This Week – October 8, 2016

This Week in Washington, D.C.

  • ICD-10 Grace Period Ends; ACG can help make sure you are using the current ICD-10 set
  • The States and MOC: An ACG Update from Missouri
  • ACG MACRA Tidbit for the Week: Resource Use and Episodes of Care

From ACG National Affairs Committee Chair, Whitfield L. Knapple, MD, FACG

ICD-10 Grace Period Ends; ACG can help make sure you are using the current ICD-10 set

ACG has previously alerted members that the grace period for using the wrong ICD-10 codes has ended.  Beginning October 1, 2016, all Medicare claims must include valid ICD-10 codes to the highest level of specificity possible.
ACG members should also note that there have been recent updates to the ICD-10 code set. The 2017 ICD-10-CM files are to be used for discharges and patient encounters occurring from October 1, 2016 through September 30, 2017.

The recent transition to the significantly expanded ICD-10 code set, as well this grace period ending September 30th, requires ACG members and GI practices to know the most appropriate diagnosis codes.  Need help?  Please visit the ACG Member ICD-10 Playbook.  This website contains beneficial resources for your use, including the “ICD-9 to ICD-10 Coding Bridge” tool, which provides up-to-date ICD-10 code sets, and allows you to quickly compare any ICD-9 code to its corresponding ICD-10 code(s).

Fortunately, ACG has also updated our handy charts which compare the ICD-9 codes and descriptions to their corresponding ICD-10 codes.  Feel free to print these out for your practice.  ACG has divided these charts into common GI categories.

Make sure you attend the 2016 ACG Postgraduate Course

The ACG 2016 Annual Scientific Meeting & Postgraduate Course will also provide assistance in better preparing your practice for ICD-10 coding changes, and help explain the transition into the ICD-10 coding system’s impact on GI providers.

From ACG Governor for Missouri, Dayna S. Early, MD, FACG

The States and MOC: An ACG Update from Missouri

I wanted to share some news on the legislative front in Missouri. In late August 2016, two bills were passed in the Missouri legislature that address the issue of Maintenance of Certification (MOC), and participation in certain health plans.

As you may know, the ACG, along with many other societies, has been working hard to convince ABIM to modify its MOC program to one that focuses on lifelong learning instead of lifelong testing.  ACG is also very active at the state level, advocating for legislation that prohibits MOC as a condition to privileges and licensure.  North Carolina and Oklahoma have passed legislation that prohibits conditioning licensure, hospital privileges or reimbursement on MOC status.  ACG has also partnered with the Michigan State Medical Society, urging for your help in getting two bills passed by the MI state legislature.

To learn more about the contents of these two bills, please click here to read the full blog.



Resource Use and Episodes of Care

The “Resource Use” component of MIPS initially represents only 10% of your composite MIPS score in 2019, increasing to 15% of your score in 2020, and then 30% beginning in 2021 and beyond.

This MIPS category is somewhat similar to the current value-based payment modifier, where CMS looks at claims data at the practice level to determine whether group practices are cost-efficient compared to other providers.  Under MIPS, however, CMS will perform this review at the individual provider level as well.  Performance in this category is assessed through your Medicare claims data.  Providers will not be required to submit additional data for this MIPS category.

ACG has previously discussed the “Resource Use” category and provided some background for GI clinicians.

What is an “Episode of Care”?

CMS is mandated by Congress to develop “episodes of care” to use as a part of this Resource Use MIPS category.  Episodes of care include all the care related to a defined medical event (e.g., a procedure), including the care for the event itself, any pre-cursors to the event (i.e., diagnostic tests, pre-operative visits), and follow-up care.  Similar initiatives have already started in Tennessee and Ohio.  An “episode of care” is not a bundled payment, or other episode-based alternative payment model.  This is a subset of the Resource Use category and still a part of MIPS.

CMS has invited ACG physician volunteers to participate in CMS-led advisory panels, in order to review and comment on potential episode ideas.  CMS has stated its intention to allow ACG and specialty societies to be involved in the details of GI episode.  ACG physician volunteers are mindful of the consequences of any recommendations.  However, it is also important to be collaborative and proactive in the early stages of this process in order to avoid future problems.  For example, ACG believes it is important to tie quality measures to any measures on utilization and costs.  There will also be a public comment period for any proposed episode of care in GI, allowing ACG to actively participate in all phases of this process.

These new episodes may include procedural, acute, and/or chronic condition episodes.  Procedural episodes will involve claims data during a defined set period of time.  If, for example, CMS chooses “screening colonoscopy,” CMS will determine a time window both before and after the screening colonoscopy procedure, and organize Medicare claims information related to the procedure.  CMS will then compare these claims to other Medicare providers’ claims falling into the same defined episode.  Providers will receive regular updates on their Resource Use (and each episode) as part of the Quality and Resource Use Reports (QRURs).  Acute episode measures may be hospital-based diagnostic groups.  Chronic episodes focus on chronic conditions in GI.

QRURs are currently available for the Medicare value-based payment modifier and will be modified for MIPS.  ACG members can now access a QRUR on behalf of their practice here.  QRURs are provided for each Medicare-enrolled Taxpayer Identification Number (TIN).  This requires the practice to first have an Enterprise Identity Data Management (EIDM) account.  You can create an EDIM account by following these directions.