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Newsletter September 28, 2015

Friday, October 9, 2015   (0 Comments)
Posted by: Diane Berg
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Newsletter September 25, 2015

Newsletter September 25, 2015

 

Florida Orthopedic Community Bulletin

 

September 28, 2015

 

 

 

ICD-10 Update - Workers' Comp

On October 1, 2015 the Centers for Medicare & Medicaid Services (CMS) will be transitioning to ICD-10 (diagnosis coding). In line with the CMS policy, the Division of Workers' Compensation will require ICD-10 codes for medical bills andmedical EDI transactions containing dates of service on or after 10/1/15. The Division will require ICD-9 codes on medical bills and medical EDI transactions with dates of service prior to 10/1/15.

 

In an effort to promote the self-executing nature of the workers' compensation system, the Division urges all interested parties to consider Rule 69L-7.710(5)(j)1.a., F.A.C. in securing correct diagnosis codes.The rule states, in part, the insurer, service company/TPA, or entity acting on behalf of the insurer can:

 

"Secure and/or correct the information on the medical bill and proceed to make a reimbursement decision to pay, adjust, disallow, or deny billed charges within45-calendar days from the "date insurer received".

 

If you have any questions or concerns please contact the Medical Services Section at Workers.MedService@myfloridacfo.com.

 

Source: Division of Workers' Compensation

 

CMS updates guidance on ICD-10 flexibilities

 

The U.S. Centers for Medicare & Medicaid Services (CMS) has updated its guidance document regarding ICD-10 flexibilities. Among other things, the document includes the following section:

 

How does the CMS 24-month look-back period for Medicare fee-for-service audits intersect with the 12-month period of audit flexibility? Will the auditors review and deny claims from the October 2015-October 2016 period for ICD-10 code specificity after October 2016?

 

Contractors conducting medical review (Medicare Administrative Contractors/Recovery Auditors/Supplemental Medical Review Contractor) will not deny claims solely for the specificity of the ICD-10 code as long as there is no evidence of potential fraud. This is consistent with current medical review policies and is not applicable to prepayment denials because of a National Coverage Determination or a Local Coverage Determination.


Learn more about the ICD-10 transition

View the guidance document (PDF)

Find more resources from the AAOS(member login required)

 

Source:AAOS Headline News Now

 

 

Medical leaders ask CMS to delay implementation of Comprehensive Care for Joint Replacement payment model



An article in HealthLeaders Media reports on opposition to the U.S. Centers for Medicare & Medicaid Services (CMS) proposed Comprehensive Care for Joint Replacement payment model. Under the model, payment and quality measures for hip and knee arthroplasty would be bundled at hospitals in 75 randomly selected geographic areas, with most hospitals in those regions required to participate. Hospitals in which the procedure is performed would be accountable for costs associated with the entire episode of care, from the time of surgery through 90 days postoperative. A final rule is expected to be released Nov. 1, with an implementation date of Jan. 1, 2016, but the American Association of Orthopaedic Surgeons (AAOS) states that 2 months is not enough time for hospitals to develop the infrastructure necessary to implement the new system, and has asked CMS for a 1-year delay in implementation.Read more.

 

The AAOS submitted comments on the proposed rule prior to the deadline date.
Read more.

 

Source: AAOS Headline News

 

 

Senate committee chair threatens legislative action if HHS won't delay finalization of Stage 3 meaningful use.

 

Morning Consult reports that the chair of the U.S. Senate Health, Education, Labor, and Pensions Committee has threatened legislative action if the Obama administration refuses to delay until 2017 finalization of Stage 3 meaningful-use rules. Among other things, the proposed rule for Stage 3 released by the U.S. Department of Health and Human Services (HHS) requires providers to send electronic summaries for 50 percent of patients they refer to other providers, receive summaries for 40 percent of patients who are referred to them, and reconcile past patient data with current reports for 80 percent of such patients. However, many observers say the technology isn't widely available to carry out such requirements.Read more.

 

AAOS, together with a number of other healthcare organizations, sent letters to HHS Secretary Sylvia Burwell and the U.S. Office of Management and Budget (OMB) asking for a pause in Stage 3 implementation and a reevaluation of the meaningful use program in light of recent changes to Medicare.


Read the letter to HHS (PDF)

Read the letter to OMB (PDF)

Source:AAOS Headline News

 

 

Aetna, Anthem CEOs insist mergers will "enhance competition"

TheNew York Times (9/23, Pear, Subscription Publication) reports that the chief executives of Aetna and Anthem "told skeptical senators on Tuesday that consumers would benefit if the federal government approved their plans to acquire two other big insurers." Aetna CEO Mark T. Bertolini said in testimony before the Senate Judiciary Committee that his company's proposed merger with Humana will "enhance competition" by giving consumers an alternative to Blue Cross and Blue Shield plans. Anthem CEO Joseph R. Swedish, meanwhile, "said his company's merger with Cigna would 'uniquely benefit consumers' by expanding access to care through a more extensive network of doctors and hospitals." Nonetheless, Consumers Union "expressed doubts about the deals," and Sen. Richard Blumenthal (D-CT) "objected to the mergers, saying they could cause harm by reducing competition."

The Los Angeles Times (9/23, Howard) reports that senators from both parties "raised concerns about how the deals would affect healthcare costs." Additionally, American Hospital Association CEO Richard Pollack "testified that he was concerned about the possibility of rising prices and limited choices under an Aetna/Humana merger, especially for the millions of seniors who buy Medicare Advantage plans."

 

The AP (9/23, Murphy, Gordon) notes that before the deals can close, the Justice Department "must pass judgment on whether the mergers would make the companies so dominant that they could create a competitive imbalance." In the meantime, "senators wanted to weigh in although Congress doesn't rule on the mergers."

Source: AMA Morning Rounds



 

 

State Pharmacy Board Revising Rules For Pain Meds
Prescription Pad
Florida is still grappling with the pill mill crisis of four years ago.But with the problem of too many prescriptions receding in the rear-view mirror, the problem now is too few.

The Florida Board of Pharmacy is reworking its rules for prescribing controlled substances. The concern among members is that Florida's efforts combating pill mills has left some pharmacists hesitant to fill valid prescriptions.Read more

Source: Health News Florida

 

 

HHS will focus on uninsured in five regions during ACA open enrollment period, Burwell says

The New York Times (9/23, Pear, Subscription Publication) reports HHS Secretary Burwell said Tuesday that when the third open enrollment season under the Affordable Care Act begins on November 1, the Obama Administration will "focus efforts to expand health coverage to the uninsured in Dallas, Houston, northern New Jersey, Chicago and Miami."

 

The Washington Post (9/23, Goldstein) reports that the focus will be "on 10.5 million uninsured Americans, trying to persuade them to sign up for coverage that they have ignored or rejected in the past." Burwell said, "Those who are uninsured are going to be a bigger challenge."

 

The Wall Street Journal (9/23, Radnofsky, Subscription Publication) reports Burwell added, "While our goals may be harder to reach, we're working smarter to reach them. We know Americans are depending on us and we're doing everything we can to help them find the coverage they need."

 

Source: AMA

 

 

Upcoming Events

 

FOS Announces Capitol Hill Days Tallahassee - November 16-17, 2015

The FOS is putting together our advocacy team that will travel to Tallahassee on November 16th and 17th for the 2016 Orthopaedic Capitol Hill Days. Committee Meetings are already underway in Tallahassee for the 2016 Legislative Session. Physicians and Administrators are welcome to join us as we charge the hill and advocate on behalf of orthopaedics in Florida.

 

The event will include a debriefing and dinner on Monday evening, November 16th. Followed by Hill Visits on Tuesday, November 17th. The FOS staff will make all of the appointments and will provide talking points and leave behind materials. All you need to bring is your wealth of knowledge and enthusiasm and some business cards.

 

This is a great opportunity to visit with legislators, develop meaningful relationships, and lobby for important issues such as raising physician fees in workers compensation, expansion of Ambulatory Surgery Centers, and reducing administrative burdens on physician practices.

 

Attendees will be required to pay for their own hotel and transportation. We do have a small block of hotel rooms set aside. Once you confirm you are interested, we will assign a room to you and send you confirmation.

 

Attached is a very preliminary draft of our agenda for the trip.

 

Please email the FOS directly if you are interested in participating, fcobbe@cobbemanagement.com

 

 

 

 

 

 

Corporate Partners

 

 

 

Stay Connected

 

Like us on FacebookFollow us on TwitterView our profile on LinkedInView our videos on YouTube


 

Forward this email


This email was sent to diane@cobbemanagement.com by fcobbe@cobbemanagement.com |

Update Profile/Email Address | Rapid removal with SafeUnsubscribe| About our service provider.


Florida Orthopaedic Community
| 1215 E Robinson Street | Orlando | FL | 32801


 

 

Florida Orthopedic Community Bulletin

 

September 28, 2015

 

 

 

ICD-10 Update - Workers' Comp

On October 1, 2015 the Centers for Medicare & Medicaid Services (CMS) will be transitioning to ICD-10 (diagnosis coding). In line with the CMS policy, the Division of Workers' Compensation will require ICD-10 codes for medical bills andmedical EDI transactions containing dates of service on or after 10/1/15. The Division will require ICD-9 codes on medical bills and medical EDI transactions with dates of service prior to 10/1/15.

 

In an effort to promote the self-executing nature of the workers' compensation system, the Division urges all interested parties to consider Rule 69L-7.710(5)(j)1.a., F.A.C. in securing correct diagnosis codes.The rule states, in part, the insurer, service company/TPA, or entity acting on behalf of the insurer can:

 

"Secure and/or correct the information on the medical bill and proceed to make a reimbursement decision to pay, adjust, disallow, or deny billed charges within45-calendar days from the "date insurer received".

 

If you have any questions or concerns please contact the Medical Services Section at Workers.MedService@myfloridacfo.com.

 

Source: Division of Workers' Compensation

 

CMS updates guidance on ICD-10 flexibilities

 

The U.S. Centers for Medicare & Medicaid Services (CMS) has updated its guidance document regarding ICD-10 flexibilities. Among other things, the document includes the following section:

 

How does the CMS 24-month look-back period for Medicare fee-for-service audits intersect with the 12-month period of audit flexibility? Will the auditors review and deny claims from the October 2015-October 2016 period for ICD-10 code specificity after October 2016?

 

Contractors conducting medical review (Medicare Administrative Contractors/Recovery Auditors/Supplemental Medical Review Contractor) will not deny claims solely for the specificity of the ICD-10 code as long as there is no evidence of potential fraud. This is consistent with current medical review policies and is not applicable to prepayment denials because of a National Coverage Determination or a Local Coverage Determination.


Learn more about the ICD-10 transition

View the guidance document (PDF)

Find more resources from the AAOS(member login required)

 

Source:AAOS Headline News Now

 

 

Medical leaders ask CMS to delay implementation of Comprehensive Care for Joint Replacement payment model



An article in HealthLeaders Media reports on opposition to the U.S. Centers for Medicare & Medicaid Services (CMS) proposed Comprehensive Care for Joint Replacement payment model. Under the model, payment and quality measures for hip and knee arthroplasty would be bundled at hospitals in 75 randomly selected geographic areas, with most hospitals in those regions required to participate. Hospitals in which the procedure is performed would be accountable for costs associated with the entire episode of care, from the time of surgery through 90 days postoperative. A final rule is expected to be released Nov. 1, with an implementation date of Jan. 1, 2016, but the American Association of Orthopaedic Surgeons (AAOS) states that 2 months is not enough time for hospitals to develop the infrastructure necessary to implement the new system, and has asked CMS for a 1-year delay in implementation.Read more.

 

The AAOS submitted comments on the proposed rule prior to the deadline date.
Read more.

 

Source: AAOS Headline News

 

 

Senate committee chair threatens legislative action if HHS won't delay finalization of Stage 3 meaningful use.

 

Morning Consult reports that the chair of the U.S. Senate Health, Education, Labor, and Pensions Committee has threatened legislative action if the Obama administration refuses to delay until 2017 finalization of Stage 3 meaningful-use rules. Among other things, the proposed rule for Stage 3 released by the U.S. Department of Health and Human Services (HHS) requires providers to send electronic summaries for 50 percent of patients they refer to other providers, receive summaries for 40 percent of patients who are referred to them, and reconcile past patient data with current reports for 80 percent of such patients. However, many observers say the technology isn't widely available to carry out such requirements.Read more.

 

AAOS, together with a number of other healthcare organizations, sent letters to HHS Secretary Sylvia Burwell and the U.S. Office of Management and Budget (OMB) asking for a pause in Stage 3 implementation and a reevaluation of the meaningful use program in light of recent changes to Medicare.


Read the letter to HHS (PDF)

Read the letter to OMB (PDF)

Source:AAOS Headline News

 

 

Aetna, Anthem CEOs insist mergers will "enhance competition"

TheNew York Times (9/23, Pear, Subscription Publication) reports that the chief executives of Aetna and Anthem "told skeptical senators on Tuesday that consumers would benefit if the federal government approved their plans to acquire two other big insurers." Aetna CEO Mark T. Bertolini said in testimony before the Senate Judiciary Committee that his company's proposed merger with Humana will "enhance competition" by giving consumers an alternative to Blue Cross and Blue Shield plans. Anthem CEO Joseph R. Swedish, meanwhile, "said his company's merger with Cigna would 'uniquely benefit consumers' by expanding access to care through a more extensive network of doctors and hospitals." Nonetheless, Consumers Union "expressed doubts about the deals," and Sen. Richard Blumenthal (D-CT) "objected to the mergers, saying they could cause harm by reducing competition."

The Los Angeles Times (9/23, Howard) reports that senators from both parties "raised concerns about how the deals would affect healthcare costs." Additionally, American Hospital Association CEO Richard Pollack "testified that he was concerned about the possibility of rising prices and limited choices under an Aetna/Humana merger, especially for the millions of seniors who buy Medicare Advantage plans."

 

The AP (9/23, Murphy, Gordon) notes that before the deals can close, the Justice Department "must pass judgment on whether the mergers would make the companies so dominant that they could create a competitive imbalance." In the meantime, "senators wanted to weigh in although Congress doesn't rule on the mergers."

Source: AMA Morning Rounds



 

 

State Pharmacy Board Revising Rules For Pain Meds
Prescription Pad
Florida is still grappling with the pill mill crisis of four years ago.But with the problem of too many prescriptions receding in the rear-view mirror, the problem now is too few.

The Florida Board of Pharmacy is reworking its rules for prescribing controlled substances. The concern among members is that Florida's efforts combating pill mills has left some pharmacists hesitant to fill valid prescriptions.Read more

Source: Health News Florida

 

 

HHS will focus on uninsured in five regions during ACA open enrollment period, Burwell says

The New York Times (9/23, Pear, Subscription Publication) reports HHS Secretary Burwell said Tuesday that when the third open enrollment season under the Affordable Care Act begins on November 1, the Obama Administration will "focus efforts to expand health coverage to the uninsured in Dallas, Houston, northern New Jersey, Chicago and Miami."

 

The Washington Post (9/23, Goldstein) reports that the focus will be "on 10.5 million uninsured Americans, trying to persuade them to sign up for coverage that they have ignored or rejected in the past." Burwell said, "Those who are uninsured are going to be a bigger challenge."

 

The Wall Street Journal (9/23, Radnofsky, Subscription Publication) reports Burwell added, "While our goals may be harder to reach, we're working smarter to reach them. We know Americans are depending on us and we're doing everything we can to help them find the coverage they need."

 

Source: AMA

 

 

Upcoming Events

 

FOS Announces Capitol Hill Days Tallahassee - November 16-17, 2015

The FOS is putting together our advocacy team that will travel to Tallahassee on November 16th and 17th for the 2016 Orthopaedic Capitol Hill Days. Committee Meetings are already underway in Tallahassee for the 2016 Legislative Session. Physicians and Administrators are welcome to join us as we charge the hill and advocate on behalf of orthopaedics in Florida.

 

The event will include a debriefing and dinner on Monday evening, November 16th. Followed by Hill Visits on Tuesday, November 17th. The FOS staff will make all of the appointments and will provide talking points and leave behind materials. All you need to bring is your wealth of knowledge and enthusiasm and some business cards.

 

This is a great opportunity to visit with legislators, develop meaningful relationships, and lobby for important issues such as raising physician fees in workers compensation, expansion of Ambulatory Surgery Centers, and reducing administrative burdens on physician practices.

 

Attendees will be required to pay for their own hotel and transportation. We do have a small block of hotel rooms set aside. Once you confirm you are interested, we will assign a room to you and send you confirmation.

 

Attached is a very preliminary draft of our agenda for the trip.

 

Please email the FOS directly if you are interested in participating, fcobbe@cobbemanagement.com

 

 

 

 

 

 

Corporate Partners

 

 

 

Stay Connected

 

Like us on FacebookFollow us on TwitterView our profile on LinkedInView our videos on YouTube

 

Forward this email


This email was sent to diane@cobbemanagement.com by fcobbe@cobbemanagement.com |

Update Profile/Email Address | Rapid removal with SafeUnsubscribe| About our service provider.


Florida Orthopaedic Community
| 1215 E Robinson Street | Orlando | FL | 32801

 


more Calendar

12/6/2019 » 12/7/2019
2019 Winter FOS & BSOF Coding & Reimbursement Conference

6/18/2020 » 6/21/2020
2020 FOS Annual Scientific Meeting

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