This webinar covers how to accurately reflect the patient’s risk and the medical necessity of services and procedures through documentation improvement and specificity of ICD-10-CM coding (with examples).
Increasingly, CMS and other major payers, including private insurance plans, are requiring providers to participate in “risk adjusted” and “pay-for-performance” reimbursement models in order to participate in their managed care plans. Most of these plans require a degree of payment based on the risk (acuity of diseases) of the patient, combined with demonstrated improved health outcomes. Improvement in patient health outcomes require a strong understanding of how to improve provider documentation and how to ensure all of a patient’s chronic illnesses are coded at least once per year (during the annual physical in most cases) with the most appropriate ICD-10-CM codes. This session will focus on the most common deficiencies in documentation and code assignment for various medical specializations and offer specific strategies to correct these deficiencies. Examples will be provided throughout.
Areas Covered In The Session:
- An overview of CMS’s MIPS program
- An overview of how Medicare Advantage Plans and other payers use hierarchical condition categories (HCCs) to determine reimbursement amounts based on risk sharing
- Detailed discussion of most common documentation deficiencies for various specialties and their impact on correct coding which, in turn, negatively impacts reimbursement.
- Detailed discussion, with examples, on how to remedy the deficiencies in documentation and ICD-10-CM coding to support medical necessity of services and procedures, report the most accurate acuity of each patient’s chronic health conditions (especially the combinations of conditions that increase a patient’s health risk), and make it easier to educate the patient on reducing their risk
- Review free resources available through CMS
At the conclusion of this presentation, participants will be able to:
- Work with clinical staff to improve documentation practices so that all conditions that impact the acuity of a patient’s chronic diseases are captured with the highest degree of specificity
- Increase the collaboration between coding staff and clinicians so that coders are able to assign the most specific and appropriate ICD-10-CM codes
- Identify the most common chronic diseases that impact reimbursement in these models – especially when a patient has multiple chronic conditions – and understand the impact of using less specific ICD-10-CM codes than should be assigned
- Outpatient hospital medical coders
- Billing specialists
- Practice managers
- Outpatient hospital staff responsible for auditing claims
Brandy Ziesemer is the health information program manager and professor with Lake-Sumter State College. She is a Registered Health Information Administrator and a Certified Coder Specialist. She was an AHIMA-approved ICD-10-CM & PCS Trainer from August 2011 through June 2017. She is also a member of: the American Health Information Management Association and the Florida Health Information Management Association (AHIMA/FHIMA), the Health Information Management Systems Society (HIMSS) and of the Professional Association of Healthcare Office Managers (PAHCOM).
Brandy was the FHIMA ICD-10 Task Force Leader from July 2013-June 2015. The focus of the taskforce included ICD-10-CM/PCS training (basic and “All Hands on Deck), physician outreach and education in Florida, and acting as a liaison between CMS along with their training partner, Noblis, FHIMA, PAHCOM and AAPC to offer free training to clinicians and their staff.
Over the past year, Brandy has presented three “Food for Thought” sessions for practice managers affiliated with Florida Hospital Waterman. Topics included: MACRA/MIPS; Documentation Improvement to increase the accuracy and specificity of ICD-10-CM code selection; and mastering the correct use of CPT/HCPCS modifiers.
Brandy has co-authored a CPT coding book, contributed to a health informatics book and written a text on Medical Office Management and Technology. She is also the editor of PAHCOM’s six Practice Management Manuals and an advisor to PAHCOM’s education staff.
Brandy has been awarded 3 service awards through FHIMA: Educator of the Year; Literary Award and in 2015, Distinguished Services Award.
Prior to joining the LSSC faculty in 1997, she had extensive experience working with managed care organizations in California and New Jersey, and consulting in physician practice management in Florida. She and her husband moved to Florida from Northern California in 1993.