As 2018 draws to an end, so do your chances to prepare for the ICD-10, HCPCS, CPT and Medicare policy changes taking place in 2019. December 11th marked Kassouf & Co.’s 16h annual coding workshop, where Kim Huey (“Kim the Coder”) delivered important updates to attendees from all over the state of Alabama. If you missed this year’s workshop, we have highlighted some key takeaways to help you prepare for the upcoming year:
- Some guidelines have changed with regard to reporting BMI ICD-10 diagnoses. The new update states BMI codes should only be assigned when it impacts the patient (i.e. the patient is overweight or obese). However, in some cases, payers will request the reporting of a patient’s BMI because it represents a measure of one of their programs (e.g. Blue Cross BlueShield).
Medicare Policy Changes:
- Providers are no longer required to document medical necessity in order to justify a home visit.
- For established patients, there will no longer be a requirement to re-record history and exam information previously documented if there is evidence the practitioner reviewed the information.
- Chief complaints entered by ancillary staff do not have to be re-entered by the practitioner when the provider indicates he/she has reviewed and verified the information.
- The blended reimbursement proposal for office visit levels 2 through 5 was delayed until 2021. Pending any changes, levels 2 through 4 will have one, single payment rate. Kim indicated the AMA is working diligently to address many issues with the current and outdated E/M model. By 2021, the AMA may have a different framework for E/M services which could nullify these proposed changes altogether. While there is no guarantee the goal will be met by 2021, watch out for policy updates in the future.
- Virtual check-in services will be reimbursable when performed by a physician for established patients. Currently, there is no frequency limitation in 2019.
- Telehealth services will be expanded to include prolonged preventive services.
- There will be an expansion in Interprofessional services. With patient consent and acknowledgement of beneficiary cost-sharing, consultative physicians can now be paid for an Interprofessional telephone, internet and/or EHR assessment and management service.
- Clinical Psychologists, Physical Therapists, Occupational Therapists, Speech-Language Pathologists, Audiologists and Registered Dieticians or Nutrition Professionals have been added to the list of clinicians eligible to participate in MIPS.
- The low-volume threshold has been expanded to include a third element. Practices that provide 200 or more covered professional services can elect to participate in the program.
- 26 quality measures have been removed and 8 new measures have been added.
- The Cost category has increased to 15 points. The Quality category decreased to 45 points.
- To avoid negative adjustments, you must meet or exceed 30 points while the threshold for exceptional performance will be 75 points in 2019.
We urge you to prepare for the coding and policy changes we will encounter next year. Consult your advisors to ensure all changes have been addressed and you are prepared to embrace and implement these changes.
By: Stewart Garner, Healthcare Consultant at Kassouf & Co., P.C.
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