Acevedo Consulting Incorporated's Newsletter: Eye on Compliance Eye on Compliance

Acevedo Consulting Incorporated's
Eye on Compliance
 
Eye on Compliance is a quarterly newsletter prepared to inform our clients and friends about important topics and firm news.
 
Volume 1, Issue 1 - March 2016

What the Value-based Payment Modifier Means for Your Practice
by: Katherine Becker, JD, LLM, CHC, CHPC, CPC-A
Associate Consultant
 
Originally published in the AAPC's Healthcare Business Monthly, January 2016
 
The Centers for Medicare & Medicaid Services (CMS) is slowly implementing the value-based payment modifier, starting with groups that include 100 or more eligible professionals (EPs) and working down to solo practitioners.  Providers who deliver high quality care at a low cost will be eligible for a positive reimbursement adjustment, while providers who deliver low quality care and high costs will be subject to significant negative adjustments. Continue Reading
 
How will your organization adapt as Fee-for-Service transitions to quality driven reimbursement?  Join Katherine during the May 10, 2016 webinar where CMS's Value-Based Payment Modifier (VBPM) and the Merit Based Incentive Payment System (MIPS) along with Quality and Resource Use Reports (QRUR) will all be reviewed and discussed.

Modifier 25: Have You Received a Comparative Billing Report (CBR)?
by: Candice Fenildo, CPC, CPMA, CPB, CENTC
Associate Consultant
 
Originally published in the Florida Society of Rheumatology's Newsletter, February 2016
 
The Office of Inspector General (OIG) reports that approximately 35% of claims submitted with modifier 25 are done incorrectly. In fact, your practice may have received a Comparative Billing Report (CBR) in the mail detailing your use of 25 as compared with that of your peers. These reports come from eGlobalTech and measure an individual physician or qualified health care professional’s use of CPT codes 99211 through 99215 (established patient office visits) and CPT modifier 25 (a significant, separately identifiable evaluation and management service by the same provider on the same day). Continue Reading
 
Has your physician received a CBR report and you're not sure what to do with the data?  Contact our team today to hear more about how we can assist.

HIPAA-HITECH Audits
2016 promises HIPAA-HITECH audits by the Office of Civil Rights ("OCR"). This comes after criticism from the Office of Inspector General ("OIG") claiming that the OCR has failed to ensure that Covered Entities and Business Associates maintain complaince in protected PHI and the OIG's 2016 Work Plan addition to review "the adequacy of the Office of Civil Rights oversight over the security of electronic protected information."
 
The OCR will randomly select Covered Entities and Business Associates without any notice and those selected will be given a very short period of time to respond. 
 
To help safeguard your risk, it is important to ensure that privacy programs are up-to-date, that a current security risk analysis ("SRA") is on file and that all employees have had appropriate training. 
 
ACI can assist organizations with each of these goals. Click here to read more about our privacy services.

Meaningful Use Attestation Error Fixed
The Centers for Medicare & Medicaid Services (CMS) shut down the Medicare & Medicaid EHR Incentive Program Registration and Attestation System on Sunday, February 21, 2016 to correct an error that prevented eligible professionals (EPs) from claiming an exclusion for Measure 1 of the Patient Electronic Access Objective number 8.
 
The exclusion (Patient Electronic Access, Measure 1 Exclusion: Any EP who neither orders nor creates any of the information listed for inclusion as part of the measures except for 'Patient Name' and 'Provider’s name and office contact information.’) was unable to be chosen by providers during attestation.
 
Eligible professionals whose attestation was rejected as a result of not meeting objective 8 may modify and resubmit their attestation information by the original deadline of March 11, 2016 at 11:59 PM EST. 

Widespread Probe Notification for  99214
First Coast Service Options Inc. (FCSO) announced last week that they will conduct a widespread probe (WSP) review of CPT code 99214 (Office/outpatient visit established).  This decision is in response to recent Comprehensive Error Rate Testing (CERT) reports that noted aberrant billing errors identified with 99214.  The CERT report went on to indicate that the errors were based on insufficient documentation, medically unnecessary services, and incorrectly coded services.
 
Provider types affected include Internal Medicine, Family Practice and Cardiology. FCSO will complete the WSP for dates of service August 1, 2015 to January 31, 2016 to validate that the documentation supports the medical necessity and the level of service billed.
 
For FCSO announcement click here.

The Medicare EHR Incentive Program Hardship Application Deadline Extended
In January, CMS posted new, streamlined hardship exception application forms that reduce the amount of information that eligible professionals (EPs), eligible hospitals, and CAHs must submit to apply for an exception. 
 
CMS announced last week that it has extended the application deadline for the hardship exception to July 1, 2016. CMS announced it was extending the deadline to allow providers sufficient time to submit their applications and avoid adjustments to their Medicare payments in 2017.
 
For additional informaion click here.

Firm News:
Congratulations to Associate Consultant, Katherine Becker, for recently becoming Certified in Healthcare Privacy Compliance (CHPC) through the Health Care Complaince Association.
 
Additionally, Congratulations to Associate Consultant, Candice Fenildo, for recently becoming a Certified Professional Coding Instructor (CPC-I) through the AAPC.
 
Acevedo Consulting Events:
2016 Update: The OIG Work Plan
March 8, 2016 12-1pm EST
 
Meaningful Use
April 5, 2016  12-1pm EST
 
2016 OIG Work Plan for the Hospice & Palliative Program
April 26, 2016 12-1pm EST
 
Quality Metrics: How Will they Impact Your Future Payments
May 10, 2016  12-1pm EST
 
ICD-10: Do You Know the Basics
June 14, 2016  12-1pm EST
 
Register Here
 

Community Events Featuring Acevedo Consulting:
AAHPM & HPNA Annual Assembly: Office Hours, Billing and Coding 
March 10-12, 2016 - Chicago, Illonois
 
HIPAA Compliance and Enforcement Trends
Broward County Medical Association
March 23, 2016  11:30-1pm - Fort Lauderdale, Florida
 
2016 Billing and Coding Update
Broward Health 
March 25, 2016  9-11am - Deerfield Beach, Florida
 
CPT & Medicare Changes for Rheumatology
Network of Rheumatology Managers and Crescendo Bioscience
March 29, 2016 and March 31, 2016 - Webinars
 
PQRS for Rheumatology
Network of Rheumatology Managers and Crescendo Bioscience
April 12, 2016 and April 14, 2016 - Webinars
 
National Hospice and Palliative Care Organization 2016 Management & Leadership Conference: HIPAA Security Best Practices 
April 20, 2016 - Oxon Hill, Maryland
 
National Hospice and Palliative Care Organization 2016 Management & Leadership Conference: Palliative Care Billing & Coding
April 21, 2016 - Oxon Hill, Maryland
 
ICD-10 for Otolaryngology Reviewed
Network of Florida Otolaryngologists
May 19, 2016  12-1pm EST - Webinar
 
ICD-10: Documentation and Coding Tips for Rheumatology
Network of Rheumatology Managers and Crescendo Bioscience
May 24, 2016 and May 26, 2016 - Webinar