Importance of Diagnosis & HCC Coding

    Diagnosis Coding is Becoming Increasingly Important Diagnosis coding is becoming more and more important.  The shift from volume to value, requires HCC coding for patient acuity not just diagnosis coding for medical necessity.  During the “Good Old Days” (think pre-Meaningful Use) as well as during the Meaningful Use Era, diagnoses were primarily required…


MIPS Advancing Care Information Measure

Advancing Care Information, or ACI, is a simplified version of the retired Meaningful Use program.  Many of the most disliked MU requirements (CPOE, Clinical Decision Support) are no longer required.  The required elements of ACI focus on: ePrescribing, patient access to their chart, HIPAA security risk assessment and HIE.  Partial credit scoring is now available…


MIPS Improvement Activities Measure

Improvement Activities is a new category that was created to improve patient access and the patient experience.  Practices and eligible clinicians have a lot of flexibility to choose the Improvement Activities that are most beneficial to their patients and practice.  There are a total of 93 activities and 8 different domains from which to choose. …


MIPS Quality Measure

The Quality category is nearly identical to the PQRS program.  Eligible clinicians can choose the quality measures that are most meaningful for their specialty and their patients.  Providers can choose from a total of 271 measures across 6 domains.  For the 2017 transition year, quality will be 60% of the aggregate MIPS score, this will…


MIPS (Medicare Incentive Payment System)

MIPS is the new Value Based Reimbursement model created to shift risk to healthcare providers and to reward those who can deliver outstanding healthcare at a competitive cost.  Most physicians will be participating in MIPS under QPP.  All eligible clinicians who see more than 100 unique Medicare patients and have more than $30,000 in eligible…


Overview of MACRA, QPP, & MIPS

MACRA is landmark, bi-partisan legislation passed by Congress.  It is designed to dramatically shift the payment of healthcare from the current Volume Based Reimbursement model to a model based on quality and cost effectiveness. MACRA repealed the flawed Sustainable Growth Rate, phased out Meaningful Use, PQRS and the Value Based Modifier programs. It created two…


Three Questions Your Practice Should Be Asking About Unspecified ICD-10 Codes

The average physician practice is using unspecified ICD-10 codes at a rate of 31.5%.  There are significant short term and long term risks to using unspecified codes.  It is important to know what the unspecified rate is for your practice and to know what that unspecified rate means. These are three questions your practice should…