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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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Monitoring ICD-10 Post-Implementation Issues

Monitoring ICD-10 Post-Implementation Issues | EHR and Health IT Consulting | Scoop.it

Planning and execution efforts toward successful ICD-10 implementation have been the largest resource-intensive undertaking by healthcare in decades. The last couple of years have enlisted dedicated planning by government agencies, healthcare plans, EHR vendors, and health information educators in facilitating the transition from ICD-9 to ICD-10.


The cost of ICD-10 preparation was a valid concern for healthcare. Physicians and other qualified healthcare providers were impacted financially with making initial capital investment in certified EHR systems. The cost of initial training for their private clinics or group practices added to expenditures. Time and resources have been allocated to electronic data exchange testing over two fiscal years in anticipation of possible system interface and program incompatibilities. Concurrently, healthcare professionals had prepared for the code system changes by participating in provider-to-vendor testing while EHR companies, clearinghouses, and healthcare plans have been focused on vendor-to-payer data transmission.


The healthcare industry had ample time to analyze the factors that currently affect efficient and uninterrupted quality healthcare, but have healthcare providers anticipated the factors that will affect their practices after implementation?


A national effort to transition to a new and improved, but vastly different coding system inevitably affects various groups and multiple healthcare transactions. As a result of inaccurate data capture and delays in medical billing, it is critical that providers and administration examine how ICD-10 impacts patient care and reimbursement.

There are different factors that contribute to inferior health data reporting and to delays in provider cash flow:


INACCURATE DATA CAPTURED


1. EHR keywords tend to mimic the alphabetic index of the code book and are not set up in user-friendly clinical terms. Physicians and other qualified healthcare providers may have difficulty in locating the most specific and accurate ICD-10 code when using keyword search and look-up tools in their EHR.


2. Physician documentation practices may not correlate to main terms and subterms in which the ICD-10 code book or electronic code books are organized, making it more challenging for coders or other designated staff members to find the most appropriate code based on the completed notes.


3. Lack of physician engagement and the decision to not seek training in ICD-10 documentation lends itself to inconsistencies of code assignments from one healthcare provider to another. Many EHR products carry over the diagnosed conditions in the patient's current and past medical history. Other providers from the same practice may choose to assign these same ICD-10 codes previously noted in the record. Even if the providers were to decide to assign their own code and not carry over the previous ones, the lack of uniformity in the practice not only implies that there are coding errors being made, but that the data collected by insurance carriers, independent research groups, government agencies, and public health organizations is not a valid representation of current illnesses. Additionally, incorrect data exchanged across electronic systems is useless information and potentially harmful to the patient's health when shared with outside healthcare providers and facilities involved in the care of the same patient. The movement toward ICD-10 was fueled by a critical need to improve the quality and effectiveness of patient care. Inconsistent and inaccurate data quality thwarts this purpose.


4. General Equivalent Mapping (GEMs) resources are intended to provide the most approximate equivalent code from ICD-9, cross-walked to each possible ICD-10 code. The translation is not a perfect one because ICD-10 includes a plethora of information that previously had not been part of the ICD-9 code description. For example, ICD-10-CM introduces combination codes that detail the underlying disease and current manifestation, routinely seen in diabetes affecting other organ systems. The new coding system has established several new concepts and features for


ICD-10 diagnostic codes, allowing providers to:


• Include information on laterality

• Identify if it is the patient's initial encounter

• Identify the gestational trimester in which the disease process was diagnosed (including the severity of illness)

• Include the external cause

• Expand on the description of injuries, fractures, complications, adverse effects, and poisonings to now include very particular information, such as:

– The Gustilo grade of an open fracture

– If underdosing or noncompliance is due to medication cost-reduction

– If the provider is treating a pregnant patient for a particular condition that first developed during the mentioned trimester and not the episode of care that she presented for

– If the resulting complication resulted intraoperatively or postoperatively


While GEMs serve as a time-saving tool, the matching ratio from ICD-9 to ICD-10 is most frequently not a perfect 1:1 correlation. Most ICD-9 codes will map out to multiple possible options for correct ICD-10 code selection. Exclusive reliance on the GEMs will lead to incorrect code submission on billing claims.


REVENUE DELAYS AND REIMBURSEMENT REDUCTIONS


1. The medical profession continues to be reimbursed on our current fee-for-service (FFS) system. National and Local Coverage Determination policies issued by CMS list and detail the diagnostic codes for symptoms and conditions that necessitate commonly performed diagnostic or therapeutic procedures. These acceptable diagnostic codes support the ordering or performing of any diagnostic tests or treatments. Incorrect ICD-10-CM assignment increases the number of "medical necessity" denials for CPT and HCPCS II procedures billed by physician practices.


2. CMS released data on healthcare providers, clearinghouses, and billing companies that participated in their July 2015 end-to-end testing with MACs and DMEs. Medicare published information stating 29,286 claims were received, but only 25,646 were accepted. Additionally, 52.7 percent of all submitted claims were professional services from healthcare providers, 2.6 percent of claims denied by CMS were due to submission of invalid ICD-9-CM codes, and 1.8 percent were due to invalid ICD-10 codes. This 4.4 percent denial rate was higher than the 3 percent reported in April's end-to-end denials. Health information managers (HIM) and providers spent 36 years learning how to assign three-digit to five-digit codes for a complete code selection. Now, providers and coders have to correctly select the required number of alphanumeric characters — anywhere from three characters to seven characters. Denials for invalid code submission further delay provider reimbursement.


3. Code assignment errors increase with untrained clerical and ancillary staff responsible for reviewing billed codes. Coding errors include: incorrectly assigned unspecified codes, codes of lesser specificity, missed diagnostic codes, and symptoms. This is especially critical for practices engaged in the HCC Risk Adjustment coding incentives in which captured data for severity of illness and comorbidities is directly tied to annual financial incentives for the practice.


4. The nearly quintuple growth in available diagnostic codes presents challenges when physician practices redesign their encounter form or superbill. Practices have to be selective about which commonly used diagnostic codes will be featured on the superbill for quick reference and which will be excluded.


5. Medical coders increase the number of queries addressed to healthcare providers for incomplete documentation and unspecified diagnostic conditions. While this is most likely to occur in the inpatient setting, physician practices with in-house medical coders will have billing claims held until the providers adequately respond to clarification requests.


6. Productivity rates decrease because of the increased time required to document properly for specific codes. Medical coders and HIM professionals take additional time to accurately locate and sequence the appropriate codes based on documentation. The increase delay in billing the professional claims increase the number of days in A/R and adversely affect the practice's cash flow. Independent providers and provider practices had been advised to budget for the anticipated financial impact at least six months prior to implementation.


EFFECTIVE MANAGEMENT AFTER OCT. 1


Several measures should be taken in order to streamline the transition in medical practices. Examination and revision of internal policies and processes is essential to ensuring that quality patient data is captured, while maintaining compliance in billing practices.


1. Provider practices should seek assistance from the EHR vendor.


• Vendors are best equipped to provide training and can also instruct office managers on how to run reports detailing the 50 most commonly used diagnostic and symptom codes in the practice.


• EHR companies can effectively re-label many diagnostic codes so that the keyword or main term appears as the clinician deems natural, and not necessarily as the medical coder is trained to look them up in the alphabetic index of the code book.


2. Practices should rely on industry resources for proper coding guidance.


• The American Hospital Association (AHA) publishes quarterly guidance on ICD-9-CM and now ICD-10 code assignment. Many challenging coding questions have been posed to the AHA by medical coders and the responses are available and organized by ICD-9 and ICD-10 codes.


• CMS has publicly released physician guidance on ICD-10-CM coding in multiple medical specialties. Information tips are available to registrants of their listserv. Also, the "Road to 10" online resources are specifically designed to assist physician practices in raising awareness and promoting physician engagement, as well as offering free training for physicians and other healthcare providers.


• The National Center for Health Statistics (NCHS), an agency under the Centers for Disease Control, has additional resources. NCHS offers official guidelines on proper ICD-10-CM and ICD-10-PCS code assignment.


• The ICD-10-CM/PCS Transition Workgroup is an online community forum hosted and managed by the NCHS (on phConnect Collaboration for Public Health) to assist physicians in this implementation (visit bit.ly/PHC-ICD10 for more information).


• The American Health Information Management Association (AHIMA) offers a number of physician coding resources, including an "ICD-10 Toolkit" developed in 2012 which still proves relevant and instrumental today (visit bit.ly/AHIMA-ICD10-toolkit for more information).


• The AMA has printed and electronic ICD-10 publications on coding and documentation intended for providers. They offer online and live training for physicians.


Practices will need training and retraining after reevaluating post-implementation operations. Staff members come and go and providers may take medical posts in other organizations. Consistent and high-quality data reporting is essential and will directly impact practices as our healthcare industry phases out the FFS model and moves toward a value-based payment model. Practices should be making provisions for educational reinforcement after ICD-10 implementation, and should strongly consider the benefits of employing certified medical coders and HIM professionals.


BEST PRACTICES


The financial health of physician outpatient practices is affected by accurate ICD-10 coding. Just as importantly, patient health outcomes are directly tied to proper coding. Proper planning is key to compliance and optimal revenue management.


Continuing education and employment of certified coders will minimize coding errors. Close monitoring of the revenue cycle and reassessment of internal processes will help identify gaps. Utilizing industry resources is a cost-effective means of improving processes. All of these combined are ingredients in the best recipe for post-implementation success.

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Four ICD-10 Myths from a Critical Doc

Four ICD-10 Myths from a Critical Doc | EHR and Health IT Consulting | Scoop.it

Have you ever stood near the tracks and listened to a train coming? When the train is far away all you can hear is the distant echo of the whistle. It’s easy to ignore.  As the train gets closer you hear the engine and see the smoke. As the train comes to the station it becomes a thundering, screeching, hissing mass of steel.

If you are close enough, it can even startle you.


With an Oct. 1 start date imminent, the ICD-10 train is getting awfully close. Anyone harboring hopes of Congress rescuing us at the last minute is kidding himself. If your practice is not prepared, there are plenty of health IT companies out there who will gladly take your money to rescue you safely away from the tracks.


The supporters of ICD-10 —bureaucrats, health IT vendors, and medical academicians —have been assuring us this is for our own good. The era of big data in healthcare is coming, so they say, and ICD-10 is the perfect vehicle for collecting the rich, detailed data that will bring the next big age of medicine. ICD-9 is decades old and needs to be replaced by a system which can accommodate the advances in diagnostic acumen of recent years. Privately, these groups ridicule our misgivings and assume that we’ll complain for a while and just get over it.


Last February, Congress held hearings on ICD-10. This was supposed to be the last decision-making step before committing to the program. In reality, it was a choreographed farce designed to suppress the concerns of real-world physicians. The witnesses included two health IT vendors, two lobbyist groups, one academic physician, and two private practice physicians. All but one of the witnesses, the late urologist and president of the Medical Association of the State of Alabama, Jeff Terry, supported ICD-10.  Most of the remaining witnesses either stood to benefit financially from ICD-10 or were insulated from its effects by the academic environment.


But there is more to ICD-10 than the propaganda peddled by supporters.  Let’s look at some of the myths about ICD-10:


1. ICD-9 is outdated and needs to be replaced.  The former is true.  The latter is not.  The structure of ICD-9 (five numeric placeholders) theoretically allows for 100,000 codes.  ICD-9 could have been easily expanded by adding one or two placeholders and allowing letters to be used. This would expand capacity to over two billion codes. It would have allowed horizontal expansion (i.e., the addition of Ebola infection to the appropriate category —a favorite example of ICD-10 supporters) as well as vertical expansion (the breakdown of otitis media into left vs. right).  This could have been done without rendering any ICD-9 codes obsolete. 


2. ICD-10 based big data will improve patient care.  ICD-10 supporters would have us believe that ICD-10 based data will lead to medical miracles falling from the sky.  These utopian fantasies fail to consider the implications of the scientific method.  Medical advancements come only from experiments based on hypotheses.  Hypotheses dictate experimental design, including the methods and structure of data collection.  Lacking any hypotheses, ICD-10 creates a one-size-fits-all data collection method for all fields of medicine.  This makes absolutely no sense.


3. ICD-10 will improve quality of data collection.  I almost believed this until I began to prepare my practice for ICD-10 months ago.  Instead of a rational expansion of diagnoses I found —for my specialty, at least —a haphazard, nonsensical collection of codes created seemingly at random.  I’m not talking about the “burned by water skis on fire” stuff we have all heard about.  I discovered that every code related to ear pathology is obsessively divided into left ear, right ear, or both.  Even “vertigo of central (nervous system) origin,” which by definition does not involve the ears, requires a choice of left or right ear!  But other diagnoses —facial paralysis, head and neck cancers, sinusitis, and others —have no ICD-10 division by side.  The diagnosis of vocal cord paralysis, in which the side of involvement has long been recognized to be clinically significant, is not separated by side.  In fact ICD-10 has fewer codes for vocal cord paralysis than does ICD-9.  Does this mean that ear disorders are more worthy of big data research than sinusitis, head and neck cancer and vocal cord paralysis?  Who decided that?  There is no way, for otolaryngology at least, that such a poorly designed coding system will yield any useful data.  Don’t hold your breath waiting for any big data medical miracles.


4. Third-party payers are ready.  Who are they kidding?  Didn’t CMS claim that healthcare.gov was ready two years ago?  How many test payments to providers were sent?  There is no way to adequately test a system this complex before it goes live. Remember that CMS and private insurers have no risk on the table.  If their systems “mysteriously” fail to pay claims, they benefit by keeping the cash they would otherwise have paid out.  On the other hand, physicians will be unable to pay rent and make payroll if payments on claims are interrupted more than a few days.


The only rationale that explains ICD-10 is the desire of its supporters for a top-down, big government, centrally controlled healthcare system that regards doctors and patients as nothing more than cogs in the machine.  The folks at the top fancy themselves worthy of conscripting the rest of us into becoming uncompensated data collectors.  Doctors know that quality of care starts from the bottom, not the top —with a doctor, a patient, an exam room, and a conversation.  At best, ICD-10 will be an expensive distraction that draws money and time away from patient care.  At worst, it will paralyze the health care system.

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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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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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Medicare Will Not Deny Claims for Minor ICD-10 Errors

Medicare Will Not Deny Claims for Minor ICD-10 Errors | EHR and Health IT Consulting | Scoop.it

The Centers for Medicare & Medicaid Services (CMS) have provided a new guidance for healthcare providers that are attempting to meet the ICD-10 transition deadline on October 1. Many medical care professionals and clinicians are concerned that they may see their claims denied due to minor ICD-10 errors when filing claims in October and beyond.


However, the CMS guidance will put physician fears to rest, as it includes a clause stating that Medicare will not be denying claims for 12 months due to minor ICD-10 errors such as mistakes regarding the specificity of the ICD-10 diagnosis code as long as the codes used come from the right group.


“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. However, a valid ICD-10 code will be required on all claims starting on October 1, 2015,” the CMS guidance stated.


CMS is also planning to develop a stronger communication and collaboration platform that can help keep better track of any ICD-10 implementation issues and prevent minor ICD-10 errors. CMS has established an ICD-10 Ombudsman to better understand provider issues and solve any problems in a more efficient manner. Once the ICD-10 transition deadline gets closer, CMS will be issuing ways for providers to reach out to the Ombudsman.


When it comes to quality reporting, using incorrect specificity of an ICD-10 diagnosis code in program year 2015 would be considered part of minor ICD-10 errors and would not be subject to auditing or source verification as long as the code came from the “correct family of codes.”


“When the Part B Medicare Contractors are unable to process claims within established time limits because of administrative problems, such as contractor system malfunction or implementation problems, an advance payment may be available,” the guidance explains. “An advance payment is a conditional partial payment, which requires repayment, and may be issued when the conditions described in CMS regulations at 42 CFR Section 421.214 are met. To apply for an advance payment, the Medicare physician/supplier is required to submit the request to their appropriate Medicare Administrative Contractor (MAC).”


The news that claims due to minor ICD-10 errors will not be denied is sure to allay the fears of many physicians across the country. However, preparing for the coming ICD-10 transition is still vital, as valid ICD-10 codes are still a requirement for billing starting on October 1, 2015. CMS recommends providers to make a plan for meeting the deadline, train staff, update processes, improve communication among vendors along with payers, and test relevant systems and processes. With the guidance and assistance of CMS, the healthcare industry should be geared up to effectively transition to the new coding set by deadline.

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Non-profit startup launches free ICD-10 conversion tools

Non-profit startup launches free ICD-10 conversion tools | EHR and Health IT Consulting | Scoop.it

Providers looking for software to ease the ICD-10 transition got a new quiver of options – thanks to a medical student. 


ICD-10 Charts, in fact, joined a growing crop of software tools coming to market as the countdown to compliance keeps moving ahead. What makes it unique, however, is the bold claim that the free software it updated on Tuesday essentially walks providers through the conversion in four steps.


The first tool, ICD-10 Charts Bulk Converter, can be used to transition a user's existing ICD-9 data to ICD-10 for as many as 10,000 codes. Second is to organize that information and once the new codes are in Chart Builder, providers can sort, search, edit, rearrange and remove them and by using the Combination Coder functionality users can consolidate related ICD-9 codes into a single ICD-10 instance. 


The third step is to integrate ICD-10 Chart into the providers practice. That tool enables physicians to save, print or export charts into either Excel files or a variety of EHRs.


For the fourth and final step ICD-10 Charts also made available the Training Academy portal comprising more than 25 modules with both general ICD-10 information and specifics for specialists.

Size and timing

The Centers for Medicare and Medicaid Services tossed hospital executives and industry observers something of a surprise on Monday by conceding to a one-year period in which it will not deny erroneous claims after the October 1, 2015, compliance deadline, so long as those are submitted in ICD-10.


Whereas ICD-10 Charts is not likely to have broad appeal among large or tech-savvy providers already making way toward ICD-10, CMS' move means that now is a good time for any mid-size or small practices and specialty groups to evaluate their options for migrating to the new codes.


Indeed, plenty of options exist, ranging from 3M Health Information Systems recently-launched suite of conversion and workflow tools for ICD-10, offerings from Trizetto and Proviti.


Some EHR vendors, including Amazing Charts, athenahealth, NextGen, Practice Fusion and others are advertising that they will help customers meet the mandate.


Industry associations such as the AAPC, AHIMA and Healthcare IT News owner HIMSS, meanwhile, are making available crosswalks, educational and other resources. And there are some easy-to-find online tools for anyone who only needs to convert to ICD-10 one code at a time. 

Why it's free

ICD-10 Charts co-founder Parth Desai first met ICD-9 back in high school. At that time he was working for his father, in the family's internal medicine practice, where his mother served as, among other roles, a medical coder.


Then, two years after earning an undergraduate degree, Desai moved back home before medical school, was introduced to ICD-10, and recognized immediately how difficult it could be for physicians.


"My mom said, 'you have to find us a training program to get our codes done,'" Desai said. "There were plenty of good tools on the market, but none of them catered to practices. They were just too expensive."

So ICD-10 Charts went a different direction. This spring, in fact, with about 10,000 visitors to its site and some 5,000 users, Desai took the beta to his school, Mercer University School of Medicine, and switched to a virtual private server with capacity for at least 1 million simultaneous users and the ability to add more if needed.


"I'm in medical school, my dad's a physician, my brother's a physician, my girlfriend, she's in med school. Our main interest is in helping people – especially these practices struggling with so much," Desai explained. "The last thing I wanted was for my dad to shut his practice and work at a hospital because of regulations and not because he's ready to retire."

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Is Dual Coding an Effective ICD-10 Training Strategy?

Is Dual Coding an Effective ICD-10 Training Strategy? | EHR and Health IT Consulting | Scoop.it

With the October 1 deadline only a mere three months away, following an effective ICD-10 training strategy is of the utmost importance in order to receive standard reimbursement from the Centers for Medicare & Medicaid Services (CMS) as well as other insurers.

One ICD-10 training strategy that a particular medical care organization followed is to dual code diagnostic records and claims in both ICD-9 and ICD-10 coding sets. The Journal of AHIMA reported that the health information management department at Baystate Health has been coding records in ICD-9 and ICD-10 since the beginning of 2014.


This type of dual-coding ICD-10 training strategy has been effective at showing healthcare professionals how the new coding set compares with the older ICD-9 codes. Recently, the organization has taken it one step further. Baystate Health’s new ICD-10 training strategy is to spend one day per week coding in only ICD-10.


This extra time spent on only coding via the new diagnostic and procedural codes will help the healthcare staff at this facility understand what their workflows will be like by the ICD-10 transition deadline on October 1, 2015.


It may benefit more healthcare organizations to use this ICD-10 training strategy and spend some time coding in only ICD-10 before the deadline takes place. The way Baystate Health has developed the new strategy is by having one individual complete the necessary codes in ICD-10 one day per week while another professional codes the same record in ICD-9 immediately afterward.


There are a variety of benefits when it comes to coding in only ICD-10 and preparing for the October 1 deadline. Instead of having to switch back and forth between two coding sets, healthcare professionals will be able to focus more on the new codes during a longer time period.

Healthcare providers should be prepared for the October 1 deadline as it is unlikely any more ICD-10 delays will take place. While there are a variety of organizations that have attempted to postpone the deadline or put an end to the coding transition altogether, the Centers for Medicare & Medicaid Services (CMS), the Coalition for ICD-10, and other federal agencies seem focused on sticking to the deadline regardless.


“Calls for a safe harbor or grace period based on code specificity appear to be a reaction to physicians’ fears that there will be a huge uptick in claims denials if non-specific codes are reported,” the Coalition for ICD-10 reported. “However, these fears are refuted by the results of CMS’ recent end-to-end testing, which showed only a 2% denial rate associated with ICD-10-related errors, thus demonstrating that the transition to ICD-10 will have a minimal impact on the rate of claims denials.”


“A safe harbor for the use of non-specific codes is unnecessary and detracts industry attention from getting ready for the ICD-10 compliance date. There is no evidence supporting the need for a safe harbor,” the Coalition for ICD-10 continued.

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Physician Organizations Fear ICD-10 Integration Disruptions

Physician Organizations Fear ICD-10 Integration Disruptions | EHR and Health IT Consulting | Scoop.it

While the Centers for Medicare & Medicaid Services (CMS) continue to urge healthcare providers to prepare for the coming ICD-10 integration, many stakeholders are concerned that the healthcare industry will encounter large disruptions to patient care services and financial reimbursements if the ICD-10 compliance deadline remains steadfast.


In its latest mailing, CMS encourages providers to train their staff on ICD-10 coding with the Quick Start Guide. In the meantime, representatives from the California Medical Association, Florida Medical Association, Medical Society of the State of New York, and the Texas Medical Association sent a letter to Andy Slavitt, Acting Administrator at CMS, asking for additional assistance with the ICD-10 integration.


In particular, the organizations are asking CMS to develop a two-year ICD-10 integration period during which doctors will not be penalized for any coding mistakes or system malfunctions. Additionally, the letter asks for a two-year ICD-10 transition period that prevents audits from taking place due to ICD-10 coding errors. The medical organizations are urging CMS to prevent physician payment reductions due to ICD-10 coding mistakes throughout the two-year period.


“The Oct. 1 mandatory implementation of the ICD-10-CM coding system is a looming disaster,” the letter to CMS exclaimed. “The results of the recent end-to-end tests give us little confidence that the nation’s physicians, electronic health records, claims clearinghouses, commercial insurance companies, and government agencies will be ready when we ‘throw the switch’ to ICD-10.”


“The voluminous technical problems associated with the far simpler adoption of the National Provider Identifier and the HIPAA 5010 transaction standards give us even further cause for concern,” the letter continues. “Even those practices that are most prepared for this transition tell us they worry about the confusion and reduced productivity they expect to accompany ICD-10.”


Since many physician organizations and healthcare providers are concerned with meeting the deadline for the ICD-10 integration and a multitude of bills are coming out to support a modified transition period, the American College of Rheumatology created a policy brief that outlines six myths and facts about the ICD-TEN Act (H.R. 2247).

First, there is a general misconception that the ICD-TEN Act will undermine coverage and healthcare quality, the organization explained. However, the bill made a “distinction between diagnosis code errors and sub-code errors.”


Additionally, many believe that the ‘Safe Harbor’ provisions discount the fact that CMS must make sure providers are paid appropriately for their services. However, medical coverage and medical necessity can be assessed using the correct ICD-10 diagnosis codes instead of the sub-codes, which is what the ICD-TEN Act focuses on.

Along with these potential myths, many feel that the ‘Safe Harbor’ provisions could lead to incomplete documentation. However, the American College of Rheumatology explains that the ICD-TEN Act will remain accountable for ensuring “coding specificity is achieved without disrupting patient care.”


“Sub-codes most often indicate subtypes or locations of disease. While this specificity is beneficial for disease surveillance and some treatment decisions, it is not relevant to determination of coverage or medical necessity, and should not be used to deny payment for services rendered,” Dr. William Harvey, a practicing rheumatologist and chair of the ACR Government Affairs Committee, said in a public statement. “The ICD-TEN Act is carefully worded to allow Medicare to continue to accurately determine medical coverage and medical necessity using the new base ICD-10 diagnosis codes.”   

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Physician Practices Still Lagging With ICD-10 Prep, Testing

Physician Practices Still Lagging With ICD-10 Prep, Testing | EHR and Health IT Consulting | Scoop.it

Provider organizations have completed many key steps in the ICD-10 implementation process, but are still lag behind in testing, according to a new survey from the eHealth Initiative and the American Health Information Management Association (AHIMA).


The survey, which is done annually, polled 271 providers, and was conducted between May and June of this year. Overall, 78 percent of those surveyed said they are providing ICD-10 resources and educational materials to their staff; 73 percent said they are creating teams to assess readiness and make implementation preparations; 72 percent said they are training staff on ICD-10 use; 66 percent said they are updating their systems to support ICD-10 codes; and 64 percent reported they are reviewing internal processes and workflows.


In terms of preparation for the ICD-10 transition, 50 percent of respondents said they have conducted test transactions with payers and clearinghouses; 34 percent said they have completed all internal testing; and 17 percent said they have completed all external testing. Only 19 percent of respondents reported having no plans to conduct end-to-end testing.


However, the results differed when broken down into hospitals and physician practices. Most hospitals (85 percent) have trained their staffs on using ICD-10, compared with 41 percent of physician practices. Sixty-four percent of hospitals have budgeted for time and costs associated with the transition, while just 19 percent of practices have done the same. Seventy-two percent of hospitals said they performed the necessary system upgrades and updates to support ICD-10, compared with 36 percent of physician practices. And six in 10 hospitals said they conducted test transactions using ICD-10 codes with payers and clearinghouses, compared with just 17 percent of practices. The research also found that the larger the organization, the more prepared it was.


What’s more, despite limited testing and evaluation, organizations generally believe ICD-10 will reduce revenues: 38 percent of those surveyed said that revenue will decrease; 21 percent said revenue won’t be affected; 6 percent said revenue will increase; and 34 percent said that his or her organization has not conducted a revenue impact assessment. The biggest reasons for why there would be a decrease in revenue were: transition will result in increased number of denied claims or decreased reimbursement (78 percent); and reduced coding productivity or accuracy will increase costs (80 percent).


However, organizations recognize many long term benefits of ICD-10, a growing sentiment since last year’s survey, according to the research. Also, most respondents expect to continue managing the impact of ICD-10 following the deadline, the data revealed.

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ICD-10: A Patients Perspective

ICD-10: A Patients Perspective | EHR and Health IT Consulting | Scoop.it

With ICD-10 coming in 111 days, as a patient I start to stress out about how it might impact me.  A physician once told me that “90% of physicians are already doing the required ICD-10 documentation, but they just need to add laterality in order to be more specific”.  Sounds simple, but is this statement truly accurate?  And if not, what will the downstream impact be to patients?


Let’s deep dive into the patient experience in the current ICD-9 world.  A simple health maintenance exam with vital signs (pulse oximetry included) and a urine dip would generally be covered by many insurers.  In the ideal world, this occurs without any added hassle to the patient, but what if the urine dip is “abnormal” and gets sent for a culture with an ICD-9 code of V70.0 (Routine General Medical Examination)?  The culture likely won’t be covered and the patient may eventually receive a bill for services that otherwise would have been covered by the insurance company had the test been associated with the correct supporting diagnosis.  A patient without insight into medical billing may just pay out of pocket without further research into why the services were not covered by the insurer.  In some cases however, a patient with a medical background may be savvy enough to recognize the problem was related to an incorrect ICD-9 code assignment. 


Given the abnormal urine dip, the culture should have been billed with a problem code and not a health maintenance code.  Had this been done, the patient may not have been responsible for the entire balance of the culture. The patient in this example notified her provider’s office of the problem, and even explained to the billing personnel how to fix the problem.  Six months later, she was still stuck in the midst of what I will label as “healthcare gridlock”.  The insurance company would pay for the culture if a problem code were submitted, but the billing office couldn’t change the code without the doctor first adding the appropriate documentation to the record.


If provider documentation isn’t clear and concise enough to get to an appropriate ICD-9 code now, then fast forward to October 1, 2015 when ICD-10 is relevant, who suffers?  Sure the provider’s office will not receive adequate payment (or none at all) for services rendered, but will the patient be left to pick up the pieces?  If we can’t get it right in ICD-9 (and the aforementioned scenario seems to happen far too often) then how are we so confident that those 90% of providers will get it right in ICD-10?  Rather than assuming that risk and potentially putting patients in difficult financial situations, wouldn’t it be helpful to add prompts to your existing EHR so that providers are clear on what MUST be documented to reach an appropriate ICD-10?  With all of the initiatives and mandates that providers are subjected to these days, we can help ease their transition to ICD-10 by customizing your EHR templates to support thorough and efficient ICD-10 documentation workflows.


When all is said and done, if it isn’t correctly documented, then it wasn’t done (at least that is what a coder might have to assume) and chances are that the patient will have to eat some portion, or even the entirety, of the bill.  With Galen’s Clinical Documentation Improvement service offering, our goal is simple – to make sure your organization is well prepared for ICD-10 so you can get paid and patients do not have to suffer.

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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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ICD-10 implementation: Examining the potential aftermath

ICD-10 implementation: Examining the potential aftermath | EHR and Health IT Consulting | Scoop.it

It's up to health information management leaders to help their facilities understand what to expect when the ICD-10 deadline hits Oct. 1, six months after that and beyond, according to anarticle published in the Journal of the American Health Information Management Association.


The article examines what doctors and hospitals can expect beyond October in three phases:


  • Implementation to six months: A drop in coder productivity is expected across the board, though facilities that have practiced dual coding or engaged in end-to-end testing will be much better off, the article notes. There's a big difference between learning a coding system and being able to understand clinical factors of a diagnosis. Pat Maccariella-Hafey, director of education at Health Information Associates, says organizations should focus on making sure coders have a strong understanding of the guidelines of ICD root operations. Training should continue well after Oct. 1, and HIM departments will need to be prepared to defend their code assignments for accurate and timely reimbursement.
  • One to five years post-implementation: Sandra Kersten, a senior consultant for eCatalyst Healthcare Solutions currently assigned as an ICD-10 project manager at a Chicago-area hospital, foresees a permanent reduction in coder productivity, making it a smart move for hospitals to invest in extra coders. This is an opportunity for students and less-experienced coders, according to the article, because no one will have that much experience with ICD-10. Maccariella-Hafey foresees coders becoming more educated in the clinical aspects of medicine and surgery. And the benefits of more precise, accurate data from ICD-10 are expected to be felt within the overall healthcare system as well, providing a better view of the quality of patient care and patient self-management.
  • Five to 10 years later: A major expectation about ICD-10 is that it will help stimulate programs like patient-centered medical homes, value-based purchasing, and accountable care organizations by giving the government and care management organizations better data to work with. Everyone stands to benefit from improved data quality, according to Maccariella-Hafey. Researchers and public health-monitoring organizations are expected to be able to compare data apples to apples for global disease monitoring.


Some organizations still believe there will be another ICD-10 delay, while the American Medical Association has backed legislation to ban the implementation altogether.


In addition, House lawmakers are calling on the Centers for Medicare & Medicaid Services to make any ICD-10 contingency plan they may have public.

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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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ICD-10 Compliance a Struggle for Some Physician Practices

ICD-10 Compliance a Struggle for Some Physician Practices | EHR and Health IT Consulting | Scoop.it

October 1 has come and gone, and nearly two weeks in to ICD-10 compliance most of the healthcare industry is relatively mum on the transition to the newer clinical diagnostic and procedural code set. More than likely, healthcare organizations and professionals are busy enough adapting to ICD-10 and its more specific set of codes.

That’s not to say some are not speaking out or in support of ICD-10 compliance.


Two recent weekend reports in the Florida’s Crestview News Bulletin and Maine’s Bangor Daily News paint two very different pictures of ICD-10 compliance at the two-week mark.


Apparently, some physician practices in the Florida panhandle are going through the motions in adapting to the federal mandate for ICD-10 compliance which began back on October 1. Brian Hughes reports that medical offices are encountering difficulties with the code set.


“Large practices and medical companies, such as Peoples’ Home Health, usually have coders on staff. Their only job is to enter the numbers into billing records and insurance reimbursement forms,” he writes. “For smaller offices like Dr. Herf’s and Mir’s, the increased coding tasks take away staffers’ time with patients.”


Betty Jordan, the manager of physician practice of Abdul Mir, MD, views ICD-10 as more of a hindrance than a help.


“It requires so much extra work. If my doctor treated someone for rheumatoid arthritis, there’s hundreds of codes. It’s got to be specific,” she told the Crestview News Bulletin.


“It is horrible for a primary care doctor,” she further revealed. “For a specialist, they deal with the same things over and over. For us in family practice, we see all kinds of things. It’s overwhelming.”

For an administrator at the practice of David Herf, MD, the challenge of ICD-10 compliance is the result of increased specificity being married to an increase amount detail.


“It’s really, really detailed,” Andrew Linares told the news outlet. “Instead of just saying, ‘cyst of the arm or trunk,’ you have to get really specific.”


For one of the physician practices, adapting to ICD-10 is akin to learning a whole new language.


The climate in Maine appears much sunnier regarding ICD-10 compliance. Jen Lynds reports high levels of preparation among Maine healthcare organizations and professionals leading to a smooth transition.


“Health care providers across the state began working Oct. 1 with a new system of medical codes that has them describing illnesses and injuries in more detail than ever before, and officials from hospitals and medical associations said earlier this week that they are prepared for the challenge,” she writes.


According to Gordon H. Smith, the Executive Vice President of the Maine Medical Association, complaints are scarce as are ICD-10 implementation delays. Director of Communications for the Maine Hospital Association reports the same situation.


That being said, leadership at Eastern Maine Medical Center are preparing for transition-related productivity decreases for coders and billers used to the previous code set. However, things are still proceeding as planned.


“Our transition to ICD-10 has gone very smoothly here at Eastern Maine Medical Center,” Director of Coding and Clinical Documentation Improvement Mandy Reid told the Bangor Daily News. “We are using nine contract coders through outside vendors to support the ICD-10 go-live, and we secured them several months ago to be prepared. We also have added three positions in the outpatient area to help support growing volume, as well as ICD-10 coding.”


The lesson learned so far is that a clinical practice’s ability to invest in ICD-10 preparation (e.g., training) correlates to its present-day confidence in ICD-10 compliance.

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CMS Confirms Readiness to Assist During ICD-10 Transition

CMS Confirms Readiness to Assist During ICD-10 Transition | EHR and Health IT Consulting | Scoop.it

The ICD-10 compliance deadline of October 1 is less than a week away, creating a frenzy of preparation amongst coders, billers, and providers. The Centers for Medicare & Medicaid Services (CMS) senior officials recently held a conference call to answer questions regarding implementation, and specifically addressed the issue of CMS as a resource come October 1.


The September 24 call included CMS Principal Deputy Administrator Patrick H. Conway, MD, MSc, and ICD-10’s recently appointed ombudsman William Rogers, MD.


The bulk of the call consisted of a question and answer session which generally revolved around the roll of CMS as a resource for clinician practices experiencing issues with transition. Specifically, many callers were concerned with the potential government shutdown that could occur on October 1 if Congress cannot reach an agreement on the federal budget.


“In the event of a shutdown, we will continue -- and I want to be clear on this -- to pay claims,” Conway said. “We will continue to implement the ICD transition.”


Rogers made it clear that the Medicare administrative contractors (MACs) would still be working in the event of a shutdown, so claims will be accepted and paid during that time.


Conway elaborated on that point during another question, stating that payment systems are an essential part of the Medicare program and would still function in the event of a shutdown.


“In terms of staffing, we do have the flexibility to ensure core operations are operational and in effect,” Conway stated. “And obviously, our payment systems are a core piece of the Medicare program that will continue to be fully operational.”


Conway also addressed the issue of claims processing timelines and how that will affect real-time assessments of the transition. Although it would be ideal for CMS to have a clear idea of the state of the transition as soon as it occurs, Conway explains that due to the typical billing timeline, it will in reality take about one billing cycle.


“The Medicaid claims can take up to 30 days to be submitted and processed,” he said. “This end can take approximately two weeks. The Medicaid claims can take up to 30 days to be submitted and processed. For this reason, we expect to have more detailed information after a full billing cycle is complete.”


The questions on the call revolved around the cost of ICD-10 implementation, especially considering systems upgrades. According to Conway, the cost greatly relied on the specific circumstance of the practice or facility. Rogers shed light on the costs for smaller practices.

“[M]ost smaller practices just use a super bill,” Rogers explained. “t requires a little bit of an expansion of the number of diagnoses on the superbill. But they can easily cross walk their ICD-9 based super bill to an ICD-10 super bill.”


Rogers also assured callers that CMS has ample resources to ensure a smooth transition, and that they themselves will be able to serve as a resource for clinician practices. He explained that he, along with all of CMS, can serve as a major resource for providers who have questions regarding the transition process, and encourages providers to contact the ombudsman email address when in need of assistance.

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ICD-10 Implementation Progresses; Doc Practices Lag

ICD-10 Implementation Progresses; Doc Practices Lag | EHR and Health IT Consulting | Scoop.it

The latest ICD-10 readiness survey from the Workgroup for Electronic Data Interchange (WEDI) shows industry-wide progress in preparing for the ICD-10 implementation deadline although physician practices continue to lag behind health IT vendors, health plans, and health systems.


"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 states in a letter to the Department of Health & Human Services Secretary Sylvia Mathews Burwell.


Speculation about another ICD-10 delay contributed to the industry's ICD-10 preparation, WEDI claims.


"Uncertainty over further delays was listed as a top obstacle across all industry segments. While the delays provided more time for the ICD-10 transition, it seems that many organizations did not take full advantage of this additional time," the letter reads.


According to WEDI, the joint announcement by the Centers for Medicare & Medicaid Services (CMS) and American Medical Association concerning ICD-10 flexibilities after October 1 — which appeared after the survey was concluded — should go a ways toward removing this obstacle.


"Physician practices may now be working more quickly toward compliance, since the potential for further delay has been removed," it adds.


The survey included nearly half as many respondents as a similar survey conducted earlier this year in February 2015 yet still shows good progress across the healthcare industry with respect to ICD-10 compliance.


Health IT vendors demonstrated good progress over the past few months, particularly in the area of product availability:


Three-quarters indicated their production-ready software or services were available to customers. This is an increase from less than three-fifths in the February 2015 survey.  One-quarter responded that their products would not be available until the second or third quarter of 2015, but no one responded that their products would not be ready by the compliance date.


The findings reveal a dip in the percentage of health plans having completed impact assessment — from four-fifths to two-thirds — which WEDI attributed to the respondent makeup of this latest survey. That being said, health plans excelled in external testing activities with close to 75 percent of these respondents reporting having completed external testing.


Echoing the findings of AHIMA and the eHealth Initiative on provider ICD-10 readiness in July, the WEDI survey has found room for improvement for physician practices.


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," says WEDI.


In an accompanying letter to HHS Secretary Burwell on the subject of enhancing the ICD-10 transition, WEDI calls on the federal agency to make publicly available information about the readiness levels of Medicaid agencies and offer additional educational outreach to aid the healthcare industry through the historical change.

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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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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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Technology adoption without followup = failure

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Clinical Documentation Improvement Vital for Patient Care

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

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


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


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


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


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


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


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


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


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


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

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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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The ICD-10 Coding Transition Deadline is Only 99 Days Away

The ICD-10 Coding Transition Deadline is Only 99 Days Away | EHR and Health IT Consulting | Scoop.it

The deadline for the ICD-10 coding transition is only 99 days away and healthcare providers are scrambling to finish preparing for the implementation. The Centers for Medicare & Medicaid Services (CMS) continues to stress the need to be as prepared as possible for the coming ICD-10 coding transition.


Even though providers and payers have only 99 days left, there is still time to get ready if one gets started immediately. CMS is helping providers who are behind in their ICD-10 coding transition preparations by offering the ICD-10 Quick Start Guide.


The five steps a provider needs to take right now if they haven’t begun preparing for the ICD-10 coding transition are:


1) Develop a plan


2) Train healthcare and coding staff


3) Update system processes and workflows


4) Discuss issues with vendors and health payers


5) Perform system and processing testing


With only 99 days left until the ICD-10 coding transition, it’s vital to set target dates for completing the steps outlined above. At the very beginning stages of making a plan, providers would benefit from downloading and obtaining ICD-10 codes via the CMS website. These codes are available in a multitude of formats including print and electronic either through practice management systems or upgraded EHR products.


CMS encourages providers to obtain access to the ICD-10 codes. Other formats that the ICD-10 codes can be retrieved through include code books, digital media like compact discs or digital video discs, online at cms.gov/ICD10 under the “2016 ICD-10-CM and GEMS” category, or even via smartphone applications.


Some common workflows and system processes that will be affected by the ICD-10 coding transition include patient registration or scheduling, clinical documentation, billing, coding, public health reporting, order entry, authorizations, and referrals.


Additionally, it’s vital to decide how one’s clearinghouse will assist in preparing providers for the ICD-10 coding transition. It may benefit some providers who are behind in their preparations to contract with a clearinghouse in order to test submitting the ICD-10 code claims. A clearinghouse can be useful when it comes to helping identify why claims were rejected as well as offering assistance in how to revise rejected claims.


“Practices preparing for the October 1, 2015, ICD-10 deadline are looking for resources and organizations that can help them make a smooth transition. It is important to know that while clearinghouses can help, they cannot provide the same level of support for the ICD-10 transition as they did for the Version 5010 upgrade,” CMS stated in a pamphlet. “As you prepare for the October 1, 2015, ICD-10 deadline, clearinghouses are a good resource for testing that your ICD-10 claims can be processed and for identifying and helping to remedy any problems with your test ICD-10 claims.”


In order to be properly reimbursed, healthcare providers will need to be ready for the ICD-10 coding transition by October 1. In the meantime, it’s important to continue using ICD-9 codes for all services rendered before the deadline.

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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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Checklist: Are you ready for ICD-10?

Checklist: Are you ready for ICD-10? | EHR and Health IT Consulting | Scoop.it

With the Oct. 1, 2015, deadline fast-approaching, is your organization ready for ICD-10? Here's a quick readiness assessment to benchmark where you are – and where you should consider being.


Readiness checklist:


  1. Have both your Practice Management and EHR been updated to be ICD-10 compliant?
  2. If you are using the Charge module in Allscripts TouchWorksTM, have you tested submitting ICD-10 codes to your Practice Management system?
  3. If you are not using the Charge module in TouchWorksTM, have you considered implementing it to increase revenue cycle turn-around or considered updating your existing Encounter Forms to include ICD-10 codes with more specificity and using laterally to meet the ICD-10 requirements?
  4. Have you contacted all your vendors to ensure they are ICD-10 compliant, such as payers, clearinghouses, and any lab or radiology vendors?
  5. If necessary, have you loaded the ICD-10 dictionaries in both your Practice Management and EHR applications?
  6. Have you tested submitting codes from your Practice Management system to your payers and clearinghouses?
  7. Have you tested submitting orders (labs/diagnostics/imaging studies) from your EHR to appropriate vendors with ICD-10 codes?
  8. Have you identified the top 25-50 diagnoses for each specialty (based on volume and/or high revenue) and trained appropriate staff on ICD-10 criteria for coding, billing, and clinical documentation?
  9. Have you optimized all preferences and enhancements within TouchWorksTM to assist in the ICD-10 transition such as Billable Indicators and Clinical Qualifiers?
  10. Have you reviewed current clinical documentation and identified gaps for ICD-10 requirements?
  11. What else do you need to know and consider?


The preceding is just a short list of items to consider to ensure that your organization doesn’t experience challenges starting October 1st, such as payment denials, increased A/R days, and workforce overload. I’d like to focus on the clinical documentation that will need to go along with the actual ICD-10 transition. Many organizations have completed the initial items on the readiness checklist, and some were even ready a year ago prior to the delay.


Still, the ICD-10 implementation can present a significant challenge to your providers’ documentation workflows.  Each claim will not only need to have the appropriate codes, but will also require the clinical documentation from the patient visit to support the submitted ICD-10 codes. This is not any different than how ICD-9 codes work other than the obvious… ICD-10 requires more detail!


Specialties that will primarily be affected the most with the ICD-10 transition include Orthopedics, Family Medicine, Pediatrics, OB/GYN, Cardiology, and Behavioral Health. ICD-10 coding and clinical documentation will require more detail than we experienced with ICD-9. Some examples of the increased documentation include:



  • Laterality
  • Episode of Care (initial encounter, subsequent encounter, sequela)
  • Anatomical detail
  • Type of injury
  • Severity
  • Approach



Many believe this is only related to ICD-10, however, the increased documentation requirement stretches across many other healthcare initiatives, such as Meaningful Use, value-based purchasing, and hospital admission/re-admission reporting. A clinical documentation improvement program can offer several benefits for organizations, which extend to a variety of healthcare initiatives.

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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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Why You Should Support the Safe Harbor ICD-10 Conversion Bill

Why You Should Support the Safe Harbor ICD-10 Conversion Bill | EHR and Health IT Consulting | Scoop.it

The ICD-10 conversion brings with it many complications and physician groups across the country are looking to avoid putting additional time and monetary strain among providers from implementing the new coding set. In that attempt, Representative Diane Black (R-TN-6) issued bill H.R.2247 called Increasing Clarity for Doctors by Transitioning Effectively Now Act (ICD-TEN Act).


Instead of seeking to delay the ICD-10 conversion any further or put an end to the new coding system altogether as prior proposed bills have suggested, it mandates an ICD-10 transition period – or a “safe harbor” period – before which the Department of Health and Human Services (HHS) would perform end-to-end testing among all providers to determine whether the fee-for-service reimbursement system is working properly and complies with ICD-10 codes.


Dr. Will Harvey, a practicing rheumatologist and Government Affairs Committee Chair for the American College of Rheumatology, is a strong supporter of bill H.R.2247 and spoke with EHRIntelligence.com about why this legislation is so important.


When asked his reasons for supporting the ICD-10 bill, Harvey answered, “There are two reasons. One, in particular in the specialty of rheumatology but certainly true in all of medicine, a large number of our practices are small solo or small group practices with many in rural or other under-served areas, which leads us to be concerned about our ability to adequately test our systems. The reason is the end-to-end testing that’s being performed by CMS right now is restricted to around 2,500 testers who are selected because of their prototypical nature.”


“If these 2,500 people do okay with testing, then there will be enough practices like those 2,500 out there that will feel comfortable about their ability to successfully use the system,” Harvey continued. “The thing that concerns us about this is that if there are 10 electronic health records, 10 billing systems, 10 clearinghouses, and 10 revenue management software vendors out there, then that leads to 10,000 different permutations of different software types that one would use to transmit their bill from the practice to CMS and back. And, of course, there are many more than 10 of each of those things.”


“Our concern is that the 2,500 prototypical testers is not enough to reassure providers – particularly ones in rural or small areas – that their systems will work because often they have unique software products that may not be adequately tested,” Harvey mentioned.

When discussing his second reason for supporting Representative Diane Black’s ICD-10 bill, Harvey explained, “The concern related to the safe harbor period or the implementation period of 18 months is that there’s a lot of learning that will have to happen around ICD-10 after October 1. This is due to the combination of people being inadequately prepared and things like payer edits and different ways in which the codes will be used that we don’t even understand yet.”


“One of our big concerns is that the added specificity contained within ICD-10 will be used to deny or modify payment or even more egregiously be used to assess waste or fraud. We are trying to help people understand that – because of the complexity of the system – minor mistakes in sub-codes are not fraud, they’re just mistakes. Because the learning curve will continue after October 1, we think it’s very reasonable to allow providers this implementation period where they will not be penalized or denied payment on the basis of a simple mistake in a sub-code.”


“We’re not suggesting that any code be accepted,” Harvey further explained his points. “We’re just suggesting that sub-codes are the ones that are the least important when determining payment. They’re more important for epidemiological and public health purposes rather than payment.”


When asked which providers might be negatively affected by the ICD-10 conversion, Harvey replied, “From a technical perspective, it’s always more difficult for small groups or solo practitioners or people who are working in traditionally underserved areas because they work on much, much smaller margins to operate their business.”


“They often run on margins of a couple percent. Even a couple percent increase in rates of claims denial will threaten the viability of those practices and ultimately affect patient access,” Harvey stated. “From a practical perspective in who will have the most difficulty handling the increase in the number and complexity of codes based on their specialty, cardiology is one affected and oncology is another. Orthopedics perhaps has the greatest increase in the number of codes. Emergency physicians are affected [by the ICD-10 conversion] because of the large amount of specificity around accidents and injuries of various types. The number of codes that rheumatoloigists will consider for rheumatoid arthritis goes from one to 246.”


With regard to whether the ICD-1o conversion could severely impact reimbursement among a large number of providers, Harvey stated, “Unfortunately, I’m not sure [whether this would occur]. That’s part of why we would like more comprehensive testing before October 1 because it will give us that answer.”


“Our software that we have right now does not support dual coding,” Harvey continued. “We can’t run any analytics to find out whether our providers are adequately coding at an ICD-10 level. We will only be able to do that after October 1 when we turn on the ICD-10 functionality inherent in our system.”


“If we can’t start doing analytics until after October 1, how can we possibly answer how much we’ll be impacted financially, but also how can we train people if they can’t on a day-to-day basis use the new system in their daily practice? This will all happen to a large extent after October 1, which is why we’re pushing so strongly for the safe harbor period.”


When asked what safeguards under the proposed legislation are the most important, Harvey replied, “I think the most important for America’s small and solo practitioners is the testing piece because they’re at high risk. For everyone else and for those people, I think the safe harbor piece is the most important. It’s well known among the health IT industry that we have accuracy problems already with ICD-9 and that problem will only get worse during the implementation with ICD-10. We feel that it’s common sense to let everyone learn on the job for 18 months before we’re held to strict accountability for the specificity held in the coding set.”


Harvey also gave tips to healthcare providers to mitigate risk when it comes to the ICD-10 conversion by the October 1 deadline.

“Even if you cannot participate in the CMS-sponsored end-to-end testing, I hope every provider is testing their own internal systems or getting documentation from their various vendors that their systems will be ready on time,” he stated. “I think another point is to get providers and their staff trained on the new code set so that we’re minimizing the learning curve that has to happen on October 1.”


Dr. Will Harvey concluded by mentioning how it would benefit providers if the Centers for Medicare & Medicaid Services (CMS) was more transparent with regard to theircontingency plans for the ICD-10 conversion.


“They [CMS] haven’t released [the contingency plans] publicly,” Harvey concluded. “One thing we would very much like is for them to put out their contingency plans so that we can review them and see whether they’re adequate. We generally don’t feel as though legislation should be necessary to deal with these issues, but in part it’s because of CMS’ lack of transparency in this regard that we feel compelled to support this legislation.”


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