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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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Clinical Documentation Improvement Vital for Patient Care

Clinical Documentation Improvement Vital for Patient Care | EHR and Health IT Consulting | Scoop.it

Clinical documentation improvement programs lie at the heart of quality patient care and should accurately show a patient’s clinical status as well as inform which services were provided. According to the American Health Information Management Association (AHIMA), clinical documentation improvement programs transfer patient’s medical information into coded data, which is then part ofquality reporting, claims reimbursement, public health information, and disease tracking.


Health information management (HIM) professionals work as both coding experts as well as clinical documentation improvement strategists within their organizations to ensure meaningful information is captured.


In particular, clinical documentation improvement experts remain dedicated to ICD-10 implementation and the adoption of strong EHR systems across the healthcare continuum. HIM professionals work to assist physicians in remaining compliant with all patient documentation requirements.


Some policies that need to be followed when implementing clinical documentation improvement programs are hiring staff with the right education, experience, and credentials as well as ensuring ongoing education and training for such staff, according to AHIMA. The major roles that healthcare providers have in ensuring their clinical documentation is solid are reporting medical decision making, diagnostics, treatment plan, and outcomes of tests, treatments, and other procedures.


One partnership that is targeting clinical documentation improvement is Nuance Communications, Inc. and medical care predictive analytics company Jvion, according to a joint press release. The two companies are looking to better assist healthcare providers in meeting the requirements of a value-based reimbursement model.


Many medical facilities will likely experience various challenges when transitioning from a fee-for-service payment model to value-based care. Advanced Practice CDI from Nuance Communications should assist providers in this transition.


“We want to get paid for the quality of care and services we provide,” says Joann Hatton, director of Utilization Management and Clinical Documentation Management at Heritage Valley Health System, in western Pennsylvania. “It’s not about the money, it’s about improving patient care, but the positive financial impact of Nuance’s CDI program was clearly evident.”


When it comes to implementing clinical documentation improvement strategies and clinical quality metrics, Heritage Valley Health System saw a significant drop in their predicted mortality rate. This particular rate decreased by 27 percent after integrating clinical documentation improvement programs.


“Data drives our practice,” explains Jennifer Woodworth, director of Clinical Documentation Integrity Program at Swedish Health Services. “Physician and hospital compensation is tied to quality metrics, which means to prove that you are providing high quality care you need data. This real-time reporting allows us to drill down to ICD-9 and ICD-10 codes, complications and other specialized details to see how we are doing with the accuracy of physician documentation, and this enables us to create proactive initiatives that maximize our current resources.”


As more health IT tools are developed to assist providers with clinical documentation improvement programs, the healthcare industry will be ready to effectively transition to a value-based care payment model.

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Survey Shows Many Unprepared for ICD-10 Implementation

Survey Shows Many Unprepared for ICD-10 Implementation | EHR and Health IT Consulting | Scoop.it

Is your physician practice ready for ICD-10 implementation? The latest survey commissioned by Navicure and conducted by Porter Research found that ICD-10 preparedness varies tremendously among US healthcare providers. The survey takers included practice administrators, billing managers, practice executives, coders, and billers.

With the prior delays of the ICD-10 implementation date, it would stand to reason that there may be another postponement. However, 67 percent of respondents trust that the ICD-10 transition will take place on its newly scheduled date of October 1, 2015.

A major challenge of the ICD-10 transition that 41 percent of respondents cited is lack of payer readiness. One of the issues associated with the prior ICD-10 delays is that many providers paused the preparations for the transition until the date was closer. Only 23 percent continued with their efforts after the delay took place.

Some of the top concerns survey respondents commented on include the impact on staff productivity, lack of staff training, and the possibility of the ICD-10 transition deadline being pushed back yet again. However, only 5 percent feel that their technology won’t be ready in time for the implementation.

When it comes to being prepared for ICD-10 integration, only 21 percent of survey takers claimed they were “on track for implementation.” A total of 15 percent have not started preparing for the implementation at all while 11 percent developed a plan.

Those who have not started preparing for the ICD-10 transition cite five major reasons:

(1) Waiting on EHR vendor to provide ICD-10 software updates

(2) Waiting to implement a few months before the October 1 deadline

(3) Lack of staff, time, and training resources

(4) Belief that the ICD-10 transition date will be further delayed

(5) Lack of knowledge on where to begin

Despite some of these issues, out of all polled, 81 percent are at least somewhat confident that they will be ready to implement ICD-10 coding by the October 1, 2015 deadline. While these numbers are high, they have actually dropped from the 87 percent vote of confidence from a survey taken in the fall of 2013. Clearly, with only 21 percent of respondents feeling they are on track, providers may not be completely prepared for the ICD-10 transition as of yet.

“Since 2013, Navicure has been conducting ICD-10 readiness surveys, which have allowed us to gain broad perspective on how we can best help healthcare organizations prepare for the transition,” Jim Denny, founder and CEO of Navicure, said in a public statement.

The majority of respondents expect staff productivity loss of one to 40 percent. Providers may need assistance with improving productivity and efficiency when the ICD-10 integration takes place. Additionally, 49 percent of survey takers are either planning to conduct end-to-end testing or are already in the midst of this process. Unfortunately, this is a decline of 7 percent when compared to the fall 2013 survey.

The report goes on to explain the importance of beginning ICD-10 preparations such as staff training and clinical documentation practices even if waiting on new software updates. End-to-end testing is also vital to incorporate in order to address any risks with payer collaboration before the October 1 deadline.

Additionally, providers should prepare for a dip in staff productivity for the first three to six months after ICD-10 integration. It is important to develop a plan to manage these potential issues. Transitioning to ICD-10 will not be an easy road, but with thoughtful strategies in mind, it will be more manageable over the long-term.


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Why can't we use ICD-9 and ICD-10 codes after Oct. 1?

Why can't we use ICD-9 and ICD-10 codes after Oct. 1? | EHR and Health IT Consulting | Scoop.it

When the U.S. House Energy & Commerce Subcommittee on Health held its hearing "Examining ICD-10 Implementation" last month, dual coding came up.

No not the kind of dual coding that allows healthcare providers to practice ICD-10 codes until Oct. 1. But politicians kept asking why ICD-9 codes and ICD-10 codes couldn't be used at the same time.

And none of the witnesses could answer the question. You could hear the screaming across town coming from the Department of Health and Human Services (DHHS) building.

I could understand the reluctance of everyone who did not want to speak for the Centers for Medicare and Medicaid Services (CMS). But for Pete's sake, they're already there to sing the praises of ICD-10 coding. Why couldn't someone try to explain that the differences between assigning ICD-9 codes and ICD-10 codes is not the same as choosing between a Blackberry or iPhone?

CMS tried to explain it in a revised guidance statement last week:

"No, CMS will not allow for dual processing of ICD-9 and ICD-10 codes after ICD-10 implementation on October 1, 2015. Many providers and payers, including Medicare have
already coded their systems to only allow ICD-10 codes beginning October 1, 2015. The scope of systems changes and testing needed to allow for dual processing would require significant resources and could not be accomplished by the October 1, 2015, implementation date. "

Except the committee noticed that depending on dates of services, ICD-9 codes will need to be used after Oct. 1. That kind of makes me wonder too. Makes me wonder if healthcare payers are going to be able to handle a few days of ICD-9 codes.

But we get a little closer to the problem here:

"Should CMS allow for dual processing, it would force all entities with which we share data, including our trading partners, to also allow for dual processing. In addition, having a mix of ICD-9 and ICD-10 codes in the same year would have major ramifications for CMS quality, demonstration, and risk adjustment programs."

There's the rub. Things will be crazy enough not being able to compare ICD-9 years to ICD-10 years. But mixing both code sets in the same year will make data analysis about useless.

And if healthcare providers figure out that reimbursement rates are different for an ICD-9 code compared to an ICD-10 code, they're going to choose the higher paying code for medical claims.

Would it be possible for healthcare payers to deny an ICD-10 claim if they can offer lower rates for ICD-9 claims?

No, CMS wants to rip off the bandage quickly Sept. 30. It's may sting Oct. 1. But it's going to hurt worse if they try to pull it off a tiny bit at a time.


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