CMS Will Allow Non-specific ICD10 codes for 2015
The Centers for Medicare & Medicaid Services (CMS) announced a set of new policies related to the Oct. 1, 2015 transition to ICD-10. For the first year that ICD-10 is in place, Medicare claims will not be denied, and eligible professionals will not be penalized under PQRS, the value-based payment modifier or meaningful use based soley on the specificity of the diagnosis codes, as long as they are from the appropriate “family” of ICD-10 codes. In addition, CMS will authorize advance payments to physicians should Medicare contractors be unable to process claims as a result of ICD-10 complications. The Agency also announced plans to create a new communication center to monitor and resolve issues as quickly as possible, as well as an “ICD-10 Ombudsman” to assist providers. In a separate announcement, CMS indicated that nationally it accepted 90% of claims from more than 1,200 submitters who participated in CMS’ third round of ICD-10 “front end” (acknowledgement) testing.
CMS Proposes Onerous Changes to PQRS Reporting Requirements
Medicare is proposing sweeping changes to its Physician Quality Report System (PQRS) as part of its annual rulemaking process. Included in the FY 2014 Medicare Fee Schedule proposed rule are changes to the PQRS criteria that will adversely impact physician anesthesiologists. ASA is urging all members to submit comments to CMS regarding these changes.
ISSUE –Many ASA members use the “claims-based” method of reporting PQRS measures since it permits successful reporting when there are fewer than three measures applicable to an eligible professional (EP). At present, the Centers for Medicare & Medicaid Services (CMS) has criteria in place for physician anesthesiologists to successfully report quality measures; however, the proposed rule for the 2014 Medicare Physician Fee Schedule seeks to alter the criteria in a way that will place physician anesthesiologists at a great disadvantage. CMS is moving toward elimination of the claims-based reporting mechanism and is seeking comment as to whether that mechanism should be eliminated in 2017. Some of the actions described in the proposed rule would sharply curtail claims-based reporting even sooner. Specifically, of the more than 40 proposed new measures CMS intends to add to the 2014 PQRS, none allow reporting via claims.
Additionally, CMS proposes to increase the required number of measures that must be reported from the current three (3) measures to nine (9). These nine measures must cover at least three of the National Quality Strategy (NQS) domains: Patient and Family Engagement; Patient Safety; Care Coordination; Population and Public Health; Efficient Use of Health Care Resources; and Clinical Processes/Effectiveness.
Currently, there are a maximum of three measures applicable to most physician anesthesiologists. They all are within a single domain. Accordingly, if Medicare’s proposed rule is finalized, anesthesiologists will be unable to satisfactorily meet reporting requirements. This change would have a significant impact on anesthesiologist’s practice because 2014 is the performance period for your 2014 PQRS incentive and for the 2016 PQRS penalty adjustment.
WHAT CAN YOU DO? ASA has put together a grassroots effort to communicate how disadvantaged these new rules would make it for the Anesthesiology subspecialty. If you wish to join the grassroots effort use the link below and follow the ASA’s recommended steps. http://www.asahq.org/For-Members/Advocacy/Washington-Alerts/ASA-members-urged-to-contact-CMS-2.aspx
