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Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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ICD-10 Success for Large Practices, Problematic for Small

ICD-10 Success for Large Practices, Problematic for Small | EHR and Health IT Consulting | Scoop.it

Several weeks following the implementation of the ICD-10 code set, the progress of the transition appears to vary according to size of the practice. While many large practices are reporting success with the transition, some smaller ones are reporting difficulty.


According to a blog post by the Coalition for ICD-10, many of the group’s members -- which happen to be larger healthcare providers -- are reporting great success with the transition. Many, like Centegra Health System, credit this success to the ample time for preparation they received.


“Centegra Health System was prepared for a smooth ICD-10 transition after two years of careful planning. Our information technology systems have been updated and our educational plans were deployed to help with the initial roll-out,” said Centegra’s Executive Vice President, Chief Financial Officer, and Chief Information Officer David Tomlinson.



Additionally, some coalition members stated that their success on October 1st is due in large part to their early implementation of the code set.


“Northwest Community Healthcare’s transition to ICD-10 has been smooth. This is due, in part, to our early clinical rollout of ICD-10 with our Epic Go-Live date of May 1, 2015,” said President and Chief Executive Officer of Northwest Community Healthcare Stephen Scogna.


Other members of the coalition, such as insurer Blue Cross Blue Shield of Michigan, reported a few bumps in the road amidst a generally smooth transition.


““BCBSM’s ICD-10 implementation went very smoothly. Call center volumes and overall inquiries are very low. Professional and facility claims are processing as expected. A few issues noted, which we are resolving, but nothing major to report,” the insurer said.


BCBSM also reported that it was the first private insurer to reimburse the hospitals it serves.


“Received kudos from our hospitals stating that BCBSM was the first payer to pay ICD-10 claims and these claims are paying as expected. Hospitals are not reporting any major issues. Other Payers (Priority, Cigna, Aetna) are reporting the same experience in that they are not seeing any major issues.”


However, this success is in contrast to what some other smaller providers are reporting. The impact of ICD-10 on smaller providers is a little bit more weary as these providers have fewer resources to work with.

For example, Linda Girgis, MD, FAAFP, told EHRIntelligence.com that due to how small her practice is -- she and her husband are the only physicians in the family practice -- its workload has grown much larger. This work includes changing patient problem lists from ICD-9 codes to ICD-10.

"The doctors are doing it right now," she says. "I'm doing it as I come across different patients, but definitely it's adding time on to the workday."


Smaller practices are especially affected by ICD-10 troubles because much of their revenue comes from the Centers for Medicare & Medicaid Services (CMS), and the agency has been reportedly unreachable throughout the transition.


"My biller tries to call every day. Since October 1, they have messaged that they are down due to technical difficulties so it's impossible to get through to any person there,” Girgis said.


Not receiving CMS payment is problematic for small practices like Girgis’ because those payments may amount to almost 30 percent of hospital revenue. While a larger hospital, like those mentioned above, may be able to do without 30 percent of its revenue for a month or two, this kind of issue could be potentially detrimental for a practice like Girgis’.


"Big organizations, hospitals, and groups can go a few months without 30 percent of their reimbursement coming in. But for small practices, that can be devastating," argues Girgis.


CMS set a timeline for rolling out ICD-10 payments, stating that those claims would be reimbursed within the first 30 days of the new code set. As that 30-day timeline draws to a close, small practices will be waiting to see if their claims are reimbursed.

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CMS Administrator Welcomes Providers to ICD-10 Compliance

CMS Administrator Welcomes Providers to ICD-10 Compliance | EHR and Health IT Consulting | Scoop.it

On October 1, the healthcare industry began ICD-10 compliance after countless months of preparation. In a CMS post, Deputy Administrator and Director of the Centers for Medicare & Medicaid Services (CMS) welcomed providers to ICD-10 and provided words of guidance to industry stakeholders on the transition day.

According to Cavanaugh, it may take a little while before CMS is able to assess how the transition to ICD-10 is proceeding. The reasons for this are twofold: first, most providers do not file claims on the same day as a service has been provided, and second, it takes a few weeks for CMS to process Medicare and Medicaid claims.


“Even after submission, Medicare claims take several days to be processed, and Medicare -- by law -- must wait two weeks before issuing  payment. Medicaid claims can take up to 30 days to be submitted and processed by states,” Cavanaugh wrote.


It is most likely that CMS will be able to assess ICD-10 progress following the first complete billing cycle. This is consistent with other CMS claims. In aconference call with industry stakeholders which took place a week before the October 1 deadline, CMS Principal Deputy Administrator Patrick H. Conway, MD, MSc, confirmed the same timeline for checking ICD-10 progress.

Until then, Cavanaugh explained, CMS plans to closely monitor the transition. Furthermore, CMS will be managing problems and questions that are submitted to the ICD-10 Coordination Center, which is staffed by several Medicare, Medicaid, billing, coding, and health IT experts to assist during the transition. In addition to the ICD-10 Coordination Center, Cavanaugh points providers toward other ICD-10 assistance resources, including William Rogers, MD, the ICD-10 ombudsman, and Medicare Administrative Contractors (MACs).


Cavanaugh also discussed the potential benefits of the ICD-10 transition, including the promise of more detailed health data reporting and and better healthcare delivery. By increasing the detail with which medical care is reported, policy changes can be more specific to the needs of populations.


“The change to ICD-10 allows you to capture more details about the health status of  your patients and sets the stage for improved patient care and public health surveillance across our country,” he wrote. “ICD-10 will help move the nation’s health care system to better, smarter care.”


These hopes for ICD-10 have been mirrored by many industry stakeholders, including AHIMA CEO Lynne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA. Thomas Gordon recently stated howICD-10 will be of great benefit for patients because it will allow for better healthcare innovation due to the extensive detail of health records.

“As an active leader, supporter and advocate for ICD-10, AHIMA is pleased that the greater detail inherent in the code set will reverse the trend of deteriorating health data and tell a more complete and accurate patient story,” she said.


As providers continue with their transition to ICD-10, CMS is expected to report any major issues and provide guidance in fostering the smoothest transition possible.

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Survey: Texas Docs not Ready for ICD-10

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

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


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


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


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

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


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


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


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


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

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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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Preparing the Nonclinical, Non-Coder for ICD-10

Preparing the Nonclinical, Non-Coder for ICD-10 | EHR and Health IT Consulting | Scoop.it

As the U.S. healthcare system moves closer to the Oct. 1, 2015, ICD-10 implementation deadline, clinicians and coders continue preparing for this immense change in healthcare reimbursement and clinical documentation practices. While medical office operations and management continue to focus on ICD-10 education, it's important to determine the appropriate education levels of non-coding, nonclinical staff needed for ICD-10 education. Determining the details in ICD-10 education is an important consideration that an astute leader will want to eagerly identify according to their practice needs.


A practice leader's focus on educating the nonclinical, non-coding staff might include reviewing the following positions: scheduling, registration, accounts payable and accounts receivable, laboratory, revenue cycle specialists, and file clerks. For the ICD-10 transition to flow as smoothly as possible, it is imperative that all staff have knowledge of the new coding system and understand how it will impact their current positions.


In order to determine the correct level of education, analyzing current job positions should commence. This includes the review of policies and procedures, specific job aides and toolkits, work flow, and finally, transparent communication with the team. Furthermore, the revenue cycle process should be reviewed to ensure all staff with revenue cycle interactions are appropriately educated in ICD-10.


Here are some suggested processes a practice leader may follow in order to establish appropriate training in ICD-10 according to job position, including giving a brief refresher on the revenue cycle processes, and common positions that normally interact with the cycle and its specific stage. While every effort is made to cover all non-coding, nonclinical staff, it is up to the practice leader to review all positions and determine the best way to proceed with ICD-10 education for their team.


Revenue Cycle


A healthy revenue cycle is a key to a successful physician practice. A practice leader should review his current revenue cycle processes and take into consideration where the individual practice's revenue cycle starts and stops, as well as determine each staff position's interaction with the cycle.


Before education can be delivered, and staff positions are analyzed, it is crucial to remember the flow of the revenue cycle from the initial intake of patient information to zeroing out the balance in the patient's account. This will ensure a successful ICD-10 training for practice staff.

The process of a medical office revenue cycle usually resembles the following:


1. The patient calls to schedule an appointment.


2. Registration obtains prior authorization from insurance for the patient visit, if appropriate.


3. The patient presents for her scheduled appointment and signs required paperwork.


4. The physician examines the patient and documents the visit on the patient's chart.


5. The coder receives the chart and assigns the codes according to the physician's documentation.


6. The claim is sent to the payer.


7. Reimbursement is issued for the visit, if appropriate, according to the patient plan and contract.


8. Accounts receivable processes the payment and a statement is sent to the patient if monies are owed.


9. The patient pays the balance on her account.


10. The patient's account for that date of service is at zero balance.


The revenue cycle process is complete for that patient encounter.

In order to understand how a staff member interacts in the revenue cycle at each level, analyzing positions is a must. Below is a sample of how this process might look and which staff member might interact at each level:


1. The patient calls to schedule an appointment and speaks with a scheduler. The scheduler will need to do a quick intake on the patient's insurance, reason for visit, if the patient is new or established, or if he has a referral. Appropriate steps must be addressed to obtain authorization for the visit. In order for this to occur, the scheduler will need to give the patient's insurance payer an appropriate ICD code.


2. The patient arrives for the visit and checks in at the front desk. The registration specialist will confirm the patient's information and insurance, as well as collect any copays due at that time. He may also take the original requisition slip if referred by another physician. Depending on work flow and practice size, the scheduler may have to select an ICD code (the reason for the visit) for pre-authorization purposes and/or to place on the patient's superbill.


3. The patient is seen by the physician. The physician documents the patient complaint and proposed treatment, if any, in the medical record. Diagnoses and any procedures are added to the superbill. The patient checks out, the chart is completed by physician, and routed to the coder.


4. The coder reviews the chart and assigns ICD codes according to the physician documentation. The encounter is sent electronically at midnight and routes to the insurance payer.


5. The payer issues payment to the physician. Your accounts receivable or billing department processes the payment. Any monies owed are sent by the patient to the billing department. Once the patient account is zero, the claim is closed.


The ICD-10 planning phase begins with determining each staff's interaction with the revenue cycle. This can occur by reviewing processes and work flow as well as policies and procedures. Scheduling, registration, filing, billing, accounts payable and receivable, release of information, revenue cycle specialists, and privacy and security staff should be asked for the tools they use every day with current ICD-9 codes, so they can be updated to ICD-10 codes.


Structuring Training


Once the quantity of existing ICD-10 knowledge is determined, training can be disseminated to staff through a variety of delivery methods. Face-to-face, written, electronic, or a combination of two or more can be used. Four hours to eight hours of training could be sufficient, but will be determined according to the needs of each staff member. This training should be completed at least one month prior to Oct. 1, 2015.

A detailed four-hour ICD-10 training agenda may look similar to the following, starting with the morning session:


• An overview of the healthcare system and why it is expanding from ICD-9 to ICD-10.


• The differences between the two classification systems.


• The impact on various physicians and healthcare positions.


• How the medical practice is preparing for ICD-10, to include

timelines, parallel testing, upgrades, and go-live date.


• A question-and-answer session.

The afternoon agenda can be customized according to position, need, size of practice, etc. For a registration specialist, the training may look similar to the following:


• An overview of current work flow practices and where ICD-9 codes appear.


• An overview of any current daily job tools, such as coding, billing, or insurance software or interfaces.


• Updated policies and procedures to include the communication protocol with physicians regarding specific coding questions.


• Process flow changes, if any.


• ICD-9 to ICD-10 crosswalks, if available, pertaining to the practice and job title.


• Updated fee tickets with ICD-10 codes.


• Available resources: coding books, anatomy toolkits based on staff position, designated coder-of-the-day team member who can be contacted should a question arise, etc.


Additional spot training can occur after the initial training as a refresher for staff members who encounter ICD codes in their positions, followed by regular education meetings following the implementation date. The practice leader may also wish to monitor claim denials, and map back to specific steps in the process in order to further fine tune ICD-10 training with all staff (clinical and nonclinical). Lastly, updating policies and procedures, process flow charts, coding tools, and reference cards will help ensure a smooth transition for a practice.


When implementing ICD-10 in a medical practice, it's critical for a practice leader to review all nonclinical and non-coder positions, and to assess the ideal amount of training for each position. Understanding the revenue cycle and what each department contributes to the cycle will be useful in determining appropriate training methodologies for ICD-10.

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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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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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AMA's long war of words against ICD-10

AMA's long war of words against ICD-10 | EHR and Health IT Consulting | Scoop.it

One of the more notable things about the Centers for Medicare &Medicaid Services' revisions to its ICD-10 policy on Monday is the fact that the suggestions come straight from the AMA. After all, there's been no love lost between the two organizations when it comes to that subject these past few years.


Back in November 2011, for instance, AMA put the case as plainly as possible: "Stop the Implementation of ICD-10."


Putting its money where its mouth was, AMA's House of Delegates voted to "work vigorously" to make that happen.


Why? Because the ICD-10 switchover "will create significant burdens on the practice of medicine with no direct benefit to individual patients' care," said then AMA president Peter W. Carmel, MD. "At a time when we are working to get the best value possible for our health care dollar, this massive and expensive undertaking will add administrative expense and create unnecessary workflow disruptions.


"The timing could not be worse as many physicians are working to implement electronic health records into their practices," he added.

A couple years later, in June 2013, HIMSS Media's longtime ICD-10 Watcher Carl Natale covered another delegates meeting. And once again, their attitude toward those 68,000 new codes could be boiled down to two letters: N-O.


"Our AMA will immediately reiterate to the Centers for Medicare & Medicaid Services that the burdens imposed by ICD-10 will force many physicians in small practices out of business," the House of Delegates averred. "This communication will be sent to all in Congress and displayed prominently on our AMA website."


Natale called it as he saw it: "It looks like they're recommending physicians cover their ears and scream, 'Nah nah nah nah nah nah nah nah nah nah.'"


In February 2014, as the original ICD-10 deadline was eight months away (this, of course just a couple months before Congress' surprise compliance date delay), AMA once again made its case: "ICD-10 is Financially Disastrous for Physicians":


"Many practicing physicians regard ICD-10 as a costly, unfunded mandate that will not improve patient care. Indeed, the cost to meet ICD-10 is much larger than originally estimated. ... The AMA strongly urges CMS to reconsider the ICD-10 mandate."


A few months later, in November of that year, AMA President Robert Wah, MD, unleashed what to this date (or to these ears, at least) is the ne plus ultra of creatively-phrased anti-ICD invective.


"Here’s an interesting fact: Each of the six Star Wars films has this line: 'I have a bad feeling about this," said Wah in a speech to AMA board members and delegates. "That’s a common reaction to ICD-10. If it was a droid, ICD-10 would serve Darth Vader."


And he added a sequel to the Star Wars-themed jibes: "For more than a decade, the AMA kept ICD-10 at bay – and we want to freeze it in carbonite!"


This spring, as the 2015 looked more and more certain to be a certainty, AMA President Steven Stack spoke withHealthcare Finance Associate Editor Susan Morse. "ICD-10 is problematic, it requires a level of specificity and precision clinicians say we don’t think we’re going to be able to provide," he told her.


He also suggested that AMA was planning to keep up its efforts to get Capitol Hill to see things its way – even at this late date: "There’s an eternity between now and October in legislative parlance," said Stack.

Whether Monday's news will be satisfactory, at last to AMA, remains to be seen. As recently as late June, the group was reiterating that its members "remain steadfast in our belief that the ICD-10 coding system offers no real advantages to physicians and our patients – and certainly no advantages to justify the time and expense the entire health care system has invested in this transition.


"Even if ICD-10 were 'the best thing since sliced bread,'" officials argued, "its forced implementation would not be worth the extensive disruptions in patient care that surely will come without the grace period."

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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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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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ICD-10 PCS - We Don't Know What We Don't Know

ICD-10 PCS - We Don't Know What We Don't Know | EHR and Health IT Consulting | Scoop.it

After decades of experience with ICD-9, we have learned and come to grips with its quirks. We do not yet have that comfort level with ICD-10—after all, it’s still pretty new to most of us in the U.S. I’m not really concerned about the diagnosis side of ICD-10 and its clinical modification, ICD-10-CM. But what does concern me is ICD-10-PCS (procedure coding system). So far, we don’t have a good idea of how this is going to impact reimbursement, and what documentation requirements are really going to be needed. We really don’t know what we don’t know.


ICD-10-PCS coding demands a new level of documentation and coding specificity. There are few procedure codes in ICD-10 that will allow nonspecific or “not otherwise specified” codes, as are allowed in ICD-9. In the ICD-9 coding environment, it is still possible to generate a code and get reimbursed even with minimal specificity. But under ICD-10, if specificity is lacking, there may not be a procedure code that can be used, and the reimbursement will therefore suffer.


Let’s look at “lysis of adhesions” to see how this applies. If a surgeon performs a laparoscopic procedure to free up something in the abdomen that’s trapped in scar tissue and the operative note concludes that the patient performed a “laparoscopic lysis of adhesions in the peritoneum,” that would be enough information to use ICD-9 code 54.51. But there is no direct equivalent for this in ICD-10, no code that is as vague as the one in ICD-9. Instead, the surgeon needs to describe exactly what organ or organs were “released” or freed up during the procedure. If it was a loop of small bowel caught up in adhesions, then the appropriate ICD-10 code would 0DN84ZZ (release small intestine, percutaneous endoscopic approach). It would require specific mention of the small bowel in order to be coded.


So where does the problem or uncertainty come into play with this?

Well, let’s suppose (as is likely to happen) that the surgeon writes his or her usual comprehensive operative note that describes the procedure that includes a description of the dissection that was done around the small intestine. But the note itself simply states in the closing summary that the operation was a “laparoscopic lysis of adhesions in the peritoneum.” Can the coder use the description of the dissection around the small bowl to go ahead and code 0DN84ZZ? This seems to still be open to interpretation, and the last thing coding managers want as we prepare to enter the ICD-10 era is uncertainty.

As I have traveled around the country speaking with various professional groups including national and local AHIMA chapters, ACDIS chapters and coding societies, the opinions on this subject vary. Many boldly state that they would be comfortable coding from this scenario, while others want the physician to be responsible for stating the details explicitly.


Where does this leave the clinical documentation specialist? Will they be left with the responsibility for creating and managing the thousands and thousands of queries that are going to be needed to get the necessary clarification from the surgeons?

We don’t yet know.

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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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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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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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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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Gerard Dab's curator insight, July 16, 2015 8:19 PM

Technology adoption without followup = failure

#medicoolhc #medicoollifeprotector 

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

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

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


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


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


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

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


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


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

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


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


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

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

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

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


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


1. Claims denials. "While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family," CMS officials wrote in a guidance document.


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


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


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


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


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


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


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

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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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Staff Training Crucial in ICD-10 Conversion Preparations

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

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


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


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


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


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


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


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


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


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


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

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

Excellent advice for ICD-10 preparedness.

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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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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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