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Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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ICD-10 End-to-End Testing Week Shows Few Coding Errors

ICD-10 End-to-End Testing Week Shows Few Coding Errors | EHR and Health IT Consulting | Scoop.it

The Centers for Medicare & Medicaid Services (CMS) has released the results of its second effective Medicare FFS ICD-10 end-to-end testing week, which took place at the end of April.


Starting on April 27 and ending on May 1, clearinghouses, payers, billing agencies, and Medicare Fee-For-Service healthcare providers participated in CMS’ second successful ICD-10 end-to-end testing week.  Medicare Administrative Contractors (MACs) and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange (CEDI) contractor assisted the individual entities during this end-to-end testing.


CMS was able to work with a wide range of providers, submitters, and claim types, as it served the majority of volunteers. The second ICD-10 end-to-end testing week shows that the federal agency will be able to successfully accept claims when the ICD-10 implementation deadline rolls around.


With 875 participants in the ICD-10 end-to-end testing period, more than 23,000 test claims were submitted at the end of April. To see the results, click here. For the most part, participants were able to send their ICD-10 claims effectively and these were processed by Medicare billing systems without any major issues, CMS reports.


In fact, the results show that the acceptance rate was higher in April than the prior ICD-10 end-to-end testing rate from January. There were less errors related to diagnosis codes on the latest batch of end-to-end testing claims.


Out of any errors that did occur, the majority were unrelated to ICD-9 or ICD-10 diagnosis codes, CMS states. Providers who are still looking to participate in ICD-10 testing with the federal agency are encouraged to take part in acknowledgement testing, which can be performed at any time until the October 1 deadline.


The last ICD-10 end-to-end testing week with CMS will take place on July 20 to July 24, 2015. The ability to volunteer for this testing week has already ended. However, any participants from January or April are welcome to participate in the July ICD-10 end-to-end testing session again and are automatically eligible to test their systems an additional time.


It is vital to continue preparing for the ICD-10 transition over the coming months. Starting on October 1, any Medicare claims that do not use an ICD-10 diagnosis code will be invalid. The Medicare claims processing systems will be unable to accept ICD-9 codes after the deadline. The last day providers can submit ICD-9 codes to CMS is September 30, 2015. Dual coding will also not be accepted after this deadline.


While there is only four months left to prepare for the ICD-10 transition, providers can still take advantage of the many resources offered by the federal agency. The Road to 10 website, for instance, is a very useful tool in preparing for the ICD-10 implementation. CMS offers a variety of solutions for providers that are struggling to meet the ICD-10 transition deadline.

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Why Postponing ICD-10 Compliance Deadline Causes Setback

Why Postponing ICD-10 Compliance Deadline Causes Setback | EHR and Health IT Consulting | Scoop.it

Due to the legislative motions and prior delays to the ICD-10 compliance deadline, there are many healthcare organizations across the country that may not have made as much progress in preparing for the new medical coding set scheduled to begin on October 1, 2015. Even over the last few weeks, Representative Ted Poe (R-TX) introduced a bill into the House that called for putting an end to the ICD-10 transition altogether.


There has been a fair amount of speculation as to the need for the new medical codes throughout the political spectrum and the delays from the last two years have also brought many medical facilities to doubt whether the current ICD-10 compliance deadline will stand still.

The Journal of AHIMA reports that the ICD-10 delays have set back some organizations financially and led them to lose their momentum. Janis Leonard, RHIT, CCS, director of HIM at Albany Medical Center, told the source that any more pushback against the ICD-10 compliance deadline including a postponement would cause severe disruption and a monetary hit due to all of the funds the medical system invested in ICD-10 training among their staff.


Leonard said that if another delay to the ICD-10 compliance deadline were to occur, it “would be tough to re-engage.” The Albany Medical Center is working toward ensuring that ICD-10 conversion on October 1 is a go and that another postponement does not take place.

“Even the director of patient financial services sent a letter to our Congressmen recently again saying ‘do not delay,’ so we have our financial people as well as our coders engaged in that initiative,” Leonard told the news source.


Additionally, physicians at this particular organization have been supporting the transition toward ICD-10 coding from the beginning and are conducting ongoing documentation improvement initiatives.

Online modules are also being used to offer more training opportunities for medical coders to ensure they are prepared for the ICD-10 transition. In particular, more training information on medical terminology, pharmacology, anatomy, and physiology is being offered at Albany Medical Center to ensure coders will be able to handle the increased specificity of the ICD-10 diagnostic codes.


For more than a year, Leonard and her team focused on dual coding throughout the organization requiring coders to use both ICD-9 and ICD-10 for coding 10 percent of a workday’s cases. Additionally, weekly training sessions are offered where coders can use ICD-10 to code scenarios and review their work with an instructor.


When it comes to retaining a strong workforce of medical coders within a healthcare facility, Albany Medical Center focused on restructuring the career ladder and offering more incentives.


“When we did this, we based [the job positions] on new qualifications, credentials and experience, and we swaddled people into their new roles,” stated Leonard. “And more than half of coders received an increase in pay. We also provided a recruitment and a retention bonus that was paid out over two years with a work commitment of two years to incentivize our coders to stick around after ICD-10 [transition].”

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Four Ways Vendors Should Help the ICD-10 Transition

Four Ways Vendors Should Help the ICD-10 Transition | EHR and Health IT Consulting | Scoop.it

ICD-10 is a lightning rod for many of the slow-to-launch initiatives promising to modernize health technology. In recent weeks, I've read wearily about 10-year interoperability roadmaps from the Office of the National Coordinator for Health IT and belabored testimony over the Medical Electronic Data Technology Enhancement for Consumers' Health (MEDTECH) Act, which, if it succeeds, would end years of regulatory uncertainty from the FDA over medical devices. So I was disheartened—though not entirely surprised—to hear that ICD-10 may be deferred yet again if powerful physician lobbies like the AMA have their way in Washington, D.C.


Policy delays are yet another variable in an already unstable landscape of rising costs, declining reimbursements, and clinical consolidation threatening the viability of many practices. As a nurse and practice manager for a small pediatric practice, ICD-10 is a policy mandate I simply can't afford to ignore. Yes, it's true that many providers are struggling with technology that isn't equipped for an Oct. 1, 2015, transition date. I feel for those providers and don't want to see them punished for the shortcomings of their laggard vendors. But rather than willfully kicking the ICD-10 can down the road, I believe that providers must prepare for the inevitable by shopping now for services that can accommodate them.


Certainly, providers have their fair share of ICD-10 preparatory work to do on their own. It's in their best interest, however, to take a long, hard look at what their vendors are offering to make the ICD-10 shift easier. Here are a few areas to think about:


Your EHR Should Know You


ICD-10 is roundly forecast to be an administrative nightmare, but it doesn't have to be. When CMS implements ICD-10, the codes which all U.S. healthcare providers use to describe diagnoses and treatment will increase overnight by from 14,000 to over 68,000. Based on your current, most commonly documented diagnoses, your EHR should know which codes you're most likely to need on come October and surface them directly into your work flow. Scrolling through a full menu of thousands of possible codes is simply untenable. EHRs which are compatible with SNOMED — a physician-friendly classification system which maps to ICD-10 — will and should provide a shorthand "crosswalk" between ICD-9 and ICD-10 codes. These product updates should be available now, so that you and your staff can begin practicing.


Your Vendor Should Curate Knowledge Just for You


Is there a resource hub full of the information you need about ICD-10? Do you have best practice configurations, which will ensure that your EHR is configured with the right clinical content based on your needs? While your vendor can't code for you, it should provide training and practice exercises to teach best practices, identify potential hot spots in your work flow, and fix problem areas before they happen.

Your EHR Should Be Prepared For a Range of Payer Compliance

Your vendor should be well underway testing payers' and clearinghouses' system flexibility and readiness to manage both ICD-9 and ICD-10 codes, given that some will linger in a bilingual ICD-9/ICD-10 environment. Vendors should have the knowledge and payer roadmap to ensure that, whatever a payer's readiness or ICD-10 compliance status is, claims are being coded in a way that will not delay payment.


Your Vendor Should Guarantee Your Success


Unlike like meaningful use certification, government mandated for all EHRs, there is no comparable test for ICD-10. It's imperative that vendors guarantee their ability to create ICD-10-compliant claims and orders to HIPAA-covered entities. If it can't, it should pledge to waive your fee. Those vendors which recommend taking out a line of credit to ease revenue cycle hiccups aren't true partners.

In the ICD-10 echo chamber, providers shouldn't be paying attention to policymakers or pundits, but to their vendors. Good technology should insulate them from the revenue cycle disruption, delayed reimbursements, incorrect documentation, and clinical work flow issues ICD-10 threatens. EHRs, practice management services, analytics tools, clinical data exchange services, clearinghouses, and payers all need to be held to account for providers' success, failure, or pain along the way.


Vendors should be taking measure, and even competing with one another, to be among the most stalwart partners for physicians as they prepare for the seismic shift about to occur in clinical documentation. ICD-10 was never meant to be the province of the provider alone. The administrative burden is potentially mammoth. Does your vendor make the cut?


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Five Ways to Improve Coding at Your Medical Practice

Five Ways to Improve Coding at Your Medical Practice | EHR and Health IT Consulting | Scoop.it

Supplier discounts and staffing strategies are all well and good, but if you're looking to combat rising business costs in a meaningful way your best bet is effective coding. The procedural (CPT) and diagnostic (ICD-9) codes used to submit claims for reimbursement dictate how much and whether your providers get paid for the work they do. Thus, it's important to ensure your front- and back-office coding procedures are optimized for success.

That means taking steps to minimize denials, training to ensure you're not undercoding (a common problem), and readying your defenses to appeal rejected claims as needed. Such efforts can make or break your bottom line as the industry transitions to the more complex ICD-10 code set this fall.


Here's how billing and coding experts say practices can begin to code more accurately, and effectively:


1. LEARN FROM DENIALS


According to the Medical Group Management Association (MGMA), better-performing practices report a claims denial rate of fewer than 5 percent. If your rate is higher, you must diagnose the problem. The most common reasons for rejected claims can be easily remedied by using software that flags errors and omissions before they go out the door, says Mary Pat Whaley, a certified professional coder and medical practice consultant with Manage My Practice in Durham, N.C. That includes missing information, (such as prior authorization or dates of service), insufficient documentation, coding errors related to the place of service, missing modifiers, and late submissions (each payer has its own deadline for filing claims).


Confusion over primary and secondary insurance may also contribute to kicked-back claims. Secondary payers will usually deny a claim that gets submitted without the primary payer's explanation of benefit information. You may also get denied for Medicare claims that do not include a signed Advanced Beneficiary Notice of Noncoverage, or a waiver of liability, which documents if the patient is willing to assume financial responsibility for services not covered by insurance.


Finally, Medicare and other payers frequently deny claims for services deemed "not medically necessary," either because the diagnosis does not align with the service or because it's covered only at certain frequencies. Such denials can be minimized by confirming insurance coverage and authorizations prior to each visit, says Whaley.

Some payers are more particular than others. It pays to identify those that deny reimbursement most often, so you can ensure those claims are clean the first time around. Indeed, the process of resubmitting is a drain on productivity. It costs most practices an average of $25 to $30 to resubmit a corrected claim, according to the MGMA.


2. COMMUNICATE WITH PATIENTS


By understanding the payment policies of their payers, front-desk staff can work more closely with patients to verify correct insurance information, explain the coverage policies of each plan, and submit claims accurately so the claim adjudicates correctly on the first submission, says Laura Palmer, director of professional development at the MGMA. Be knowledgeable and transparent about your policies and communicate them with your patients, she advises.


3. TRAIN YOUR PHYSICIANS


To benefit from better coding both before and after the switch to ICD-10, additional training is likely required. Perhaps the best way to help physicians improve their coding accuracy is to spend 10 minutes per month at physician meetings having them read a blinded note and coding it together with a certified coder, says Whaley. "Sometimes, physicians can also benefit from having a coder shadow and scribe the visit in addition to the physician's documentation to compare what each comes up with," she says. "You would be surprised how often a physician forgets to say, 'I reviewed the … lab results, X-rays, consultation report, etc.' It's something very simple, but, if it wasn't documented, it wasn't done." Such omissions result in undercoding, which leaves money on the table.


4. IDENTIFY A CODING CZAR


Consider, too, appointing a coding czar someone in-house who is trained to track and trend claims, says Rachel Mitchell, director of client services for Applied Medical Systems, a medical practice management firm in Durham, N.C. As they do for claims submissions, most payers have deadlines for resubmitting claims and filing appeals. Your coding point person should flag any claims that have not been paid as the filing deadline draws near, in case the payer never received it, or rejects it with no time left to resubmit.


5. STAND YOUR GROUND


In an era of shrinking reimbursement, practices must also be prepared to fight for what's rightfully theirs. It takes time and effort, but appeals often pay dividends. "Sometimes you have to go to bat when you keep getting things denied and you know it's wrong," says Whaley. "You may have to go a couple of levels up the chain of command to appeal and let the payer know they have something wrong in their system. Don't overlook the idea that the payer's system may be wrong."


Finally, Palmer adds that practices should review the list of payable diagnoses when their claim is denied for medical necessity or the service is not covered as part of the benefits. And always appeal in writing following the provider manual guidelines. "Be specific about why the claim should be paid," she says. "Submit supporting documentation. Track appeal results and timing."

If you haven't made proper coding a top priority for your practice, there's no time to lose. Indeed, successful coding is your single best defense against rising costs and shrinking reimbursement. Amid the pending conversion to ICD-10, it is also the best way to minimize disruption to your future income stream.

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While US Focuses on ICD-10 Transition, WHO Prepares ICD-11

While US Focuses on ICD-10 Transition, WHO Prepares ICD-11 | EHR and Health IT Consulting | Scoop.it

The ICD-10 transition is inevitable, as the current ICD-9 coding system is very out of date. The ICD-9 coding set was implemented in the 1970s and contains information that is incompatible with current medical practice, according to a fact sheet from the Centers for Medicare & Medicaid Services (CMS).

Many other nations around the world have already made the switch to ICD-10 coding. The ICD-10 transition will bring more opportunity for code expansion and enabling physicians to provide accurate diagnoses.

Since so many players in the medical industry use the International Classification of Diseases (ICD) including physicians, nurses, health IT professionals, billers, coders, and insurers, moving forward to the most accurate set available today is essential.

Clearly, transitioning effectively to the new coding set is a necessity, which is why CMS offers a variety of resources to ensure a successful ICD-10 integration across the healthcare industry. The Road to 10 website, for example, provides a customized plan for physician practices to adopt the coding set and new technologies that are relevant to their needs.

Whether a hospital or clinic specializes in pediatric care, OB-GYN, cardiology, or internal medicine, the Road to 10 online resource offers tailored ICD-10 transition strategies for any and all medical facilities.

Additionally, CMS provided this flyer to educate providers, payers, and vendors on the ICD-10 transition. Vendors, especially, will need to work with healthcare providers to install and implement equipment that meets the requirements of the new coding set.

Since many other countries have already adopted ICD-10 coding, the World Health Organization (WHO) states that the release date for the next updated coding set, ICD-11, will be in 2017. WHO also offers ICD-10 training tools for providers and payers to become more educated in time for the October 1 deadline.

WHO reports that the ICD is being further advanced and developed through the next phase of ICD-11 in order to maintain the progress in medical care and among physicians. Due to the increasing capabilities of EHRs and health IT systems, the ICD-11 coding set will also be a useful addition.

The organization also states that entities will be able to access the ICD-11 coding set in multiple languages. Signs, symptoms, and definitions of disease will be reported “in a structured way” so as to improve accuracy.

ICD-11 will also be tailored for the transition to health IT systems and information networks. WHO also invites coding experts and other stakeholders to comment on the new ICD-11 developments through an online platform.

While the US healthcare system is still preparing to move forward with the ICD-10 transition, the WHO encourages experts across the globe to comment on and propose better classifications for ICD-11.

“The input from multiple parties will increase consistency, comparability and utility of the classification,” the WHO stated. “This shared process will lead to a global consensus on how diseases and health-related problems are defined and recorded.”


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AMA Urges CMS to Provide Backup Plans for ICD-10 Transition

AMA Urges CMS to Provide Backup Plans for ICD-10 Transition | EHR and Health IT Consulting | Scoop.it

What would happen to a medical practice that has one in five of its Medicare claims not properly processed by the Centers for Medicare & Medicaid Services (CMS)? It could lead to a serious financial disruption and strain the budgets of most medical facilities. However, this is just the scenario that could occur on Oct. 1, 2015 when the country carries out the ICD-10 transition if CMS does not develop suitable contingency plans.

The American Medical Association (AMA) and 99 other specialty groups from around the country called for CMS to develop contingency plans for the anticipated failures once the nation transitions to the ICD-10 code set, according to an AMA press release.

The impact to the healthcare sector upon ICD-10 implementation could be severe, leading to a multi-billion dollar disruption and significant access to care problems for Medicare patients. The latest end-to-end testing results show that the Medicare claims acceptance rate would decline from 97 percent to just above 80 percent if ICD-10 implementation occurred today.

Even this percentage on its own could lead to an accumulation of millions of unpaid Medicare claims, which would severely damage the financial outlook of the healthcare industry. However, since the end-to-end ICD-10 testing only speaks for about 1 percent of all Medicare providers, the acceptance rate in actuality may be lower, depending upon how prepared the country is for the ICD-10 transition by October 1.

“The likelihood that Medicare will reject nearly one in five of the millions of claims that go through our complex health care system each day represents an intolerable and unnecessary disruption to physician practices,” AMA President Robert M. Wah, M.D., said in a public statement. “Robust contingency plans must be ready on day one of the ICD-10 switchover to save precious health care dollars and reduce unnecessary administrative tasks that take valuable time and resources away from patient care.”

Along with creating contingency plans, the AMA and other groups are asking CMS to consider how the ICD-10 transition will impact the Physician Quality Reporting System (PQRS) and meaningful use requirements.

The reporting periods for both meaningful use and PQRS will take place more than three-quarters into the calendar year, which means the 2015 reporting data will use both ICD-9 and ICD-10 codes. This will be especially confusing for providers that are treating patients for the same condition right before and right after the October 1 deadline.

The AMA President Dr. Wah continued by explaining that the federal government may be “underestimating the impact” of ICD-10 implementation on providers that are already being encumbered by the many healthcare regulations currently in place. The AMA is focused on reducing burden on physicians and ensuring enough information is given regarding the effects of the ICD-10 transition. A major goal of the AMA is to confirm physicians are able to avoid Medicare payment penalties.

A total of 100 physician groups are asking CMS to provide contingency plans for the anticipated issues of the ICD-10 transition. Having plans in place can help avoid the potential backlog of millions of unpaid Medicare claims once ICD-10 implementation occurs.


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Control ICD-10 Claims and Denials: 4 Tips

Control ICD-10 Claims and Denials: 4 Tips | EHR and Health IT Consulting | Scoop.it

When the transition to ICD-10 begins Oct. 1, 2015, healthcare providers will have an additional 135,000 codes for documenting a patient's medical status and reason for a doctor's visit. Based on the additions of these codes CMS predicts that claim error rates will be more than two times higher with ICD-10, reaching a high of 6 percent to 10 percent in comparison to the current 3 percent average using ICD-9 codes. They are also predicting that denial rates will rise by 100 percent to 200 percent and days in accounts receivable will grow by 20 percent to 40 percent.

Now is the ideal time to prepare. Start by:

1. Identifying current high dollar or volume procedures as these will have the most impact to your business;

2. Developing current baseline trends by payer, clearinghouse, procedure, and diagnosis code;

3. Documenting timely filing rules for each payer to ensure you do not get denied for slow staff processing; and

4. Working with payers to create scorecards and a real-time feedback process so impacts can be communicated quickly.

A little preparation now will go a long way next year.

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Hoping for ICD-11 is “Waiting for Godot,” ICD-10 Coalition Says

Hoping for ICD-11 is “Waiting for Godot,” ICD-10 Coalition Says | EHR and Health IT Consulting | Scoop.it

Clinging on to the current outdated ICD-9 code system until ICD-11 is ready for use at some unspecified point in the future is akin to the endless idle loitering of Vladimir and Estragon in Samuel Beckett’s classic play Waiting for Godot, says the Coalition for ICD-10 in a new opinion piece.  After waiting more than twenty years for the implementation of ICD-10, the healthcare industry simply cannot afford another two or three decades for the newest code set to be finalized and ready for use.

“Based on the World Health Organization’s (WHO) current timeline, ICD-11 is expected to be finalized and released in 2017,” the commentary explains. “For the US, however, that date is the beginning, not the end.  As with every WHO version of the ICD codes, ICD-11 would need to be adapted to meet the detailed payment policy, quality assessment and other regulatory requirements of US stakeholders.”  The country could be waiting until 2041 for the entire pre-implementation process to be completed, the Coalition adds.

Meanwhile, the healthcare industry will be forced to continue to use a significantly outdated code set that cannot account for many emerging health threats or new advances in technologies, diagnoses, and procedures.  That’s just fine with representatives from the American Medical Association (AMA), whose House of Delegates voted to reject an internal report noting that implementing the changes inherent in ICD-10 would provide an important foundation for the eventual adoption of ICD-11.  The report concluded that skipping ICD-10 all together was “not recommended” as a viable course of action, yet the AMA continues its resistance to the ICD-10 codes – and the Coalition continues to fight back against their reticence.

“The US simply cannot wait decades to replace ICD-9, a code set that was developed nearly 40 years ago,” the Coalition states. “US healthcare data is deteriorating while at the same time demand is increasing for high-quality data to support healthcare initiatives such as the Meaningful Use EHR Incentive Program, value-based purchasing, and other initiatives aimed at improving quality and patient safety and decreasing costs.”

The AMA argues that the expense of ICD-10 implementation is overwhelming for smaller physicians struggling keep their doors open, pinning the costs at anywhere from $50,000 to $225,000 for a small provider.  Despite contradictions from AHIMA, the cost of the switch has been a major selling point for opponents.

However, after two one-year delays, the tide seems to be turning in support of ICD-10.  Not only is the Coalition growing, but Congress has stepped in to enforce the idea of a 2015 due date.  Will the wait for Godot be over in October?  The Coalition would certainly like to see an end to the “unending barrage of excuses” and continual delays.

“Waiting for ICD-11 is simply not a viable option,” the blog post concludes. “The absurdity of the endless waiting in Waiting for Godot culminates in frustration: “Let us not waste our time in idle discourse! Let us do something, while we have the chance!” Yes, the wait needs to be over. It’s time to stop wasting time. It’s time to get ICD-10 implemented.”

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Should physicians use the ICD-10 delay to learn how to code?

Should physicians use the ICD-10 delay to learn how to code? | EHR and Health IT Consulting | Scoop.it

As the healthcare industry comes to grips with the reality of yet another ICD-10 delay, providers must turn their attention back to completing the arduous conversion process, albeit with another year of prep time.  The additional twelve months will give physicians more time to get used to clinical documentation improvements and new technologies.

But Ron Rosenberg PA-C, MPH, President of the Practice Management Resource Group, believes physicians should also invest some serious effort in getting to know ICD-10 a little more intimately than many providers have planned.  Rosenberg spoke to EHRintelligence about how physicians should embrace a more complex role in the ICD-10 conversion if they want to see success in 2015.

What are the most pressing challenges involved in the ICD-10 conversion?

The biggest risk for the provider, of course, is not getting paid.  So the big challenge is learning the ICD-10 system, and then the second challenge is making sure your technology will accommodate the system, and that technology really falls into several categories.  The first is the tools you need to select the right code, and then the second is learning how you capture those codes into your billing system, and number three is making sure you get paid.  So to me, those are the big challenges.

How should providers address the education and workflow changes associated with ICD-10?

From my perspective, diagnosis coding is a clinical exercise.  It’s not an administrative exercise. And my bias is that the provider should be assigning the ICD codes: ICD-9 now, and ICD-10 in the future.


I mean, it’s a clinical decision.  Knowing what the diagnosis should be is a clinical decision.  Now, whether the physician documents the patient’s issues, and then somebody else codes the ICD-10 or the physician actually identifies the proper ICD-10 code…that may be arguable.  But ultimately, the physician is the one that has to assign a diagnosis.  And from my perspective, when you look at workflow, it just seems to be much more efficient to have the physicians either completely or partially identify the ICD-10 code.

So for instance, it may be that the physician assigns the first four digits to get in the ballpark, and then somebody else can go down to the last three digits, or the physician should assign the whole thing.  That is going to be up to the provider based on what their practice style is, but it’s really up to the physician to get it into the ballpark.

What would you say to physicians who feel like dealing directly with the code sets is outside their job description, or that they don’t have the time to do so?

What I found is once a clinician gets their hands around the structure and the taxonomy of the coding system, they say, you know, it’s not really that different than ICD-9.  Yeah, there is more specificity, and I may want my coders to be the ones to put in the laterality and the first visit, second visit.  But finding the right first four digits is really not much different.

I hate to use an old, old analogy, but when I was in PA training back in the 1970s, some of the first healthcare informatics was being done at the University of Vermont, and I trained nearby at Dartmouth.  They were developing computer algorithms for diagnoses, and they figured that would be a great way for a PA to be able to assist in the decision making.  And one of the things they found, much to the chagrin of the computer programmers, was that after about the first three tries, the algorithm became embedded in your memory.  You didn’t need the computer anymore.  So I guess that’s a long-winded way of saying that the physicians that have looked at the system and looked at the codes are finding that it’s not quite the big deal that they thought it was going be.

And when I say “learn the system,” I’m not talking about memorizing 75,000, 80,000, or 90,000 codes. I’m talking about understanding the structure and the taxonomy of it.  Many providers might decide that, given their practices setting and given the resources that they have, somebody else should do the coding.  Fine, but they shouldn’t just do it as a knee-jerk, “I don’t want to have to deal with this.”

How will specialists handle the switch?

It’s going to be a difficulty for many specialists.  Primary care physicians really have a challenge with ICD-10 because the universal codes are so huge for them.  But if you take a specialty like ophthalmology or cardiology, one of the places where they’re going to have difficulty is comorbidities.

In other words, you may have a set of 50 or 60 core ICD-10 codes for an ophthalmologist.  But when you start then adding in diabetes and cardiovascular disease and everything else that might also be affecting a patient, then that could be more problematic.  Maybe that’s something that your coder needs to look at because that could really add to the patient visit and add value to the clinical note.

What effect will the newly announced one-year delay have on ICD-10 preparation?

I don’t think it’s going make a difference.  In other words, providers would have been ready October 1, 2013.  They would have been ready October 1, 2014.  They’ll probably be ready in 2015.

From the software perspective and the payer perspective and claims adjudication perspective, I think it’s a much bigger deal.  And I’m sure a lot of them are very upset about this delay because they put all their resources into it already.  But if somehow the carriers aren’t ready, you know, it could have a disastrous disruption in cash flow.

It’s kind of like back in the day, when cameras had real film in them.  You would take pictures, and then you would wait breathlessly for the film to come back from the developer to see if you got anything, because you just didn’t know.  It’s not like a digital camera where you know instantly if you got the perfect shot the first time around.

And I think the go live date, whenever it is, is going to be the same way.  Everybody will be holding their collective breath.  The cost of any kind of fumbling on the part of the payers, or the systems companies, is really going to be placed on the shoulders on the practices. It would be wonderful if payers would do something like a dual coding system in the month of August, for example, where you could submit both sets of codes, and so everyone could test real-time.  Because the testing that’s going on hasn’t been universal. It’s still going to be a collective intake of breath.



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Hospital Groups Call for Avoiding Another ICD-10 Delay | EHRintelligence.com

Hospital Groups Call for Avoiding Another ICD-10 Delay | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
Hospital groups have written a letter to leaders of Congress asking the latter to avoid another ICD-10 delay.

With less than ten months to go before healthcare organizations and providers need to comply with most recent ICD-10 transition deadline, the standoff between proponents and opponents of the 2015 ICD-10 compliance date is increasing in intensity.

A band of hospital and health system associations have written a letter to leaders of Congress asking the latter to avoid another ICD-10 delay. A total of eight industry groups have undersigned the petition:


“As the organizations representing more than 5,000 hospitals and health systems across the country, we strongly support the announced October 1, 2015 ICD-10 compliance date and oppose any steps to delay,” the organizations write. “Recent ICD-10 implementation delays have been disruptive and costly for hospitals and health systems, as well as to health care delivery innovation, payment reform, public health, and health care payment.”

The letter to Representatives John Boehner (R-OH) and Nancy Pelosi (D-CA) and Senators Harry Reid (D-NV) and Mitch McConnell (R-KY) specifically recalls the setbacks resulting from the most recent one-year delay of ICD-10 implementation from 2014 to 2015:

The delay added billions of dollars in extra costs. Many of our members had to quickly reconfigure systems and processes that were prepared to use ICD-10 back to ICD-9. Newly trained coders who graduated from ICD-10 focused programs were unprepared for use of the older code set and needed to be retrained back to using ICD-9. Further, training of existing coders needed to be repeated given the one-year delay. This results in a doubling of costs that are not productive. A further delay would only add additional costs as existing investments would be further wasted and future costs would grow.

The advocacy by the hospital and health system associations comes shortly after Medical Society of the State of New York and Texas Medical Association called on their members to persuade Congress to implement two-year ICD-10 delay until 2017. Those provider association have highlighted the negative financial implications for physician practices if an industry-wide ICD-10 implementation failed on Oct. 1, 2015.  The letter’s timing of December 5 also coincides with the message delivered by the Coalition for ICD-10 following remarks by American Medical Association President Robert Wah, MD, that contained arguments against and jokes about new code set.

Based on the types of organizations working in favor and against an additional ICD-10, a division clearly exists between hospitals and hospitals and physician practices. While advocates for the latter reiterate the readiness of their constituents, their counterparts see nothing bad negative consequences ahead for their members. And this division likely to puts to be any lingering doubts about the forces behind the most recent ICD-10 delay.



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Seven ICD-10 Transition Steps Medical Coders Should Follow

Seven ICD-10 Transition Steps Medical Coders Should Follow | EHR and Health IT Consulting | Scoop.it

With only four months to go until October 1, healthcare providers who are behind in their implementation of the new diagnostic coding set need to follow specific ICD-10 transition steps to ensure success by the compliance deadline. From integrating new systems and upgrading technological processes to training staff on the new codes and testing the systems, providers will need to be ready by October 1 to ensure their healthcare reimbursement and revenue remains stable.


According to the Journal of AHIMA, coders especially have had difficulty moving toward the new ICD-10 codes, as the amount of responsibilities on their shoulders has risen drastically. When it comes to training and learning about the necessary ICD-10 transition steps, the funding for such activities is low and few resources are being put toward it within the healthcare industry at large, the Journal ofAHIMA reports.


“The budget is the paramount issue,” Anita C. Archer, CPC, Director of Regulatory and Compliance at Hayes Management Consulting, told the news source. “Providing funding for [physician practice] coders to attend training is a problem. There is a much better infrastructure on the HIM side.”


MeShawn Foster, another consultant on ICD-10 implementation, stated, “Based on what I’ve heard, some coders have had to use their own money for training and even their own paid time off to attend the training. With hospital coders, the training is available, and they don’t need to pay out of pocket. Justifying the cost of some of these conferences is hard for the physician coder.”


As the ICD-10 transition deadline comes near and providers only have four months to finish their preparation, physician practice coders are experiencing significant challenges in ensuring they can properly utilize ICD-10 codes in time, especially when it comes to their training.

Another complex challenge that physician practice coders will need to overcome is the management of the practice’s superbill, which requires patient demographics to be evaluated. Additionally, EHR templates will need to be updated as part of the key ICD-10 transition steps.


The Journal of AHIMA offered seven practical tips for providers to follow as they adhere to some common ICD-10 transition steps on their path toward the October 1 deadline. These tips are:


1) Become an expert on using the ICD-10 diagnostic codes.


2) Start at the beginning and convert only the top 20 ICD-9 codes to the new ICD-10 codes. This will prevent coders from becoming overwhelmed.


3) Set aside one to two hours for practicing dual-coding per week.


4) Network with other physician practice coders to reduce the costs of ICD-10 training.


5) Find a physician leader in larger medical practices to advocate for ICD-10 training and preparation on the coders’ behalf.


6) Offer ideas and opinions on template design along with template updating.


7) Schedule weekly meetings in order to discuss any and all ICD-10 implementation issues.


By following the seven tips above, physician practice coders will be on their way toward successfully transitioning toward the ICD-10 code set.

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3 things to know about the Cutting Costly Codes Act of 2015

3 things to know about the Cutting Costly Codes Act of 2015 | EHR and Health IT Consulting | Scoop.it

As far as proposed legislation goes, the latest attempt to avoid ICD-10 cuts straight to the point.

Republican Texas Rep. Ted Poe reintroduced what was formerly the Cutting Costly Codes Act of 2013 at April’s end, and after a several day delay in posting the text to Congress.gov, it is publicly available.

Whether the Cutting Costly Codes Act of 2015 will meet the same fate as its predecessor and essentially die on the House floor remains to be seen, but at this point industry consensus suggests its passage is a long shot.

That said, here are three things to know now.

1.) The proposed bill “prohibits the Secretary of Health and Human Services from replacing ICD-9 with ICD-10.” That’s one thing to know about the Cutting Costly Codes Act of 2014, of course, and neither ICD-10 advocates nor opponents should be particularly surprised by that intention.


2.) Unlike the Protecting Access to Medicare Act of 2014, which prevented HHS from mandating the deadline before October 1, 2105, Cutting Costly Codes aims to push ICD-10 back indefinitely. As such, no new compliance deadline is suggested.


3.) The bill also calls on The Government Accountability Office to “conduct a study to identify steps that can be taken to mitigate the disruption on healthcare providers resulting from a replacement of ICD-9.”

Whereas the first two are pretty straightforward, that last provision is likely to raise a number of eyebrows among industry observers.

What, after all, could possibly be less disruptive for replacing ICD-9 than converting to ICD-10?


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ICD-10 Documentation and Quality Reporting Changes

ICD-10 Documentation and Quality Reporting Changes | EHR and Health IT Consulting | Scoop.it

In the physician practice, it cannot be stressed enough that only ICD-10 will be utilized come Oct. 1, 2015. The first thing that needs to be understood is what exactly is changing in regard to the diagnosis codes in ICD-10.

COMPARE AND CONTRAST


ICD-10 has gone from 17 chapters to 21 chapters. While this might sound like the cause of all the additional codes, it really is not. In ICD-9, there were the V-codes and E-codes that were not classified as "chapters." That accounts for two of the four new chapters. The other two are the result of diseases of the eye and ear each being promoted out of the nervous system chapter. There are also some codes that have been reclassified into more appropriate categories based on current medical knowledge.


In contrasting the two code sets, ICD-10 has changed how injuries are classified. They are now grouped by the body site injured and then by the type of injury, whereas ICD-9 only classified injuries by type. To allow for future expansion, ICD-10 codes can be as small as the three-character category code and as information rich as a seven-character code that includes laterality, severity, and episode of care. Additionally, ICD-10 has switched over to alphanumeric versus the straight numeric ICD-9.


QUALITY AND PERFORMANCE REPORTING


Documentation has been touted as one of the biggest challenges with ICD-10, which is understandable considering the need for more specificity in order to obtain the most accurate code to describe the patient's condition. The more precise the description of a patient's condition, the more detailed the code choice can be. This leads to better data for outcomes reporting, research, and public health statistics, just to name a few benefits. The goal of documentation improvement is not to increase the amount a provider charts on a patient. The goal is to give an accurate depiction of the symptoms that lead to diagnosis, and the treatment course chosen to most effectively care for the patient. When looking at the groups of quality measures in the Physician Quality Reporting System (PQRS), ICD-10 offers the physician a greater number of combination codes to more succinctly report the more common etiologic and manifestation relationships.


DIABETES MELLITUS


In ICD-10, there was a significant change in the diabetes mellitus codes. In ICD-9, there was only the 250 category. With ICD-10, there are five categories, but the most significant change is the combination codes that were created. As mentioned earlier, there have been a number of additional codes added to ICD-10, and diabetes is one of the places where that occurred. These added combination codes actually reduce the number of codes to report. Rather than using two codes to describe a single condition, the diabetes combination codes describe both the etiology (diabetes) and the manifestation (such as, glaucoma) all in one code. A perfect example of this is type 2 diabetic retinopathy with macular degeneration. In ICD-9, it would have taken three codes to capture every detail of this condition. In ICD-10, it only takes one code. So if there is type 2 diabetic retinopathy with macular degeneration, then there is also a type 1 diabetic retinopathy with macular degeneration. Sufficed to say, the same would be true for each of the other three categories of diabetes mellitus. It is for this reason that, when looking in the 2015 PQRS Measures Group Specifications Manual, there is going to be a longer list of possible codes the diabetes group. The number of reportable diabetes codes for Jan. 1, 2015, through Sept. 30, 2015, is 54. Beginning Oct. 1, 2015, there are a total of 92 reportable diabetes codes. Again, these codes provide more granularity, and therefore improved data.


While some providers may be alarmed at the increased availability of these more definitive code descriptions, there is a change with ICD-10 many will be pleased about. No longer will they be inundated with queries asking if the diabetes is controlled or uncontrolled. This classification is removed from ICD-10. However, if the terms "inadequately controlled," "out of control," or "poorly controlled" are used in documentation, coders will be guided by the ICD-10 index to use the type of diabetes with hyperglycemia.


ASTHMA


Another reportable diagnosis in the PQRS Measures Group is asthma. While the number of reportable diagnoses for asthma has also increased when comparing ICD-9 to ICD-10, the number of codes is significantly lower. There is only an increase of four additional codes in the list of reportable asthma diagnoses. This change is attributable to the addition of terms that more appropriately reflect the current clinical classification of asthma. The terms that have been added are "mild intermittent," "mild persistent," "moderate persistent," and "severe persistent." Providers that see a high number of asthma patients should be aware of these classifications and utilize an appropriate source to make consistent diagnosis and treatment decisions based on the chosen source.


FOCUS AREAS


On Dec. 10, 2014, a joint presentation was done by CMS and the American Health Information Management Association (AHIMA). The following list was provided as documentation focus areas:

• Disease type

• Disease acuity

• Disease stage

• Site specificity

• Laterality

• Missing combination code detail

• Changes in timeframes associated with familiar codes


By reviewing the 2015 PQRS Measures Group Specifications Manual and focusing on this list of areas for documentation improvement, any physician practice can improve not only their documentation, but also demonstrate improved quality of care by providing a clear picture of the patient throughout the care continuum.


Now that some of the groundwork has been laid, it is time to build on the foundation of strong documentation. Every ounce of clarity noted in the provider documentation builds a complete picture of the patient's health, history, treatment, and quality care. Additional steps for preparation are easily accomplished when these building blocks are in place.


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How ICD-10 could ease reimbursement efforts

How ICD-10 could ease reimbursement efforts | EHR and Health IT Consulting | Scoop.it

While preparing for ICD-10 should include actively protecting your organization's revenue stream, the new code set almost certainly will make some aspects of reimbursement easier, according to Pam Jodock, HIMSS senior director of health business solutions.

The enhanced specificity in ICD-10 should decrease in the amount of documentation required to get claims processed, Jodock tells RevCycleIntelligence.com in a recent interview.

"There should be fewer claims pended for requests for medical records because the ICD-10 code will provide the information not included in ICD-9 codes today," Jodock says. "Hopefully over the course of time, we'll see a streamlining of claims payment and providers will see a reduction in the number of claims that get pended or rejected at first pass."

Also, with more specificity, providers will be better able to explain the severity of their patient mix with Medicare or Medicaid reimbursements, she says.

"Providers can only control a small portion of outcome with their patients. There are other things--comorbidities, lifestyle choices and adherence to medication protocol--that will impact outcome," Jodock says. "The more of that type of information that providers are able to capture, the better able they'll be able to account for those factors when negotiating appropriate reimbursement levels."

She urges practitioners to understand, going into the Oct. 1 deadline for implementing ICD-10, the trends from their pended claims for the previous 12 months. Then, she says, abnormalities can be caught quickly before they become a financial threat.

Many organizations were pleased that the legislation to replace the Sustainable Growth Rate (SGR) formula that the House has sent to the Senate did not include another delay for ICD-10. Members of the House have opposed any further delay, saying it would be costly and time-consuming.

However, the American Medical Association and 99 state and specialty societies have voiced concerns with plans for the transition, citing insufficient end-to-end testing and inadequate contingency plans should failures occur.


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Docs sound warning about ICD-10 dangers

Docs sound warning about ICD-10 dangers | EHR and Health IT Consulting | Scoop.it

In a letter this week to the Centers for Medicare & Medicaid Services, more than 100 medical societies aired "a number of concerns that do not appear to be addressed" as the ICD-10 deadline looms.

Writing March 4 to CMS Acting Administrator Andrew Slavitt, the groups – including American Medical Association, the American Academy of Family Physicians and most state medical associations – made the case that "the transition to ICD-10 represents one of the largest technical, operational, and business implementations in the health care industry in the past several decades."

As they gird for the "profound impact" the code set change will have on physicians, the medical groups pointed to several areas they find lacking less than seven months from the Oct. 1, 2015, transition deadline.

Chief among them is testing. Despite CMS' triumphant announcement this past week that it is "ready for ICD-10" – touting a success rate of 81 percent claims accepted in end-to-end testing with volunteer providers, clearinghouses and billing agencies, the letter writers argue that "there still remains a lack of industry-wide, thorough end-to-end testing of ICD-10 in administrative transactions."

The data from those end-to-end tests "show only a broad overview of the number of claims received (14,929), number of claims accepted (12,149), acceptance rate (81 percent), and partial information about the reasons and percentages of rejected claims," they write. That acceptance rate "was still well below average, and we continue to be concerned about the limited scale of testing being performed."

Beyond the matter of claims processing, the physicians expressed deep concerns about the "ability to correctly collect and calculate quality data during and after the transition to ICD-10." While CMS has specified quality measures for ICD-10, "we foresee unintended consequences for measure denominators and measure rates due to potentially conflicting timelines," they argue.

For example, while ICD-10 is expected to begin in earnest on Oct.1, 2015,  the Physician Quality Reporting System and meaningful use quality reporting periods are based on the calendar year, according to the letter. As such, "many of the MU and PQRS measures capture encounters pre and post visit and will straddle the October 1 date, requiring that physicians report ICD-9 for the first segment and ICD-10 for the final portion."

So far, at least, CMS hasn't indicated "how it plans to address and correctly tabulate quality performance reporting metrics after the transition to ICD-10."

The stakeholders also cite concerns about risk mitigation – for instance pointing out that "previous HIPAA mandates – such as the National Provider Identifier, NPI, and the upgrade to Version 5010 transactions – resulted in significant claims processing disruptions that caused physicians to go unpaid for weeks and sometimes months." Those were much less complex than ICD-10, but "still resulted in significant disruptions."

Meaningful use certification is another worry: Docs who bill Medicare must use a certified electronic health record or face MU penalties – Version 2014 certified software is required to accommodate ICD-10 codes, the letter points out – but "many EHR vendors were behind in delivering upgrades to physicians in 2014 to meet the MU program. There is no data that indicates when vendors will be ready to deliver the ICD-10 upgrades and what help will be available for physicians whose vendors decided not to certify to 2014."

As physicians asked to "assume this significant change at the same time they are being required to adopt new technology, re-engineer workflow and reform the way they deliver care," the signatories wrote that they "remain gravely concerned that many aspects of this undertaking have not been fully assessed and that contingency plans may be inadequate if serious disruptions occur on or after October 1."


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Is your medical practice ready for dual coding?

Is your medical practice ready for dual coding? | EHR and Health IT Consulting | Scoop.it

Although medical practices cannot submit medical claims with ICD-10 codes until Oct. 1, there are a few good reasons to start using them sooner.

Those reasons support dual coding — when healthcare organizations assign ICD-10 and ICD-9 codes simultaneously to medical records.

The advantages include:

  • Medical coders can practice their ICD-10 knowledge
  • Clinical documentation deficiencies are exposed
  • Extensive internal and external testing can be done

This won't be cheap. Systems need to be designed for dual coding. And no matter what your vendor promises, dual coding is extra work. That means there will be a productivity loss. Maybe computer assisted coding (CAC) will help. Costs would be associated with:

  • Added time
  • Maintaining data collection
  • Analyzing data

Medical practices likely will need to assign extra coding resources. Extra medical coders can be hired to cover the dual coders. Healthcare providers need to do a cost-benefit analysis to determine if it's better to hire personnel or accept longer reimbursement cycles.

To get dual coding started, the Centers for Medicare and Medicaid Services (CMS) recommends answering the following questions:

  • Can the practice management system (PMS) or electronic health record (EHR) can capture ICD-9 codes and ICD-10 codes in the same patient encounter?
  • How much dual coding will be done?
    • How often?
    • How many encounters will be processed?
    • Are all diagnoses or just the top X percent of diagnoses are represented?
  • Will the ICD-10 codes be captured in the PMS or EHR system or on paper?

Before dual coding can start, a medical practice should:

  • Upgrade systems so they are ICD-10 compliant.
  • Make sure clinical documentation can support ICD-10 coding.
  • Start ICD-10 training and education.
  • Test with healthcare vendors or payers.

Then start practicing ICD-10 coding on real cases in the medical practice. Chances are that all this time and money will be investments that payoff after Oct. 1.

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ICD-10 Prep for Small Practices: 5 Ways to Get on Track

ICD-10 Prep for Small Practices: 5 Ways to Get on Track | EHR and Health IT Consulting | Scoop.it

Small medical practices have felt the ripple effect of the ICD-10 delay  in different ways, depending on how close to readiness they were at the time the new date was announced.

Recently, the Workgroup for Electronic Data Interchange released findings from an ICD-10 readiness survey that demonstrated a high degree of procrastination in how actively health organizations were working toward compliance with ICD-10.

If your practice is among those only partially ready or just in the initial stages of a transition plan, here are five key tips to keep moving forward toward compliance:

1. Make sure trading partners are on track. The most important step to a smooth ICD-10 transition is to look closely at trading partners. It’s important to focus first on your biggest payers. Will they be able to support your practice after the conversion deadline? Do they have a clear transition plan with milestones that are already being met? If not, your practice needs to understand why. Achieving compliance requires a cooperative effort among entities, and any trading partner showing signs it may not meet the deadline may require your practice to seek alternative partners. What would it take (in time and money) to transition to working with these new partners should the need arise?

2. Test systems for process flow. Start testing your practice’s internal systems, such as its information management, billing, and scheduling systems. Simulate a typical patient visit to the office and send data from each step to test the viability of work flows and flush out where bottlenecks occur. Remember that with each identified disruption, there is likely a correlated negative impact on revenue that should be calculated and rolled back into the plan (see Step #5: Revisiting the plan).

3. Test with trading partners. Once your practice’s internal systems pass your tests with flying colors, conduct end-to-end testing in cooperation with your external partners. An AHIMA/eHealth Initiative survey reveals that 65 percent of organizations will be able to begin testing before the 2015 deadline; 63 percent will begin those tests this year. That’s good news for some of the industry, but your practice’s entire ecosystem will succeed or fail based on how well the collective functions together. Start by sending the most common types of test claims using ICD-10 codes. You may need to shift timelines to include the use of testing environments and the additional time that may be required to adjust to processing the test claims. If your practice has a large number of trading partners, test with the biggest ones first.

4. Survey your practice management vendor. Your practice management vendor is one of the most important pieces of the process. Review the CMS checklist of questions and the recently released list of 15 ICD-10 readiness questions. Will your PM vendor’s software require any hardware upgrades? Can its solution handle both ICD-9 and ICD-10 codes? Dual coding is important to mitigate the risks of being totally down should something go deeply wrong with using ICD-10 coding. What resources are available to help with test transactions? Review the vendor contract and examine the cost/benefit of any changes that will cost time or money.

5. Revisit the budget and implementation plan. After you take the above steps, revisit the budget and re-assess existing implementation plans. The e-Health/AHIMA survey reveals 35 percent of practices believe their revenue will go down after October 2015. Expected areas of difficulty include coding, documentation, and reimbursement.

While getting ready for ICD-10 is a massive process for a practice, the challenges are not insurmountable. Sharing and collaboration of best practices among organizations is a wise use of effort, and trading partners may already have dedicated resources to test the claims process with a variety of partners simultaneously.

Most importantly, don’t lose sight of the fact that beyond compliance, there is an industry upside to using ICD-10. The new codes are superior and in the end, it’s all about increasing the quality of care.


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CMS extends deadline for April ICD-10 end-to-end testing

CMS extends deadline for April ICD-10 end-to-end testing | EHR and Health IT Consulting | Scoop.it

The Centers for Medicare & Medicaid Services (CMS) is extending the deadline for healthcare providers to apply to partake in ICD-10 end-to-end testing in April, according to the latest edition of Medicare Learning Network (MLN) Connects.

Previously the federal agency had set a deadline date of January 9. Now providers have until January 21 to submit application to be one of approximately 850 volunteers taking part in the weeklong ICD-10 end-to-end testing event between April 26 and May 1.

The first week of ICD-10 end-to-end testing Medicare Administrative Contractors (MACs) and the Common Electronic Data Interchange (CEDI) contractor is schedule for the last week of January. Participants in this week of testing are automatically enrolled to test again in April and July.

According to CMS, the goal of ICD-10 end-to-end testing is threefold:

  • Providers and submitters are able to successfully submit claims containing ICD-10 codes to the Medicare Fee-For Service (FFS) claims systems
  • CMS software changes made to support ICD-10 result in appropriately adjudicated claims
  • Accurate remittance advices are produced

The agency’s ICD-10 end-to-end testing activities follows its earlier work on acknowledgement testing — the ability to submit claims with ICD-10 codes to the Medicare Fee-For-Service (FFS) claims systems and receive confirmation of acceptance or rejection.

Last month, CMS released results from its acknowledgement testing in November that included more than 500 providers, suppliers, billing companies, and clearinghouses and close to 13,700 claims.

“Acceptance rates improved throughout the week with Friday’s acceptance rate for test claims at 87 percent,” the federal agency stated in late December. “Nationally, CMS accepted 76 percent of total test claims. Testing did not identify any issues with the Medicare FFS claims systems.”

According to CMS, acknowledgement testing also included the submission of intentionally erroneous claims as part of negative testing. “Additionally, claims using ICD-10 must have an ICD-10 companion qualifier code. Claims that did not meet these requirements were rejected,” the federal agency added.

Through a series of frequently asked questions (FAQs), CMS has provided several details about ICD-10 end-to-end testing:

How is ICD-10 end-to-end testing different from acknowledgement testing?

The goal of acknowledgement testing is for testers to submit claims with ICD-10 codes to the Medicare Fee-For-Service claims systems and receive acknowledgements to confirm that their claims were accepted or rejected.

End-to-end testing takes that a step further, processing claims through all Medicare system edits to produce and return an accurate Electronic Remittance Advice (ERA). While acknowledgement testing is open to all electronic submitters, end-to-end testing is limited to a smaller sample of submitters who volunteer and are selected for testing.

The federal agency gave no indication that the extension is the result of a limited number of provider applications.


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Andre Mouton's curator insight, January 9, 2015 2:37 PM

Look outside of the US to get this fixed. Not that complicated

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No ICD-10 Delay Included in Latest Congressional Spending Bill | EHRintelligence.com

No ICD-10 Delay Included in Latest Congressional Spending Bill | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
Lawmakers have not included an ICD-10 delay in the 2015 Congressional spending omnibus.

Rumors of another ICD-10 delay appear to be greatly exaggerated – this time, at least.  Despite calls from the Medical Society of New York to include an additional two-year delay of ICD-10 in the $1 trillion omnibus spending bill that funds most Congressional activities through the majority of 2015, the legislation did not include an additional push-back of the health information management schema before lawmakers agreed on the final form of the bill.

While the legislation is certainly not the only opportunity for Congress to scupper the new code set, it does give providers some confidence going into the holidays that ICD-10 will continue as planned on October 1, 2015.  Uncertainty about the actual implementation date has left many healthcare organizations wondering about the point of spending time, effort, and money on upgrade systems and processes to be compliant with ICD-10 requirements.  Advocates of postponing ICD-10, or scrapping it all together, have tried to feed on these worries to build momentum for their cause.

“The onerous penalties tied to these mandates add to the hysteria that is running through physicians’ offices and is generating many early retirements,” states the Medical Society of New York in a letter addressed to Rep. John Boehner in November. “If every entity in the complex medical payment pyramid does not function perfectly on October 1, 2015 then physicians’ income goes to zero which is a steep price to pay for a new imperfect coding system.”

The American Medical Association, another staunch advocate of abandoning the ICD-10 mandate, has also raised arguments about the cost of implementation and the burden on physicians to comply with the new codes in addition to several other major healthcare reform initiatives.  Boasting that the AMA has held off ICD-10 for more than ten years, Dr. Robert Wah recently made a speech decrying ICD-10’s less common codes and urging providers to join his organization in opposition to the code set.

However, after the most recent delay from 2014 to 2015 shocked ICD-10 proponents and threw the industry into turmoil, many organizations just want to get it over with.  In another letter to Rep. Boehner, this time from a coalition of hospital and health systems, ICD-10 advocates note that repeated delays have been highly disruptive, costly, and frustrating for the healthcare community.

“The delay added billions of dollars in extra costs,” state the American Hospital Association, Premier Healthcare Alliance, and a number of health systems.  “Many of our members had to quickly reconfigure systems and processes that were prepared to use ICD-10 back to ICD-9.  A further delay would only add additional costs as existing investments would be further wasted and future costs would grow.

Wrangling over the true financial impact of implementation has added to the confusion among healthcare providers, who have been chronically lagging behind recommended timelines and guidelines for testing, education, and upgrades.  “The lack of progress by providers, in particular smaller ones, remains a cause for concern as we move toward the compliance deadline,” said Jim Daley, WEDI chairman and ICD-10 Workgroup co-chair in a September letter to HHS Secretary Sylvia Burwell. “Delaying compliance efforts reduces the time available for adequate testing, increasing the chances of unanticipated impacts to production. We urge the industry to accelerate implementation efforts in order to avoid disruption on Oct. 1, 2015.”

Lawmakers have until Thursday to vote through the omnibus spending bill if they are to avoid another paralyzing governmental shutdown.  While the most recent ICD-10 delay was slipped into the SGR reform bill without much notice, it does not appear that the divisive code set will make a cameo in this latest bipartisan agreement.



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