money for meaningful use under Medicare.

CMS was careful to point out that this extension applies only to the Medicare EHR Incentive Program. This extension does not affect those providers who are participating under the Medicaid EHR Incentive Program. CMS also urged providers to attest as soon as possible despite the extension.

PQRS vs. CQMs—What’s the Difference and How Do I Report Them?

There’s a lot of confusion and frustration in the healthcare industry right now about the government quality programs, where they overlap (and where they still don’t), and how to report the correct information.

A (Brief) History

The Physician Quality Reporting System (PQRS) has been around since 2007. Traditionally providers voluntarily reported at least three measures by including level II CPT codes on their Medicare Part B claims, and they received an incentive payment from CMS.

Clinical Quality Measures (CQMs) were introduced in 2011 as part of the EHR Incentive Program, better known as meaningful use. This program required providers to manually enter a calculated percentage for six to nine measures to receive an incentive as part of meaningful use.

A Confluence of Program Changes

Recently, the Centers for Medicare and Medicaid Services (CMS) initiated plans to align the PQRS and the CQM measures to make reporting easier for providers. At the same time, CMS is laying the groundwork to discontinue the claims-based PQRS reporting that providers have become accustomed to. CMS’ goal is for providers to electronically submit a file that contains all of their yearly quality data to satisfy the requirements for both PQRS and CQMs. You may have heard of this file referred to as QRDA. Continue reading

Will the Implementation of ICD-10 Interfere with Meaningful Use?

No, but…Michael_Opsteegh

The implementation of ICD-10 does not affect your meaningful use (MU)  calculations. While the compliance date for ICD-10 is October 1—well into your meaningful use reporting year—you will not see any impact on your MU calculations.

It seems strange to think that such a disruptive change as ICD-10 wouldn’t impact your MU attestation. The transition from ICD-9 to ICD-10 applies only to diagnosis codes in offices and outpatient settings. The MU core and menu set measures do not require specific diagnosis codes. Therefore, ICD-10 will not impact your MU calculations.

The clinical quality measures (CQMs), however, are very dependent upon the proper diagnosis codes being in place. Eyefinity has you covered in this regard. Our 2014 Edition CQMs will accept your ICD-9 and your ICD-10 codes. Even when you switch midway through your reporting period, your calculations will reflect both code bases.

Here’s the but…

There’s one small detail that you may need to address one time. You’ll need to add any ICD-10 codes  to your clinical decision support rules to ensure that your diagnosis still trigger the correct clinical decision alerts (Stage 1, core measure 10; Stage 2 core measure 6).

Sink or Swim with ICD-10; My story

dr_bob_day_webBy Dr. Robert (Bob) Day, Jr., Broadway Eye Center, Garland, TX

In our office, preparing for ICD-10 coding is similar to a life-boat drill….go over the basics and depend on the technology used by the boat captain to keep you from getting in the water over your head.

The Basics

To get started, I identified the resource that’s familiar and comfortable to me. In my case, it’s the American Optometric Association (AOA).

My staff and I viewed webinar recordings from AOA’s EyeLearn Webinar recordings.They were very interesting to watch, but like most continuing education lectures, I’m not likely to remember much of it.

We also chose the AOA’s 2015 ICD-10 Coding Bundle, for those times when we would need to look up specific codes. With our reference library in place, I consciously rejected all online websites that show conversion tables from ICD-9 to ICD-10. These websites only give unspecified eye codes, even though ICD-10 is based on which eye is being coded.

Finally, and in my opinion most importantly, I will depend on the technology of my Electronic Health Record software to take care of 95% of the coding for me.  I know that a few patients will present with strange problems (corneal injury to the right eye from a left elbow of a taller person during basketball practice on a Tuesday!) for which I will rely on my reference book. But for the most part, I will trust my EHR to steer me out of the undertow.

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ICD-10—We are in this together

Dane Laverty, Eyefinity.com Product Manager

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You’ve heard about the changes to expect when the industry transitions to ICD-10. You know that practices will be impacted, and must plan and prepare, but have you considered what needs to happen on the other end to keep the claims process moving?

Solution providers, clearinghouses, insurers, and CMS all must be prepared for ICD-10 before October 1, 2015 to accommodate services and claims when it begins. From every angle, the change to ICD-10 is a really big deal.

I’ve been working hard to ensure Eyefinity.com is prepared to handle the cutover to ICD-10 on October 1. Our team is wrapping up development and it’s come together really well. But what does this mean to you? According to the law, all payers must accept and process claims using only ICD-10 codes on October 1. It’s a hard and fast rule and date, with no exceptions.

You’ve probably used Eyefinity’s eClaim to submit claims to VSP. But did you know that you can use eClaim to submit claims to over a thousand other payers?

Eyefinity.com handles millions of claims each year, every one of which contains diagnosis codes. Suffice to say, the effort to coordinate changes in our systems while monitoring the status of all of the payers that eClaim submits to has kept me up at night, ensuring that it works efficiently and without problems. Eyefinity, VSP, and our partners have worked closely to ensure a seamless transition from ICD-9 to ICD-10, so that on October 1 Eyefinity will be ready to support you.

We’re taking a proactive approach to be sure that we’ll be ready for the change in plenty of time. Will you be ready, too? It may not be easy, but the key to success is taking the time to research and learn now.

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What does 2015 hold for meaningful use?

Since the meaningful use program began, there has been an abundance of challenges to successfully demonstrate and attest.  According to CMS, only 4% of eligible professionals (EPs) have successfully attested to Stage 2, and beginning this month, 257,000 EPs will be assessed penalties as a result.

Progressively Tougher RequirementsPROOF_19922DR_fixit_blog
As the program currently stands, beginning this year, the meaningful use demonstration period is required to run for the full 365 days of the year, rather than 90 days as required in previous years. In an effort to mitigate the additional challenge and facilitate successful attestation, Representative Renee Ellmers introduced the Flexibility in Health IT Reporting Act (Flex-It) in 2014.

If passed, Flex-It will reduce the demonstration period in 2015 to 90 days, rather than the full year that is currently required for those attesting for either Stage 1 or Stage 2. Those in their first year of Stage 1 will attest to a three month period regardless of the outcome of the rule. In 2015, EHR solutions must be 2014 certified to qualify for meaningful use attestation.

Though the act was submitted, no decision was made in 2014. Not to be dissuaded, Rep. Ellmers has reintroduced the bill in January, and has the backing of legislators from both the Democrat and Republican parties.  Stay tuned, we’ll keep you posted on the status of the Flex-It Act, when its fate is decided, and all of the latest news on meaningful use.

Do you have questions about meaningful use? We’re here to help! Contact us at meaningfuluse@eyefinity.com.

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