April showers bring social determinants of health flowers
The showers of April have brought a burst of blooms in the Social Determinants of Health (SDoH) reimbursement garden. First, the Centers of Medicare and Medicaid Services (CMS) released its 2020 rate sheet. As expected by the industry, Medicare Advantage and Part D plan supplemental benefits are set to expand in several areas. The emphasis on care moving outside of hospitals translates to a necessary increase in reimbursement for non-clinical resources and programs that help to minimize readmissions, as well as enhance the wellness of populations.
In 2016 CMS amended the Medicaid Managed care rule so Medicaid MCOs could support patients with nonmedical expenses. There has been talk since by CMS about the need to further expand coverage of non-clinical services that directly impact population health (e.g. air filter systems, fans). Yet, it was insurance companies, especially the Managed Medicaid and Medicare Advantage providers that stepped up first to bridge the needs gap. The majority provide robust funding for gaps in transportation, nutrition, GED prep classes and tests, employment, linkage to fitness programs, plus.
Fast forward to 2020 and CMS will begin to pay for services that promote healthy home environments, expanding coverage to two main SDoH: food insecurity and access to care (AKA: transportation). Traditionally where CMS goes the other payers follow, but in the scope of the SDoH it presents the reverse is true. The reimbursement expansion by CMS is set to include the following:
The opioid crisis will also receive greater fiscal emphasis, with supplemental benefits for patients with opioid use disorders. In addition, cost-sharing reductions for those persons who live with chronic pain will also be added. Medicare Part D plans will add at least one overdose reversal drug to the low cost-sharing tier. It is hoped this action will improve access to medications for those persons who need them.
Telehealth reimbursement will see expansion for remote patient monitoring under certain circumstances. Social cohesion and isolation are major SDoH, particularly for children and adults who live with disabilities, and adults receiving services under Long Term Services and Support programming. Telehealth services help directly address this determinant through an array of virtual programs and care processes.
The American Medical Association and UnitedHealth Care
The other hearty April blossom came with the American Medical Association announcing their alignment with United Healthcare to advance 23 new ICD-10 codes that address social barriers to care (AKA: the SDoH). Keep in mind that UnitedHealthcare already joined with NCQA and the National Association of Community Health Centers to advocate with CMS for code expansion of the most popular SDoH of food insecurity and access to care in the form of transportation. The expanded ICD-10 code recommendations encompass six key areas. These include the following:
The pressure is on for payers to empower new means of reimbursement for the SDoH, particularly with compelling recent evidence how the determinants impact 80 percent of health outcomes, and cause over 50 percent of readmissions. Now, expansion of the ICD-10 codes is a big plus for all, but only a small part of how to boost revenue. If the organization’s processes aren’t in place to make the best use of the codes, then they are for naught. It is just over a year that the American Hospital Association (AHA) approved non-clinical documentation from the interprofessional team to validate the use of the ICD10 Z codes; the psychosocial and socioeconomic stressor that impact health and behavioral healthcare outcomes and speak to the SDoH.
Providers must still hone their documentation skill and the efforts to assure they are garnering their share of appropriate reimbursement. Collaborative coalitions and communication are a must for all professionals involved in the documentation and coding effort. It will be quite interesting to see just how many organizations have been able to successfully use the Z codes, plus how much money they have captured. In the meantime, if CMS adopts the expanded ICD-10 codes, they may begin as early as 2020. My gut says it is a pretty good guess that we will see one mega roster of ICD-10 codes to be used for the SDoH come October.
Stay tuned for further updates on this exciting topic!
Today is election day. I wanted to talk about the process by which laws are passed and regulations created in healthcare. Recently, the fall of
As the November elections neared, you might have expected Washington to slow to a crawl amidst campaigning and uncertainty about the future. However, the show
Please log in to your account to comment on this article.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
This webcast, presented by Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, a recognized expert with over 30 years of experience, offers essential strategies to improve outpatient clinical documentation integrity. You will learn how to enhance the accuracy and completeness of patient records by adopting best practices in coding and incorporating Social Determinants of Health (SDOH). The session also highlights the role of technology, such as EHRs and CDI software, in improving documentation quality. By attending, you will gain practical insights into ensuring precise and compliant documentation, supporting patient care, and optimizing reimbursement. This webcast is crucial for those looking to address documentation gaps and elevate their coding practices.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Copyright © 2024 ICD10monitor. Powered by MedLearn Media.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
👻Spooky Sale is Back!👻 Get 31% off all three Medlearn brands, using code SPOOKY24.
