Today’s Top Story
CMS takes steps to smooth Oct. 1 transition to ICD-10.
The U.S. Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) have announced details of a plan to assist physicians in the transition to ICD-10. Although the Oct. 1 deadline remains, several of the changes announced and detailed below are supported by the American Association of Orthopaedic Surgeons (AAOS). The following changes are included:

  • During the first year ICD-10 is in place, Medicare claims will not be denied solely based on the specificity of the diagnosis codes as long as they are from the appropriate family of ICD-10 codes; both Medicare Administrative Contractors and Recovery Audit Contractors will be required to follow that policy.
  • During the first year ICD-10 is in place, CMS will not subject physicians to penalties for the Physician Quality Reporting System (PQRS), the value-based payment modifier, or meaningful use based on the specificity of diagnosis codes as long as they use a code from the correct ICD-10 family of codes.
  • If Medicare contractors are unable to process claims as a result of problems with ICD-10, CMS will authorize advance payments to physicians.
  • CMS plans to establish a communication center to monitor and resolve issues as quickly as possible.

CMS reminds physicians that Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of services after Sept. 30, 2015, nor will they be able to accept claims for both ICD-9 and ICD-10 codes. Read more…
Read the joint AMA/CMS announcement…
Read more in AAOS Advocacy Now…

Other News

Study: TKA more likely among patients with greater baseline functional impairment.
Findings from a study published in the August issue of the journal Clinical Orthopaedics and Related Research (CORR) suggest that baseline physical function may be an important element in patients considering total knee arthroplasty (TKA). The authors reviewed data on 2,946 patients (5,796 knees) participating in the Multicenter Osteoarthritis Study. After adjustments, they found that patients with the greatest functional impairment at baseline (WOMAC scores 40–68) were at 15.5 times the risk of undergoing TKA over 30 months compared with the referent group (WOMAC scores 0–5). Read the abstract…
     The August issue of CORR is a theme issue presenting data from the symposium “Musculoskeletal Sex Differences Across the Lifespan,” which was sponsored by the AAOS, the Association of Bone and Joint Surgeons (the parent society of CORR), the National Institutes of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases, the Orthopaedic Research Society, the Center for Musculoskeletal Health at the University of California, Davis, and the Society for Women’s Health Research. View the table of contents, with links to abstracts…

CMS to allow some stays under “Two-Midnight” rule; plans to prioritize such cases for review.
HealthLeaders Media reports on a CMS proposed rule that would, among other things, change the so-called “Two-Midnight” rule, which specifically identifies the minimum length of a hospital stay for Medicare beneficiaries to qualify as an inpatient stay. CMS plans to allow inpatient admissions on a case-by-case basis, depending on documentation and physician judgment. The writer notes that CMS expects short stays for minor surgical procedures or hospital care to be rare and plans to monitor such admissions and prioritize them for medical review. Read more…

Study: Multiple pharmacies and overlapping opioid prescriptions linked to increased risk of overdose.
A study published in the May issue of The Journal of Pain suggests that the use of multiple pharmacies and overlapping opioid prescriptions may be an indicator of increased risk of opioid overdose. The researchers reviewed data on 90,010 Medicaid enrollees who used at least 3 opioid prescriptions for a minimum of 90 days, and found that, among a subgroup of patients who had both overlapping prescriptions and used a minimum of four pharmacies, the overdose rate was 26.3 per 1,000 person-years (PYs), compared with 4.3 per 1,000 PYs for those with neither characteristic. Read the abstract…

Study: Many “new” opioid recipients progress to longer-term use.
According to a study published in the July issue of the journal Mayo Clinic Proceedings, many patients who receive a prescription for opioid medication may progress to an episodic or long-term prescribing pattern. The research team reviewed records of 293 patients given a new prescription for an opioid analgesic during 2009. They found that 61 patients (21 percent) progressed to an episodic prescribing pattern, while 19 patients (6 percent) progressed to a long-term prescribing pattern. The research team notes that episodic or long-term prescribing patterns were significantly associated with nicotine use and substance abuse. Read more…

How will MIPS consolidate Medicare quality reporting systems?
An article on AMA Wire examines the potential impact of the new merit-based incentive payment system (MIPS), which consolidates the Physician Quality Reporting System, the value-based payment modifier and the meaningful use electronic health record incentive program. MIPS was created by the Medicare Access and CHIP Reauthorization Act (MACRA), which also eliminated the Medicare Sustainable Growth Rate formula. “Under the MIPS, physicians will have the chance to earn bonuses if they score above average performance thresholds and avoid penalties if they meet those thresholds,” the writer states. “The MIPS also will give physicians the chance to score better and receive more credit for more quality improvement efforts—including a new category of clinical practice improvement activities—than under current programs.” In addition, adjustment factors for performance assessment under the MIPS will be made using a sliding scale, with credit provided to those who partially meet performance metrics, and for improvement as well as achievement. Read more…

California.
According to the California Medical Association, about 40 physicians in the San Francisco Bay area have received contract termination notices from Aetna Health Insurance due to an above-average use of high-level evaluation and management (E/M) codes. The company states that physicians whose billing pattern of high-level E/M codes exceeded two standard deviations above the mean for their assigned marketplace were issued a notice of termination. Read more…

Call for volunteers: OKU Evaluation Committee.
July 31 is the last day to apply for several openings on the Orthopaedic Knowledge Update (OKU) Evaluation Committee. The following positions are available:

  • Foot & Ankle Item Writer (one member opening)
  • Hand & Wrist Item Writer (two members)
  • Trauma Item Writer (two members)
  • Orthopaedic Diseases Item Writer (two members)
  • Orthopaedic Rehabilitation Item Writer (one member)

Applicants for these positions must be active fellows, candidate members, emeritus fellows, or candidate member applicants for fellowship with broad orthopaedic experience in the relevant topic. Learn more and submit your application…(member login required)