Convention Q&A: MACRA, MIPS, APMS—Why CDI is an Essential Ingredient of the Alphabet Soup
The 2017 AHIMA convention session, “MACRA, MIPS, APMS—Why CDI is an Essential Ingredient of the Alphabet Soup,” will take place Monday, October 9 in room 150ABC of the Los Angeles Convention Center. Journal of AHIMA recently spoke with presenter Laura Legg, RHIT, CCS, CDIP, executive director of revenue integrity and compliance at Healthcare Resource Group in Spokane, WA for a preview of her session.
What are you hoping members will take away from your session?
To move forward into 2018, it is necessary to retire some myths about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and bring the facts and benefits about this value-based program to the forefront. Due to the current changes and uncertainties, there are a lot of rumors. Although I don’t have all the answers, I do think approaching MACRA with a focus on quality care and making patients healthier is important. MACRA, Merit-Based Incentive Payment System (MIPS), and Advanced Alternative Payment Models (APMs) all focus on quality care for patients, cost reduction, and improved communication among caregivers; these are all objectives we can all get behind.
What should HIM professionals should be focusing on now in regards to MACRA?
HIM professionals should continue to focus on quality of clinical documentation and ICD-10 coding accuracy and specificity. Measuring performance under ICD-10-CM will provide important key metrics that we can focus on to improve performance for MACRA. If you have not already begun to measure unspecified code usage, Hierarchical Condition Category (HCC) risk adjustment, and diagnosis coding depth, you should begin now. My session will fully explain why these key metrics are so important under MACRA.
Can you talk about the role of CDI in MACRA, MIPS, and APMS?
The quality measures under MACRA are very specific, and clinical documentation will need to match or exceed that level of specificity for physicians to be successful in participating. Understanding that there are penalties under MACRA, we must also understand that this payment system presents opportunity for higher reimbursement to physicians with exceptional performance. Exceptional performance can only be achieved with accurate clinical documentation, accurate data gathering, and reporting.
How should AHIMA members be preparing for the 2018 proposed MACRA rule?
Many of the fears surrounding MACRA are because of the complexity. I often use the analogy “how do you eat an elephant?” one bite at a time. Learn the intricacies of this payment system in small doses by reading about it, attending education sessions, and most important discussion with you peers. There is probably someone in your organization who can assist you in learning and moving forward to 2018. I started by reading everything I could get my hands on and it has really paid off.
How can attendees start incorporating the lessons from your session in their organization right away?
Included at the end of my session is establishing your plan for 2018. This is designed to assist attendees in taking away actionable initiatives. The emphasis is on clinical documentation, necessary metrics, and understanding risk adjustment. Attendees will take away some clinical examples and common coding scenarios with which to educate physicians and others in their organizations.
What else would you like attendees to know about your session or data analytics in general?
It’s important to focus efforts because providers need assistance to focus their documentation in the right way at the right time. Correct data and code submission are vital to optimize reimbursement under MACRA, MIPS, and APMs. Every team member entering data or authoring entries into the patient record at the point of service must be accurate and understand value-based payment programs.