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We’re all in this talented community of auditors together, and we look forward to getting to know you better. So sit back, scroll down and enjoy!
It may be hard to believe but ICD-10 updates for October 2022 are already just around the corner. Sheri Poe Bernard recently posted a link to the CMS Proposed ICD-10 updates, highlighting some of the more interesting changes coming up.
Here is a quick summary of the new ICD-10-CM codes by chapter.
These new ICD-10-CM codes recognize injuries and conditions caused by several elements we see in today’s world. For example, as a result of our aging population there are over 60 new codes related to dementia. CMS also added the Z91.A series, given that caregivers impact their patient’s health.
The current offering of motorized transportation options has also initiated a variety of interesting new codes. Case in point, there are now 237 new codes related to “Electric (assisted) bicycle.” For example: V20.01XA: Electric (assisted) bicycle driver injured in collision with pedestrian or animal in nontraffic accident, initial encounter.
Similarly, there are also 237 new codes relate to motorcycle injuries. For example: V20.09XA: Other motorcycle driver injured in collision with pedestrian or animal in nontraffic accident, initial encounter.
As we move towards a more energy conscious world, there are best practices to stay safe and there will be “a code for that!” when injuries occur.
We’re excited to announce the upcoming launch of our new products and features for Swiftaudit.
For the past year, the SpringSoft Medical team has worked to add several new features to our core Swiftaudit Essentials platform. We listened to you, designing features to make your jobs easier.
On March 1, 2022 our new Swiftaudit product series will be online and available: • CodeBook which provides access to our Coding Tools on your phone, tablet or PC. • Essentials is our core Swiftaudit platform supporting pro-fee reviews, and includes Codebook. • Standard starts with Essentials and adds the ability to upload billing data into an auditor work queue. • Standard+RA supports reviews for pro-fee and risk adjustment.
In addition to these new products and features, we are upgrading our payment platform with improved invoices and payment receipts.
To facilitate the launch of our new product line, there will be a brief interruption of service from 8:00AM to 9:00AM on Tuesday, March 1st, 2022 (EST).
The MLN Fact Sheet describes CMS due diligence program called CERT.
The CMS CERT Program measures improper payments in the Medicare FFS Program. The CERT Program is managed by two contractors, the CERT Statistical Contractor (CERT SC) and the CERT Review Contractor (CERT RC). The Statistical Contractor determines how claims will be sampled and calculates the improper payment. The Review Contractor requests medical records from providers and suppliers who billed Medicare. The Review Contractor reviews the selected claims and associated medical records for compliance with Medicare coverage, coding, and billing rules.
THE ERROR FINDINGS
The MLN Fact Sheet lists common procedures often found with insufficient documentation by the CMS CERT Program. These common procedures and findings include:
Vertebral Augmentation Procedures (VAPs) ● Missing signature and date ● No evidentiary radiographs performed to support medical necessity ● Insufficient medical record documenting that the provider tried conservative medical management but it failed or was contraindicated ● No signed and dated attestation statement for the operative report if a physician signature was missing or illegible; if the operative report is electronically signed, the protocol should also be submitted
Physical Therapy (PT) Services ● Documentation did not support certification of the plan of care for physical therapy services. ● The physician’s/NPP’s signature and date of certification of the plan of care or progress note indicating the physician/NPP reviewed and approved the plan of care is required.
Evaluation and Management (E/M) Services ● Office Visits Established, Hospital Initial, and Hospital Subsequent were identified as the top three CERT errors in E/M service categories ● High errors rates of insufficient documentation, no documentation, and incorrect coding which supported the medical necessity and accurate billing of the E/M services
Durable Medical Equipment (DME) ● Certain DME HCPCS codes (such as, hospital beds, glucose monitors, and manual wheelchairs) require a valid detailed written order prior to delivery ● The physician’s NPI must be on the valid detailed written order ● Medicare will pay claims only for DME if the ordering physician and DME supplier are actively enrolled in Medicare on the date of service ● As a condition for payment, a physician, PA, NP, or CNS must document a face-to-face examination with a beneficiary in the 6 months prior to the written order for certain items of DME
Computed Tomography (CT) Scans ● Documentation of the plan or intent to order a CT scan was insufficient to support medical necessity. ● If the handwritten signature is illegible, include a signature log, and if electronic, the protocol should also be submitted.
THE FINANCIAL IMPACT
CMS CERT Program reports $25.03 billion in improper payments in 2021.
Do you know your organization’s exposure to documentation errors?
Swiftaudit has seen no indication that this vulnerability has impacted our platform’s security. Our primary development platform is .Net in a Microsoft Azure service, therefore this particular Java-based vulnerability doesn’t pose a significant risk. Additional information is available at Microsoft’s Response to CVE-2021-44228 Apache Log4j 2 page.
We are monitoring the issue and will stay vigilant. Swiftaudit is committed to the security of your data. We will post updates as information becomes available.
The official 2022 ICD-10-CM Guidelines are now available and active! This updated code set is to be used for discharges and patient encounters occurring from October 1, 2021 through September 30, 2022. It’s time to get familiar with what’s new and what has changed.
To help provide a quick reference, we have split the original 115 page document into separate Chapters, each approximately 2-5 pages long and with a focus on specific code groups. By referencing our Chapter list you can more efficiently focus on the specialty you are coding, auditing or teaching.
Be sure to review Section 1.B. General Coding Guidelines for the latest ICD-10-CM general coding guidance.
See what has changed for ICD-10-CM in 2022 in the Tabular Addenda (42 pages).