As an ophthalmologist, you’ve already learned dozens of abbreviations. But once you start practice, you’ll need to know a few others that you won’t use or see in chart documentation. Here are the three most important for 2015.
No. 1 ICD-10 – As a physician, you’re ultimately responsible for chart documentation, even if an assistant does much of the work. Right now, the U.S. health system uses a 14,500-code set known as ICD-9. But come Oct. 1, 2015 – yes, less than six months from now – the entire U.S. health system changes to ICD-10. For service dates from Oct. 1 onward, all payers will deny claims submitted in the wrong code set.
With nearly 70,000 codes, ICD-10 enables much more precise documentation – but it’s also more to know. Fortunately, ophthalmology-specific codes account for a fraction of the full code set. And the Academy’s coding experts are already fluent in ICD-10.
To help you and your staff learn the new code set, the Academy has developed a host of ICD-10 products and resources with its practice management division, the American Academy of Ophthalmic Executives. Key resources:
You can also attend a state-specific CODEquest seminar, depending on your location. Offered in collaboration with the local state society, these seminars are scheduled through the summer.
No. 2 PQRS – If you’re like most U.S.-based ophthalmologists, you probably participate in Medicare. In recent years, the Medicare system has increasingly sought data on the effectiveness of the care it provides, through various quality-reporting programs. One of the largest is the Physician Quality Reporting System.
After several years of small bonuses for successful PQRS participation, the Centers for Medicare and Medicaid Services now requires all physicians to report, except for those who meet the limited exemptions.
Those who don’t report successfully for 2015 PQRS face up to 6 percent in penalties on all 2017 Part B Medicare fee-for-service payments:
- 2 percent 2017 penalty for unsuccessful 2015 PQRS reporting, plus
- Additional 2 percent 2017 value-based modifier penalty, if their practice has less than 10 eligible providers; OR
- Additional 4 percent 2017 value-based modifier penalty if their practice has 10 or more eligible providers.
Bottom line: PQRS participation matters.
The good news is that physicians have the highest success rate when reporting PQRS via registry. And the Academy’s IRIS™ Registry (Intelligent Research in Sight) is a PQRS-qualified registry. That means you can avoid CMS penalties and gain valuable insights from the data you report.
CMS plans to begin publicly releasing PQRS provider data in 2016, but it won’t support the kind of clinical benchmarking the IRIS Registry provides.
Key resources for PQRS participation:
No. 3 EHR/EMR – While some in the banking industry have already embraced the Apple Watch, medical record-keeping has lagged behind. Some practices and health systems have sophisticated EHR systems, even giving patients access to their own data. But others still use paper claims to get paid.
To spur physician adoption of electronic health records, CMS introduced a program commonly called “meaningful use.” Under the program, providers must progress sequentially through increasingly sophisticated stages of EHR use.
As with PQRS, providers who fail to successfully demonstrate meaningful EHR use for 2015 (as defined by the applicable stage) face future penalties.
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About the author: Christi A. Foist is YO Info’s managing editor and a communications manager for the Academy.