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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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Survey: Texas Docs not Ready for ICD-10

Survey: Texas Docs not Ready for ICD-10 | EHR and Health IT Consulting | Scoop.it

Just 10 percent of Texas physicians are confident that their practice is prepared to transition to ICD-10 on Oct. 1, according to a new survey from the Texas Medical Association (TMA).


In July of 2015, Texas physicians were surveyed regarding their practice’s readiness to transition to ICD-10. Approximately 37,000 Texas Medical Association members and non-members with email addresses in the TMA database were emailed a link to the survey. The results are based on 936 responses. According to TMA, 97 percent of respondents currently treat patients in active medical practice. Among physicians who quit treating patients in active medical practice, 48 percent quit due to regulatory and/or administrative burdens and 22 percent quit due to ICD-10.


Nearly two-thirds (65 percent) of all physicians responding have little or no confidence that their practice is prepared to transition to ICD-10 by the deadline, even though the new coding system is supposed to enable doctors’ offices to collect and report more detailed patient data. “It’s horrible,” TMA President Tom Garcia, M.D., said in a statement. “The United States is the only country that couples the ICD coding with payment. The implications are that the doctor/patient relationship is going to be stressed.”


The survey found that few physicians have begun transitioning to ICD-10 extensively (7 percent). Physicians employed in hospitals are least likely to feel their practice has begun to transition to ICD- 10 extensively (3 percent). Even among physicians who feel very confident their practice is prepared to transition to ICD-10, only 42 percent report their practice has begun transitioning extensively.

Regarding training, 53 percent of physicians report the staff, and 46 percent report the physicians in their practice have taken ICD-10 preparation courses or training. Physicians in partnerships (34 percent) and the staff of solo practices (39 percent) are least likely to have taken preparation courses or training in ICD-10.


What’s more, older physicians are more likely to close or sell a practice and/or retire early in response to delayed or denied claims payments as a result of ICD-10. Physicians in the youngest age group (40 years and younger) are more likely to terminate or renegotiate plan contracts (34 percent).


Regarding electronic health record (EHR) status, 74 percent of physician respondents said that their practice currently uses an EHR. Among EHR users: 65 percent report their EHR is currently capable of handling ICD-10 codes; 29 percent of physicians whose EHR is not currently capable of handling ICD-10 codes are expecting an update; 15 percent of physicians report their will be a median cost of $10,000 associated with this update; and 1 percent of physicians report their software will need to be replaced.


The survey found that physicians fear the massive switch to the new coding system will disrupt patient care, and delay payment. In fact 83 percent of the doctors anticipate delayed or denied claims because of the transition, regardless of specialty. More than one-third of the physicians expect disruption so bad they will have to draw from personal funds to keep their practice open (36 percent) and almost one-third (30 percent) might retire early over anticipated cash-flow problems. (Almost half of the doctors age 61 or older might retire early.) Nearly a third (32 percent) might cut employees or reduce employee work hours or benefits.


Responding to the industry’s pleading, Medicare has said it will not deny doctors’ claims for one year whose ICD-10 codes are not specific enough, as long as the doctor submits an ICD-10 code from the correct family of codes. And if the doctor submits claims in the correct code family but are not specific enough, Medicare also will not audit those. Dr. Garcia said, “I asked for two years’ grace period but they only gave us a one year grace. I think it is going to take at least three years before this thing is finally settled down.” 

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Solving Medical Practice Problems Post-Tech Adoption

Solving Medical Practice Problems Post-Tech Adoption | EHR and Health IT Consulting | Scoop.it

Your practice could have all the latest and greatest technologies at its disposal, but that doesn't necessarily mean it's going to be the fastest, most efficient, or highest-quality care provider. The opposite could be true, in fact, if technology is not well incorporated into your practice after it is implemented.


Unfortunately, many practices are struggling with post-implementation challenges, according to our 2015 Technology Survey Sponsored by Kareo, the findings are based on responses from more than 1,100 readers. While most of the respondents said they are using an EHR for instance, they also said their productivity is suffering as a result; and while more than half said they have implemented a patient portal, they also said they are struggling to get patients to use it.


But it's not just using technology post-implementation that is raising problems for practices; it's also protecting information that is stored on those devices after implementing them. While many respondents said they are using mobile devices in their everyday work, for instance, few said their practice has established mobile device security rules.

Here's a look at these post-implementation technology challenges and others reflected in our survey findings, and advice from experts regarding how your practice can adapt.


CHALLENGE #1: POST-EHR PRODUCTIVITY DROP


Each year for the past four years, we asked survey respondents to identify their "most pressing information technology problem." In 2012, 2013, and 2014, the most common response among survey takers was "EHR adoption and implementation." This year, for the first time, "a drop in productivity due to our EHR," and a "lack of interoperability between EHRs," received the highest percentages of responses.


Let's address the productivity challenge first. Medical practice consultant Rosemarie Nelson says practices that are struggling to get back up-to-speed after implementing an EHR should first assess whether "reverse delegation" between the provider and nursing support staff is to blame. "What happens is once we have this EHR in place and people see that they can task or message somebody else in the practice, they suddenly start to maybe put the burden in a place it shouldn't be," says Nelson. "In the paper days ... the nurses would manage all the incoming correspondence for the physician; they would manage the phones, they would manage the fax machine; basically they were managing [the physician's] paper inbox. Now, with the EHR, suddenly everything just goes to the physician's inbox." To get delegation moving back in the proper direction, Nelson recommends practices modify how nurses screen materials coming into the EHR so that physicians only receive information that requires a physician's review. One option, Nelson says, might be to allow a nurse "surrogate" to manage the physician's inbox so that the materials are prescreened appropriately.  


Jeffery Daigrepont, senior vice president of the Coker Group, a healthcare consulting firm, has similar guidance regarding EHR documentation."When we work with clients, if we see or observe a physician doing the vast majority of data entry, then usually that is a sign that the system was implemented incorrectly," he says. "You really want to design your work flow and processes in a way that minimizes the doctors' time to do the data entry part."


He says practices should consider modifying their EHR to better meet physicians' work flow needs and to create a more standardized work flow for common patient complaints. "... One thing that computers are really good at doing is remembering things," says Daigrepont. "So if you know that for every time you have a patient with this particular visit or diagnosis you are going to follow these five or six steps or action items and it's pretty consistent patient after patient after patient, a lot of times [improving productivity] comes down to spending a little bit of extra time to design your [EHR] around your work flow and around the physician's behavior."


Practices should also consider "add-on" tools, such as voice recognition software and shortcut and abbreviation tools, that may help physicians navigate the system more quickly, says Nelson. To identify time-saving tools, she recommends consulting your vendor and engaging with EHR user groups.


CHALLENGE #2: EHR INTEROPERABILITY ISSUES


As noted, another common post-EHR implementation challenge identified by survey respondents was "lack of interoperability between EHRs." For practices struggling in this area, particularly those struggling to meet the transition-of-care requirements in meaningful use due to difficulty exchanging information with other healthcare systems, Nelson advises stepping up communication with those other healthcare systems. Work with them to find a solution, or pool resources to find one.


"Some of that is just pushing your partners," says Nelson. "If it's a hospital [make sure] they get discharge summaries pushed to you; if it's a key referral, then every certified EHR has to have the ability to share what's called a CCD [Continuity of Care Document] or a CCR [Continuity of Care Record]," says Nelson. "That [CCD or CCR] has key elements in it, which is really all we need. We need to have the patient's problem list, we need to have their medication list, we need to have their allergy list, labs would be great ... Some practices may not realize that they could get this [CCR or CCD] from another practice, and/or they may not realize that they are getting it, so they treat it like a fax instead of learning how to import it into their system so they don't have to re-enter data."


Also, consider participating in the Direct Project initiative, which helps support simple electronic exchanges between practices and their healthcare partners, says Nelson. 


CHALLENGE #3: A LACK OF PATIENT PORTAL ENGAGEMENT


It's not just EHRs that are raising problems for practices post-implementation. While 54 percent of our 2015 Technology Survey Sponsored by Kareo respondents said their practice has a patient portal (up from just 20 percent in 2011), many respondents indicated they are struggling to make the most of their portal's capabilities. Sixty-three percent, in fact, said that "getting patients to sign up/use the portal" was their biggest patient portal-related challenge.


For practices struggling in this area, Nelson recommends using "teachable moments" to promote the portal; for example, when physicians and staff are about to share information with patients, or when they plan to share information with patients. A nurse who is following up with a patient after the physician visit might say, "If you go to our website and register for the portal, you'll be informed when your lab results are ready and you'll be able to view them online."


To increase the likelihood patients will follow through with signing up for the portal, send a text message or e-mail with information on how to sign-up for the portal shortly after the patient visit, says Daigrepont. "If you just say, 'Hey go to the portal,' as the patient is leaving, by the time they get in their car they've already forgotten that information."

Also, make sure that the portal offers key features that patients value, such as the ability to:


• Request appointments;

• Get prescriptions renewed;

• Review test results; and

• Look at visit summaries from previous visits.


"We have to offer more on the portal to make it worthwhile for [patients] to come back," says Nelson. "It's just like any website that a physician or nurse would go to, if there isn't anything of value after the second time they go, they're not going to want to go a third time."

Finally, when promoting the portal to patients, reassure them that the portal is secure, says Daigrepont. "I think a lot of times people are reluctant, especially when it comes to their healthcare information to [sign up] if they are not very much reassured that their privacy will be protected."


CHALLENGE #4: MOBILE DEVICE SECURITY


EHRs and patient portals are not the only technologies practices and physicians are implementing. More are also using mobile devices, such as smartphones and laptops, to store and share protected health information (PHI) and to communicate with patients. Sixty-seven percent of our survey respondents said they use mobile communication devices in the performance of their job.


While mobile devices streamline communication, they also raise potential security problems. In fact, the majority of HIPAA breaches occur due to lost or stolen mobile devices. Yet many practices are failing to take the proper precautions to secure the data stored on mobile devices, particularly when it comes to the use of personal mobile devices for work purposes. Only 32 percent of our survey respondents said they have implemented rules regarding this use of technology.


If your physicians and staff are using mobile devices for professional use, Nelson recommends:


• Requiring all devices to be password protected (and requiring those passwords to be changed every few months);

• Prohibiting staff from downloading PHI to mobile devices;

• Working with vendors to put safeguards in place that prevent staff from downloading PHI to their devices (staff and physicians may be able to view information remotely, but not download it); and

• Encrypting PHI so that the information stored on mobile devices is protected.


Practices should also inform physicians and staff that, in the event of a potential HIPAA breach, the practice may need to access the device, disable it, remotely wipe it, and so on, says Daigrepont. "I think as business owners you just have to be upfront with your employees," he says. "Say, 'We're happy to give you the convenience of using your personal device, but there's a little bit of a trade-off and here's what you need to know.'"


To ensure all staff and physicians are on board with your mobile device security rules, consider requiring them to sign a mobile device security agreement. 


CHALLENGE #5: OVERALL TECH SECURITY


The increasing use of mobile devices for work-related purposes is not the only new technology that is raising security problems for practices. When acquiring a new piece of technology, whether it is an EHR, patient portal, or mobile device, the practice needs to assess how the use of that technology might raise security risks, and act accordingly to address and reduce those risks.


One of the best ways to do this is by conducting a security risk analysis, during which practices analyze the potential risks and vulnerabilities to the confidentiality, integrity, and availability of their electronic PHI.


Despite the fact that conducting a risk analysis is required under both HIPAA and meaningful use, only 36 percent of our survey respondents said they have conducted one.


That's a troubling statistic, says Michelle Caswell, senior director, legal and compliance, at healthcare risk-management consulting firm Clearwater Compliance, LLC. "We really try to get organizations to not think of the risk analysis as this sort of draconian regulation that [HHS'] Office of Civil Rights (OCR) is putting down on them," says Caswell, who formerly worked at the OCR. "We always say that if you do not conduct a risk analysis, you do not know what risks there are to your organization."


IN SUMMARY


Practices have rapidly implemented new technologies over the past few years, but that is only half the battle when it comes to using that technology effectively. Here are some of the common post-implementation challenges practices face:


• Productivity losses

• Interoperability problems

• Lack of patient engagement with new technologies

• Communication work flow problems

• New security risks

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Gerard Dab's curator insight, July 17, 2015 1:19 AM

Technology adoption without followup = failure

#medicoolhc #medicoollifeprotector 

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ICD-10: CMS won't deny claims for first year

ICD-10: CMS won't deny claims for first year | EHR and Health IT Consulting | Scoop.it

In a surprise concession, the Centers for Medicare & Medicaid Services announced Monday that it would work with the American Medical Association on four steps designed to ease the transition to ICD-10.


Despite longtime disagreements on the topic, CMS will now adopt suggestions made by none other than the AMA with regard to the code set conversion. Those changes concern:


1. Claims denials. "While diagnosis coding to the correct level of specificity is the goal for all claims, 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 record 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," CMS officials wrote in a guidance document.


2. Quality reporting and other penalties. "For all quality reporting completed for program year 2015 Medicare clinical quality data review contractors will not subject physicians or other Eligible Professionals (EP) to the Physician Quality Reporting System (PQRS), Value Based Modifier (VBM), or Meaningful Use 2 (MU) penalty during primary source verification or auditing related to the additional specificity of the ICD-10 diagnosis code, as long as the physician/EP used a code from the correct family of codes," CMS explained. "Furthermore, an EP will not be subjected to a penalty if CMS experiences difficulty calculating the quality scores for PQRS, VBM, or MU due to the transition to ICD-10 codes."


3. Payment disruptions. “If Medicare contractors are unable to process claims as a result of problems with ICD-10, CMS will authorize advance payments to physicians,” AMA president Steven Stack, MD, noted in a viewpoint piece on the group’s website.


4. Navigating transition problems. CMS intends to create a communication center of sorts, including an ICD-10 Ombudsman, "to help receive and triage physician and provider issues." The center will also "identify and initiate"resolution of issues caused by the new code sets, officials added. 


"These provisions are a culmination of vigorous efforts to convince the agency of the need for a transition period to avoid financial disruptions during this time of tremendous change," wrote Stack.


While AMA played a pivotal role in bringing about these CMS concessions, it was not the only party calling for a smoother conversion to the new code set.


Some members of the U.S. Congress have publicly suggested a dual-coding conversion period wherein CMS would accept and process claims in both ICD-9 and ICD-10. Instead of dual coding, CMS indicated that "a valid ICD-10 code will be required on all claims starting Oct. 1, 2015."


So as things stand today, providers have to use ICD-10 come October – but CMS will be more flexible about denials and payments than it has previously suggested it would be.

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Staff Training Crucial in ICD-10 Conversion Preparations

Staff Training Crucial in ICD-10 Conversion Preparations | EHR and Health IT Consulting | Scoop.it

Healthcare providers who are behind in their ICD-10 conversion preparations may benefit from following the ICD-10 Quick Start Guide provided by the Centers for Medicare & Medicaid Services (CMS).


The five steps that providers will need to take when it comes to their ICD-10 conversion preparations are the following: (1) developing a plan, (2) training the healthcare staff, (3) updating system processes, (4) working with vendors and health insurers, and (5) testing workflow processes and systems.


When it comes to training the clinical staff (including nurses, doctors, and medical assistants) and moving forward with ICD-10 conversion preparations, it’s vital to focus on new clinical concepts and documentation obtained through ICD-10 codes. When training coding and administrative staff including coders, billers, and practice management employees, the focus should be on ICD-10 fundamentals.


CMS provides a variety of resources including webinars, national provider calls and presentations, the Road to 10 website, and email updates. Physician groups, healthcare organizations, hospitals, payers, and vendors also offer a variety of resources for medical providers who are still behind with some common ICD-10 conversion preparations.


The very first step to take is to identify the top 25 most common ICD-9 codes used in one’s medical facility. Common diagnosis codes are also available on the Road to 10 website and other resources.


Teach your healthcare and coding staff how to code the most common cases using the ICD-10 coding set. Using reports via one’s practice management software and billing documents, providers can better identify the most commonly used ICD-9 codes.


Once the top 25 codes are gathered and there is still time before the ICD-10 implementationdeadline, providers are encouraged to expand ICD-10 coding of typical cases past an additional 50 or more codes. This would ensure the majority of a provider’s cases are managed effectively under ICD-10.


Even though the ICD-10 coding set has expanded to more than 68,000 codes, providers will only need to use a small section of the set. Along with training staff, updating system processes is vital for one’s ICD-10 conversion preparations. All hardcopy and electronic forms need to be updated while information gaps should be resolved before the October 1 deadline.


Clinical documentation will need to include laterality, the number of encounters (initial or subsequent), kinds of fractures, and other information about related complications. It is useful to put together a documentation checklist detailing new concepts that should be captured with ICD-10 codes. Once systems are in place, ICD-10 end-to-end testing is crucial to ensure a healthcare facility is prepared for the October 1 deadline.


“With four months remaining to correct issues discovered during testing, the high rate of successful submission of ICD-10 codes is especially encouraging for physician offices since half the claims submitted for end-to-testing were professional claims,” the Coalition for ICD-10 commented on CMS’ latest ICD-10 end-to-end testing results. “These results indicate that significant progress has been made since the January end-to-end testing with the overall rejection rate dropping from 19 to 12 percent and ICD-10 rejections dropping from 3 to 2 percent.”

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Direct Reimbursement Solutions's curator insight, July 1, 2015 3:10 PM

Excellent advice for ICD-10 preparedness.

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Bracing for ICD-10 Implementation Deadline amid ICD-9 Shortfalls

Bracing for ICD-10 Implementation Deadline amid ICD-9 Shortfalls | EHR and Health IT Consulting | Scoop.it

With the ICD-10 implementation deadline only three and a half months away, it is beneficial for healthcare providers to continue their last-minute preparations for the coming ICD-10 transition. The Centers for Medicare & Medicaid Services (CMS) includes a variety of tools and resources for providers to utilize when getting ready for the ICD-10 implementation deadline.


From the Road to 10 website to videos and expert columns, CMS is working toward preparing healthcare providers for the coming ICD-10 implementation deadline on October 1, 2015. In a video called “ICD-10: Getting from Here to There – Navigating the Road Ahead,” Dr. Ricardo Martinez, Fellow of the American College of American Physicians, discussed how the International Classification of Diseases (ICD) version 10 is a significant improvement over the more outdated ICD-9 codes being utilized across healthcare facilities today.


The video also went over key steps that small medical practices should incorporate when preparing for the ICD-10 implementation deadline. In particular, providers will need to understand how the new codes will differ from the older ICD-9 codes.


“As a practicing physician, I see the limitations of ICD-9 every day and why input from the medical community into the development of ICD-10 has been so valuable,” Martinez explained. “ICD-9 is outdated – even antiquated by today’s practice standards – and it limits the speed and accuracy with which I can gather information, gain insights, and, more importantly, care for my patients.”


“Today, ICD-9 doesn’t even address laterality, which signifies if a condition affects the left or the right limb,” continued Martinez. “On a professional note, when recently faced with a complex patient who had an acute stroke in history of a previous stroke, we had to search through many old records to determine whether that old stroke was left or right side, wasting valuable time that could have been dedicated to patient treatment. With a single code, ICD-10 will provide us with more detail. Better data makes better care possible.”


“To help small provider practices and other healthcare professionals with the transition to ICD-10, the Centers for Medicare & Medicaid Services is actively working with physicians, industry leaders, and others,” Martinez mentioned. “Healthcare has been using the international classification of diseases for over a century to identify and track diseases and help us improve our care for our patients.”


“Although most of the world transitioned to ICD-10 years ago, the currently used version of ICD-9 is fundamentally unchanged since its implementation in the United States in 1979,” Martinez stated. “One major limitation of ICD-9 is that it predates many modern technological advances and clinical terminology reflecting the use of CT scans, for example, which were also invented in 1979. Therefore, an update was necessary to account for these innovations in medicine.”


“For years, practitioners noted the need for increased specificity within clinical terminology, documentation, and coding to accurately represent the care provided to their patients,” Martinez clarified. “Under sponsorship of the World Health Organization (WHO), a group of physicians developed the basic structure for ICD-10. Then, each specialty provided input on the subset of procedure or diagnosis code needed. Addressing both the changes in medicine and the need for increased specificity, ICD-10 will capture greater detail in the clinical encounter for each patient.”

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Three ICD-10 Work Flow Changes to Consider

Three ICD-10 Work Flow Changes to Consider | EHR and Health IT Consulting | Scoop.it

The first few months on the ICD-10 coding system are expected to cost both money and time. We all know how to prepare for the possible financial hit — be in as good financial shape as possible going in and have some money saved to cover any shortfalls. That might be a challenge, but at least you know what you need to do.

But you can't just put extra time in a savings account to tide you over when things get messy in October. Or can you? Actually, with a little creative scheduling and work flow management, you might be able to do just that.


Here are a few ideas to help you get started.


• During the first few months of ICD-10, your coders and the people in the business office are going to have all that they can handle getting used to the new coding system and dealing with the inevitable snafus. So, as best you can, arrange for them to have as little as possible to deal with that doesn't involve making the ICD-10 transition run smoothly. "Verify insurance and benefits eligibility at the scheduling call when at all possible, and also let the front office work the exceptions," recommended Elizabeth Woodcock, president of Woodcock and Associates practice management consulting firm. "If you aren't already doing this in the front office, this is a good time to start. Let the business office focus on billing and getting paid."


• Woodcock also recommended that you consider staffing up in preparation for the transition to ICD-10. "You may be able to delay a retirement or ask a previous employee to do some contract work for the few months surrounding ICD-10. And be prepared for some overtime," she said. Christine Lee, manager of provider practice services with Care Communications, a health information management consulting firm, suggested trying to shift to other employees anything billing staff normally does that doesn't relate directly to ICD-10. "In smaller organizations, people wear a lot of hats, so it might be feasible to switch responsibilities around a little bit. You might even consider hiring temporary outside help," she said. "It might mean spending more money, but the revenue saved by getting claims out faster and with fewer errors might make up for that."


• You might also be able to increase your coding efficiency (and success rate) by having what Lee calls "a designated clean up crew" to deal with lingering ICD-9 claims —depending on your turnaround time, this could take a couple of months. Not only would this be a more efficient way to structure the work flow, it could reduce errors as well. Lee recommended that even if you don't go as far as to have a team just for ICD-9 claims, you organize things so that coders don't have to switch codes sets more than once a day.


The transition to the ICD-10 coding system is "kind of like Y2K," joked Woodcock. And if you do a good job organizing your work flow before ICD-10 becomes a reality, it might be just as anticlimactic.

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Superbill and Forms Revision for ICD-10

Superbill and Forms Revision for ICD-10 | EHR and Health IT Consulting | Scoop.it

The ICD-10 implementation date is just four short months away. Physicians must ensure that their forms, including their superbills, are ready for the conversion on Oct. 1, 2015.

Superbill Revision


Many physician practices use a superbill to account for the services rendered (CPT codes) and patients' diagnoses (ICD-9 and ICD-10 codes). These forms must be updated on a regular basis to reflect any code changes. The conversion to ICD-10 will require a major overhaul of the superbill. Each ICD-9 code that is listed on the existing superbill will need to be converted to the related ICD-10 code. There is not always a 1:1 match when translating an ICD-9 code to an ICD-10 code. In fact, due to the greater specificity in most areas of ICD-10, there could be several ICD-10 codes that map back to just one ICD-9 code.


CMS' website provides a list of the mappings of ICD-9 to ICD-10 codes called the General Equivalence Mappings (GEMs); view it here: bit.ly/CMS-GEMs. This tool is helpful as a first step for practices to compare the commonly used ICD-9 codes to the related ICD-10 codes. However, the user must keep in mind that these GEMs are not a crosswalk. The full list of ICD-10 codes, including coding guidelines and conventions, must be reviewed to determine the appropriate code assignment.


Since the list of ICD-10 diagnosis codes a practice utilizes could be quite extensive, the use of a superbill for diagnosis coding might need to be reevaluated. There are other solutions, such as the use of EHR, which would better assist physicians in selecting appropriate codes.

It's also important to remember that the physician documentation within the record (outside of the superbill), must justify the services provided and fully describe the patient's diagnoses. The superbill does not stand on its own for coding and billing purposes.


Other Forms Revision


Besides the superbill, there may be other forms that will need to be revised in anticipation of ICD-10. Physician practices should take an inventory of all forms currently used, whether paper or electronic, and review them for ICD-9 codes. Any forms that currently include ICD-9 codes will need to be refreshed with ICD-10 codes.


Some areas that may currently include ICD-9 codes are patient scheduling and registration, documentation templates within the EHR, coding and billing forms, and external reporting/databases. Once these impacted areas are identified, it's essential to communicate any required changes to the forms with the affected parties to ensure readiness for the ICD-10 conversion.


EHR Readiness


Most physicians use some type of EHR within their practice. It is essential that the EHR is ready for the conversion to ICD-10. If the practice has purchased an EHR from a vendor, a readiness assessment should have already been completed several months ago for ICD-10. However, if this process has not been done, practices should contact their EHR vendor immediately to ensure that it will be compliant with ICD-10 on Oct. 1, 2015.


Some practices have created their own "home-grown" EHR which will also need to be evaluated for ICD-10 readiness. Physicians and their coding staff should practice assigning ICD-10 codes within their EHR system to ensure that the system is capable of accepting these codes. It's important to remember that the current ICD-9 codes are between three digits and five digits, whereas the ICD-10 codes are between three characters and seven characters.


Many EHRs have built-in documentation templates that physicians use to assist with capturing the complete clinical picture of the patient. These templates may need to be revised for ICD-10 as well.


Next Steps


Leading up to ICD-10 implementation, a physician practice should have already created an ICD-10 communication plan, developed a budget, completed staff and physician education, performed readiness testing, analyzed documentation, reviewed quality reporting requirements, and revised superbills and other forms. Use these remaining four months wisely to ensure a smooth transition on Oct. 1, 2015.

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Errors after ICD-10 Compliance Deadline Affect Reimbursement

Errors after ICD-10 Compliance Deadline Affect Reimbursement | EHR and Health IT Consulting | Scoop.it

The ICD-10 compliance deadline is right around the corner and providers will need to be ready to transition to the new coding set by October in order to receive sufficient reimbursements for medical care services from the Centers for Medicare & Medicaid Services (CMS). In preparation for the ICD-10 transition deadline, providers are still struggling with a variety of challenges in moving from ICD-9 coding to the extensive list of diagnostic codes.


paper published in The American Journal of Emergency Medicine evaluates ICD-9 codes in an Illinois emergency department’s Medicaid database to see whether mapping tools could better prepare emergency room doctors to transition toward ICD-10 codes.

Out of 1,830 codes encountered in the study, 27 percent or 574 codes represented complicated multidirectional mappings. The results show that these particular mappings are convoluted. In a secondary analysis, 23 percent of 622 diagnostic codes were found to be clinically inaccurate.


Out of these mappings, 8 percent represented clinically incorrect visit encounters. Inaccuracy of these mappings could potentially affect physician reimbursement when providers switch to the new codes after the ICD-10 compliance deadline takes hold.


The paper goes on to explain that the ICD-10 transition will affect workflow processes, coding procedures, and health IT support. Due to the greater detail and expansion of the coding set, there will be a wide range of operations to prepare in time for the ICD-10 compliance deadline.


When it comes to physician reimbursement, clinical documentation, and public health reporting, the accuracy of diagnostic codes among the emergency care sector is vital. Essentially, one of the biggest challenges is that, due to the high spike in the number of codes under ICD-10, the chance for mistakes and selection of the wrong code rises dramatically.


“The Center for Medicare and Medicaid Services and the Centers for Disease Control and Prevention created the General Equivalence Mappings (GEMs) in order to ensure data consistency at the national level during ICD-9-CM to ICD-10-CM transition,” researchers from the University of Illinois wrote in the published paper. “Although ICD-10-CM/Procedure Coding System transition is forecasted to be costly and represent logistical and business challenges in the healthcare field, its benefits are significant and include improved quality of care, cost savings from increased accuracy of payments and reduction of unpaid bills, and improved tracking of health care data as related to public health. These benefits are balanced by such challenges as planning and implementation, price of entry, shortage of qualified/trained coders, need and expense for further training of the workforce, and loss of productivity leading to escalated cost during transition.”


The results of this study illustrate the potential impact of transitioning to the new codes upon the ICD-10 compliance deadline. Along with modifying clinical workflow, the financial reimbursements among hospitals and clinics may be affected negatively upon the ICD-10 conversion.


Over the coming months, medical care providers including emergency room physicians will need to ensure their staff and facilities are ready for the ICD-10 compliance deadline. From training to upgrading systems and end-to-end testing, hospitals and clinics will need to be prepared to avoid reduced reimbursements starting in October.

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ICD-10 Implementation Vital for Value-based Care Payments

ICD-10 Implementation Vital for Value-based Care Payments | EHR and Health IT Consulting | Scoop.it

When the SGR bill was passed by the Senate without any ICD-10 implementation delays, the proponents of the new coding set rejoiced. Not only did passage of this bill bring about a stronger formula for Medicare reimbursements but it also meant that the ICD-10 implementation would most likely take place by the scheduled deadline of October 1, 2015.


When President Obama signed the Medicare Access and CHIP Reauthorization Act of 2015 into law on April 16, the legislation moved American physicians away from fee-for-service payments toward value-based care and accountable care delivery, according to the Healthcare Information and Management Systems Society (HIMSS).

Additionally, the new SGR bill includes innovative objectives for establishing the meaningful use of certified EHR technology. These payment models will be key for improving population health outcomes throughout the country. The volume-based payment reductions under the prior sustainable growth rate formula will now be altered with a new annual payment update of 0.5 percent through 2019.


By 2019, doctors will be able to choose their reimbursement method among two options: the Merit-Based Incentive Payment System or the Alternative Payment Model. While the Merit-Based Incentive Payment System will depend upon the performance of physicians, doctors who choose the Alternative Payment Model must utilize certified EHR technology standards and authorized quality measures as well as assume financial risk.


The overall push toward value-based care among the federal government, patient advocacy groups, and healthcare providers will require the medical industry to quickly and efficiently transition to the ICD-10 coding set. Documenting patients’ medical histories as well as accurately reporting and coding diagnoses and treatments is vital in the quest to pay for value and enhance population health outcomes across the sector.


The Coalition for ICD-10 also reports on the importance of the ICD-10 implementation in the move toward value-based care, as ICD-9 codes do not have the same capabilities as the newer coding set. While the healthcare community supports the SGR reform bill, many physician groups are still against the ICD-10 implementation and are hoping for additional delays.


However, a move toward measuring and paying for value-based care is not possible without transitioning to a modernized form of diagnostic and procedure coding. In order to accurately measure the value of a healthcare service, it is vital to have the detail available in the ICD-10 coding set, the coalition explains.


One example of the subpar quality of ICD-9 codes involves putting two patients with similar conditions but differing symptoms under the same code while ICD-10 accounts for a variety of divergence among patients. Essentially, ICD-10 codes will include key information about patients and record their medical history more accurately with additional detail.


“Despite opposition to ICD-10 by some physician groups and a few isolated state medical societies, there is general recognition in the medical community that a modern and precise coding system like ICD-10 is essential for measuring and paying for value,” the Coalition for ICD-10 stated. “ICD-9 represents medicine of a bygone era. It cannot support a move to measuring and paying for value. To meet the demands of SGR there can be no further delays in the ICD-10 implementation date.”


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CMS Chief to Address ICD-10 Implementation in National Call

CMS Chief to Address ICD-10 Implementation in National Call | EHR and Health IT Consulting | Scoop.it

The Centers for Medicare & Medicaid Services (CMS) continues gearing up for the October 1 ICD-10 compliance deadline with Acting Administrator Andy Slavitt scheduled to address the ICD-10 transition during a national provider call later this month.


On August 27, Slavitt will provide a national implementation update as the nation reaches the five-week countdown to October 1. Also scheduled to speak are American Health Information Management Association (AHIMA) Senior Director of Coding Policy and Compliance Sue Bowman and American Hospital Association (AHA) Director of Coding and Classification Nelly Leon-Chisen.


Two recent surveys show industry-wide progress toward a successful ICD-10 transition in October. In July, the 2015 ICD-10 Readiness reportpublished by AHIMA and the eHealth Initiative stated that half of respondents had completed test transactions with payers or claims clearinghouses.


Despite these positive findings, the report also revealed that ICD-10 preparation gaps still remain for many providers in the area of testing and revenue impact assessments. Only 17 percent indicated that they had completed all external testing. Similarly, only a minority of respondents (23%) have contingency plans related to ICD-10 go-live.

More recently, latest ICD-10 readiness survey from the Workgroup for Electronic Data Interchange (WEDI) showed physician practices to be lagging behind their counterparts.


As compared to seven-eighths of hospitals and health systems ready for October 1, less than a half of physician practices indicated they would be ready. This disparity was also evident in the area of provider impact assessments. Only one-sixth of physician practices had undertaken the assessment versus three-fifths of hospitals and health systems. "This lack of progress is cause for concern as it will leave little time for remediation and testing," WEDI reported.


In a letter to Department of Health & Human Services Secretary Sylvia Mathews Burwell, WEDI cautioned that without a concerted effort the ICD-10 transition could lead to negative consequences for the healthcare industry.


"We assert that if the industry, and in particular physician practices, do not make a dedicated and aggressive effort to complete their implementation activities in the time remaining, there is likely to be disruption to industry claims processing on Oct 1, 2015," the organization stated.


Around the same time, CMS provided clarification about ICD-10 flexibilities it make available to providers following a joint statement with the American Medical Association (AMA) in June. The major ICD-10 flexibility is the federal agency's decision not to reject claims coded incorrectly in ICD-10.


"Medicare claims with a date of service on or after October 1, 2015, will be rejected if they do not contain a valid ICD-10 code," the federal agency stated. "The Medicare claims processing systems do not have the capability to accept ICD-9 codes for dates of service after September 30, 2015 or accept claims that contain both ICD-9 and ICD-10 codes for any dates of service. Submitters should follow existing procedures for correcting and resubmitting rejected claims."


Here's a quick look at the agenda for the MLN Connects Call:


  • National implementation update, CMS Acting Administrator Andy Slavitt
  • Coding guidance, AHA and AHIMA
  • How to get answers to coding questions
  • Claims that span the implementation date
  • Results from acknowledgement and end-to-end testing weeks
  • Provider resources


As the entire healthcare industry counts down to October 1, CMS appears ready to ramp up its activities.

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Is ‘Safe Harbor’ Needed After ICD-10 Implementation Deadline?

Is ‘Safe Harbor’ Needed After ICD-10 Implementation Deadline? | EHR and Health IT Consulting | Scoop.it

As the ICD-10 implementation deadline drew closer, more lawmakers began attempting to develop a different type of transition period in which healthcare providers would not be penalized for reporting inaccurate ICD-10 codes. For example, HR 2247, the ICD-TEN Act, would create a “safe harbor” for providers in which they wouldn’t be denied reimbursement “due solely to the use of an unspecified or inaccurate sub-code.” 


The Coalition for ICD-10 states that the Centers for Medicare & Medicaid Services (CMS) has often accepted less specific codes under ICD-9 and, when the ICD-10 implementation deadline hits, the new reporting requirements will have no difference in level of specificity.


“CMS has reiterated numerous times that their acceptance of unspecified codes will not change as a result of the ICD-10 transition,” the Coalition for ICD-10 explains. “Furthermore, it would be inappropriate and a violation of coding rules to require a level of specificity that is not documented in the medical record. Indeed, CMS has made it abundantly clear that it would be inappropriate to select a specific code that is not supported by the medical record documentation or to conduct medically unnecessary diagnostic testing in order to determine a more specific code.”


Essentially, the ICD-TEN Act was proposed due to physician fears that there may be a significant increase in the number of claim denials once the ICD-10 implementation deadline takes effect.

However, the latest CMS end-to-end testing results show that there is only a 2 percent denial rate of claims due to ICD-10 errors. This shows that the physician fears may be unfounded.


According to the Coalition for ICD-10, a “safe harbor” transition period is not necessary and the current status of the ICD-10 implementation deadline should take effect on October 1 as is.


Additionally, CMS released its acknowledgement testing results taking place between June 1 and June 5. CMS accepted a total of 90 percent of claims submitted across the nation during this time period.

While a 10 percent denial rate is significant, CMS holds that the majority of claim rejections were due to submission errors within the testing environment that won’t affect the processing of claims when real claims are submitted after the ICD-10 implementation deadline.


It is time for providers to be ready for the ICD-10 implementation deadline or else risk having their claims rejected once October 1 hits. Any provider who submits ICD-9 codes after the deadline risks having the claims returned to their facility, returned as unprocessable, or rejected, according to apamphlet from CMS.


“As we look ahead to the implementation date of ICD-10 on October 1, 2015, we will continue our close communication with the Centers for Medicare and Medicaid Services to ensure that the deadline can successfully be met by stakeholders,” House Energy and Commerce Committee Chairman Fred Upton (R-MI) and House Rules Committee Chairman Pete Sessions (R-TX) stated at the end of 2014. ““This is an important milestone in the future of health care technologies, and it is essential that we understand the state of preparedness at CMS.”

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How health systems can help physician practices prepare for ICD-10

How health systems can help physician practices prepare for ICD-10 | EHR and Health IT Consulting | Scoop.it

Many physician practices are ill-prepared for ICD-10, and health systems must ensure the right tools are in the hands of those who need them most, according to Bill Reid, senior vice president of product management and partners at SCI Solutions.


"Hospitals risk unsuccessful transitions if physician offices in their communities aren't ready," Reid writes for ICD10Monitor.com. Recent studies show that many still are not, despite the Oct. 1 implementation deadline looming.


For instance, a survey unveiled by the eHealth Initiative earlier this month showed that of 271 providers, half said they have conducted test transactions using ICD-10 codes with payers and clearinghouses. Only 34 percent said they have completed internal testing, while 17 percent have completed external testing.


Eighty-eight percent of test claims were accepted during the Centers for Medicare & Medicaid's second round of ICD-10 testing in April.

There are tools that health systems can use to ensure their "healthcare brethren" are moving forward with ICD-10, according to Reid. A cloud-based business management tool can help create a "crosswalk" to convert the ICD-9 code used most often to ICD-10 equivalents. The business management tools help ensure incidents are coded correctly, he says.


"These electronic bridges help ... make it as easy as possible for community physicians to send in accurate orders and referrals, with the correct codes being used from the start of that workflow," Reid says.


One scenario where this works includes if a patient needs to be scheduled for a CT scan. While the patient is at the practice, staff can use the management tool to schedule the order and while doing so select the prognosis which the program will then autopopulate the correct ICD-9 and ICD-10 codes.

The Workgroup for Electronic Data Interchange has warned that unless all industry segments move forward with implementation of ICD-10, "there will be significant disruption on Oct. 1, 2015."

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Final Steps to Take Before the ICD-10 Implementation Deadline

Final Steps to Take Before the ICD-10 Implementation Deadline | EHR and Health IT Consulting | Scoop.it

As the countdown to the ICD-10 implementation deadline continues and the healthcare industry gets closer to October 1, those ready for the new diagnostic coding set will stand out from the rest of the crowd. An article by Pam Jodock, Senior Director at the Healthcare Information and Management Systems Society (HIMSS), describes three types of medical organizations that are either moving forward with the ICD-10 implementation deadline or are behind in their ICD-10 preparations.


The healthcare entities that have implemented new system upgrades and trained their staff on the ICD-10 coding set while ignoring any ICD-10 delays should be more ready than others once October 1, 2015 hits.


The second type of provider likely stopped his or her ICD-10 preparationsonce the 2014 ICD-10 delay was announced but resumed at the beginning of this year. Those who began in January or February should still be in good shape to meeting the ICD-10 implementation deadline. The third type of provider, however, may have difficulty being completely prepared for the new coding set by October 1 if they postponed all plans in hopes of another ICD-10 delay.


Jodock continued to explain that there are a number of steps that well-prepared healthcare providers should have already completed. These include:


  • Remediating systems to identify ICD-10 codes for any services performed on October 1, 2015 and after
  • Completed or undergoing testing with partners and payers
  • Coding staff trained and tested on the ICD-10 codes
  • Contingency plans developed to prepare for any potential reimbursement delays
  • Reassurance from payers, clearinghouses, and other partner entities that they are prepared for the ICD-10 implementation deadline
  • Full training of the medical team on any new clinical documentation procedures


Following these steps among others will ensure greater success among healthcare providers in being well-prepared for the ICD-10 implementation deadline. However, any medical organizations that are behind in their ICD-10 preparation efforts should not worry, Jodock explains.


The Centers for Medicare & Medicaid Services (CMS) offers a variety of services to help providers better prepare for the new diagnostic and procedural coding set. For example, Medicare Adminstrative Contractors (MACs) are offering free billing software to providers and more than 50 percent of MACs are providing physicians and healthcare professionals the ability to submit ICD-10 claims via their provider portals upon the ICD-10 implementation deadline.


A presentation offered by CMS called “ICD-10: Preparing for Implementation and New ICD-10-PCS Section X” discussed further steps on moving forward with ICD-10 preparation.


 “ICD-10 is really foundational to our nation’s healthcare. We really want to make sure everyone is prepared,” Denisia Green, Deputy Director of the National Standards Group, said during the presentation. “We have free resources, tools, and testing available to everyone.”


“ICD-10 is set. The date is set for October 1, 2015. What we want you to understand is that there are not that many codes,” Green explained. “Yes, you have to take a look at the codes that you use. Over half of the codes are laterality. If you look at the code set by category, some of the codes have actually been streamlined in ICD-10. I think one of the things that we have to keep in mind is who are the patients that we take care of and that will help to dictate what codes you’re going to be using.”

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Navigating the Complex Translations from ICD-9 to ICD-10

Navigating the Complex Translations from ICD-9 to ICD-10 | EHR and Health IT Consulting | Scoop.it

Changes in how medical diagnoses are coded under ICD-10 may complicate the financial analysis, research projects and training programs that depend on look-back comparisons of healthcare data, according to researchers at the University of Illinois at Chicago (UIC). The report, a collaboration of researchers at UIC and at the University of Arizona, is also online in the Journal of the American Medical Informatics Association (JAMIA).


To this end, Andrew Boyd, M.D., assistant professor of biomedical and health information sciences at UIC and first author of the paper, and his health information science colleagues, have been looking at issues that could come up as physicians and hospitals change from one system to the other. Previously they found that some ICD-9 codes map well to ICD-10, but many more have highly convoluted mappings, and some don’t map at all. This forward-mapping is needed for continuing payments of ongoing medical conditions, Boyd says.


Boyd has been leading the charge in tackling this mapping issue for the last few years. In 2013, UIC researchers found that 60 percent of the ICD-9 codes are “non-entangled motifs,” which would map without discontinuity and should be immediately interpretable. However, it’s those remaining convoluted codes, which accounted for 36 percent of the codes the researchers looked at, which could cause problems.  In one study, where the researchers looked at 24,008 clinical encounters in 217 emergency departments, 27 percent of the costs were associated with convoluted diagnoses.


And last year, Boyd and other UIC researchers looked at the coding ambiguity for hematology-oncology diagnoses to anticipate the challenges all providers may face during the transition from ICD-9 to ICD-10. The researchers used a web-based tool, developed in house, to input the ICD-9 codes and translated them into ICD-10 codes. They looked at whether the translation made sense; whether a loss of clinical information occurred; and whether a loss of information had financial implications.


“Now, we are taking the same methodology and looking backward,” Boyd says. Reverse-mapping from ICD-10 back to ICD-9 will be important for all sorts of retrospective analyses, he says, “because we have 30 years of data that we want. We don’t want to lose all this information.” Clinical researchers and analysts conducting studies across datasets—and hospital administrators who manage growth and watch trends for strategic planning—will need to pull data under both the new and the old codes, he notes.


Boyd says while there is a huge educational burden on the industry in preparing for ICD-10, memorizing codes, and understanding what documentations are necessary for the new codes, his focus is on is what ICD-9 codes are currently used for in healthcare. “There are plenty of consultants and other companies for that other stuff. We have tried to focus on what reports can you run in ICD-10, and after you code, can you map backwards and run old reports in ICD-9 until you have enough ICD-9 data to make clinical decisions?” he says.  As such, Boyd says that organizations might not be able to run all of their reports meaningfully in ICD-10 until 2018. “Our focus has thus been on using the science of the network, the mathematical theories designed to help connecting networks to help find the hard parts or find the areas where the reports might not make sense. And you have to engage the clinicians to figure it out,” he says.


The aforementioned web portal tool and translation tables were created to provide guidance on ambiguous and complex translations and to reveal where analyses may be challenging or impossible. The tool lists all ICD-9-CM diagnosis codes related to the input of ICD-10-CM codes and classifies their level of complexity, which can be: one-to-one “identity,” or reciprocal, the simplest (28 percent of ICD-9 codes fall under this category); class-to-subclass (12 percent); subclass-to-class (22 percent); “convoluted” (36 percent); or “no mapping” (1 percent). “The healthcare system runs on data,” Boyd says. “We are fundamentally changing the way we record the data.” Although the new system will improve the way the data is sorted and recorded, he says integrating it with the last 30 years of information will be difficult.


The alternative to forward mapping, Boyd says, is to dually code in ICD-9 and ICD-10, a process that he says would double the cost of professional coding and double the time of physicians. “We have a $3 trillion dollar healthcare system, so not even all the big organizations will be able to code everything,” Boyd says. “Some will for internal purposes, but the cost is so huge to have everyone in the country do that.” As such, in the sense of mapping forward, Boyd says that it’s easier because you can map to the same general concepts. “Right now, for example, we say ‘ear infection’ in ICD-9,” he says. “You’ll have to specify right, left, or unspecified in the future. And if you map backwards you’re losing data. If you map forward, it maps forward to ‘unspecified ear infection,’ so at least you get the idea,” Boyd explains.


Boyd says that everything his team has done in this arena has been published online and is available for free use. They have created a tool where the user can create either the organization’s top 25 codes or 100 codes used in practice, and then the tool will give them a graphical output so the user can see how the codes are interrelated.


“Besides that, we also generate an online table so you can take that an incorporate it into your own reports,” Boyd says. “We also label the list of your own codes that you provide us into one of those five complexity categories. We have additionally created a separate online tool for when you’re in ICD-10; we provide the network backwards and we indentify the same categories,” he says. “All of this helps you understand the robust network in a comprehensive manner. We’re all in this together.  The idea is to reduce the costs and burden for everyone.”

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Outcomes after ICD-10 Transition Deadline Look Promising

Outcomes after ICD-10 Transition Deadline Look Promising | EHR and Health IT Consulting | Scoop.it

Those who have had concerns about the coming ICD-10 transition deadline may have less to worry about now that the latest batch of ICD-10 end-to-end testing from the Centers for Medicare & Medicaid Services (CMS) has been successful. The acceptance rates of the ICD-10 claims during the April end-to-end testing has been higher than the prior round of end-to-end testing from January, according tothe Journal of AHIMA.


Essentially, there has been more test claims sent to CMS as well as fewer errors found after submitting the ICD-10 claims. This points the way toward a more successful ICD-10 transition deadline come October, as fewer mistakes would keep financial reimbursement across the healthcare sector more stable. Most importantly, the majority of errors that did occur during the end-to-end testing period were not related to ICD-9 or ICD-10 codes.


“With four months remaining to correct issues discovered during testing, the high rate of successful submission of ICD-10 codes is especially encouraging for physician offices since half the claims submitted for end-to-testing were professional claims,” theCoalition for ICD-10 stated in an article. “These results indicate that significant progress has been made since the January end-to-end testing with the overall rejection rate dropping from 19 to 12 percent and ICD-10 rejections dropping from 3 to 2 percent.”


Out of the 23,138 test claims that were sent over to CMS, a total of 20,306 ICD-10 end-to-end testing claims were accepted. This shows that as many as 88 percent of claims should be accepted when the ICD-10 transition deadline rolls around. While this is good news, there may be slight problems at a handful of medical facilities as 2 percent of claims submitted were found invalid due to errors in ICD-10 diagnosis or procedure codes.


The Coalition for ICD-10 also explains that there were “zero claims rejected due to front-end CMS system issues for professional and supplier claims.” Since out of the 12 percent of rejected claims only 2 percent were due to actual ICD-9 or ICD-10 coding errors, the healthcare industry seems to be in a stronger position toward successfully submitting their claims after the ICD-10 transition deadline.


The other errors that occurred hold no bearing on ICD-10 and would only be rejected under ICD-9, the Coalition states. Currently, CMS systems are capable of accepting institutional claims as well as professional and supplier claims.


Everyone who participated in ICD-10 end-to-end testing in April received Remittance Advices, which should steer them toward the right direction if any errors occurred on their end. Currently, there is less than four months to fix any issues before the ICD-10 transition deadline takes hold.


CMS will be conducting educational sessions about submitting ICD-10 claims prior to the final end-to-end testing session in July before the ICD-10 transition deadline takes effect on October 1. The federal agency continues to urge medical care providers to prepare for the coming ICD-10 implementation in order to avoid any reimbursement delays or rejections after the ICD-10 transition deadline.

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Direct Reimbursement Solutions's curator insight, July 1, 2015 2:03 PM

With only four months to go, it seems that ICD-10 testing is going very well. Good news for providers of care.

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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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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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Free iOS App from ADP AdvancedMD Allows Any Physician Practice to Assess ICD-10 Preparedness

Free iOS App from ADP AdvancedMD Allows Any Physician Practice to Assess ICD-10 Preparedness | EHR and Health IT Consulting | Scoop.it

South Jordan, Utah – February 24, 2015– ADP® AdvancedMD, a leader in all-in-one, cloud electronic health record (EHR), practice management, medical scheduling, medical billing services as well as a pioneer of big data reporting and business intelligence for smaller medical practices, today announced the release and availability of AdvancedMD ICD-10 Toolkit, a free app that gives private practices a suite of ICD-10 preparation tools. Now anyone with an iPhone or iPad running iOS8 can easily test their readiness and train staff for the October 1deadline, free of charge. Customers of AdvancedMD practice management software can also leverage the app to add ICD-10 codes to their charge slip templates.

“ADP AdvancedMD has been a leader in the ICD-10 transition process and a champion of independent physicians and small practices, with such tools as MyICD10.AdvancedMD.com, a website aimed at helping medical practices prepare for the ICD-10 transition, featuring a timeline and a wealth of tools, training and tips to help practices prepare for the change,” said Raul Villar, president, ADP AdvancedMD. “With less than half of all practices ready for the change, we saw a need for a tool that would aid the entire community of independent physicians in their progress.”

The app was created as part of the ADP AdvancedMD iCommit program, which offers incentives to engineers for independently pursuing innovations in addition to their regular jobs.

“We decided that there should be a tool to help everyone prepare for the change to ICD-10 and give our community the ability to gauge their readiness,” said Barlow Tucker, software engineer, ADP AdvancedMD. “A free app was the clear choice because it’s easy to access and use, plus it allows people to get an ICD-10 ‘checkup’ at any time.”

The AdvancedMD ICD-10 Toolkit allows users to:

– Track preparedness for ICD-10
– Compare ICD-9 codes with the ICD-10 equivalents, including risk of increased specificity
– View potential high-risk areas
– Search for ICD-10 codes and sub codes
– View articles and action plans to guide a specific transition

Download the new AdvancedMD ICD-10 Toolkit app for iPad®, iPhone®, and iPod Touch® available for free on the Apple app store.


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Direct Reimbursement Solutions's curator insight, June 29, 2015 6:08 PM

Why this is our choice for software solution.