steve adams,...surviving the value modifier, pqrs & mips cpt, pqrs, value modifier and icd-10...

Surviving the Value Modifier, PQRS & MIPScpt, pqrs, value modifier and icd-10

Steve Adams, MCS, COC, CPC, CPMA, CPC-I, PCS, FCS, COA

email: steve.adams@inhealthps.com 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: steve.adams@inhealthps.com

Web: www.thecodingeducator.com

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