BREAKING NEWS – Update Release
News for Week Ending : 10/31/2015
Discharge Planning
Discharge Planning Proposed Rule Focuses on Patient Preferences
Today, the Centers for Medicare & Medicaid Services
(CMS) proposed to revise the discharge planning requirements that hospitals,
including long-term care hospitals and inpatient rehabilitation facilities,
critical access hospitals, and home health agencies, must meet in order to
participate in the Medicare and Medicaid programs. The proposed changes would
modernize the discharge planning requirements by: bringing them into closer
alignment with current practice; helping to improve patient quality of care and
outcomes; and reducing avoidable complications, adverse events, and
readmissions.
ICD-10
Some documentation issues will require physicians to
capture new information; others involve updated, modified, and otherwise
expanded documentation needs.
Top-10 problem areas are:
- Diabetes mellitus
- Injuries
- Drug underdosing
- Cerebral infarctions
- AMI
- Neoplasms
- Musculoskeletal conditions
- Pregnancy
- Respiratory/vents
- ICD-10-PCS
Diabetes
mellitus. ICD-9 features 59 codes for diabetes, while ICD-10
offers more than 200. The expanded diabetes code set has added a provision of
“poorly controlled” to the categories of controlled or not controlled. Coders
typically today have to query physicians to code the controlled levels, and
adding another measurement will make coding even more complex.
ALERT : The fact is : No true crosswalk' exists between ICD-9
and ICD-10
CMS launches new ACO dialysis model
On October 7, 2015, CMS announced the new
accountable care organization (ACO) dialysis model, the Comprehensive ESRD Care
(CEC) Model, participants.
The CEC Model is designed specifically
for beneficiaries with ESRD and builds on experiences from other models and
programs with ACOs, including the Pioneer ACO Model and the Medicare Shared
Savings Program. In the CEC Model, dialysis facilities, nephrologists, and
other providers have joined together to form ESRD Seamless Care Organizations
(ESCO) to coordinate care for ESRD beneficiaries. This model will encourage
dialysis providers to think beyond their traditional roles in care delivery and
support beneficiaries as they provide patient-centered care that will address
beneficiaries’ health needs in and out of the dialysis facility.
Notification of
1st Quarter FY 2016 interest rate for overpayments and underpayments
On October 13, 2015, CMS posted Transmittal 255 providing notice of
the new interest rate for Medicare over- and underpayments for the first
quarter of 2016. Interest is assessed on delinquent debts to protect the
Medicare Trust Funds.
Effective Date: October 20, 2015
Implementation Date: October 20, 2015
Medicare and
Medicaid programs; Electronic Health Record Incentive Program—Stage 3 and
Modifications to Meaningful Use in 2015 through 2017
On October 16, CMS posted a final rule with
comment period in the Federal Register
regarding the requirements that eligible professionals (EPs), eligible
hospitals, and critical access hospitals (CAH) must meet to qualify for
Medicare and Medicaid electronic health record (EHR) incentive payments and
avoid downward payment adjustments under the Medicare EHR Incentive Program. In
addition, this final rule with comment period establishes the requirements for
Stage 3 of the program as optional in 2017 and required for all participants
beginning in 2018. The final rule with comment period continues to encourage
the electronic submission of clinical quality measure (CQM) data, establishes
requirements to transition the program to a single stage, and aligns reporting
for providers in the Medicare and Medicaid EHR Incentive Programs. Comments are
due December 15, 2015.
Effective Date: December 15, 2015.
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