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    Is a ‘perfect storm’ heading for urology?

    ICD-10 specificity, MIPS, changing buy and bill formula could significantly impact specialty

    Robert A. Dowling, MDDr. Dowling“The perfect storm” is a commonly and perhaps overused metaphor that describes an effect of combined circumstances to produce an unusually strong effect. Independent urologists have absorbed remarkable change at a remarkable pace in the last 10 years—change in the understanding of urologic disease and treatment, change in adoption of technology, change in insurance reform, change in health care reimbursement, and change in the cost of operating a medical practice.

    Also by Dr. Dowling: What overpayments rule means for your practice

    The next few years may bring more change in a more compressed time frame than ever before. Could a perfect storm be brewing, and what should you be doing about it?

    ICD-10 flexibility set to expire

    On Oct. 1, 2015, the Centers for Medicare & Medicaid Services and other payers stopped accepting ICD-9 codes and began rejecting claims without valid ICD-10 codes. The transition brought dire predictions of interruptions in cash flow, drawing on lines of credit, practices shutting down, and information systems crashing. In retrospect, the transition was relatively smooth and has been compared to the Y2K “nonevent.”

    Perhaps lost in the memory of this successful management of change is the “flexibility” that CMS issued in July 2015 regarding the specificity of codes (bit.ly/ICD10guidancestatement): “For 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical records review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family.”

    Read - Buy and bill: Know the nuances, save your margins

    In other words, starting Oct. 1, 2016, urologists face claims rejections if they choose a nonspecific code or an incorrect code from the same family when a specific code exists. A good indication of your practice’s compliance in this regard would be the utilization of C67.9-Malignant Neoplasm of Bladder, unspecified: If you are still using this nonspecific code, it could signal a gap in your adoption of ICD-10 that should be addressed before Oct. 1, 2016.

    Next: Negative PQRS pay adjustments

    Robert A. Dowling, MD
    Dr. Dowling is president of Dowling Medical Director Services, a private health care consulting firm specializing in quality ...


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