CMS Medicare Initiative

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CMS Medicare Initiative

• Hill Physicians Medical Group

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Hill Physicians

• over 2500 physicians and 20 hospitals
• 550 Adult PCPs
• 227 Pediatricians
• 370,000 Commercial HMO enrollees
• 16,000 Medicare Advantage enrollees

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Hill Physicians.

• A pure IPA
• We dont capitate our physicians, but pay fee for
  service
• Always received ICD9 codes.but focus was on CPT
  coding
• Needed to re-focus their attention

4
How we started

• Convened a very small group(8) as a focus group
  and beta testers for tools
• Meeting frequency- not a one time event
• They developed the tools
• Revised them 6 times within the first 2 weeks
• Offered to have someone come review 3-4 of their
  charts with them

5
Expanded the Message to Targeted Physicians

• Convened small groups of physicians who had large
  numbers of Medicare Advantage enrollees
• Meeting frequency
• Tested the tools, provided report, offered review
  of 3-4 charts
• Convened their office staff
• Distributed the same tools
• Constantly revised the tools

6
PCP Panel Meetings

• Presentation by physician expert
• Case study
• Code the note without the tools
• Code the note with the tools
• Follow up every quarter
• Next steps
• Develop experts for every panel(11)
• Specialists

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A Practicum

• Review the note and problem list
• Fill out the provided Route Slip as you would
  in your own office.
• Try to include all appropriate diagnoses
• Determine the appropriate visit code

8
Tools

• Danze/Hagenbush cheat sheet
• Commonly used ICD-9 Codes sheet
• Classes/Info for Billers