Monday, March 31, 2014
‘Doc Fix’ Bill Includes Key Changes to Diagnostic Coding
‘Doc Fix’ Bill Includes Key Changes to Diagnostic Coding
By Rebecca Adams, CQ HealthBeat Associate Editor
Physicians would get a reprieve from having to implement a new system of diagnostic codes used to get paid by insurers and the government under the “doc fix” bill that the House passed by voice vote on Thursday.
The legislation (HR 4302) prevents the Department of Health and Human Services from going ahead with the implementation of the ICD-10 code sets until Oct. 1, 2015 — a year after it is currently scheduled to be put into effect.
The transition has already been delayed once.
The American Medical Association, the American Academy
Until now, Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner has insisted that the change would take place as scheduled, with no more delays.
She said earlier this month that “end to end” testing of the system with providers will be conducted over the summer and fall (See CQ HealthBeat, March 4, 2014).
Not every trade association was happy that the House approved a further delay. The Advanced Medical Technology Association, known as AdvaMed, called on the Senate to strike the delay when it acts on the measure on Monday. AdvaMed represents manufacturers of health information systems, diagnostic products and medical devices.
“We are disappointed that the legislation includes a further delay of the ICD-10 procedure coding system,” said JC Scott, AdvaMed senior executive vice president of government affairs. “ICD-10 is the next generation coding system that will modernize and expand the capacity of public and private payers to keep pace with changes in medical practice and health care delivery.”
Scott added, “It makes no sense to delay something that will provide higher quality information for measuring service quality, outcomes, safety and efficiency.”
Another provision affecting coding in the doc fix bill could save $4 billion over 10 years, according to the Congressional Budget Office. It would cut about 0.5 percent under certain circumstances from Medicare spending on physician services.
The provision builds on an initiative by the Centers for Medicare and Medicaid Services. Since 2008, CMS officials have taken a second look at payment recommendations put forward by the American Medical Association/Specialty Society Relative Value Scale Update Committee. The committee, known as the RUC, makes recommendations that significantly influence how much CMS decides to pay physicians.
The committee has a disproportionately high number of specialists on it, say some health policy experts, and that can affect the payment recommendations. Some say that specialty care in particular is over-valued.
CMS officials have tried in the past few years to more closely scrutinize the RUC recommendations.
The doc fix bill would give federal officials more ammunition and direction. The provision provides a long list of codes and code sets that HHS officials should analyze, including codes that have experienced the fastest growth and those that are often billed multiple times for a single treatment. Officials would also focus on those codes that have experienced substantial changes in practice costs recently.
The legislation further states that HHS officials should set an annual savings target of 0.5 percent of spending on physician services. If federal officials meet the goal, then they can redistribute the savings among physicians.
If they don’t, then HHS officials are supposed to cut spending until the target is met. The idea of taking money away gives a wide range of physician groups pause.
“The challenge is that this really would be money out of the system, versus redistribution within the system,” said Shawn Martin, American Academy
The family physicians group would support the idea if it didn’t involve potentially reducing money for all physicians. If the target was met by shifting money within the system, then family and primary care doctors might benefit because CMS officials could take money away from specialty care and redirect it to primary care. Some health policy experts contend that specialty care is overvalued while primary care should get higher rates.
“We think it’s a worthy public policy goal but taking money away from physician services is not a good idea,” said Martin. “We’re caught between something we think is important and something really bad.”
The Alliance of Specialty Medicine flat-out opposes the provision. The specialists’ group lobbied hard against the language and listed it as a main reason for opposing the doc fix patch.
“The vast majority of physician services have been reviewed, resurveyed, and revalued, over the course of the last few years,” the group said in a March 25 letter to Democratic and Republican leaders in both chambers. “We do not believe this provision is necessary and therefore urged its elimination.”
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Sunday, March 16, 2014
Major Health Insurance Plans Say They'll Be Ready for ICD-10
Major Health Insurance Plans Say They'll Be Ready for ICD-10
March 13, 2014 04:04 pm Sheri Porter – AAFP
For many months now, the AAFP has urged family physicians to prepare for this year's Oct. 1 deadline for implementation of the ICD-10-CM code sets for outpatient diagnostic coding.
A big part of that preparation entails adequate end-to-end testing between hospitals, large health systems, independent physician practices and the health insurance companies who pay for a good deal of those health care services. In particular, it is important that the nation's largest private payers including UnitedHealthcare (UHC),Aetna , BlueCross BlueShield (BCBS) and Humana, are ready for the transition so payments to physicians are not delayed.
Thus, in early February, Laura Schmidt, an AAFP private sector advocacy strategist, sent key contacts at each of the companies a list of questions. "We are interested in confirming that (your company) will be ready to fully process claims using ICD-10 codes as of Oct. 1, 2014," wrote Schmidt, who then posed her questions on readiness.
For example, the AAFP asked each insurer to
· confirm that testing of their internal products and processes was complete;
· acknowledge that "upstream" testing of incoming data/processes from the clearinghouses and other health IT companies with which the insurer partnered was complete;
· identify how many provider groups had, or planned to, submit claims to test the "downstream" process;
· share any problems or issues that testing revealed;
· ensure the availability of contingency plans to tackle problem areas;
· provide opportunities for multiple testing episodes for physician practices to test the claims process; and
· divulge plans for how any post-implementation issues would be resolved.
Schmidt said payers indicated that they are working to ensure success with their larger clients first -- such as hospital systems and large practice groups -- before moving on to readiness with smaller physician practices.
All of the payers had set up ICD-10 preparedness pages on their individual websites specifically dedicated to assisting physicians.
Most importantly, all of the health insurance companies who responded said they would be ready for the Oct. 1 deadline.
"Payers want this transition to run smoothly, too," said Schmidt. "They've invested a lot of time and money into the ICD-10 implementation, just as family physicians have. The bottom line is that no business, big or small, involved in this effort can afford a slowdown in its billing and payment processes."
Regarding specific payer readiness, Aetna Senior Medical Director Christopher Jagmin, M.D., reported that his company began large-scale internal testing and targeted external testing in 2013 and would continue throughout 2014.
"We plan to use what we learned from our testing as we work with all of our providers and vendors in coming months," said Jagmin, who is a family physician and an AAFP member. "We are evaluating the best communication mechanisms for sharing our testing results industrywide," he added.
Humana said it was developing a payer/provider collaboration ICD-10 testing program for physicians scheduled for rollout in the spring. Humana listed its top three ICD-10 concerns as
· accurate use of ICD-10 coding for claims submitted after Oct. 1;
· vendor readiness to support ICD-10 early enough for physicians to prepare for the transition date; and
· physician readiness to support ICD-10 on Oct. 1.
In addition, Humana said it was developing a series of webinars to help answer physician questions and indicated that its ICD-10 testing programs with facilities and physician offices would "help mitigate any at-risk claims issues."
A BCBS Association spokesperson said he expected each of the 37 independent locally operated BCBS plans to participate in the downstream testing process. He said most plans would conduct multiple rounds of testing, "but it is an expensive process and has limits."
In addition, BCBS expressed concern that small physician practices were not further along in the process and suggested that a lack of preparedness by health IT vendor partners was part of the problem. "This, in turn, will probably create bottlenecks in testing downstream," said the spokesperson.
Jerry Frank, M.D., UHC's national medical director of physician engagement, said his company had performed extensive internal testing "to verify predictable processing outcomes" since March 2013 and would conclude testing in June. He added that external downstream testing would begin in April and continue through September.
Frank, also an AAFP member, acknowledged that UHC did not have the resources necessary to test claims for all physicians who requested such testing. He pointed to a contingency plan already developed by which UHC will publish key findings from ICD-10 claims testing with selected physicians on its provider information portals.
"Providers can review summarized test findings so they can learn from the experience of those who were able to submit test ICD-10 claims," said Frank. In addition, as part of the planning process, UHC already has created a team dedicated to identifying and resolving ICD-10 issues that crop up after the new code sets become mandatory next fall.
Schmidt said overall, findings from the payer survey were positive. "Insurers indicated that they'll be ready for the Oct. 1 ICD-10 deadline, and our members need to assume a sense of urgency to be ready as well," she said.
Thursday, March 13, 2014
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Thursday, March 6, 2014
GAO Delves into Issues with High Cost Medicaid Beneficiaries
GAO Delves into Issues with High Cost Medicaid Beneficiaries
On February 19th, the Government Accountability Office (GAO) published a report on high-cost Medicaid beneficiaries. In FFY 2009, the GAO found that 31.6 percent of all Medicaid expenditures were spent on the most expensive Medicaid-only beneficiaries, who were 4.3 percent of total Medicaid beneficiaries. Conversely, states spent another third (33.1 percent) on all other Medicaid-only beneficiaries, who represented 81.2 percent of total Medicaid beneficiaries. The report found that dual eligibles followed a similar pattern.
On February 19th, the Government Accountability Office (GAO) published a report on high-cost Medicaid beneficiaries. In FFY 2009, the GAO found that 31.6 percent of all Medicaid expenditures were spent on the most expensive Medicaid-only beneficiaries, who were 4.3 percent of total Medicaid beneficiaries. Conversely, states spent another third (33.1 percent) on all other Medicaid-only beneficiaries, who represented 81.2 percent of total Medicaid beneficiaries. The report found that dual eligibles followed a similar pattern.
Overall, the GAO found that the likelihood of being a high-expenditure Medicaid-only beneficiary was based on certain characteristics, including:
- 24.4 percent for those residing in a long-term care facility;
- 20.8 percent for those with HIV/AIDS;
- 18.3 percent for those with disabilities; and,
- 13.3 percent for new mothers or infants
Wednesday, March 5, 2014
Tuesday, March 4, 2014
Medical Marijuana And Abortion Bills Move Forward
Mon., March 3, 2014
Medical Marijuana And Abortion Bills Move Forward
By Jeanne Bonner GBP
Any bill that didn't pass one of the General Assembly's chambers Monday won't have a clear shot at becoming law in the final 10 days of this year's 40-day legislative session. That is to say, any bill that didn't pass by Monday will die, if its sponsors are unable to find another bill onto which they can graft the measure. It's a maneuver known as finding a vehicle, and it's often a way for controversial bills to get a second chance.
Crossover Day is usually one of the longest days of the session at the Gold Dome. And on Monday, lawmakers began voting on bills mid-morning per their normal schedule. But the Senate adjourned around a little after 6 p.m. And the House adjourned well before midnight. That's early for the Georgia Legislature.
Long Day, But Fewer Bills
The session has been moving quickly because lawmakers want to adjourn so they can raise money for their re-election campaigns. And indeed, the 2014 election was never far from lawmakers' minds. As one lobbyist put it, "It's the slowest Crossover Day in at least a decade."
A Capitol staffer agreed, saying, "They don't want to do anything that's going to cost them a vote."
That means, fewer bills and less debate. But that doesn't mean there weren't a few bills that raised hackles.
On the House side, lawmakers spent hours debating several bills: the so-called medical marijuana bill, a measure that would block the local implementation of the Affordable Healthcare Act, and a measure that would strip the Governor's office of the power to expand Medicaid rolls.
Across the Capitol, senators logged hours mainly debating a bill that would nix coverage of abortion under the state employee healthcare plan. They also passed a bill that would bar the state from levying ad valorem taxes.
Controversy, Thy Home Is In the Medical Field
Predictably, the abortion debate in the Senate was heated. But this year, the Democrats raised the bar by trying to place wire coat hangers on every Senator's desk. Their aim was to say Republicans want to send
Sen. Mike Crane, a Newnan Republican, denied the bill stemmed from a purported GOP 'War on Women.'
"It's not about what is permissible or what is not," he said on the floor of the Senate. "It's simply a matter of, who is going to pay for it?"
But Crane also opposes abortion, and he didn't shy away from giving his opinion on the issue. And the hangers.
"It's evil. It's evil. This isn't election-year politics," he said of abortion.
And since this was Crossover Day, he didn't leave it there.
"Wave around a vacuum. The method of choice for abortion - do you know, why don't we put that up on the screen? - is evacuation. Where they put a vacuum into the uterus, and they suck a child apart piece by piece."
The debate did have a few nuances. While the chamber's Democrats called the bill another skirmish in the GOP's war against women, Freddie Powell Sims, a Dawson Democrat who represents District 12, saw the issue a bit differently.
"SB 98 is a bigger battle in the overall campaign against this state's working class poor and middle class," she told her colleagues. "It does not improve the quality of life of the working poor in district 12."
She added, "I don't know who the bill continues to target year after year."
What she said must have resonated because Lt. Gov. Casey Cagle, a Gainesville Republican who presides over the Senate, took the unusual step of saying, "Thank you, Senator, for the way you conduct yourself."
From Abortion To Marijuana
Another medically-related bill that captivated lawmakers Monday was a measure that would legalize medical marijuana for treatment of a rare seizure disorder. Some lawmakers have voiced opposition because the cannabis oil in question is an untested drug that's not approved for this use by the Food and Drug Administration.
The bill is sponsored by Macon Republican Allen Peake. He took inspiration from
He acknowledged the speed at which the bill has moved through the legislature by saying, "Let me address the elephant in room: we are moving way too fast."
But he said the bill provides for strict oversight, and is narrowly focused.
“It’s not a slippery slope to legalizing cannabis in general,” he said. “It doesn’t provide immediate access for those who need it.”
Rep. Sharon Cooper, who chairs the House’s Health and Human Services committee , voted for the bill but raised some concerns. She said the bill’s supporters are giving the families false hope. She also said the solution proposed in the bill isn’t the only way to help children with these disorders. And even if Gov. Nathan Deal signs Peake’s bill into law, it will take time for families to obtain the oil.
“If we raise these families’ expectations that they are going to get something quickly – even if everything sails through and this can get implemented, it will take months or a year or more, and that really bothers me,” the Marietta Republican said.
And she said no one can guarantee cannabis oil won’t have side effects or provoke unintended consequences.
After the vote, Peake and House Speaker David Ralston said the bill still faces an uphill battle in the Senate.
“I hope you can find someone over in the Senate to champion this bill,” Ralston told some of the bill’s supporters.
Medicaid Expansion And Other Bills That Passed the Legislature Monday
The House also passed a bill that would prevent a sitting governor from expanding Medicaid rolls. Under the Affordable Care Act, the federal government would pay the full cost of new enrollees in
Democrats have cried politics over the bill, and have questioned the point in continuing to fight what's known as Obamacare.
In presenting the bill, Jan Jones, the Speaker Pro Tem and a Milton Republican, repeated what the Georgia GOP has long said: give the state the money in block grants to distribute as it sees fit.
“Our state could make great progress if we were given the opportunity by
Rep. Ed Lindsey, an Atlanta Republican, said he supports Gov. Nathan Deal but his one voice can’t be the final one, apart from the legislature, on such a big decision.
“I supported him in 2010 and I intend to support him in 2014,” he said. “But he is not the person in this Capitol who is closest to the people.”
Democrats said the measure is just one more obstruction of the federal healthcare reform act.
Here are some of the other bills lawmakers making news Monday:
HB 772, which would require applicants for welfare to take a drug test to receive the benefits, passed. A similar law is already on the books in
HB 707, which would prevent any state agency from carrying out aspects of the Affordable Healthcare Act, passed the House.
HB 1080, which would authorize a statue of the Reverend Martin Luther King, Jr. on state Capitol grounds, passed the House. A similar bill passed the Senate last year.
HB 702, which would place a monument to the Ten Commandments in a prominent spot at the Capitol, passed the House. Currently, a monument to the Judeo-Christian laws sits in the basement of the Capitol.
SB 281, which would require the state employee healthcare plan include a high deductible option with health savings account, passed.
SB 214, which would allow winners of the state lottery to remain anonymous if they donated 25 percent of their winnings back to the Lottery for Education Account, did not come up for a vote in the Senate, even though it was on the calendar.
SB 404, which would have made it more difficult for immigrants to obtain
More Controversy To Come
Some of the session’s hot-button measures – including a bill that would allow guns in churches and bars – didn’t come up on the floor of either chamber Monday. That’s because those bills had already passed one chamber and hence weren’t in jeopardy of dying for the session. But now lawmakers will turn their attention back to those bills.
Other measures raising eyebrows died because of a lack of support. For example, one of the so-called religious freedom bills failed to make it onto the Senate calendar for a vote Monday. Josh McKoon, a Columbus Republican, is the bill’s sponsor. He held a press conference Monday afternoon where he announced he will travel the state for the rest of the year to gauge support for the bill among voters. His measure would allow business owners to refuse service to customers if they believe it would violate their religious beliefs. But others say it’s a tool for the religious right to discriminate against same-sex couples.
Lawmakers are in session every day of this week. And the Senate could take up the 2015 budget as early as Wednesday. The sprint to March 20 begins in earnest.
CMS Chief Tavenner: No Delay for ICD-10, but Some Meaningful Use Relief
CMS Chief Tavenner: No Delay for ICD-10, but Some Meaningful Use Relief
Friday, February 28, 2014 iHealth Beat
At the Healthcare Information and Management Systems Society's annual conference on Thursday, CMS Administrator Marilyn Tavenner said that there will be no further delays to ICD-10 but that the agency would offer more flexibility in hardship exemptions for Stage 2 of the meaningful use program, Clinical Innovation & Technology reports.
Tavenner's Comments on the Meaningful Use Program
Under the 2009 federal economic stimulus package, health care providers that demonstrate meaningful use of certified electronic health record systems can qualify for Medicaid and Medicare incentive payments (Walsh, Clinical Innovation & Technology, 2/27)
Earlier this week, a large coalition of provider organization sent a letter asking HHS Secretary Kathleen Sebelius to delay the timeline of the meaningful use program (Ackerman, iHealthBeat, 2/25).
Although the federal government has not acted on the groups' request, Tavenner said during her keynote speech that CMS would be more flexible with its hardship exemptions and would consider such applications on a case-by-case basis (Clinical Innovation & Technology, 2/27).
Currently, CMS offers hardship exemptions for new providers, those facing natural disasters and those who do not have face-to-face interaction with patients (Pittman, MedPage Today, 2/27).
Tavenner noted that some health care providers might be facing other issues that prevent them from meeting Stage 2, such as not having tested and certified EHR software or EHR vendors going out of business.
Tavenner stressed the importance of moving forward with the meaningful use program.
She said that interoperability requirements of Stage 2 of the program are "a key step to everything going forward," especially value-based payment programs. She added, "Now is the time for us to start moving forward" (Conn
Officials said more specific details on the hardship exemptions would be available in early March (MedPage Today, 2/27).
Tavenner's Comments on ICD-10
Addressing the upcoming ICD-10 deadline, Tavenner said, "Now is not the time for us to stop moving forward" (Weiner, HealthLeaders Media, 2/27). She added, "Let's face it ... We've delayed this several times, and it's time to move on" (Modern Healthcare, 2/27). "There will be no change in the deadline for ICD-10," she said (HealthLeaders Media, 2/27).
In August 2012, HHS released a final rule that officially delayed the ICD-10 compliance date from Oct. 1, 2013, to Oct. 1, 2014, partially to look at the incremental changes needed in reforming health care (iHealthBeat, 2/20).
According to Healthcare Informatics, Tavenner also highlighted several steps that CMS is taking to support ICD-10 testing, such as its recent decision to conduct end-to-end testing (Perna/Hagland,Healthcare Informatics, 2/27).
Reaction
Shortly after Tavenner's speech, the College of Healthcare Information Management
Chantal Worzala, director of policy at the American Hospital Association, in a statement said AHA "is disappointed that CMS will not make changes to the timelines or provide additional flexibility in the meaningful use requirements." Worzala added, "The AHA will work closely with the agency to ensure that the hardship exceptions protect hospitals from unwarranted penalties."
Meanwhile, American Medical Association President Ardis Dee Hoven raised concerns about CMS' lack of a "back-up plan" for ICD-10 testing, in the event that "last-minute testing demonstrates anticipated problems with this massive coding transition." He said, "At the end of the day, sticking hard and fast to the ICD-10 deadline without a back-up plan to address disruptions in medical claims processing will hurt doctors and their patients" (Modern Healthcare, 2/27).
Monday, March 3, 2014
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