In May, we expect to see the release of the International Classification of Diseases, 11th Edition, for Mortality and Morbidity Statistics (ICD-11-MMS) by the World Health Organization. Work will then begin in the U.S. to adapt it for our clinical use as ICD-11-CM. Hopefully, with the benefit of foresight and lessons learned from the past, we will not reenact the pain we all had with the ICD-10-CM/PCS implementation.
Given it’s time for New Year’s resolutions—and my resolution is to work smarter, not harder—it seems appropriate to talk about techniques for bringing balance back into our lives.
Project REFRESH brought the deletion of many standards and elements of performance (EP), and you will see even more changes beginning in January. This column will also review the changes to the Evidence of Standards Compliance (ESC) corrective action plan for Requirements for Improvement (RFI) that must be submitted after a survey.
Coding experts take a look at changes to ICD-10-PCS, including guideline updates, the addition of “other devices” characters, and new tables added for root operation Replacement.
CDI review teams can get bogged down and discouraged by routine. A CDI manager should be visible, positive, and combat team complancency and routine fatigue.
Three major types of payer record reviews are conducted every year: The Healthcare Effectiveness Data and Information Set (HEDIS), Medicare Risk Adjustment, and Commercial Risk Adjustment. As the volume of payer and health plan reviews continues to climb, millions of patient records are requested.
Most physicians are familiar with the MIPS quality models: These are the Physician Quality Reporting System (PQRS) measures that we’ve been reporting for years with the old Medicare value-based purchasing program. What we don’t know much about are the new cost efficiency models in MIPS, which are based solely on hospital and physician ICD-10-CM/CPT claims data rather than a clinical abstraction of our medical records.
