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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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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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Latest ICD-10 Developments and What Physicians Should Know

Latest ICD-10 Developments and What Physicians Should Know | EHR and Health IT Consulting | Scoop.it

With October less than three months away, physicians need to be prepared for the ICD-10 conversion.


By now, everyone in the healthcare industry knows that the effective date for ICD-10 implementation is Oct. 1, 2015. Moreover, because of the multiple delays of the effective date of the transition, there is no excuse for physicians not to be ready to change coding systems. Some larger institutions have already been utilizing the more specific standards of the U.S. version of ICD-10. Specifically, ICD-10 in the U.S. has two categories – ICD-CM and ICD-PCS.


ICD-10 CM is “[t]he International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is a system used by physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital care in the United States,”  according to Tech Target. Funded by the U.S. Centers for Medicare and Medicaid, ICD-10–PCS is specific to the United States and is utilized for procedural codes. The biggest obstacle for most physicians and coders is the increased specificity, which translates into a cash-gap increase. If the condition or procedure is not correctly coded, the claim will be denied and have to be re-filed utilizing one of approximately 69,000 ICD-10 CM codes compared to approximately 14,000 ICD-9 CM codes.


On July 6, 2015, the Centers for Medicare and Medicaid (CMS) and the American Medical Association (AMA) issued a joint statement. “ICD 10 implementation is set to begin on October 1, and it is imperative that physician practices take steps beforehand to be ready,” said AMA President Steven J. Stack, MD.  “We appreciate that CMS is adopting policies to ease the transition to ICD-10 in response to  physicians’ concerns that inadvertent coding errors or system glitches during the transition to ICD-10 may result in audits, claims denials, and penalties under various Medicare reporting programs.  The actions CMS is initiating today can help to mitigate potential problems.  We will continue to work with the administration in the weeks and months ahead to make sure the transition is as smooth as possible.”


Simultaneously, Representative Marsha Blackburn (R-TN), introduced H.R. 3018, Coding Flexibility in Healthcare Act of 2015. The purpose of the act was to provide a six-month safe harbor period for the transition to ICD-10 for submitted claims. The bill is still in Committee and has not been voted on by either the House or the Senate.


The takeaways for physicians include:


• Utilize the resources available through the AMA and CMS;

• Coordinate with all insurance companies to make sure that their systems are compatible and see if a “test run” can be done on submission claims;

• Review the contracts of EHR providers and see if there is a provision for a subscriber to recover for lost revenue in the event of a delay, glitch or system error in the claims submission process with ICD-10; and

• Be as specific as possible in medical documentation.

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How Meaningful Use Requirements Support Population Health

How Meaningful Use Requirements Support Population Health | EHR and Health IT Consulting | Scoop.it

Industry stakeholders may debate the value and impact of meaningful use requirements new or modified, but a representative from Coastal Medicine of Rhode Island remain adamant that certified EHR technology and its use are crucial to the healthcare organization's approach to population health management.


"In 2006, we simply could not foresee the crucial role that the EMR would play in population health management. Today, the EMR plays a crucial role in functions," Coastal Medical Chief Operating Officer Meryl Moss, MPA, EMHA, told the Senate Committee on Health, Education, Labor & Pensionsin written testimony earlier this week.


Moss was one of three witnesses called to testify during a hearing on the EHR user experience, much of which focused on health data exchange and health IT interoperability.


"Our initial notion was that the EHR would function like a glorified word processor. In 2006, providers, office staff and leadership were thinking of the EHR only in terms of scheduling, billing, and documentation of care," she explained. "Over time, Coastal recognized the power of the EHR as a tool for mining data to guide proactive outreach and provision of care to patients."


A HIMSS Davis Award winner, Coastal Medical was an early participant in the EHR Incentive Programs as well as the Medicare Shared Savings Program (MSSP) and the Advanced Payment Model has met with success in reducing the total cost of care for Medicare beneficiaries by levering CEHRT.


"Today we view the electronic health record first and foremost as an essential tool for population health management," added Moss.

In her written testimony, Moss credited federal incentive programs and EHR certification standards with promoting EHR use among its providers:

1.  They focused on improving care for patients.

2. They provided a clear road map and guidelines for achieving program goals

3. They supplied dollars for infrastructure development and support; and

4. They created a financial incentive for physicians.

In particular, Moss praised the EHR Incentive Programs for taking some of pressure off of providers in choosing appropriate EHR technology. "Individual physicians and physician groups often do not have the expertise, sophistication or bandwidth to differentiate between individual electronic health records and ensure that the required functionality truly exists in an EHR product," she asserted.

According to Moss, similar incentives are essential to pushing EHR adoption forward and advancing the exchange of health information:

We would recommend that incentive programs continue to reward EHR adoption, interoperability, improved patient access, and improvement of performance on quality measures. This is still new work for many in our industry, and we are learning how to better care for populations of patients every day. These programs help us to focus on what is most important, and provide revenue for infrastructure support that is in short supply in many physician groups.

Alongside incentives should come EHR certification criteria focused on healthcare analytics, which Moss identified as one of her organization's "biggest challenges" and requiring increased attention.

"We would recommend that future iterations of EHR certification criteria include a requirement that data analytics capabilities be integrated into the electronic health record, so that both the financial and clinical data can be analyzed and presented in an efficient and effective manner," she maintained. "We will need such tools if we are to succeed in our mission to provide better care, better health, and lower cost of care for the populations we serve.

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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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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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ICD-10 Compliance, Stage 2 MU Prompt More IT Adoption

ICD-10 Compliance, Stage 2 MU Prompt More IT Adoption | EHR and Health IT Consulting | Scoop.it
The healthcare industry is on track for spending billions of dollars on health IT products throughout 2015. With the ICD-10 compliance deadline looming in October, most providers are looking to adopt advanced IT systems that incorporate the new ICD-10 coding set.

Almost 60 percent of polled hospitals leaders stated they will be focusing on transitioning to ICD-10 compliance throughout 2015, according to a report from peer60. Some typical IT products many may be purchasing include revenue cycle management, population health management, patient engagement, EHR, and ICD-10 migration systems.147504495

The researchers also broke down the surveyed hospitals by size and found that the bigger organizations are more likely to invest in health IT technology over the next year due to having more resources to spend. However, the report also discovered that very small hospitals are more likely to purchase an EHR system when compared to larger medical facilities.

It is likely that larger hospitals already have EHR systems set up and are looking toward health IT than can better coordinate care, engage patients, and provide analytics. Additionally, every hospital with over 1,000 patient beds was planning on purchasing a major IT solution in 2015.

EHR vendors are likely to remain busy throughout this year, as 27 percent of surveyed hospitals are looking to either replace a current EHR system or install a new one in the ambulatory care setting. Additionally, 31 percent of those looking to replace a system are undecided on whether to purchase from their previous vendor. This means that around one in ten hospitals will be changing their EHR vendor.

The data analytics market is also emerging among health IT systems. Despite it being a new avenue, 26 percent of hospital leaders said they are planning to buy an enterprise analytics suite in 2015, with 30 percent of these tools being first time purchases. Chief Information Officers (CIOs) were the key positions that were looking to incorporate analytics systems in their healthcare facilities. Additionally, 25 percent of those who already have analytics products are looking to update and replace their systems with more enhanced features. Nonetheless, 40 percent of the survey takers are unsure whether they will be renewing their data analytics software.

With Stage 2 Meaningful Use requirements calling for greater patient engagement and the creation of patient portals among medical facilities, the healthcare sector is poised to incorporate more patient-centric solutions. However, the report found that 40 percent of hospital leaders have not picked a patient engagement strategy as of yet. Regardless, 48 percent of hospitals will be addressing patient engagement in 2015.

Others in the industry are already choosing replacement products to increase patient engagement at their facilities. With many looking to leave their current health IT vendor, there is definitely a market for product replacement aimed toward improving the patient-doctor relationship. Smaller hospitals are still considering their options.

Along with data analytics and patient engagement, more providers are looking for health IT products that improve population health management. All of these resources should move the healthcare sector toward enhancing the quality of care and patient safety over the coming years.
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Physicians Still Sour on Meaningful Use Attestation Changes | EHRintelligence.com

Physicians Still Sour on Meaningful Use Attestation Changes | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
The adjustments involved in successful meaningful use attestation still get a thumbs-down from pessimistic physicians.

Physicians are still not sold on the idea of changing their daily workflows to meet the requirements of meaningful use, finds a new study in BMC Medical Informatics and Decision Making.  In a survey of 400 providers at 47 ambulatory practices, the researchers found a general unwillingness among all types of physicians to adapt to the needs of Stage 1 meaningful use (MU), and a general lack of confidence in their organization’s ability to rise to the challenges presented by EHR implementation.

The study cites the importance of effective change management strategies as a foundation for preparing healthcare providers for the impact of EHR implementation and meaningful use attestation.  “In busy practice settings, such change efforts are often difficult to implement effectively. In fact, experts have suggested that without sufficient readiness for change, change efforts are more likely to lead to unrealized benefits or fail altogether,” the authors write.  “With billions of dollars invested in MU and the countless hours spent by providers and clinical staff on MU implementation nationally, unrealized benefits from the program would carry significant financial and opportunity costs for health care systems.”

Resistance to the changes involved in meaningful use is nothing new in the healthcare industry.  The study adds to the anecdotal notion that physicians are particularly unwilling to embrace workflow changes due to new technologies and requirements.  While approximately 83% of nurses and advanced practice providers (APPs) indicated a willingness to change their workflow in response to meaningful use, just 57.9% of physicians reported the same.  Nearly 45% of nurses and APPs believed their organization would be able to address any problems that arose during meaningful use attestation, but only 28.4% of physicians were optimistic about overcoming issues.

Specialists were nearly three times more likely than primary care providers to believe that meaningful use would divert significant attention away from the practice of patient care.  Twelve percent of specialists thought their interactions will patients would suffer, compared to 4.4% of other providers.  However, specialists were no more likely than other providers to believe their organizations were unready to tackle meaningful use.

“These results suggest that leaders of health care organizations should pay attention to the perceptions that providers and clinical staff have about MU appropriateness and management support for MU,” the study concludes. “Change management efforts could focus on improving these perceptions if need be as it is feasible that doing so could improve willingness to change practices for MU.”

The authors suggest that organizational leaders invest in education for their staff about the benefits and opportunities involved in meaningful use.  Creating opportunities to provide guidance, demonstrations, and training for EHR proficiency and documentation measures required for attestation may help to ease trepidation among providers, while indicating a strong sense of support along with a clear implementation framework may help to make meaningful use attestation a more successful prospect.


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New Calls for Meaningful Use Reporting Changes, ICD-10 Delay | EHRintelligence.com

New Calls for Meaningful Use Reporting Changes, ICD-10 Delay | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it
HIMSS is seeking less stringent 2015 meaningful use reporting requirements while the Medical Society of the State of New York is petitioning for another ICD-10 delay.
While one industry association is calling on its members to support legislation that would make changes to 2015 meaningful use reporting, another is urging Congress to consider legislating an additional two-year delay for ICD-10 compliance.
As first reported by the Journal of AHIMA, the Medical Society of the State of New York began passing around a letter to members of Congress asking to delay the ICD-10 transition until October 2017 “in order to allow for physicians to work thru the myriad of new government regulations that face us.”
The provider association has highlighted the financial implications of a failed industry-wide ICD-10 implementation on Oct. 1, 2015.
“The onerous penalties tied to these mandates add to the hysteria that is running through physicians’ offices and is generating many early retirements,” the letter states. “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 medical society is calling on members of the House Energy and Commerce Committee to include the two-year delay as part of “must pass piece of legislation during the upcoming Lame Duck Session in 2014.”
The move by the Medical Society of the State of New York mirrors that of the Texas Medical Association, which is advocating for a similar two-year ICD-10 delay.
Also calling for legislative action is HIMSS which has put out a message to its members to contact their representatives in Congress about the Flexibility in Health IT Reporting (Flex-IT) Act of 2014. The bill (HR 5481) introduced in September by Representatives Renee Ellmers (R-NC) and James Matheson (D-UT) would replace the full-year reporting for meaningful use in 2015 with a quarterly one.
HIMSS, which supports the bill, is looking to galvanize support among its constituents. “Members of Congress are not hearing from their constituents about 2015 Meaningful Use Reporting Period and that is where you can help! HIMSS is engaged in an effort to let members of Congress hear from their constituents about this important issue.”
Falling short of the bill’s passage, the industry association foresees the potential for Congress to consider other legislative avenues in the future. “Even without this bill passing, with enough Congressional support CMS may be persuaded to change the current policy,” the group maintains.
This legislation also has the support of the College of Healthcare Information Management Executives (CHIME), which has repeatedly called on the Centers for Medicare & Medicaid Services to reconsider meaningful use requirements in 2015 just as the federal agency showed a willingness to do in 2014.
“The misstep by officials to require a full-year of reporting using 2014 Edition certified EHR Technology (CEHRT) in 2015 puts many eligible hospitals and physicians at risk of not meeting Meaningful Use next year and hinders the intended impact of the program,” the organization stated in September. “To date; only 143 hospitals have met Stage 2 to date, representing a very small percentage of the 3,800 hospitals required to be Stage 2-ready within the next 14 days.”



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Approaching an ICD-10 Implementation with Confidence

Approaching an ICD-10 Implementation with Confidence | EHR and Health IT Consulting | Scoop.it

The deadline for implementing ICD-10 is rapidly approaching.  Providers and practices should be preparing for the transition and approaching the implementation with confidence. They should be doing this even with therecent announcement from CMS on creating a one-year grace period, allowing for flexibility in the claims auditing and quality reporting process during the transition.  Addressing the following 11 steps will help assure your practice will be on track for a successful transition on Oct. 1, 2015 and going forward: 


1. UNDERSTAND ICD-10


Review the major differences between ICD-9 and ICD-10 and how those differences will affect a clinician’s specialty as well as your organization as a whole. Reviewing the “Official Guidelines for Coding and Reporting” for ICD-10 is a good starting point. 


2.  CREATE YOUR INTERNAL IMPLEMENTATION AND COMMUNICATION TEAM


Include staff from the administrative and clinical sides of your practice and divide up the work that needs to be accomplished. Make sure you communicate the changes required by ICD-10, both from a workflow standpoint as well as clinical documentation.


3.  REVIEW THE IMPACT AREAS OF YOUR PRACTICE AND MODIFY PROCESSES


Consider all the different systems you use, the organizations you exchange data with, as well as what electronic and paper-based workflow processes you use that drive clinical encounters and the billing process.  Make sure all of these are updated and/or modified appropriately for ICD-10 compatibility.

4.  REACH OUT TO YOUR SOFTWARE VENDORS


Ask vendors about any needed upgrades to use ICD-10, what training (if any) will be needed, and cost estimates. Don’t forget to ask about the ability to concurrently use ICD-9 and ICD-10 and how long you’ll have the ability to do that.


5.  DEVELOP YOUR BUDGET


Make sure you consider software and hardware upgrades, education and training costs, the cost of temporary staff during transition should it be needed, changes to printed materials, additional time for documentation review, and the cost of lost coder, clinical and/or revenue cycle staff productivity.


6.  CONTACT YOUR CLEARINGHOUSES AND HEALTH PLANS


Ask if all their upgrades to accommodate ICD-10 have been completed and if they haven’t, when they will be. Also ask how they (the clearinghouse and health plans) will help your practice with the transition, when can you test claims and other transitions with ICD-10 codes, and whether they provide a list of any data content changes needed. Don’t forget to ask the health plans when they expect to announce their revised ICD-10-related coverage/payment changes. 


7.  IMPROVE CLINICAL DOCUMENTATION


This may be one of the most challenging aspects of ICD-10.  Identify potential documentation issues by beginning to crosswalk ICD-9 codes to ICD-10 codes. The goal should be to identify any gaps in the documentation that prevent a coder from selecting the appropriate ICD-10 code.


8.  TRAIN YOUR STAFF


Identify your education needs. While everyone will need to be trained, not everyone will need to be trained at the same level. Identify who should be trained on what.  You will also need to identify the best training mode for each group and the timeframe for providing that training. 


9.  TEST YOUR SYSTEMS


Testing is critical to success with implementation.  Plan for both internal and external testing.  This will need to be scheduled, so begin the planning now.


10.  PLAN FOR CONTINGENCIES


Every practice needs to plan for decreased staff productivity and prepare for the possibilities of other financial challenges during the initial implementation period. You should set aside some cash reserves for the practice. It may also be wise to consider establishing a line of credit. 


Preparing now for the transition to ICD-10 will help ease the burden of compliance on Oct. 1, 2015 and assure you will not have a major disruption in your practice revenue.


11. UNDERSTAND THE ICD-10 GRACE PERIOD


Make sure you familiarize yourself with the new grace period rules, including some key points below. CMS also announced the establishment of a communication center and an ICD-10 ombudsman to help receive and triage physician and provider issues. 


  • Medicare contractors will not deny claims based solely on the specificity of the ICD-10 diagnosis code as long as a valid code from the right family of ICD-10 codes is used. Moreover, physicians will not be subject to audits as a result of ICD-10 coding mistakes during this one-year period.
  • Physicians will not be penalized under the various CMS quality reporting programs for errors related to the additional specificity of the ICD-10 codes, again as long as a valid ICD-10 code from the right family of codes is used.
  • If Medicare contractors are unable to process claims within established time limits because of ICD-10 administrative problems, such as contractor system malfunction or implementation problems, CMS may in some cases authorize advance payments to physicians. 
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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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Does Healthcare Fraud Impact Meaningful Use Audits?

Does Healthcare Fraud Impact Meaningful Use Audits? | EHR and Health IT Consulting | Scoop.it

While the majority of medical providers are preparing for the ICD-10 transition deadline and are utilizing diagnostic coding accurately, there are certainly outliers who have attempted to defraud the healthcare system and the Centers for Medicare & Medicaid Services (CMS). These outliers may even affect the CMS’ stance on meaningful use audits. Former Central Texas Hospital owner Tariq Mahmood is one such individual that has been sentenced to 135 months in federal prison last Monday for submitting false and fraudulent claims to healthcare payers including CMS.

The Cameron Herald reported that Mahmood was ordered to pay $599,128.02 to CMS and Blue Cross Blue Shield of Texas due to the violations of identity theft and fraudulent medical care claims. Mahmood had owned and operated a handful of hospitals across the state of Texas including Lake Whitney Medical Center, Central Texas Hospital in Cameron, Renaissance Terrell Hospital, Cozby Germany Hospital in Grand Saline, and Community General Hospital in Dilley.Meaningful Use Audits

Prosecutors Assistant U.S. Attorneys Nathaniel C. Kummerfeld, Frank Coan and Special Assistant U.S. Attorney Ken McGurk claimed during the trial that Mahmood and other individuals defrauded Medicare and Medicaid from January 2010 to April 2013 by submitting false identities and inexistent diagnoses and treatments.

Currently, ICD-9 diagnostic codes are being utilized by healthcare providers while the ICD-10 coding set will be required to use by October 1, 2015, which is the ICD-10 transition deadline. Mahmood, however, modified and incorrectly sequenced diagnostic codes to reflect the wrong medical conditions and diagnoses of his patients without checking their healthcare records. The names of Medicare beneficiaries and their associated numbers were also incorrectly and fraudulently used.

“Americans enjoy the best health care in the world and the cost for this care is expensive,” U.S. Attorney John M. Bales said in a statement.“What we do not need is providers like Tariq Mahmood who masquerade as physicians who pretend to care about American health care but actually are determined to loot the Medicare Trust Fund. He is now being held to account, and I congratulate the prosecution team for a job very well done.”

Former chief financial officer of the Cameron hospital and the Shelby Regional Medical Center Joe White will also be sentenced for defrauding the government and healthcare payers on Monday, April 27.

White had made a false statement regarding the meaningful use achievements of the Shelby Regional Medical Center and claimed the hospital met relevant meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs. This false statement led to the hospital being awarded $785,655 from Medicare.

Healthcare professionals that defraud the medical payer system along with federal agencies lead to difficulties among honest providers who have successfully met meaningful use requirements and are preparing to accurately and authentically send ICD-10 coding claims to CMS by the ICD-10 transition deadline. For example, current meaningful use audits are burdening a variety of healthcare professionals who have received financial incentives from CMS for meeting relevant meaningful use requirements.

The American Academy of Family Physicians has asked CMS to offer a report that outlines the reasons why some providers have failed the meaningful use audits. Since healthcare fraud is a serious issue across the nation, federal agencies are likely to continue pursuing claims under the EHR Incentive Programs and filing additional meaningful use audits.Since healthcare fraud is a serious issue across the nation, federal agencies are likely to continue filing additional meaningful use audits.

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State Hospitals Go Digital for ICD-10 Compliance Deadline

State Hospitals Go Digital for ICD-10 Compliance Deadline | EHR and Health IT Consulting | Scoop.it
In order to prepare for the ICD-10 compliance deadline by October 1, medical facilities will need to integrate revenue cycle and EHR systems that follow the new coding set. The State of Washington Department of Social and Health Services (DSHS) recently announced their association with health IT supplier Cerner Corporation to revolutionize their revenue cycle systems and EHR technology in order to better align with ICD-10.

Recently Victoria Roberts, Deputy Assistant Secretary at DSHS, and Justin Dickey, Consulting Practice Director at Cerner, spoke with EHRIntelligence.com to discuss their collaboration further and better prepare providers for the ICD-10 compliance deadline. The two individuals began by discussing how the collaboration will lead to better preparedness for the ICD-10 transition.147504495

“In Washington state, we have two state hospitals that are each about 100 years old and a much newer child study and treatment center. Within those 100 years, these facilities have all worked very independently. They are still very dependent on paper systems,” Roberts explained. “This project is allowing us to really look at how to work with continuity between hospitals, develop more consistent policy and practice, and bring the hospitals into the current century.”

Justin Dickey added: “Our teams are coming together to focus on standardizing workflow and developing a standardized tool set with the Cerner Millennium clinical and revenue cycle platform. More than technology, this is a lot about organizational change management and making sure we have the training programs in place to facilitate the use of the tool set we’re delivering.”

The integration of these health IT tools such as the revenue cycle system will play a key role in improving patient safety and quality of care. Victoria Roberts expanded on this goal.

“The biggest [part of this] is how we share information across shifts and across wards about individual patients,” Roberts said. “One of the things that I’ve been pushing forward is finding a way [to help] nurses and mental health technicians immediately see through the Cerner system the alerts they need to pay attention to.”

“Right now in our facilities, we continue to use white boards and white boards aren’t always updated as they should be. Sometimes things happen at 10 o’clock in the morning that don’t get communicated to the shift that comes at 3 o’clock in the afternoon. The hope is that through the Cerner system that information can be entered into the EHR and then communicated out through the alert board.”

Roberts went on to explain how allergy and medication alerts play a role in helping physicians provide safe care. Cerner representative Justin Dickey mentioned that “a task-driven clinical workflow allows [Cerner] to ensure they’re leading clinicians down the right path and also to have a mechanism that measures the quality of documentation as care is progressing through the organization.”

While the health IT tools are used in collaboration to increase the quality of care, they are also impacting the revenue cycle and ensuring that the document quality of claims are up to high standards. The two individuals went on to speak about solutions they’re incorporating to prevent any issues once the ICD-10 compliance deadline takes hold.

“One of the [solutions] we’re dependent on is the dashboard report,” Roberts said. “This allows us to understand the workflow and how well different staff are adopting to the model.”

“Our toolset has a physician dashboard that allows us to zero in on clinicians’ usability experience,” said Justin Dickey. “It identifies the areas where we may need to increase training and assist [promoting] workflow. The dashboard helps track problem areas and gives a tool set that shows what to focus on and issue remediation.”

While incorporating new health IT systems is necessary for the ICD-10 transition, providers are also concerned about other areas with regard to the upcoming ICD-10 compliance deadline. Many fear delayed payments and claim rejections from the Centers for Medicare & Medicaid Services (CMS). Victoria Roberts and Justin Dickey spoke about best practices to follow in order to avoid these issues during the ICD-10 compliance deadline.

“From the state perspective, it’s really anticipating and planning for the training curve that will take for the staff to support the implementation. We’re going from a primarily paper system to an electronic system with staff who rarely have need to even check e-mail,” Roberts explained. “It’s figuring out how to invest and support the staff during the transition.”

Justin Dickey added that Cerner is “helping define those workflows and giving the tools necessary to manage denials and throughput [as well as] giving a visual of what’s happening through the care process and payment process.”

The new EHR systems that DSHS will be using include a diagnostic assistance tool that includes natural language clinicians can easily understand. It provides a simple way to find the right diagnostic coding at the needed specificity instead of forcing physicians to search through a large variety of codes.

“The natural language helps clinicians choose and navigate down to the appropriate level of specificity within the ICD-10 code set,” Justin Dickey mentioned.
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Epic Trails in Black Book Ranking of Inpatient EHR Vendors

Epic Trails in Black Book Ranking of Inpatient EHR Vendors | EHR and Health IT Consulting | Scoop.it

Between system replacements, EHR interoperability issues, and ICD-10 implementation delays, the health IT landscape has been as complex as ever over the last year. In an effort to get the industry ready for coming challenges, Black Book Market Research conducted an inpatient EHR user survey to find out the top inpatient EHR vendors for 2015.

The survey focused on identifying EHR vendors that score highly in certification-required EHR capabilities, clinical workflow applications, documentation functionalities, connectivity, and accountable care data mandates.

Black Book polled 14,000 nurses and 5,000 hospital staff using EHR technology among 702 hospitals. The survey was taken from August 2014 to February 2015. One interesting finding from the poll shows that 74 percent of hospital CIOs and medical technology leaders claimed their selection of EHR systems consisted of “significant nursing input.”

“Black Book survey findings included a substantial improvement in reducing the gap between hospital nursing, physician, administrative, financial and technology stakeholder satisfaction, although there’s still a long way to go,” Doug Brown, Managing Partner of Black Book, said in a company press release.

Out of all nurses responding, 14 percent felt that clinicians’ perspectives were considered highly when selecting healthcare technology to improve workflow and care. About one in five hospital IT managers – 19 percent – state that the current EHR system used in their practice is not the best technology to operate in their facility.

Many find that their EHR systems are not meeting the needs of their facility including their EHR interoperability goals and cost-cutting strategies through expensive add-ons. The survey also illustrated that 69 percent of hospital technology leaders feel that nursing satisfaction has risen due to EHR system updates that occurred after implementation because of nurses’ concerns.

Only 10 percent find that the improvements in nursing satisfaction is due to training and adjustment in EHR use while 20 percent of respondents attribute it to enhancements in EHR functionalities and updates.

The Black Book survey uncovered the top three EHR vendors to be CPSI, Cerner, and Allscripts. Epic Systems was right behind Allscripts among hospitals with 250 beds or more. For the past three years, Epic had earned top client bestowed honors among academic teaching facilities and large hospitals.

CPSI received a nursing and clinician satisfaction rating of 90.2 percent and a technology and financial administrative satisfaction rating of 95.4 percent. Cerner’s satisfaction rating among nurses and clinicians hit 91 percent while the technology and financial administrative satisfaction rating was at 94.1 percent.

Allscripts had its nursing and clinician satisfaction at 83.2 percent with the technology and financial administrative satisfaction hitting 92 percent. Hospital CIOs and IT managers selected Cerner as their first choice for an EHR system suitable within the hospital setting. Other vendors that scored well include Epic Systems, GE Healthcare, Meditech, McKesson, and Siemens.

In order to ensure high physician and nursing satisfaction within the healthcare system, providers will need to implement top EHR systems capable of meeting the demands of the industry and being customized to fit physician practice needs.


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AMA Lists EHRs, Meaningful Use, ICD-10 as Top 2015 Challenges

AMA Lists EHRs, Meaningful Use, ICD-10 as Top 2015 Challenges | EHR and Health IT Consulting | Scoop.it

The New Year’s celebrations may be dying down this week as the healthcare industry gets back to work, but the American Medical Association (AMA) wants providers to keep a watchful eye on ten major challenges that they will face during the year ahead.  From ICD-10 to meaningful use to improving population health management and chronic disease care, the AMA list highlights some common complaints.

At the top of the list is a familiar refrain: the ongoing burden of regulatory initiatives such as meaningful use that have frustrated physicians for years.  The AMA has long advocated for changes to the program, and plans to “intensify” its efforts to push CMS towards greater flexibility for the program, especially after more than 50% of providers were notified that they will be receiving Medicare payment adjustments in 2015.

The overly-strict requirements of the EHR Incentive Programs “are hindering participation in the program, forcing physicians to purchase expensive electronic health records with poor usability that disrupts workflow, creates significant frustrations and interferes with patient care, and imposes an administrative burden,” AMA President Elect Steven J. Stack, MD said in a statement.

Coupled with meaningful use is the AMA’s other nemesis – ICD-10.   While the organization has tried everything from a Twitter rally to Congressional letters to industry appeals in order to continue delaying the code set indefinitely, the new list of challenges takes a bit of a different tack.  Instead of reiterating the AMA’s opposition to the codes, the list simply says that the AMA “has advocated for end-to-end testing, which will take place between January and March and should provide insight on potential disruptions from ICD-10 implementation, currently scheduled for Oct. 1.”

“Given the potential that policymakers may not approve further delays, ICD-10 resources can help physician practices ensure they are prepared for implementation of the new code set,” the section continues, which is some of the mildest language the AMA has used about the ICD-10 transition for some time.

Is there a little hint of resignation to defeat now that Congress itself has backed the 2015 implementation date, or will the AMA continue its lengthy fight until the very end?  The degree to which the AMA pushes resistance instead of readiness over the next few months may impact how many providers are prepared for the deadline and how many continue to pin their hopes on a postponement.

Other items on the list that will impact physicians in 2015 include the rampant abuse of prescription medications, the spread of diabetes and heart disease, and the need to adequately modernize medical education and the AMA’s Code of Medical Ethics.

The list also highlights the need to continue medical research and the sharing of clinical knowledge, to which end the AMA is launching JAMA Oncology, a new journal in its network of publications.  Physician satisfaction and the financial sustainability of medical practices is also on the AMA’s mind as it beta tests professional tools to help physicians chart a profitable course for the future.

To round out the top ten issues for the healthcare industry in the coming year, the AMA includes the need for reform to the Medicare physician payment system after the latest temporary Congressional SGR fix in April, the need to ensure adequate provider networks for patient care, and upcoming judicial rulings on healthcare-related issues such as liability, patient privacy, and the regulation of practices by state licensure boards.


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CMS Extends Hospital 2014 Meaningful Use Reporting Deadline | EHRintelligence.com

CMS Extends Hospital 2014 Meaningful Use Reporting Deadline | EHRintelligence.com | EHR and Health IT Consulting | Scoop.it

While this week marks the end of one and beginning of another year, those in the healthcare industry should take note of all that transpired in the previous year to avoid similar setbacks in 2015. This is especially true for matters scheduled to have been addressed over the last 12 months.

ICD-10 delays, meaningful use changes, health IT vendor competition, and EHR implementation gaffes. Based on the interest of our readers, those were the most popular topics of 2014 on EHRIntelligence.com.

ICD-10 transition delay one more year

More than any other topic on our news site, ICD-10 garners the greatest amount of our readership’s attention and given its high stakes, it makes sense. This past October was supposed to usher in a new era of clinical coding — the move from ICD-9 to ICD-10 — and put the United States on par with other leading nations in terms of healthcare documentation.

The Congressional debate over the sustainable growth rate (SGR), however, swiftly dashed those visions. Close to one week after expectations began to build that Congress would vote on an SGR patch that included a one-year ICD-10 compliance delay, the Senate voted in favor of the bill. While the rest of the nation took this as business as usual on the Hill, the healthcare industry scrambled to put new plans together for postponing their 2014 ICD-10 implementation activities.

What the delay meant to providers depended on where they practices. Larger healthcare organizations reported high levels of ICD-10 readiness while some smaller physician groups and practices were completely unsure where they stood. No matter their view of the most recent ICD-10 delay, most are committed to removing ICD-10 implementation pain points to be ICD-10 ready by Oct. 1, 2015.

The bending but not breaking of meaningful use

This past year began with eligible professionals and hospitals working to achieve Stage 2 Meaningful Use, but that is hard to do when certified EHR technology is unavailable.

Early hints of changes to meaningful use reporting in 2014 emerged as early as February when the Centers for Medicare & Medicaid Services (CMS) introduce a new meaningful use hardship exception dealing with a lack of available CEHRT.

In September, the federal agency finalized a rule intended to give providers greater flexibility in meeting meaningful use requirements in 2014 — known as the flexibility rule. However, this did not turn out to be CMS’s final move.

The flexibility rule was followed by the reopening of the meaningful use hardship exception application submission period for both EPs and EHs and the extension of the 2014 meaningful use attestation period for EHs and critical access hospitals through the end of the year.

Despite their intentions, neither has put to rest repeated calls for 2015 meaningful use reporting requirement changes by industry stakeholders.

Heading to a showdown

Prognosticators in health information technology (IT) have foreseen consolidation in the marketplace over the next few years. But it is unlikely that they saw things playing out as they did in 2014.

Cerner’s acquisition of Siemens Health Siemens over the summer is an example of how quickly and dramatically the market can change. Most viewed the maneuver as a power play by the Kansas City-based health IT company to contend with Epic Systems and its market share among health systems and hospitals.

While the growth of both Cerner and Epic continues to loom large over the industry, they still have to contend with numerous other players in the ambulatory care space, especially given Epic’s recent loss to athenahealth as the top overall software vendor over the past year.

Expect more to come.

Squeaky wheel gets the grease

When EHR implementations go well, those involved in the process are more than willing to share details of their experiences. When they don’t, it is like pulling teeth.

Poorly managed EHR implementations can prove costly. The University of Arizona Health Network saw red of a different variety as a result of its Epic EHR adoption. Whidbey General Hospital felt the financial effects of a software glitch in its MEDITECH EHR that crippled its billing system and left it short on cash. Meanwhile, a Cerner EHR implementation gone awry led to the dismissal of Athens Regional Medical Center’s CEO.

If 2014 was a busy year, then 2015 is only likely to be busier. Stay with us as we continue our coverage of meaningful use, EHR and ICD-10 implementation, and anything else health IT-related that comes our way.



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