Upload
others
View
3
Download
0
Embed Size (px)
Citation preview
Surviving the Value Modifier, PQRS & MIPScpt, pqrs, value modifier and icd-10
Steve Adams, MCS, COC, CPC, CPMA, CPC-I, PCS, FCS, COA
email: [email protected] web: thecodingeducator.com
www.thecodingeducator.com
Discussion Points
• Physician Compare• Value Modifier • Quality, Cost, Experience• ICD-10 & Risk Adjustment• PQRS • QRUR• CCM and TCM
Physician Compare
Value Based Modifier
Value ModifierBy now you are probably aware that there is a big push to move away from paying for care on a "fee-for-service" basis and toward paying for value and quality of care instead. To ensure that the market could move toward value more effectively, the Affordable Care Act required Medicare to establish a "value modifier (VM)" that provides for differential payment to providers based upon the quality of care furnished to Medicare beneficiaries compared to the cost of that care during a performance period. -
Value Added Modifier
Quality
Value Modifier Reduction
Additive
Costs
Experience
Risk
ICD-10 and Risk Adjustment
SOURCE: Chronic Condition Data Warehouse (CCW). Medicare Beneficiary Summary Files.
Anemia
DM
DM
HPL
HTN
HF
Hyperlipidemia
Long Term Use
Non Compliance
Tools for ICD-10
National Center for Health Statistics
Chapters
Internet
IPhone
I-phone/Android Application
Intelligent Medical Object(IMO)
SOURCE: Chronic Condition Data Warehouse (CCW). Medicare Beneficiary Summary Files.
PQRS for Dummies
What is PQRS• The Physician Quality Reporting System (PQRS) is a
reporting program that uses a combination of incentive payments and payment adjustments (penalties) to promote reporting of quality information. Although PQRS is a standalone "pay for reporting" program, it drives other CMS programs that require quality reporting that are "pay for performance," including the Value-Based Payment Modifier Program.
PQRS Registry
Specialty Measure Setshttp://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQ
RS/MeasuresCodes.html
QRUR – Final Score
QRUR • Information on performance is provided to
participants in the form of Physician Quality & Resource Use Reports (QRURs). These reports are used to monitor the potential value modifier adjustment, and to improve performance.
What Do I Do?
What Do I Do?
Merit Based Payment
2018 End of PQRS Reductions – Not So Fast –
2019 - MIPS
SOURCE: Chronic Condition Data Warehouse (CCW). Medicare Beneficiary Summary Files.
Discussion Points
• Physician Compare• Value Modifier • Quality, Cost, Experience• ICD-10 & Risk Adjustment• PQRS • QRUR• CCM and TCM
Questions?
Any QuestionsDirect: 706-483-4728
E-Fax: 770-709-3698
E-mail: [email protected]
Web: www.thecodingeducator.com
Facebook: facebook.com/kingofcoders