Webinar:Billing & ICD-10 Implementation

Introductions

Moderator:Bryan NievesIgeaRegional Sales Manager

 

Presenter:Leysi M. CasanovaDiverse Medical Group, Inc. President

 

Procura is the world’s largest provider of healthcare business software solutions for post-acute care delivery. Whether an organization is complex and expanding or laser-focused, we offer a portfolio of software solutions to help your healthcare organization increase profitability, reduce risk and improve patient care.

Procura solutions are implemented in 2,300 customer sites, managing care for 1.7 million people in the U.S., Canada and Australia. Built upon decades of industry experience and enabled by highly configurable, intuitive and scalable technologies, Procura’s product brands include ContinuLink, Procura, Progresa and Igea.  

 

Billing & ICD-10 Implementation

Home Health Billing Basic Billing Process ICD-10-CM Basics About ICD-10-CM Coding Process Updates and Final Rule Expected Issues Understanding what has changed Resources

Webinar Agenda

Home Health Billing Basics HH PPS (Home Health Prospective Payment System)

Medicare pays Home Health agencies a predetermined base payment for each 60 day episode of care provided to a Medicare Beneficiary.

These payment rates may vary and/or be adjusted due to numerous contributing factors.

Billing Basics continuedHH PPS payments are made in two installments:

RAP (initial payment) TOB 322Initial episode 60% / Recertification episodes 50%

Final Claim (also known as End of Episode Bill) TOB 329 Initial episode 40% / Recertification episodes 50%

Billing Process OASIS Data Completed

POC completed and sent to

referring provider

F2F Certification

sent

OASIS Data Exported

RAP Submitted

ICD-10-CM Basics

Contains up to 7 characters

Character 1 always alpha(all letters except U are used)

Characters 3-7 may vary alpha and numeric Placeholder “X”

Character 2 always a number

About ICD-10-CM Considerable differences of ICD-10-CM Code set in comparison to previous ICD-9-CM are:

Considered to be much more specific Laterality Contains more combination codes Codes Fractures Alpha character are not case sensitive ICD-10-CM codes are used on OASIS C1

Coding Process RequiredOASIS C1 completed

QA Review

Code Case

Generate POC

Billing

Updates & FR effective Jan 1st 2016

MEDICARE Open Enrollment reminder CMS FINAL RULE (CMS-1625-F)

o HH PPS Payment Rate Updateo ICD-10-CM Coding Guidelines in regards to Initial Encounterso HH VBP Model

Change Request 9369

Reminder: Medicare Open Enrollment

CMS Medicare open enrollment ends December 7, 2015

For more information please visit Medicare.gov or call 1-800-MEDICARE

Run routine eligibility checks

Final Rule (CMS-1625-F)

Effective Jan 1st 2016

Updates (HH PPS) rates

Implements the 3rd year of the 4-year phase-in

Updates the HH PPS case-mix weights

Finalizes reductions to the national, standardized 60-day episode payment rate in CY 2016, CY 2017, and CY 2018 of 0.97 percent

ICD-10-CM “Initial Encounters”

Provides a clarification regarding the use of the ‘‘initial encounter’’ seventh character applicable to certain ICD–10–CM code categories.

(S00–T88), were revised in the Draft 2015 ICD–10–CM

Please visit the following site for more detailed information regards to this update: https://www.cms.gov/center/provider-type/home-health-agency-hha-center.html

Note: Under Related Links if you click on CMS-1625-F (PDF) you will be able to pull up the complete

Final Rule from the Federal Register.

HH VBP ModelBeginning January 1, 2016, CMS will be implementing the HH VBP Model which stands for HOME HEALTH VALUE BASED PERCHASING. For all HH certified agencies providing care to Medicare beneficiaries through out 9 selected states. These 9 selected states are:

MASSACHUSETTS MARYLAND NORTH CAROLINA FLORIDA WASHINGTON ARIZONA IOWA NEBRASKA TENNESSEE

AUTHORIZED BY SECTION 1115A OF SECTION A OF THE SOCIAL SECURITY ACT THIS TASK IS TO IDENTIFY WETHER PAYMENT INCENTIVES CAN SIGNIFICANTLY CHANGE PROVIDERS BEHAVIOR TO WAYS THAT SHIFTS HHAs TO VALUE BASED PERCHASING AND IMPROVES QUALITY OF CARE.

Change Request (CR) 9369Change Request (CR) 9369 was released by CMS on Friday, October 16, 2015, providing Additional G-Codes that will differentiate Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) / Licensed Vocational Nurses (LVNs) in Home Health and Hospice claims.

CR9369 establishes new G-codes to differentiate levels of nursing services provided during a hospice stay and a home health episode of care. These two G-codes and the retirement of G0154 will be effective on institutional claims (Types of Bill 032x, 081x, and 082x) for hospice dates of service on and after January 1, 2016, and for home health episodes of care ending on or after January 1, 2016.

The new codes are: G0299 – RNs G0300 – LPNs / LVNs

The two codes, G0299 and G0300, has been implemented to allow the Medicare MACs to appropriately pay hospices for RN visits during the last seven (7) days of life in the Routine Home Care (RHC) setting when those visits are eligible for the Service-Intensity Add-on (SIA). 

See MLN Matter Number: MM9369

CR9369 Continued ……. Some software systems may not currently be prepared

to handle this change, especially with home health.

The most important thing to have in mind with this is education to the staff responsible selecting the appropriate codes / scheduling.

What about G Code G0164 - Teaching & Training

Expected Issues Improper coding Software readiness Billing staff readiness to identify rejections /

Denials Increased Denials, Rejections & RTP Increase coding turn around time Delayed claims processing Improper G Code use / scheduling

Understanding what has changed

Code sets used on OASIS C1 and claim may differ Addition of 7th Character (When 7th Character applies and is missing codes will be invalid causing

claims issues Placeholder “X” is now used in certain codes, when applicable must be used in order for code to be

valid MOO90 determines which code set is used on OASIS As of 10/1/2015 Episode Dates determine which code set is used on Rap and Final Claim Translation of codes as needed Code changes on final claims as needed OASIS C1 & Final claims are compared to verify HIPPS codes match. HH PPS Payment updates have been made. ICD-10-CM ‘Initial Encounter” codes have been updated HH VBP Model implementation effective 1/1/16 for 9 selected states. Service provided by an RN will be coded as G0299 (Direct skilled nursing services of a registered

nurse (RN) in the home health or hospice setting) Service provided by an LPN / LVN will be coded as G0300 (Direct skilled nursing of a licensed

practical nurse (LPN) / licensed vocational nurse (LVN) in the home health or hospice setting).

Resources

https://www.cms.gov/Outreach-and-Education http://www.palmettogba.com/ https://www.ngsmedicare.com/ https://www.cms.gov/center/provider-type/home-health-agency-hh

a-center.html See MLN Matter Number: MM9369

Igea Point of Care

Easy conversion from ICD-9 to ICD-10

Compatible with any device

Works Offline

Converted to ICD-10

Medline Plus Integration Caregiver Focused

Interface Real Time QA Access

Back Office ICD-10 Conversion

Billing Advising Tool

Integrated Facilitates Optimizing

Reimbursements

Electronic Visit Verification via GPS

Electronic Visit Verification via

Telephony

Automatic Payment Posting

New For Waivers and Commercial Insurance

Expedites Posting of Payments

Reduce Errors in Manual Posting

Thank you for attending!Reach out for additional details or to discuss further.

Slides will be made available.

Igeasoftware.com1.866.848.4833 1.866.802.7704 

Continulink.com Leysi M. Casanova, CEO786-797-0300diversemedicalgroup@gmail.com