ICD-10 Update and AccuChecker

Information regarding the ICD-10 update is beginning to come out.

The Oct. 1, 2016, updates to the ICD-10 code sets includes about 1,943 additional codes and at least 400 code revisions. The really good news is that all those changes will apply to all healthcare professionals.

For cardiology practices, there are three top cardiology coding changes in the ICD-10 updates:

·         Hypertensive crisis

·         Familial hypercholesterolemia

·         Myocardial infarction

Learn more about AccuChecker Online. No need to purchase new CPT Books or ICD-10 Books, we do quarterly updates.  All files are maintained and updated on a QUARTERLY basis.

The AccuChecker Files consist of:

·         ICD-10

·         CPT CODING

·         CCI~NCCI

·         LCD

·         Fee Schedules

·         PQRS

·         HEDIS

Our clients enjoy the ACK HOTLINE ( Support ).

Members of AccuChecker enjoy unlimited phone support and/or email support.

Understanding the quality measures are KEY to your survival:  Success or Failure

Q&A :   Denials / Coding / HEDIS / PQRS

The ACK Hotline is Free with the purchase of AccuChecker or a monthly subscription for Support Only $69.00 per month.

For more details call:  305-227-2383  or 1-877-938-9311

email:  psilben@hppcorp.com

Why Does Coding Count?

Why Does Coding Count?

 

Coding Accuracy–We are all required by HIPPA to follow the International Classification of Diseases (ICD)(ICD-10 October 1, 2015) coding guidelines. This includes compliant code selection and documentation to support codes reported. The health care system and the patients count on the providers to assist with showing medical necessity. 

Risk Management–Health plans are reimbursed based on providers’ code submission on claims. Codes need to be reported to the highest level of supported specificity so correct payment is received, and hold if in case of an audit of coding versus documentation. The system counts on providers to assist in keeping risk low by coding their best. 

Quality of Care–Medicare Advantage plans are ranked by CMS on a star rating scale of 1 to 5. Factors within the quality scale directly relate to codes reported and supported on the provider level. The higher the star rating, the better recognition the health plans receive from Medicare.  Providers are scored on the performance for: MRA and/or HEDIS. Physicians that deal with traditional Medicare, their scoring is based on PQRS.

Today’s healthcare requires a physician to be more involved in the administrative aspect and the quality of care rather than patient care.  A provider now has to be concerned with: 

·         PQRS

·         HEDIS

·         Meaningful Use

·         Quality Measures

·         Core Measures

Pending how the provider performs on these scores:

·         It will determine his/her contract(s) with Health Plans

·         Failure to comply will result in a payment reduction

·         Failure with Risk Management / Capitation

·         Audits 

We are proud to introduce MCAR REPORTS a complete set of management reports for IPAs, MSOs and PCP Practices that have Risk Agreements with HMOs Plans. The MCAR Reports give you complete awareness over what is happening with every HMO Plan that your organization participates in risk operations. 

MCAR - MANAGED CARE REPORTS is an online service available created from data files downloaded from HMOs servers. Within 24 to 48 hours our team produces all reports needed to manage your risk business. MCAR Reports are viewed from our secured HIPPA compliant servers however most reports are downloadable in EXCEL format files. 

MCAR Reports services can range from only generating reports to having our management team assisting clients in managing the risk operations.

Clients can select MCAR Report services “A LA CARTE” choosing monthly reports needed and/or consulting services they prefer.

 

FOR MORE INFORMATION PLEASE CONTACT:

HPP Management Group, Corp.

Developers of the AccuChecker Product Line

Phone: (305) 227-2383  or 1-877-938-9311 

Email:  fcortes@hppcorp.corp

Website: http://www.accuchecker.com

Transition to Value-Based Care

Transition to Value-Based Care

As hospitals, health systems, academic medical centers and hospital-employed physician groups/foundations position their transition to value-based care as a top priority, a goal of improving the patient experience is closely related.   

Physicians should understand the challenges hospitals and physicians now face in the new world of changing reimbursements and how an integrated patient access strategy can lead to both improved clinical and financial performance.  Provider organizations should be  using a centralized approach to improve compliance among their physician practices, prevent revenue leakage, increase physician referrals, and improve the overall efficiency of their staff will also be required.     

Understanding the new trend providers should be able to :

 

•             Identify how industry trends are reshaping how hospitals, health systems and physician groups must interact with and engage their patients

•             Understand how hospital readmissions, poor transitions of care, inconsistent chronic care management, scheduling capacity management, and repeat visits by patients to the emergency department affect operational costs, decrease reimbursement, and often lead to a poor patient experience

•             Detail the benefits and metrics of success of having targeted patient-centered functions managed by centralized call centers and how people, processes, and tools are fundamental

•             Describe how an innovative "concierge" approach to patient interactions helps providers improve financial and clinical performance and allow for a more predictable, repeatable patient experience

AccuChecker is meeting the goals to transition to value-based care and compliance. We have been helping physicians since 1983 with a proven track record. The challenges today are great and providers do not have time to prepare, it is sink or swim.  The current trend :

·         ICD-10 implemented 10/01/2015  ( ICD-11 Forthcoming )

·         PQRS – penalties to be increased and enforced

·         HEDIS

·         Meaningful Use ( Stage 3 to begin )

·         Value-Based Care ( Chronic Care Management (CCM), Transitional Care Management (TCM), Patient-centered medical home recognition (PCMH) )

HPP AccuChecker is the solution to guide you in today’s healthcare – Success and Compliance.

FOR MORE INFORMATION

HPP Management Group, Corp.

5201 Blue Lagoon, Suite 800

Miami, FL 33126

Phone: (305) 227-2383 or 1-877-938-9311

Email: pesilverio@hppcorp.com

Website: http://www.accuchecker.com

OIG Work Plan 2016: Top Things to Watch

OIG Work Plan 2016: Top Things to Watch 

 OIG’s Strategic Plan outlines the vision and priorities that guide OIG in carrying out its mission to protect the integrity of HHS programs and operations and the health and welfare of the people they serve. The Strategic Plan articulates four goals that drive OIG’s work:  

• fight fraud, waste, and abuse;

• promote quality, safety, and value;

• secure the future; and

• advance excellence and innovation.

OIG ensures an efficient and effective use of its resources through integrated planning, monitoring, and reporting processes. Together these processes are used to set organizational priorities that best further our strategic goals, measure and analyze the impact of our work, and inform strategic and operational change.

 

Clinical laboratory payments:

In 2016, the OIG plans to conduct an annual analysis of Medicare clinical diagnostic laboratory tests to examine expenditures and the new payment system.

Using EHR to support care coordination through ACO:

In 2016, the OIG will review the extent that providers participating in ACOs in the Medicare Shared Savings Program use electronic health records to exchange health information to achieve their care coordination goals.

Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) requirements:

The OIG will review the compliance of the IRF PPS in 2016, which covers the documentation required in support of the claims paid by Medicare.

Intensity-modulated radiation therapy (IMRT) Services:

In past OIG review have identified hospitals that have incorrectly billed for IMRT services. Hospitals need to be aware that the OIG intends to review Medicare outpatient payments for IMRT beginning in 2016.

Effects of the Competitive Bidding Program on Medicare Beneficiaries Access to durable medical equipment:

The OIG have plans of determining the effects of the competitive bidding program on Medicare beneficiaries’ access to certain types of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS)—in 2016.

 

FOR MORE INFORMATION

HPP Management Group, Corp.

5201 Blue Lagoon, Suite 800

Miami, FL 33126

Phone: (305) 227-2383 or 1-877-938-9311

Email: pesilverio@hppcorp.com

Website: http://www.accuchecker.com

 

 

 

 

 

 

 

 

 

 

 

Don’t lose valuable dollars to an inefficient medical billing process.

Are you not getting paid what you deserve? Don’t lose valuable dollars to an inefficient medical billing process.

Here are some COSTLY mistakes:

 

·         ICD- 10

·         Getting Paid On Time

·         Revenue Losses

·         An Inefficient or Costly Billing Team

·         The Various Quality Indicators

 

The Solution :                   ACK Support Services

How it Works:

 

$59.00 per month

Unlimited Phone Support

Unlimited Email Support

No Contract , cancel whenever

Hours of Operation : [Mon-Thurs 8-5 and Friday 8-1]

 

ü  Claims Analysis

ü  ICD-10 Mapping

ü  HEDIS

ü  PQRS

ü  ACO

ü  PCMH

ü  Medical Policy

ü  Coding and Reimbursement

ü  Credentialing

 

·         Your Source of Information a phone call away

·         Comprehension of  the Changes, phone call / email away

Payment and Policy Changes

Policy Changes for Medicare Inpatient Rehabilitation Facilities

Proposed Fiscal Year 2016 Payment and Policy Changes for Medicare Inpatient Rehabilitation Facilities (CMS-1624-P)

On April 23, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule outlining proposed fiscal year (FY) 2016 Medicare payment policies and rates for the Inpatient Rehabilitation Facility Prospective Payment System (IRF PPS) and the IRF Quality Reporting Program (IRF QRP).  The FY 2016 proposals are summarized below.

Proposed Changes to IRF payment policies and rates:

Changes to the payment rates under the IRF PPS.  CMS is proposing to update the IRF PPS payments for FY 2016 to reflect an estimated 1.9 percent increase factor (reflecting a new IRF-specific market basket estimate of 2.7 percent, reduced by a 0.6 percentage point multi-factor productivity adjustment and a 0.2 percentage point reduction required by law). CMS is proposing that if more recent data are subsequently available (for example, a more recent estimate of the market basket or multifactor productivity adjustment) we would use such data, to determine the FY 2016 update in the final rule. An additional 0.2 percent decrease to aggregate payments due to updating the outlier threshold results in an overall update of 1.7 percent (or $130 million), relative to payments in FY 2015.

No changes to the facility-level adjustments. As stated in the FY 2015 IRF PPS final rule (79 FR 45872, 45882 through 45883), CMS froze the facility-level adjustment factors at the FY 2014 levels for FY 2015 and all subsequent years, unless and until we propose to update them again through future notice and comment rulemaking. For FY 2016, CMS will continue to hold the facility-level adjustment factors at the FY 2014 levels as we continue to monitor the most current IRF claims data available to assess the effects of the FY 2014 changes.

ICD-10-CM Conversion.

 In the FY 2015 IRF PPS final rule (79 FR 45872), CMS finalized conversions from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) to the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) for the IRF PPS, which will be effective when ICD-10-CM becomes the required medical data code set for use on Medicare claims and IRF‑PAI submissions. CMS reminds providers of IRF services that the implementation date for ICD-10-CM is October 1, 2015.

Be aware of all upcoming changes.

ACK Support Services

 ACK Hotline is your solution for your Medical Reimbursement.  A support service that will assist you with : 

PQRS                                                  HEDIS

National Quality Measures                ICD-10

Coding                                                  Meaningful Use

Value-Based Modifier                         MRA

 

How It Works:

·         Unlimited Email Support

·         Unlimited Calls

·         No Contracts ~ Cancel When You Want

·         $59.00 per Month

·         Service is:  Monday through Thursday  8:00AM to 5:00PM

      Friday 8:00AM to 1:00PM

 

Avoid the penalties and understand how to navigate in today’s medical reimbursement !!!

 

For More Details: 305-227-2383  or 1-877-938-9311 ( Ask For Felicia )

 

 

HPP Management Group, Corp.

5201 Blue Lagoon Dr.

Suite 815

Miami, FL 33126

Upcoming Changes

Upcoming Changes

ICD-10

With the implementation of ICD-10 looming, many providers are bracing for the impact of a new system on their productivity and revenue stream. And with claim denial rates projected to double post-transition, it's never been more important to equip your practice with processes and resources that help mitigate these new challenges.

Meaningful Use

Most healthcare professionals understand how electronic health records (EHRs) can drive greater patient engagement and improve the quality of care.

Medicare Advantage

On February 6, 2015, the Centers for Medicare & Medicaid Services (CMS) issued a final rule revising regulations for the Medicare Advantage (MA) program (Part C) and prescription drug benefit program (Part D). This final rule implements statutory requirements, improves program efficiencies, strengthens beneficiary protections, clarifies program requirements, improves payment accuracy, and makes technical changes for Contract Year (CY) 2016.

Providers need to be aware of all the changes that are evolving rapidly in the healthcare industry.  How do we accomplish this?    The response is:   ACK Support Services

ACK Hotline is your solution for your Medical Reimbursement.  A support service that will assist you with:

PQRS                                                 HEDIS

National Quality Measures               ICD-10

Coding                                                Meaningful Use

Value-Based Modifier                       Medical Policy 

 

How It Works: 

·         Unlimited Email Support

·         Unlimited Calls

·         No Contracts ~ Cancel When You Want

·         $59.00 per Month

·         Service is:  Monday through Thursday  8:00AM to 5:00PM

         Friday 8:00AM to 1:00PM

 

Avoid the penalties and understand how to navigate in today’s medical reimbursement !!!

 

For More Details: 305-227-2383  or 1-877-938-9311 ( Ask For Felicia )

 

 

HPP Management Group, Corp.

5201 Blue Lagoon Dr.

Suite 815

Miami, FL 33126