Care Coordination in the Era of MACRA
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is leading to changes in the realm of clinical and operational demands in health care. Read more, below, to learn about balancing reporting requirements while simultaneously ensuring optimum patient care.nnConcerns over the cost of health care and apparent lower health outcomes in the United States compared to other developed countries have significantly influenced program development by the Centers for Medicare and Medicaid Services (CMS). New reimbursement strategies intended to address cost and drive quality—specifically the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)—are placing new clinical and operational demands on the health care industry.nnSo in the era of MACRA, providers need to balance reporting requirements (which can be time-consuming) while continuing to put patients first. One of the best ways to do this is to ensure patient care is well coordinated.nnMoving Forward with MACRAnnMACRA made fundamental changes in the way health care providers are paid for Medicare patients. MACRA included the repeal of the Sustainable Growth Rate (SGR) and moved toward rewarding providers for performance through the Merit-based Incentive Payments System (MIPS) and, ultimately, the Advanced Alternative Payment Model (AAPM).n
nThis article originally posted on Healthcare-Informatics.com.
Welter Healthcare Partners is excited to present our monthly Code Spotlight! Each month, Welter Healthcare Partners will spotlight a unique CPT or ICD-10 code to profile and discuss practice applications of the code, as well as pertinent guideline reminders.nnICD-10 Code – E11.65 – Type 2 Diabetes Mellitus with HyperglycemiannICD-10 code E11.65 represents the appropriate diagnosis code for uncontrolled type 2 diabetes without complications.nnClinical documentation must support the following: Elevated glucose (sugar) levels, length of condition, severity of illness, if insulin use is required, and any associated manifestations or underlying chronic diseases. High blood glucose levels in diabetes mellitus are indicative of inadequate or poorly controlled diabetes. Reporting specificity is increasingly important if you participate in an HCC risk adjustment payment model. Clinical documentation must support the complexity of the diagnosis code(s) reported.
In a final rule published Wednesday, the Centers for Medicare and Medicaid Services have established new requirements for the use of electronic health records. Check out the article, below, for more information! nn”We are establishing new requirements or revising existing requirements for eligible professionals, eligible hospitals, and critical access hospitals participating in the Medicare and Medicaid Electronic Health Record Incentive Programs,” stated the rule, which goes into effect October 1, 2017.nnFor 2018, CMS will allow a 90-day reporting period. This is a significant difference from the complete year that CMS had aimed for under the Obama administration. This change applies to hospitals and physicians in the Medicare and Medicaid meaningful use programs.nnAlso in 2018, CMS will allow healthcare providers to use 2014-certified EHRs, 2015-certified EHRs, or a combination. Initially, CMS was requiring 2015-edition EHRs beginning in January 2018. However, healthcare organizations had raised concerns that the 2015-certified EHRs were more sophisticated and that they would not have enough time to install and test the systems.nnIn a statement, CMS administrator Seema Verma said this final rule will provide flexibility for acute and long-term care hospitals as they treat Medicare’s sickest patients.n
As part of the new coding format for our newsletter, Welter Healthcare Partners is excited to offer you a new surgery coding series in which we want to help you! The 2nd week of every month we will highlight a complicated surgical case. This week we are highlighting a general surgery case. We want to hear from you! If you have a complicated surgery case and need help with coding, please upload the operative note by clicking on the link below. Remember to remove ALL patient protected health information and organization identifiers. Welter Healthcare Partners will not use any medical records submitted in which PHI is not removed and protected. Click Here To Submit Redacted Surgery Case Study. 
Known for putting patient experience first, the Cleveland Clinic revolves around relationship-centered communication. Check out this article, where experts dissect this philosophy and explain why it makes moral and financial sense! nnHospitals and providers are more aware than ever that communication and empathy can make all the difference in how a person feels about a hospital stay or medical encounter. But with competing priorities such as patient safety, quality, and other elements that visibly impact the bottom line, the ‘why’ for investing in patient experience can be a tough sell. Experts from the Cleveland Clinic note the following ways doing the right thing translates to dollars.nnThe Centers for Medicare & Medicaid Services began tying Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores to hospital reimbursement in 2012.nnWhile the penalties for sub-par performances have increased slowly, the dollars now are substantial. As of this year, HCAHPS scores determine up to 2% of a hospital or health system’s Medicare payments.nn”The risk for not giving patients a good experience financially now becomes very high, so hospitals or practices that don’t stand behind the fact that we need to take care of our patients both behaviorally and clinically stand to lose a significant amount of money,” says Lori Kondas, MBA, senior director for the office of patient experience at the Cleveland Clinic.nn n
Medicare Wellness Services:nBilling for Medicare wellness services can be a huge pain point for any primary care practice. However, the pain is well worth it when you consider that providing these services can result in tens of thousands of additional reimbursement dollars for your practice. These services can reimburse up to $174 per visit.nnListed below are some strategies to ensure success and compliance with Medicare Wellness Services:n