preparing for meaningful use stage 2 and icd 10

Presented by

Eileen Seagraves, COT

Whitsett Vision Group

Preparing for Meaningful Use Stage 2 and ICD-10

• Discuss Meaningful Use Stage 2

• Value-Based Payment Modifier (VM) and PQRS

• ICD-10

• CBR, RAC and CERT

Introduction

Whitsett Vision Group April 2014

• Staff Training and Upgrading our EHR system is required

• New changes for MU1 vs. MU2

Meaningful Use Stage 2

• 15 Core objectives

• 5 of 10 menu objectives

• 20 total objectivesStage 1

• 17 Core objectives

• 3 or 6 menu objectives

• 20 total objectivesStage 2


Meaningful Use Stage 2The Cores – EPs must meet all 17 of the core objectives


Core Objective Measure Change

1. CPOE Use CPOE for more than 60% of medication,30% of laboratory, and 30% of radiology

Meds increased, labs and x-rays added

2. E-Rx E-Prescribe more than 50% of eligible medications

% increased and Stage 1 formulary check folded in

3. Demographics Record demographics for more than 80% % increased

4. Vital Signs Record vital signs for more than 80% % increased

5. Smoking Status Record smoking status for more than 80% % increased

6. CDS Interventions Implement 5 clinical decision support interventions + drug/drug and drug/allergy

Increased from one rule

7. Labs Incorporate lab results for more than 55% Moved to core and increased

8. Patient List Generate patient list by specific condition Moved to core

9. Preventative reminders Use EHR to identify and provide reminders for preventative/follow-up care for more than 10% of patients with two or more office visits in the last two years

Moved to core

Meaningful Use Stage 2The Cores


Core Objective Measure Change

10. Patient Access Provide online access to health information for more than 50% with more than 5% actually accessing

Replaces electronic copy

11. Visit Summaries Provide office visit summaries for more than 50% of office visits within one business day

Changed from three days

12. Education Resources Use EHR to identify and provide education resources more than 10%

Moved to core

13. Secure Messages More than 5% of patients send secure messages to their EP New

14. Rx Reconcilliation Medication reconciliation at more than 50% of transitions of care

Moved to core

15. Summary of care Provides summary of care document for more than 50% of transitions of care and referrals, with 10% sent electronically and at least one sent to a recipient with a different EHR vendor, or, successfully tested with the CMS test EHR

Incorporates Stage 1 objectives

16. Immunizations Successful ongoing transmission of immunization data Increased from one test

17. Security Analysis Conduct or review security analysis and incorporate in risk management proves

Includes data at rest

Meaningful Use Stage 2The Menu Objectives – EPs must select 3 out of 6


Menu Objective Measure Change

1. Imaging Results More than 10% of imaging results are accessible through certified EHR technology

New

2. Family History Record family health history for more than 20% New

3. Syndromic Surveillance Successful ongoing transmission of syndromicsurveillance data

Increased

4. Cancer Registry Successful ongoing transmission of cancer case information

New

5. Specialized Registry Successful ongoing transmission of data to a specialized registry

New

6. Progress Notes Enter an electronic progress note for more than 30% of unique patients

New

Value Based Modifiers (VM) and Physician Quality Reporting System (PQRS)


• What is a Value-Based Modifier?

▫ VM assesses both quality of care furnished and the cost of that care under the Medicare Physician Fee Schedule (for Medicare, Medicare as a secondary and Railroad Medicare except injectable drugs)

▫ The VM is a new per-claim adjustment that is applied at the Tax ID group level to physicians billing under that Tax ID

▫ CMS is required to apply the VM to all physicians and groups of physicians starting 2017

Reporting for VM and PQRS


• If a group does not seek to report quality measures as a group, CMS will calculate a group quality score of at least 50% of the EPs within the group report measures individually▫ At least 50% of EPs must successfully avoid the 2016 PQRS payment adjustment

The more participating physicians in the practice, the greater the total bonus and ability to avoid the 2% payment adjustment

▫ EPs may report on measures available to individual EPS via the following mechanisms:ClaimsCMS Qualified RegistriesEHRClinical Data Registries (new for 2014)

• The Tax ID group does NOT have to register for this option

• Practices who fail to participate in 2014 will be subject to a self-imposed 2% penalty in 2016 (in addition to the 2% sequestration)

• How do we avoid this?▫ Report 3 measures 50% correctly

• How do we receive a 0.5% bonus?▫ Report 20 cataract surgical cases of which the majority or at least 11 must

be Medicare Part B patients through the IRIS registry (www. aao.org/iris)

▫ OR Report 9 measures in 3 quality domains correctly 50%

PQRS 2014


Quality Domains


Patient SafetyCommunications and

Care Coordination

Patient and Family Experience

(None unique to ophthalmology)

Population Health EfficiencyClinical Process and

Effectiveness

Cataract Group Measure


4 Measures/20 Patients

Measure 191 Cataracts: 20/40 or BCVA within 90 days following cataract surgery – only surgeons can report

Measure 192 Cataracts: Complications within 30 days following cataract surgery requiring additional surgical procedures – only surgeons can report

Measure 303 Improvement in patient’s visual function within 90 days following cataract surgery

Measure 304 Patient satisfaction within 90 days following cataract surgery

Quality Domains and Group Measures (IRIS Registry)Whitsett Vision Group April 2014

Patient Safety • Cataracts: Complications within 30 days following cataract surgery requiring additional surgical procedures (Registry and EHR reporting only)

• Documentation of current medications in the medical record

Communication and Care Coordination

• Biopsy follow-up (Registry only)• Primary open-angle glaucoma: reduction of IOP by 15% or documentation of a plan of care• Melanoma: coordination of care (registry only)

Efficiency • Melanoma: over utilization of imaging studies (Registry only)

Population Health • Preventative care and screening: tobacco use: screening and cessation intervention

Clinical Process and Effectiveness

• Primary open-angle glaucoma: optic nerve evaluation• ARMD: dilated macular exam• Diabetic retinopathy: documentation of presence or absence of macular edema and level

of severity of retinopathy• Diabetes Mellitus: dilated eye exam in diabetic patient• Melanoma: continuity of care – recall system (registry only)• Cataracts: 20/40 or better VA within 90 day following surgery ( Registry and EHR reporting

only)

• Through claims and registry: physicians can report fewer than the required number of measures or measures in fewer than 3 quality domains, BUT you will be subject to measure applicability validation (MAV) to ensure we have reported on all available measures.

• Through EHR: physicians are permitted to submit measures that contain zero values as long as we first submit all of the measures for which we have patient data.

• At least one measure must have patient data

What if we don’t have 9 measures?



• ICD, International Classification of Diseases created by World Health Organization (WHO)

• The bill was passed to delay ICD-10 implementation to October 1, 2015!

• We need to take this time to practice, practice, practice

• After NextGen conversion to PROD on May 12, 2014, we need to do a test run through www.aao.org

ICD-10

http://www.aao.org/


ICD-9 ICD-10

• Code format: 5 numeric characters 7 alpha-numeric

• Characters: Digits 0 – 9 Digits 0-9; Letters A-T, V-Z

• Aprox Number of codes: ICD9-CM Vol. 1&2: 13,000 ICD10-CM: 68,000ICD9-CM Vol. 3&4: 4,000 ICD10-PCS: 87,000

ICD-9 vs. ICD-10


• ICD-9 format: 111.1 or 111.11

• ICD-10 format: H11.1, H11.11, or H11.1-

• Example for Hyperopia H52.0-▫ H52.01 Hypermetropia right eye

▫ H52.02 Hypermetropia left eye

▫ H52.03 Hypermetropia bilateral

• Presbyopia is only H52.4!

• No dash means there is no additional instructional materials – so always look up codes thoroughly

ICD-9 vs. ICD-10


• 1. Look up the main term in the Alphabetic Index (doesn’t always use common sense)▫ Example: Horseshoe tear of the retina w/out detachment is:BreakHorseshoe tear H33.31 –

H33.311 right

H33.312 left

H33.313 both

• 2. Observe the punctuation and cross-reference any notation

How to Use ICD-10


• 3. Add the appropriate final seventh character, when indicated, for:▫ A- initial encounter▫ D – subsequent encounter▫ S – sequel (Condition resulting from a disease, injury, or other trauma)▫ X is used as a placeholder in the 6th position

• 4. Add the appropriate final seventh character, when indicated, for glaucoma staging only▫ 0 – stage unspecified▫ 1 – mild stage▫ 2 – moderate stage▫ 3 – severe stage▫ 4 – interdeterminate stage

How to Use ICD-10 Cont’d


• Multiple chalazia are excised for RUL, LUL, LLL

• CPT code is 67805 with NO modifiers

• ICD-10 codes will be H00.11, H00.14, and H00.15

▫ By the way, cataract has over 70 codes!

ICD-10 Example


• Closure of lacrimal punctum for bilateral lower punctum:

• Correct claim submission:▫ 1. 68761-RT and 68761-LT (correct for commercial plans)

▫ 2. 68761 is payable once per session (incorrect for any payer)

▫ 3. 68761-E1, 68761-E2, 68761-E3, and 68761-E4 (correct for commercial)

▫ 4. 68761-50 and 1 in the unit field (only one correct for Medicare and also accepted by commercial plans)

Challenge


• Who isn’t required to transition to ICD-10?▫ Worker’s Compensation

▫ Auto Insurance

▫ Home Owner’s Insurance, and/or

▫ Business Owner Liability

• Ophthalmology is the only medical specialty to have their own specific ICD-10 book

ICD-10


• An audit is rumored to be like undergoing an autopsy without the benefit of death.

• Comparative Billing Report (CBR) – if we receive one from Medicare, look for any outliers

• Recovery Audit Contractors (RAC) – physicians do not receive an audit outcome report and all Medicare carriers publish results of CERT audit outcomes

• Comprehensive Error Rate Testing (CERT) – do not ignore record requests!

• CERT shares their findings with RAC

CBR, RAC, and CERT


Thank You!

preparing for meaningful use stage 2 and icd 10

Healthcare

mu2 meaningful use stage

terms meaningful use

mu stage

core objectivemeasurechange10

new core measures

coreswhitsett vision

cms test ehrincorporates

ehr system