mediserve · the middle class tax relief and jobs creation act ... states that “the secretary of...
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MediServe
More than 25 Years Serving the Rehab and Respiratory Community
•Rehabilitation
• Outpatient
• Inpatient
• Acute Care
• Private Practice
•Respiratory
•CORE Focus (Compliance, Outcomes, Revenue, Efficiency)
•250+ Clients
•Based in Chandler, Arizona
About MediServe
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A Few of Our Rehab Clients
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Claims-Based Outcomes Reporting (CBOR): July 1 is nearing, Are You Prepared?
Loli Fulton, OTR/L Shawn Hewitt, OTR/L
MediServe Product Managers
CMS Review and Update
Compliant and Efficient Workflows
FAQs from our Industry Community
The Right Tools for your Tool Box
CBOR Agenda
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Claims Based Outcomes Reporting (CBOR)
The Middle Class Tax Relief and Jobs Creation Act of 2012 (MCTRJCA; Section 3005(g); states that “The Secretary of Health and Human Services shall implement, beginning on January 1, 2013, a claims-based data collection strategy that is designed to assist in reforming the Medicare payment system for outpatient therapy services subject to the limitations of section 1833(g) of the Social Security Act (42 U.S.C. 1395l(g)). Such strategy shall be designed to provide for the collection of data on patient function during the course of therapy services in order to better understand patient condition and outcomes.”
This claims-based data collection system is being implemented to include both 1) the reporting of data by therapy providers and practitioners furnishing therapy services, and 2) the collection of data by the contractors. This reporting and collection system requires claims for therapy services to include nonpayable G-codes and related modifiers. These non-payable G-codes and severity/complexity modifiers provide information about the beneficiary’s functional status at:
• The outset of the therapy episode of care,
• Specified points during treatment, and
• The time of discharge.
CR8005 MLN Matters: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8005.pdf
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Claims Based Outcomes Reporting (CBOR)
Medicare Part B…Primary AND Secondary
Test Period: January 1, 2013 – June 30, 2013
CBOR Compliance Mandatory: starting July 1, 2013
Must use outcome measures that map to a 7 point scale AM-PAC, FOTO, OPTIMAL and NOMS were recommended by CMS in IOM
Reporting Frequency: Initial evaluation, on or before every 10th visit, re-evaluation, and discharge (if patient attends the discharge session).
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Claims Based Outcomes Reporting (CBOR)
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Claims Based Outcomes Reporting (CBOR)
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Claims Based Outcomes Reporting (CBOR)
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Evaluative Procedures. The presence of an HCPCS/CPT code on a claim for an evaluation or re-evaluation service listed as follows requires reporting of functional G-code(s) and corresponding modifier(s) for the same date of service:
CMS Update
One-Time Visits:
• Therapist documents and codes all 3 G code/Modifier sets (current, goal and discharge)
Addition of CPT code:
• 96125- Standardized cognitive performance testing per hour of a qualified health care professionals time, both face-to-face time administering tests and time interpreting results and preparing report.
On or before 10 visits (not 30 days) CR8005 MLN Matters: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8005.pdf
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Focus on CORE
COMPLIANCE • Requirement for G-Codes and Modifiers be in the ‘documentation’ and on
the bill
− If they can’t find it, they’ll deny
OUTCOMES • CBOR Conversion Tool and Cards: translates outcome scores to modifier
levels
− www.mediserve.com/cbor
REVENUE • Real-time exception reporting for a clean bill out
− Denial Prevention
EFFICIENCY • Integrated workflow into the documentation for therapists
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CBOR Workflow
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*Don’t forget your G codes and modifiers must accompany a CPT code for a date of service!
CBOR Workflow
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*Don’t forget your G codes and modifiers must accompany a CPT code for a date of service!
CBOR Workflow
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*Don’t forget your G codes and modifiers must accompany a CPT code for a date of service!
Challenges you will face…
Compliance Challenges • Evaluative CPT is charged without an associated G Code/Modifier…and
visa versa
• Current/Discharge level codes are present without a Goal level code…and visa versa
• Goal level is lower than the current level
• G Code is Present without an associated modifier
• Improper G Code transition
• Presence of Current and Discharge levels on different impairments on the same date of service
• Presence of 2 or more different primary functional impairments coded on the same date of service
• Primary impairment G Code has been discharged without a new impairment G Code in the subsequent treatment note if continuing treatment
• Duplicate G Code/Type of the same primary functional area on the same date of service
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Challenges you will face…
• Clearly identifying patients that are Medicare Part B
• Multiple modifiers that can be on a claim: 59, KX, GN, GO, GP, C Modifier
• G codes do not require the KX modifier
• Charge master modifications that are required to support G codes and modifiers
• Tracking the 10th visit
• Therapist forgets to do a standardized assessment
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Compliance Challenges continued:
FAQs
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Common Questions about Claims-Based Outcomes Reporting:
http://www.mediserve.com/resource/analysis/cms-clarifications-on-cbor/
Tools for your Tool Box…
MediServe CBOR Conversion Tool…FREE
http://www.mediserve.com/resource/analysis/cbor-conversion/
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Visit our website: www.mediserve.com/resource/analysis/free-cbor-reference-guides/
Order FREE CBOR Cards
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Please allow for 4 week delivery time!
• Easily select the correct G-code and modifier based on therapist documentation
• Alert therapists and managers automatically when G-codes need to be applied
• Monitor claims based data collection compliance using specifically designed reports in MediLinks
• Comply with all CMS G-code scoring rules for evaluations, progress notes, goals and discharges
• Seamlessly change from primary G-codes to subsequent functional categories
• ICF-based content aligns to CMS’ new functional impairment categories, so the system will adapt easily to future changes, including DOTPA
• Insert a variety of standard outcomes measures like Boston University’s AM-PAC™ – see how you can use the AM-PAC at your facility…
• Eliminate denials due to missed recertifications by tracking progress notes and recertification requirements simultaneously
CBOR Highlights in MediLinks
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Tools for your Tool Box…MediLinks
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Don’t Forget
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CMS is not playing around…
They will deny your charges starting July 1st if they are not coded accurately
CBOR…BE READY WITH MEDISERVE!
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Free CBOR Conversion Tool: http://www.mediserve.com/resource/analysis/cbor-conversion/
Free CBOR Cards:
www.mediserve.com/resource/analysis/free-cbor-reference-guides/
Online CBOR Frequently Asked Questions http://www.mediserve.com/resource/analysis/cms-clarifications-on-cbor/
Send additional questions to:
THANK YOU!