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With the delayed release of the proposed 2016 Medicare Physician Fee Schedule, the CAP is rescheduling its webinar on Medicare's payment rule to July 14 at 1 PM ET.

Following the release of Medicare's payment rule, CAP members can see the new pathology-specific policies by registering for the College's webinar "Understanding the 2016 Medicare Physician Fee Schedule Proposed Rule." Throughout this hour-long panel discussion, CAP experts will explain the changes proposed by the Centers for Medicare & Medicaid Services (CMS) regarding the 2016 fee schedule.

The proposed fee schedule will contain reimbursement changes affecting pathologists. During this session, attendees will learn about the proposed rule's pathology-related policies, the potential impact on pathologists, and the CAP's advocacy efforts to impact the CMS’ proposal prior to its finalization.

Sign up for this complementary webinar presentation today.

At this article's deadline, the government had not yet released the proposed fee schedule. Once the fee schedule is released, CAP members will receive a special STATLINE Alert with the College's initial analysis of the Medicare rule and new policies impacting pathologists.

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Health care providers, including pathologists and laboratories, have less than three months to finalize preparations for the transition to the ICD-10 diagnosis coding set.

Beginning October 1, all Health Insurance Portability and Accountability Act (HIPAA)-covered entities must begin using ICD-10 codes; ICD-9 codes will no longer be accepted on claims for services performed on or after October 1. Claims cannot contain both ICD-9 and ICD-10 codes, and claims that are improperly filed will be returned as unprocessable.

ICD-10 Transition Grace Period

For 12 months following ICD-10 implementation, the Centers for Medicare & Medicaid Services (CMS) will not deny Medicare reimbursements solely because the incorrect ICD-10 code, or wrong specificity, was used on claims billed by physicians under the Medicare Part B fee schedule. A valid ICD-10 code from the right diagnosis code family would be required in order to be reimbursed.

The American Medical Association (AMA), the CAP, and other physician associations had voiced concern about the upcoming ICD-10 implementation and the potential for disruption to physician offices. The CMS and AMA announced on July 6 new efforts to help physicians through the transition period.

While physicians won't face denials because the wrong ICD-10 code was used, Medicare's claims processing systems will not have the capability to accept ICD-9 codes for dates of services after September 30. Medicare also will not be able to accept claims with both ICD-9 and ICD-10 codes.

The CMS and AMA will provide more education and resources prior to the transition. The CMS also will create an ICD-10 Ombudsman to triage and answer questions about the submission of claims. The ICD-10 Ombudsman will be located at CMS's ICD-10 Coordination Center.

The CMS' upcoming milestones for ICD-10 include:

  • Setting up an ICD-10 communications and coordination center, learning from best practices of other large technology implementations that will be in place to identify and resolve issues arising from the ICD-10 transition.
  • Sending a letter in July to all Medicare fee-for-service providers encouraging ICD-10 readiness and notifying them of these flexibilities.
  • Completing the final window of Medicare end-to-end testing for providers this July.
  • Offering ongoing Medicare acknowledgement testing for providers through September 30.
  • Hosting a national provider call on August 27.

Getting Ready for ICD-10

ICD-10-CM (clinical modification) codes are very different than ICD-9-CM code sets. There are nearly five times as many diagnosis codes in ICD-10-CM than in ICD-9-CM (68,000 vs 13,000). In ICD-10-CM, the code set has been expanded from five positions (first one alphanumeric, others numeric) to seven positions. The new codes use alphanumeric characters in all positions, not just in the first position as in ICD-9.

The new code set is intended to provide a significant increase in the specificity of the reporting, allowing more information to be conveyed in a code. In addition, the terminology has been modernized and has been made consistent throughout the code set. Because there are codes that are a combination of diagnoses and symptoms, fewer codes need to be reported to fully describe a condition.

The CAP has worked to provide members with resources to prepare for the transition. During a May 21 CAP webinar, Cindy Hegner, CCS, medical practice manager for AnaPath Diagnostics in Cheyenne, WY, and Doug Knapman, senior director of practice management for the CAP, discussed ICD-10 implementation and how practices can prepare for the upcoming transition.

For instance, practices can obtain a report of the top 100 ICD-9-CM codes used throughout the year and run separate reports for anatomic pathology and clinical pathology. This will help practices or laboratories identify which ICD-10 codes to focus on for additional training.

Pathologists, ordering physicians, billing and coding personnel, and other support staff also should receive training for the transition to the new system. Hegner and Knapman said this should include educating referring physicians, documentation changes (ie, requisitions and pathology reports), and working with payers. Understanding and testing referring and payer relationships in regards to ICD-10-CM plans and state of preparedness and having coders practice with ICD-10-CM are key preparation activities. As coders practice, they should provide feedback to those creating pathology reports to ensure the necessary available detail is included.

Access the archived webinar from May 21. CAP members can email the College for their practice management questions.

After the October 1 implementation, practices will want to monitor the impact of ICD-10-CM transition on payments and claims denials and rejections, and identify and address problems and erro+rs. The physician community, including the CAP, has expressed concern about the upcoming transition.

The CAP has additional resources on ICD-10 implementation are available for members (login required).

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The CMS published its 2014 Open Payments data consisting of payments and other transfers of value to physicians from drug and device manufactures on June 30. Even though the Open Payments information for 600,000 physicians and 1,100 teaching hospitals is now public, providers can still dispute inaccuracies reported by industry groups that are now attributed to them.

The 2014 Open Payments data contain 11.4 million financial transactions. Physicians and teaching hospitals had a 45-day period beginning in April to review and dispute inaccuracies by May 20. The CMS says it also was able to verify identifying information of the associated covered recipient for 98.8% of all records submitted. Records that could not be verified were rejected.

Many physicians say the 45-day review period was too short for the 600,000 doctors included in the database. The American Medical Association (AMA) stated that many were hindered from reviewing data because they received inadequate notice of implementation deadlines and the process to check and dispute errors is cumbersome.

The CAP has engaged along with the AMA and other physician specialty societies to advocate for changes to the Open Payments program. In May, the CAP signed on to an AMA letter that supports House legislation that addresses concerns about reporting requirements for medical education.

Physicians may still attempt to correct errors that they find and the CMS will update the database. A CMS reference guide provides instructions for initiating a dispute through the CMS Enterprise Portal. However, the AMA has noted the process is time consuming and the CMS' system is not user friendly.

The CMS' Open Payments Data search tool also is available to quickly review your records. If needed, the AMA has talking points available to help explain the data to patients and the public.

The CAP will continue to keep members informed about the Open Payments system in future editions of STATLINE.

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The American Medical Association (AMA) is asking all of its members to make sure that they vote for the national medical specialty society that best represents your specialty in the AMA House of Delegates. The CAP urges every pathologist to cast a vote for the CAP, as your support is vital to assuring pathologists have a strong voice in the House of Medicine.

The AMA HOD has over 500 voting members and includes representatives from 116 national medical specialties. Voting for CAP as your specialty society not only ensures the College's ability to lead the delegation of pathology organizations in the AMA House of Delegates, it also helps increase the number of pathologists in our delegation. For every 1,000 votes CAP receives, the specialty is allowed one additional delegate in the AMA HOD.

The AMA HOD is the policy-making arm of the AMA and additional delegates mean a stronger voice for your specialty. Once you cast your initial vote, your ballot will remain in AMA records unless you choose to vote for another society.

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Register today for the CAP's "How to Host a Lab Tour" webinar on July 15. The presentation will provide training for CAP members interested in hosting a lab tour for their member of Congress.

The webinar will cover the planning and logistical details, as well as provide case studies from CAP members who have conducted tours. The presentation will cover:

  • What to expect when communicating with an elected official's office
  • Developing a good itinerary for the tour
  • Providing a hands-on experience in the laboratory

Register for this complimentary CAP webinar today!

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