HCC Blog by Caridad

Acceptable Physician Specialty Types for 2020 Payment Year (2019 Dates of Service) Risk Adjustment Data Submission   https://www.csscoperations.com/internet/csscw3_files.nsf/F/CSSCAcceptable%20Physician%20Specialty%20Types%20PY2020.pdf/$FILE/Acceptable%20Physician%20Specialty%20Types%20PY2020.pdf Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations.  The information presented herein is for general informational purposes only and is accurate as of the date of publication.

  CMS NEWS: Trump Administration Announces Medicare Fee-For-Service Estimated Improper Payments Decline by $15 Billion Since 2016 11/16/2020 CMS NEWS FOR IMMEDIATE RELEASE November 16, 2020 Contact: CMS Media Relations (202) 690-6145 |  CMS Media Inquiries   Trump Administration Announces Medicare Fee-For-Service Estimated Improper Payments Decline by $15 Billion Since 2016 Continued reduction marks fourth year Medicare FFS improper payment rate has been below 10%  The Centers for Medicare & Medicaid Services (CMS) announced today that the Medicare Fee- For-Service (FFS) improper payment rate has continued to decline, reinforcing the Trump Administration and CMS’ commitment to strengthening Medicare and protecting taxpayer dollars. This translates to less fraud, waste and abuse that can increase the fiscal burden on the nation’s healthcare system. Over the past four years, CMS’ aggressive corrective actions have led to an estimated $15 billion reduction of Medica...

 When coding for cancer diagnosis, here is a handy on line dictionary on cancer terms from National Cancer Institute.  https://www.cancer.gov/publications/dictionaries/cancer-terms Cancer Types tab Select a type of cancer to learn about treatment, causes and prevention, screening, and the latest research. NCI Dictionary of Cancer Terms The NCI Dictionary of Cancer Terms features 8,727 terms related to cancer and medicine. cancer type  https://www.cancer.gov/publications/dictionaries/cancer-terms Chart documentation may include location, site, laterality, specific site on body, including stage (how much has grown and spread).  Document current status of neoplasm, if responding to treatment, or if historical with no active treatment or recurrence Consider using the term  'in remission' in place of 'history of' when describing the cancer, as appropriate. When adjuvant therapy is used, document its purpose if curative, palliative or preventive. Document an referrals...

 This brief 5-minute video from CMS is entitled Annual Wellness Visits (AWV) Video and was released Oct 14, 2020.  The video provides health care professionals with guidance to understand expectations and requirements when submitting documentation for Annual Wellness Visits (AWV) for Medicare beneficiaries. It briefly explains the difference between a 'Routine Physical Checkup', "Initial Preventive Physical Exam' and 'Annual Wellness Visit'.  https://www.youtube.com/watch?v=r7yOUaMJyJU&feature=youtu.be Disclaimer: This guidance is to be used for an easy reference; the ICD-9-CM and ICD-10-CM code books and the Official Guidelines for Coding and Reporting are the authoritative references for accurate and complete coding. This blog may contain references or links to statutes, regulations, or other policy materials. It is not intended to take the place of either the written law or regulations.  The information presented herein is for general informational purpo...

Expanding Medicare Telehealth Services For the first time using a new expedited process, CMS is  adding 11 new services to the Medicare telehealth  services list since the publication of the May 1, 2020, COVID-19 Interim Final Rule with comment period (IFC). Medicare will begin paying eligible practitioners who furnish these newly added telehealth services effective immediately, and for the duration of the PHE. These new telehealth services include certain neurostimulator analysis and programming services, and cardiac and pulmonary rehabilitation services. The list of these newly added services is available at:  https://www.cms.gov/Medicare/ Medicare-General-Information/ Telehealth/Telehealth-Codes . In the May 1 COVID-19 IFC, CMS modified the process for adding or deleting services from the Medicare telehealth services list to allow for expedited consideration of additional telehealth services during the PHE outside of rulemaking. This update to the Medicare telehealth s...

 Billions in Estimated Medicare Advantage Payments From Diagnoses Reported Only on Health Risk Assessments Raise Concerns https://oig.hhs.gov/oei/reports/OEI-03-17-00471.asp OIG analyzed 2016 MA encounter data to determine the 2017 financial impact of diagnoses reported only on HRAs and not on any other records in the encounter data that year. Most in home HRAs were conducted by companies that partner with or are hired by MAOs to conduct these assessments-and therefore are not likely conducted by the beneficiary's own primary care provider. Twenty MAOs generated millions in payments from in-home HRAs for beneficiaries for whom there was not a single record of any other service being provided in all of 2016. Complete 45 page report can be found at:  https://oig.hhs.gov/oei/reports/OEI-03-17-00471.pdf

This was issued in response to the COVID-19 pandemic This 'Dear Clinician' letter from CMS was dated April 7, 2020.   This is just for historical reference and they published clinical guidance on a daily basis for many months since then.   Medicare Telehealth Visits:           p 3 Virtual Check-ins:                         p 4 E-visits:                                         p 4 Waiver 1135                                   p 8 Dated 4/7/2020 https://www.cms.gov/files/document/covid-dear-clinician-letter.pdf