CMS Releases 2015 Fee Schedule Final Rule

Anthony Wheeler, PhD; Matt Twetten, MA; Alexandra E. Page, MD

The Centers for Medicare and Medicaid Services (CMS) releases its Physician Fee Schedule (PFS) final rule each year, bringing with it changes to physician reimbursement and a variety of related programs. The final rule for year 2015 was released on Oct. 31, 2014, with changes to physician fees, Medicare’s Physician Quality Reporting System (PQRS), the electronic health records (EHR) Meaningful Use program, and other quality and payment initiatives.

Mapping Your Way to ICD-10 Implementation Success

Sarah Wiskerchen, MBA, CPC

As orthopaedic surgeons and their practice teams ready themselves for the implementation of ICD-10, a team-based transition action plan is essential. One step in making the transition is known as “mapping.” Mapping describes the process of comparing the codes currently used in ICD-9 to those that will be used in ICD-10 for the same condition or injury. Mapping helps to illustrate the differences in documentation requirements between ICD-10 and ICD-9.

Five Frequently Asked Questions About ICD-10

Sarah Wiskerchen, MBA, CPC

During the AAOS-sponsored ICD-10 education courses presented this year by KarenZupko & Associates, orthopaedic surgeons, practice managers, and staff had plenty of questions about ICD-10. Here are five that were frequently asked. If we’ve been using unspecified codes before, why can’t we use them now? For orthopaedics, a key feature of ICD-10 is its expansion to include greater detail about the injuries and conditions treated.

Coming Soon: Random Audits for HIPAA Omnibus Rule

Howard Mevis

The Health Insurance Portability and Accountability Act (HIPAA) Omnibus rule went into effect in September 2013. As 2015 approaches, orthopaedic practices can expect the Office of Civil Rights (OCR) in the Department of Health and Human Services to increase its random audit program. The 2013 rule expanded the penalties for privacy and security breaches identified during audits.

What You Should Know About Audits

The Centers for Medicare & Medicaid Services (CMS) has intensified its Medicare audit programs in various jurisdictions across the country. Three types of audits can occur: Comprehensive Error Rate Testing (CERT), Recovery Audit Contractor (RAC), and Zone Program Integrity Contractors (ZPIC) audits. Here are some key facts orthopaedic practices should understand about Medicare audits. Not all audits are the same Each of the three types of audits is looking at something different.

How AAOE Can Help You Thrive

Marian Lucas McCann

The American Association of Orthopaedic Executives (AAOE) is an organization of practice managers and administrators for orthopaedic surgeons and their affiliated services. Today’s members include independent physicians, group practices that went to one or a few hospitals to provide patient care, large multispecialty practices, and practices owned or service lines managed by health systems or hospitals. The adept practice administrator requires the latest in knowledge and skills.

Making the Case for Guidelines in Workers’ Compensation

Tom Farrell

The push for evidence-based guidelines in workers’ compensation is understandable. Workers’ compensation is one of the few areas of medicine in which healthcare protocols are not well scripted in advance of patient encounters. In addition, patients have no responsibility for payments such as deductibles and copayments. That leaves employers liable for 100 percent of all reasonable and required medical care. But who decides what treatment is reasonable and required?

AAOS Member Insurance Program Introduces Higher Limits on Disability Coverage

Erika Wieland

As an orthopaedic surgeon, you realize the impact an accident or injury can have on a person’s life. And though you spend your professional life working to improve the lives of those affected by tragedy, how much thought have you given to the impact an accident could have on your own life—and the lives of those you love?

Electronic Health Records: The Unintended Consequences

Patrick M. Palmer, MD

Patrick M. Palmer, MD The electronic health record (EHR) market is huge and is here to stay, having been embraced by most physicians, insurers, government agencies, and hospital systems. The EHR industry generated $24 billion in global revenues in 2013 and has an anticipated growth rate of 10 percent per year through 2015.