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  • Eligible physicians are defined as medical doctors, dentists, podiatrists, optometrists and chiropractors
    Hospital-based physicians---such as pathologists, anesthesiologists, emergency physicians or hospitalists are not eligible for the incentives
  • Multiplier that converts the geographically adjusted inputs into the Medicare allowable rate.
    Determined on an annual basis.
    Only Congress can authorize changes to the conversion factor.
    MGMA working with Congress to have CMS remove Part B drugs from formula.
  • The next two slides represent just two of many examples of how different ICD-10 is from the current system and illustrates the adjustments physicians will have to make in how they code. Today, doctors only need to understand and use four codes for diagnosing a sprained or strained ankle. Under ICD-10, they will need to determine precisely which of the 72 codes created for a sprained or strained ankle best describe the case at hand.
    This demonstrates that physicians will need software literally on their desk to go through the decision tree necessary to identify the correct coding. They can’t simply write words into a computer program; they will need to know the specifics of the appropriate code.
  • Agenda

    1. 1. Copyright 2009. Medical Group Management Association. All rights reserved. 1 Washington Update (877) ASK.MGMA, ext. 1300 Leah S. Cohen, MA Government Affairs Representative Midwestern & Western Sections lcohen@mgma.com
    2. 2. Copyright 2009. Medical Group Management Association. All rights reserved. 2 Health Care Reform: The Current Situation Democratic Leadership Democratic Leadership _______________ Gang of 6
    3. 3. Copyright 2009. Medical Group Management Association. All rights reserved. Legislation and Timing • H.R. 3200 (House version) – identical language in all three Committees of jurisdiction as “markup” began – House Ways & Means Committee approved 23 – 16 on 7/17/09 – House Education & Labor Committee approved 26 – 22 on 7/17/09 – House Energy & Commerce Committee approved 31-28 on 7/31/09. • Senate HELP Committee approves its version 13 – 10 on 7/15/09 3
    4. 4. Copyright 2009. Medical Group Management Association. All rights reserved. House committees Common provisions of interest to group practices approved: – Repealing the SGR. ($228.5 billion benefit to physicians) – Set 2010 physician payment to the Medicare Economic Index (+/- 1%). – Establish two new expenditure targets in 2011, one for primary and preventive health services (GDP +/-2%) and the other for all other providers (GDP +/- 1%). 4
    5. 5. Copyright 2009. Medical Group Management Association. All rights reserved. House committees Common provisions of interest to group practices approved: – Establish a national health insurance exchange. • facilitate the offering of health insurance choices – details determined by Health Choices Administrator. • Eligibility – Year 1- individuals not enrolled in other acceptable coverage & small employers with 10 or fewer employees. – Year two - employers with 20 and fewer employees. – Subsequent years - Health Choices Commissioner may expand employer participation as appropriate. – Create a public-option insurance plan. • Effective 2013. – Payment rates for 1st three years - rates are based on Medicare rates with a 5% add- on for practitioners who also participate in the Medicare program. After third year, up to Secretary of HHS. • Offer the same benefits. • Abide by the same insurance market reforms. • Follow provider network requirements and other consumer protections. 5
    6. 6. Copyright 2009. Medical Group Management Association. All rights reserved. House committees Common administrative simplification provisions of interest to group practices approved: • Real/near real time determination of individuals financial responsibility which may include utilization of a machine-readable health plan beneficiary identification card. • Real time adjudication of claims. 6
    7. 7. Copyright 2009. Medical Group Management Association. All rights reserved. Senate Finance discussion • America’s Healthy Future Act – Not legislative language • Replaces the scheduled 21.5 percent reduction in 2010 Medicare physician payments with a 0.5 percent increase. • Creates a 10 percent bonus payment to primary care providers if the practice exams consist of more than 60% of certain E/M codes. • Creates a 10 percent bonus payment for general surgery who perform “major procedures” in HPSA for 5 years. 7
    8. 8. Copyright 2009. Medical Group Management Association. All rights reserved. Senate Finance • Increase the equipment utilization from 50% to 65% for 2010 to 2013. – After 2013, it goes to 75%. • Creates a Medicare enrollment screening fee for providers – costing providers $350. – If the screening is requested within 12 months of the enactment of legislation, then only $250. • Administratively simplification – Adopt health plan identifiers. – Machine readable identification cards. 8
    9. 9. Copyright 2009. Medical Group Management Association. All rights reserved. Senate HELP • No jurisdiction over Medicare and federal revenue. • Cost sharing plan. • Real time determination of a patients financial responsibility at the point of service – may include machine readable health plan identification cards. • Health plan identifier 1 year enactment of legislation. 9
    10. 10. Copyright 2009. Medical Group Management Association. All rights reserved. MGMA’s HCR Asks… • Repeal the flawed SGR. • Oppose any provision that allows a non- elected entity to determine Medicare payment policies. • Support the implementation of standardized machine-readable patient identification cards • Support the adoption of the national health plan identifier to significantly streamline the healthcare claims submission process. • Permit documentation in support of a healthcare claim to be transmitted electronically using a standardized claim attachment. 10 Advocacy Center www.mgma.com/ grassroots
    11. 11. Copyright 2009. Medical Group Management Association. All rights reserved. Questions on HCR? • Check out MGMA’s Health Care Reform Resource Center. – www.mgma.com/healthcarereform • Look out for updated information in the Washington Connexion. • Join the new “Federal Legislation, Regulation and Red Tape Forum” MGMA’s expert-moderated forum in the online member community 11
    12. 12. Copyright 2009. Medical Group Management Association. All rights reserved. Employer’s Requirement 12
    13. 13. Copyright 2009. Medical Group Management Association. All rights reserved. Employer Requirement – H.R. 3200 • Require employers to offer coverage to their employees and contribute at least 72.5% of the premium cost for single coverage and 65% of the premium cost for family coverage of the lowest cost plan that meets the essential benefits package requirements or pay 8% of payroll into the Health Insurance Exchange Trust Fund. • Require employers that offer coverage to automatically enroll into the lowest cost premium plan any individual who does not elect coverage under the employer plan or does not opt out of such coverage. 13
    14. 14. Copyright 2009. Medical Group Management Association. All rights reserved. Employee Requirement – H.R. 3200 • Eliminate or reduce the pay or play assessment for small employers with annual payroll of less than $400,000: – Annual payroll less than $250,000: exempt – Annual payroll between $250,000 and $300,000: 2% of payroll; – Annual payroll between $300,000 and $350,000: 4% of payroll; – Annual payroll between $350,000 and $400,000: 6% of payroll. 14
    15. 15. Copyright 2009. Medical Group Management Association. All rights reserved. Senate Finance • Requiring all individuals to have health insurance by 2013. • Requiring all employers with more than 50 full time employees to pay a fee if the employer does not offer health insurance coverage. 15
    16. 16. Copyright 2009. Medical Group Management Association. All rights reserved. Employee Requirement – Senate HELP • Require employers to offer health coverage to their employees and contribute at least 60% of the premium cost or pay $750 for each employee who is not offered coverage. • Exempt employers with 25 or fewer employees from the requirement to provide coverage. 16
    17. 17. Copyright 2009. Medical Group Management Association. All rights reserved. Medicare Incentives in Stimulus Bill (ARRA) 17
    18. 18. Copyright 2009. Medical Group Management Association. All rights reserved. Medicare incentives for practices • Applies to all physicians who can prove use of a qualified and certified EHR, regardless of purchase date. – Hospital-based physicians & PTs are not eligible. – HHS Secretary may consider additional providers. • “Meaningful” EHR User defined as: – Using “certified” EHR technology to the Secretary’s satisfaction; – Demonstrating information exchange; and – Reporting clinical quality measures. • Timeline – Dec. 31, 2009 – Interim final rule. – Spring 2010?? – Meaningful user definition & program specifics.
    19. 19. Copyright 2009. Medical Group Management Association. All rights reserved. Medicare incentives for practices • Exact start date for EHR incentive program unclear. • If physicians are using a qualified EHR in 2011 or 2012, they can receive up to $44,000 through Medicare. • Physicians practicing in “health professional shortage areas” can receive a 10% additional payment, for a total of $48,400. • More information: MGMA’s economic stimulus and recovery website at www.mgma.com/economy. 19
    20. 20. Copyright 2009. Medical Group Management Association. All rights reserved. Medicare incentives/penalties Year Maximum Benefit per Provider Using EHR Total Medicare Payment Reduction-not using EHR First year $15,000 (if 2011 or 2012, $18,000) 0% Second Year $12,000 0% Third Year $8,000 0% Fourth Year $4,000 0% Fifth Year $2,000 2015: 1% (in some cases 2%) Sixth Year 0 2016: 2% 2017 0 2017: 3% Beyond 0 Beyond: 3% (up to 5% starting in 2019)
    21. 21. Copyright 2009. Medical Group Management Association. All rights reserved. Privacy Provisions 21
    22. 22. Copyright 2009. Medical Group Management Association. All rights reserved. New HIPAA Mandates • Changes passed as part of ARRA • Newly-released regulations require HIPAA covered entities to notify individuals whose unsecured PHI has been disclosed as a result of a breach. Notification is also required to HHS and, in some cases, the media. • Law increases state and federal enforcement authority. • New requirements will apply to business associates. • Penalties are increased. 22
    23. 23. Copyright 2009. Medical Group Management Association. All rights reserved. New HIPAA Monetary Penalties • If did not know and would not have known of violation by exercising reasonable diligence, penalty of $100 for each violation, max of $25,000 per year for all violations of an identical requirement or prohibition; • If violation was due to reasonable cause and not willful neglect, penalty of $1,000 for each violation, max of $100,000 per calendar year for all such violations of an identical requirement or prohibition; • If violation due to willful neglect, penalty of at least $10,000 for each violation, max of $250,000 per calendar year for all such violations of an identical requirement or prohibition; and • If violation is not corrected, penalty of $50,000 for each violation, max of $1,500,000 per calendar year for all such violations of an identical requirement or prohibition. • Most provisions effective on Sept. 23, 2009 and monetary penalties will be assessed beginning Feb. 2010. 23
    24. 24. Copyright 2009. Medical Group Management Association. All rights reserved. Educational Opportunity • Privacy expert Gerry Hinkley, Esq. presents an on- demand webinar and presentation at MGMA Annual Conference • “Are you ready for the new HIPAA privacy and security mandates?” – On-Demand Webinar – http://www.mgma.com/solutions/landing.aspx? cid=22714&id1=29648&mid=29648 • Annual Conference in Denver, CO – Mon., Oct. 12, 2009, 1:15-2:30 Mountain Time – http://www.mgma.com/ac/ 24
    25. 25. Copyright 2009. Medical Group Management Association. All rights reserved. 25 Proposed 2010 Medicare physician fee schedule
    26. 26. Copyright 2009. Medical Group Management Association. All rights reserved. 26 RVU PE x GPCI PE RVU malpractice x GPCI malpractice XX Conversion Factor RVU = Relative Value Units GPCI = Geographic Practice Cost Indices ++ ++ RVU work x GPCI work 2010 payment equals…
    27. 27. Copyright 2009. Medical Group Management Association. All rights reserved. Practice Expense RVUs • Data Source Change – Physician Practice Information Survey • AMA sponsored; requested by specialty societies • 70 specialties participated – Result: 70% of specialties received an increase • Primary care - improved by as much as six percent. • 11 specialties will see reductions of five percent or more. • Bottom-up method used for direct costs (clinical staff, equipment, and supplies). – Previously used top-down approach. • Impact chart available to MGMA members at mgma.com. 27
    28. 28. Copyright 2009. Medical Group Management Association. All rights reserved. 28 Conversion factor Annual updates to the cost of Medicare services and a “cap” on growth is incorporated as the conversion factor. Medicare conversion factor: $28.3208 Jan. 1, 2010 to Dec. 31, 2010 Without congressional action: -21.5 percent • Removes Part B drugs from formula.
    29. 29. Copyright 2009. Medical Group Management Association. All rights reserved. Consultation Services • Proposal – eliminate consultation codes on Jan. 1, 2010. – Includes inpatient and office/outpatient codes. – Crosswalk: • Office consults to office visits. • Hospital & facility consults to initial hospital & facility visits. – Budget neutral • Increase the work RVUs for new & established office visits by approx. 6 percent. • Increase work RVUs for initial hospital & initial nursing facility visits by approx. 2 percent. • Changes to PE and malpractice RVU calculations. 29
    30. 30. Copyright 2009. Medical Group Management Association. All rights reserved. Consultation Services • If finalized: – Develop a HCPCS code for telehealth delivery of initial inpatient consultation • Set at same rate as initial hospital care codes. – Develop a modifier to identify the admitting physician of record for hospital inpatient & nursing facilities. • Differentiate admitting physicians overseeing beneficiary care from those furnishing care. 30
    31. 31. Copyright 2009. Medical Group Management Association. All rights reserved. Imaging Provisions • Proposal: Increase the equipment utilization from 50% to 90% (45 hr/wk) for equipment priced at more than $1 million. • Suppliers of the TC of advanced diagnostic imaging services must be accredited by an organization designated by the HHS Secretary by Jan. 1, 2012. (MIPPA) – Proposal: Limits the definition of advanced diagnostic imaging services to magnetic resonance imaging (MRI), computed tomography, nuclear medicine and positron emission tomography. – Proposal: Establishes requirements and procedures for designated accreditation organizations. 31
    32. 32. Copyright 2009. Medical Group Management Association. All rights reserved. PQRI 2010 • Full and half year reporting period. • Registry and claims-based reporting method. (EHR maybe?) • Proposal: 172 total measures. – 30 new measures. – Removed 7 measures from 2009. – 50 registry-only reporting measures. – 10 EHR-only reporting measures. • Proposal: 13 group measures. – Add 6 new measure groups - CAD, HF, Ischemic Vascular Disease (IVD), Hepatitis C, HIV/AIDS, Community-Acquired Pneumonia (CAP). 32
    33. 33. Copyright 2009. Medical Group Management Association. All rights reserved. PQRI 2010 • Proposal: Group reporting option. – Must have a practice with at least 200 providers. – Report 26 measures (targeting high-cost chronic conditions and preventive care). – Reporting Period: Jan 1, 2010 – Dec 31, 2010 – To participate, self nominate. 33
    34. 34. Copyright 2009. Medical Group Management Association. All rights reserved. E-prescribing Incentive • Registry and claims-based reporting method. (EHR maybe?) • Like 2009, bonus 2% of total estimated allowed charges for all covered professional services furnished from Jan. 1, 2010 – Dec. 31, 2010. • Proposal: Group reporting option. – Must have a practice with at least 200 providers. – Each eligible professional within the group practice must report on 25 instances. – Successful e-prescribers name posted in 2011 on Physician Health Care Professionals Directory. 34
    35. 35. Copyright 2009. Medical Group Management Association. All rights reserved. E-prescribing Incentive • Proposal: Change definition of successful e-prescriber to an eligible professional who reports the G-code indicating at least one prescription during an encounter at least 25 instances during reporting period. • Proposal: Modify numerator G-codes. – G8443: indicates that providers billed at least one prescription electronically in conjunction with a visit. – Eliminates 2 remaining G-codes from 2009 program. 35
    36. 36. Copyright 2009. Medical Group Management Association. All rights reserved. Additional Provisions • GPCI – Jan. 1, 2010 – 1.0 floor will be removed. – CMS continues to review the PFS locality structure. • Malpractice RVU – Proposal: Adjusting certain codes that include a TC. • Telehealth Services – Proposal: Add individual Health and Behavior Assessment and Invention to approved list. • Self-referral revisions – Proposal: Clarify “stand in the shoes” • No written agreement necessary. • Referrals – all physicians in the organization. 36
    37. 37. Copyright 2009. Medical Group Management Association. All rights reserved. 37 MGMA & the physician fee schedule • MGMA analysis available at mgma.com for members only. • MGMA to submit comments by Aug. 28. • Visit MGMA Web site for links to: – Rule; – Fact sheets; and – Other CMS resources.
    38. 38. Copyright 2009. Medical Group Management Association. All rights reserved. Key Administrative Issues 38
    39. 39. Copyright 2009. Medical Group Management Association. All rights reserved. 39 FTC - Red Flags rule • “Creditors” required to implement identity-theft program to detect and respond to patterns, practices or specific activities – known as “red flags” – that could indicate identity theft. • MGMA strongly opposed - delayed until November 1, 2009, but FTC maintains physicians may be creditors. • Action Step: Go to MGMA resource center, review guidance & sample practice policies: www.mgma.com/policy/default.aspx?id=22932
    40. 40. Copyright 2009. Medical Group Management Association. All rights reserved. Recovery Audit Contractors (RAC) 40 ** ** If in jurisdiction transitioning to MAC, 60 day RAC blackout on either side of MAC transition date.
    41. 41. Copyright 2009. Medical Group Management Association. All rights reserved. H1N1 Vaccine • Two new codes – effective Sept. 1, 2009. – G9142 (Influenza A [H1N1] vaccine, any route of administration) describes the vaccine – G9141 (Influenza A [H1N1] immunization administration, including physician counseling the patient/family) • Medicare will cover more than one vaccine this year – if it is deemed medically necessary. 41
    42. 42. Copyright 2009. Medical Group Management Association. All rights reserved. 42 5010 transaction • 5010 is next generation version of nine HIPAA electronic transactions. • More than 850 complex changes: – Implementation guide for one transaction (health care claim) has 700 pages – Every page has a change from 4010 implementation guide • Compliance date is January 1, 2012.
    43. 43. Copyright 2009. Medical Group Management Association. All rights reserved. 43 ICD-10 • Outpatient diagnosis codes – ICD-10 vs ICD-9: Much more granular code set • MGMA concerned that adoption will disrupt the claims payment system and the cost for practices (Study shows $285,195 for a 10- physician practice) • Compliance date Oct. 1, 2013
    44. 44. Copyright 2009. Medical Group Management Association. All rights reserved. 44 Diagnosis Codes for Sprained and Strained Ankles: ICD-9-CM v ICD-10-CM 4 ICD-94 ICD-9 CodesCodes 845.00 Sprain845.00 Sprain and strain ofand strain of ankleankle unspecified siteunspecified site 845.01 Sprain845.01 Sprain and strain ofand strain of ankle, Deltoidankle, Deltoid ligament/ligament/ InternalInternal collateralcollateral ligamentligament 845.02 Sprain845.02 Sprain and strain ofand strain of ankle,ankle, CalcaneofibularCalcaneofibular (ligament)(ligament) 845.03 Sprain845.03 Sprain and strain ofand strain of ankle,ankle, TibiofibularTibiofibular (ligament) distal(ligament) distal 72 ICD-10 Codes72 ICD-10 Codes S93.401AS93.401A Sprain of unspecifiedSprain of unspecified ligament of right ankle - initial encounterligament of right ankle - initial encounter S93.401DS93.401D Sprain of unspecifiedSprain of unspecified ligament of right ankle – subsequentligament of right ankle – subsequent encounterencounter S93.401SS93.401S Sprain of unspecifiedSprain of unspecified ligament of right ankle – sequelaligament of right ankle – sequela S93.402AS93.402A Sprain of unspecifiedSprain of unspecified ligament of left ankle - initial encounterligament of left ankle - initial encounter S93.402DS93.402D Sprain of unspecifiedSprain of unspecified ligament of left ankle – subsequentligament of left ankle – subsequent encounterencounter S93.402SS93.402S Sprain of unspecifiedSprain of unspecified ligament of left ankle – sequelaligament of left ankle – sequela S93.409AS93.409A Sprain of unspecifiedSprain of unspecified ligament of unspecified ankle - initialligament of unspecified ankle - initial encounterencounter S93.409DS93.409D Sprain of unspecifiedSprain of unspecified ligament of unspecified ankle–ligament of unspecified ankle– subsequent encountersubsequent encounter S93.409SS93.409S Sprain of unspecifiedSprain of unspecified ligament of unspecified ankle– sequelaligament of unspecified ankle– sequela S93.421aS93.421a Sprain of deltoid ligament ofSprain of deltoid ligament of right ankle - initial encounterright ankle - initial encounter S93.421dS93.421d Sprain of deltoid ligament ofSprain of deltoid ligament of right ankle – subsequent encounterright ankle – subsequent encounter S93.421qS93.421q Sprain of deltoid ligament ofSprain of deltoid ligament of right ankle –Sequelaright ankle –Sequela S93.422aS93.422a Sprain of deltoid ligament ofSprain of deltoid ligament of left ankle - initial encounterleft ankle - initial encounter S93.422dS93.422d Sprain of deltoid ligament ofSprain of deltoid ligament of left ankle – subsequent encounterleft ankle – subsequent encounter S93.422qS93.422q Sprain of deltoid ligament ofSprain of deltoid ligament of left ankle – sequelaleft ankle – sequela S93.429aS93.429a Sprain of deltoid ligament ofSprain of deltoid ligament of ankle unspecified - initial encounterankle unspecified - initial encounter S93.429dS93.429d Sprain of deltoid ligament ofSprain of deltoid ligament of unspecified ankle– subsequentunspecified ankle– subsequent encounterencounter S93.429qS93.429q Sprain of deltoid ligament ofSprain of deltoid ligament of unspecified ankle– sequelaunspecified ankle– sequela S93.411AS93.411A Sprain of calcaneofibularSprain of calcaneofibular ligament of right ankle - initial encounterligament of right ankle - initial encounter S93.411DS93.411D Sprain of calcaneofibularSprain of calcaneofibular ligament of right ankle – subsequentligament of right ankle – subsequent encounterencounter S93.411SS93.411S Sprain of calcaneofibularSprain of calcaneofibular ligament of right ankle – sequelaligament of right ankle – sequela S93.412AS93.412A Sprain of calcaneofibularSprain of calcaneofibular ligament of left ankle - initialligament of left ankle - initial encounterencounter S93.412DS93.412D Sprain of calcaneofibularSprain of calcaneofibular ligament of left ankle – subsequentligament of left ankle – subsequent encounterencounter S93.412SS93.412S Sprain of calcaneofibularSprain of calcaneofibular ligament of left ankle – sequelaligament of left ankle – sequela S93.419AS93.419A Sprain of calcaneofibularSprain of calcaneofibular ligament of unspecified ankle - initialligament of unspecified ankle - initial encounterencounter S93.419DS93.419D Sprain of calcaneofibularSprain of calcaneofibular ligament of unspecified ankle–ligament of unspecified ankle– subsequent encountersubsequent encounter S93.419SS93.419S Sprain of calcaneofibularSprain of calcaneofibular ligament of unspecified ankleligament of unspecified ankle S93.431AS93.431A Sprain of tibiofibularSprain of tibiofibular ligament of right ankle - initialligament of right ankle - initial encounterencounter S93.431DS93.431D Sprain of tibiofibularSprain of tibiofibular ligament of right ankle – subsequentligament of right ankle – subsequent encounterencounter S93.431SS93.431S Sprain of tibiofibularSprain of tibiofibular ligament of right ankle – sequelaligament of right ankle – sequela S93.432AS93.432A Sprain of tibiofibularSprain of tibiofibular ligament of left ankle - initialligament of left ankle - initial encounterencounter S93.432DS93.432D Sprain of tibiofibularSprain of tibiofibular ligament of left ankle – subsequentligament of left ankle – subsequent encounterencounter S93.432SS93.432S Sprain of tibiofibularSprain of tibiofibular ligament of left ankle – sequelaligament of left ankle – sequela S93.439AS93.439A Sprain of tibiofibularSprain of tibiofibular ligament of unspecified ankle - initialligament of unspecified ankle - initial encounterencounter S93.439DS93.439D Sprain of tibiofibularSprain of tibiofibular ligament of unspecified ankle–ligament of unspecified ankle– subsequent encountersubsequent encounter S93.439SS93.439S Sprain of tibiofibularSprain of tibiofibular ligament of unspecified ankle–ligament of unspecified ankle– sequelasequela S93.491AS93.491A Sprain of other ligament ofSprain of other ligament of right ankle (Internalright ankle (Internal collateral/talofibular) initial encountercollateral/talofibular) initial encounter S93.491DS93.491D Sprain of other ligamentSprain of other ligament of right ankle (Internalof right ankle (Internal collateral/talofibular) subsequentcollateral/talofibular) subsequent encounterencounter S93.491SS93.491S Sprain of other ligament ofSprain of other ligament of right ankle (Internalright ankle (Internal collateral/talofibular) sequelacollateral/talofibular) sequela S93.492AS93.492A Sprain of other ligament ofSprain of other ligament of left ankle, initial encounterleft ankle, initial encounter S93.492DS93.492D Sprain of other ligamentSprain of other ligament of left ankle subsequent encounterof left ankle subsequent encounter S93.492SS93.492S Sprain of other ligament ofSprain of other ligament of left ankle sequelaleft ankle sequela S93.499AS93.499A Sprain of other ligament ofSprain of other ligament of unspecified ankle initial encounterunspecified ankle initial encounter S93.499DS93.499D Sprain of other ligamentSprain of other ligament of unspecified ankle subs encounterof unspecified ankle subs encounter S93.499SS93.499S Sprain of other ligament ofSprain of other ligament of unspecified ankle (Internalunspecified ankle (Internal collateral/talofibular) sequelacollateral/talofibular) sequela S96.211AS96.211A Strain of intrinsic muscleStrain of intrinsic muscle and tendon at right ankle and footand tendon at right ankle and foot level initial encounterlevel initial encounter S96.211DS96.211D Strain of intrinsic muscleStrain of intrinsic muscle and tendon at right ankle and footand tendon at right ankle and foot level subsequent encounterlevel subsequent encounter S96.211SS96.211S Strain of intrinsic muscleStrain of intrinsic muscle and tendon at right ankle and footand tendon at right ankle and foot level sequelalevel sequela S96.212AS96.212A Strain of intrinsic muscleStrain of intrinsic muscle and tendon at left ankle and footand tendon at left ankle and foot level initial encounterlevel initial encounter S96.212DS96.212DStrain of intrinsic muscleStrain of intrinsic muscle and tendon at left ankle and footand tendon at left ankle and foot level subsequent encounterlevel subsequent encounter S96.212SS96.212S Strain of intrinsic muscleStrain of intrinsic muscle and tendon at left ankle and footand tendon at left ankle and foot level sequelalevel sequela S96.219AS96.219A Strain of intrinsic muscleStrain of intrinsic muscle and tendon at ankle and foot level,and tendon at ankle and foot level, unspecified side initial encounterunspecified side initial encounter S96.219DS96.219D Strain of intrinsic muscleStrain of intrinsic muscle and tendon at ankle and foot level,and tendon at ankle and foot level, unspecified side subs encounterunspecified side subs encounter S96.219SS96.219S Strain of intrinsic muscleStrain of intrinsic muscle and tendon at ankle and foot level,and tendon at ankle and foot level, unspecified sideunspecified side S96.811AS96.811A Strain of other musclesStrain of other muscles and tendons at right ankle and footand tendons at right ankle and foot level initial encounterlevel initial encounter S96.811DS96.811D Strain of other musclesStrain of other muscles and tendons at right ankle and footand tendons at right ankle and foot level subsequent encounterlevel subsequent encounter S96.811SS96.811S Strain of other musclesStrain of other muscles and tendons at right ankle and footand tendons at right ankle and foot level sequelalevel sequela S96.812AS96.812A Strain of other musclesStrain of other muscles and tendons at left ankle and footand tendons at left ankle and foot level initial encounterlevel initial encounter S96.812DS96.812D Strain of other musclesStrain of other muscles and tendons at left ankle and footand tendons at left ankle and foot level subsequent encounterlevel subsequent encounter S96.812SS96.812S Strain of other musclesStrain of other muscles and tendons at left ankle and footand tendons at left ankle and foot level sequelalevel sequela S96.819AS96.819A Strain of other musclesStrain of other muscles and tendons at ankle and foot level,and tendons at ankle and foot level, unspecified side initial encounterunspecified side initial encounter S96.819DS96.819D Strain of other musclesStrain of other muscles and tendons at ankle and foot level,and tendons at ankle and foot level, unspecified side subs encounterunspecified side subs encounter S96.819SS96.819S Strain of other musclesStrain of other muscles and tendons at ankle and foot level,and tendons at ankle and foot level, unspecified side sequelaunspecified side sequela S96.911AS96.911A Strain of unspecifiedStrain of unspecified muscle and tendon at right ankle andmuscle and tendon at right ankle and foot level initial encounterfoot level initial encounter S96.911DS96.911D Strain of unspecifiedStrain of unspecified muscle and tendon at right ankle andmuscle and tendon at right ankle and foot level subs encounterfoot level subs encounter S96.911SS96.911S Strain of unspecifiedStrain of unspecified muscle and tendon at right ankle andmuscle and tendon at right ankle and foot level sequelafoot level sequela S96.912AS96.912A Strain of unspecifiedStrain of unspecified muscle and tendon at left ankle andmuscle and tendon at left ankle and foot level initial encounterfoot level initial encounter S96.912DS96.912D Strain of unspecifiedStrain of unspecified muscle and tendon at left ankle andmuscle and tendon at left ankle and foot level subs encounterfoot level subs encounter S96.912SS96.912S Strain of unspecifiedStrain of unspecified muscle and tendon at left ankle andmuscle and tendon at left ankle and foot level sequelafoot level sequela S96.919AS96.919A Strain of unspecifiedStrain of unspecified muscle and tendon at ankle and footmuscle and tendon at ankle and foot level, unspec. side initial encounterlevel, unspec. side initial encounter S96.919DS96.919D Strain of unspecifiedStrain of unspecified muscle and tendon at ankle and footmuscle and tendon at ankle and foot level, unspec. side subs encounterlevel, unspec. side subs encounter S96.919SS96.919S Strain of unspecifiedStrain of unspecified muscle and tendon at ankle and footmuscle and tendon at ankle and foot level, unspec. side sequelalevel, unspec. side sequela
    45. 45. Copyright 2009. Medical Group Management Association. All rights reserved. Action Steps • Monitor Washington Connexion • Contact your PMS/billing/EHR vendor and ask: – Are you aware of these new government regulations? – What is your schedule for software upgrades/training? – Will you be upgrading MY version of the software? – What are the expected costs? • Contact your major health plans and ask: – Will you be utilizing the CMS ICD-10 crosswalks? – When will you let us know about changes to coverage and payment due to ICD-10? – When can I test my claims with you? 45
    46. 46. Copyright 2009. Medical Group Management Association. All rights reserved. Administrative Simplification Initiative • America’s Health Insurance Programs and Blue Cross Blue Shield sponsoring initiative. – Access multiple insurance companies through same channel. (ie. Web portal). • Goals – “Real Time”: – Eligibility & benefit information – Status of claims – Referrals and preauthorization – Claim submission • One year, Nov. 2009 • No charge to register: www.availity.com 46
    47. 47. Copyright 2009. Medical Group Management Association. All rights reserved. 47 Join MGMA's Legislative and Executive Advocacy Response Network today and help make a difference for medical administrators nationwide! Are you LEARNing! LEARN participants will: •Answer survey questions about emerging issues. •Assist governmental and non-governmental organizations in creating policies. •Obtain access to information regarding new legislative and policy- making activities not available to the general public through results from respondents. •Be provided with networking opportunities with other LEARN colleagues. For more information, visit www4.mgma.com/marcom/learn.htm
    48. 48. Copyright 2009. Medical Group Management Association. All rights reserved. 48 MGMA Project SwipeIT! • Launched Jan. 12 • MGMA asking industry to pledge moving forward with machine-readable and standardized health ID cards: – Payers (Humana, United HealthGroup, AHIP) – Vendors (Emdeon, Availity) – Providers (more than 300 practices and other organizations have already pledged their support for this initiative) • Go to www.SwipeIT.org and pledge!
    49. 49. Copyright 2009. Medical Group Management Association. All rights reserved. 49 Public policy resources • MGMA Government Affairs Department – Call 877.ASK.MGMA (275.6462), ext. 1300 – E-mail govaff@mgma.com – Public Policy area of mgma.com • MGMA Washington Connexion™ – free, timely e-mail update on Capitol Hill actions affecting health care providers. • Join the new “Federal Legislation, Regulation and Red Tape Forum” MGMA’s expert- moderated forum in the online member community
    50. 50. Copyright 2009. Medical Group Management Association. All rights reserved. 50 Questions? mgma.com

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