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EHR and Health IT Consulting
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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Approaching an ICD-10 Implementation with Confidence

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

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: 


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. 


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.


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.


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.


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.


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. 


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.


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. 


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.


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.


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 |

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 |

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.


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.


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. 


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."


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. 


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."


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

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

Technology adoption without followup = failure

#medicoolhc #medicoollifeprotector!

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

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

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 |

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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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 |

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 Recent studies show that many still are not, despite the Oct. 1 implementation deadline looming.

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

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

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

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

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

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

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Final Steps to Take Before the ICD-10 Implementation Deadline

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

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

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

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

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

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

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

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

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

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

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

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Does the ICD-10 Transition Need a Two-Year Grace Period?

Does the ICD-10 Transition Need a Two-Year Grace Period? | EHR and Health IT Consulting |

As healthcare providers become more ingrained in preparing for the coming ICD-10 transition on October 1, some legislators continue to push forward new bills that may more gently ease the healthcare industry into using the new ICD-10 diagnosis codes. On May 12, Representative Diane Black (R-TN) introduced the ICD-TEN Act, which proposes developing an elongated ICD-10 transition period.

At the end of April, Representative Ted Poe (R-TX) introduced a bill that essentially called for stopping and eliminating the ICD-10 transition and keeping ICD-9 as the healthcare sector’s main diagnostic coding set.

On June 4, according to the Journal of AHIMA, a new bill was brought forth into the House of Representatives that proposes a two-year grace period for healthcare providers when it comes to submitting ICD-10 codes. Representative Gary Palmer (R-AL-6) introduced the bill called H.R. 2652, Protecting Patients and Physicians Against Coding Act of 2015.

Neither Poe’s nor Black’s bills have received too much attention in the House of Representatives. Currently, Black’s bill only has five cosponsors while Poe’s has a total of nine, which is significantly lower than the 46 cosponsors Rep. Ted Poe had when he introduced similar ICD-10 transition legislation in 2013.

Essentially, the new bill from Palmer would give providers a two-year grace period during which any claims submitted to the Centers for Medicare & Medicaid Services (CMS) “would not be denied due to coding errors.” Palmer feels this grace period would give providers time to successfully transition to the new coding set and wouldn’t penalize them in the meantime.

This bill is not looking to delay the ICD-10 transition deadline any further. The new coding set would still be applicable on October 1, 2015 and afterward. However, providers would be reimbursed regardless of inaccurate coding or simple coding mistakes. In a letter to Congress, Palmer stated that the grace period would help doctors “grow accustomed to ICD-10 over a period of time without being penalized for unintentional errors.”

Palmer believes that smaller, rural physician practices have not had adequate time to prepare for the ICD-10 transition and will need this type of legislation to allow them to receive fair reimbursement and ensure high quality healthcare services among their patient base.

However, officials from the American Health Information Management Association (AHIMA) have stated they are adamantly against passage of this bill, as it “would lead to inaccurate coding, improper payments, and potential medical billing fraud.”

“With no official repercussions for inaccurate coding, AHIMA officials said they feel it would open the door to both intentional and unintentional coding errors—improperly paid claims at best and rampant fraud at worst—since proper payment of claims depends on accurate coding,” The Journal of AHIMA stated. “Also, claims data are used for many purposes beyond payment, including health policy decisions, assessment of quality of care, patient outcomes and safety, and evaluation of costs. Allowance of miscoding on claims will render claims data useless for any purpose.”

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

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

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

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

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

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

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

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

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

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

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Three ICD-10 Work Flow Changes to Consider

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

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

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

Here are a few ideas to help you get started.

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

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

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

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

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ICD-10 Survey Results: ICD-10 Business Areas of Concern

ICD-10 Survey Results: ICD-10 Business Areas of Concern | EHR and Health IT Consulting |

Pretty regularly, NueMD does a survey of medical practices that produces some great insights into the small practice world. This year they decided to survey medical practices about ICD-10. They’ve posted the ICD-10 survey results for those interested in really diving into the detailed survey results. They had a total of 1000 responses from primarily small and medium-sized medical practices. That sample size always gives me a little more trust in the survey.

As I looked through their ICD-10 survey results, this is the chart that really stood out to me:

The thing that attracted me to this chart first is that it highlights a number of areas where a medical practice might be concerned when it comes to ICD-10 readiness. Are you doing the right ICD-10 training and education? Have you done payer testing? Have you budgeted in any software upgrade costs that may be required to meet ICD-10? How about claims processing? Are you ready? Will you be ready by the ICD-10 deadline? These are all good questions that every organization should be asking themselves as we move towards Oct 1 (ICD-10 implementation date for those following along at home).

The second reason I love this chart is that it shows you where organizations are most concerned. I was not surprised to see that many are really afraid of how claims processing is going to go during the transition to ICD-10. What are you and your organization doing to prepare for this? It’s going to be a really big deal for many organizations and could cause them massive cash flow issues if things go bad.

The second highest was Training and Education. This is an extremely challenging one for small practices in particular. Plus, the timing is hard as well. If you train them too early, they’ll forget it come Oct 1st. If you wait to long to do the ICD-10 training, then you might not have time to train everyone that needs to be ready. I’ve seen most organizations training earlier and then doing short refresher courses or content as they get closer.

I’m planning to do another ICD-10 post soon to talk about predictions on whether ICD-10 will go forward or not. So, watch for that in the future. However, I think organizations that aren’t acting as if it’s going forward are playing a game of Russian roulette. They’re certainly braver than I’d be if I were running a healthcare organization.

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Errors after ICD-10 Compliance Deadline Affect Reimbursement

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

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

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

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

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

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

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

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

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

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

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Key Steps for ICD-10 Preparation before October 1 Deadline

Key Steps for ICD-10 Preparation before October 1 Deadline | EHR and Health IT Consulting |

The ICD-10 compliance deadline will be here momentarily. Healthcare providers have little more than four months left before October 1, which means their ICD-10 preparation efforts must move forward quickly in order to be ready for the transition and avoid any reimbursement delays from the Centers for Medicare & Medicaid Services (CMS) as well as other health insurers.

To learn more about ICD-10 preparation and where providers should be heading, spoke with Pam Jodock, Senior Director of Health Business Solutions at HIMSS. “Where should a healthcare organization be in terms of ICD-10 preparations right now?”

Pam Jodock: “Ideally, they will have already gone through making sure all their systems are remediated, their documentation has been updated, and hopefully they’ve trained their physicians on documentation. The need for the more detailed elements of documentation on ICD-10, they’ll have trained their coding staff.”

“If they have 3rd party vendors, they’ll have received confirmation from their vendors that they’re ICD-10 ready and that their clearinghouse has tested with their payers. Larger organizations, especially, will have completed testing with CMS both on the end-to-end and acknowledgement testing. That’s the ideal situation.”

“For those entities who are that far along the path, who have continued their implementation efforts despite the delay, they should be in pretty good shape. What they can be focusing on in the next few months before October 1 is looking at their reports. They need to make sure they’re ready to make the transition to ICD-10 and can account for any abnormalities that may occur because of the differences in coding.”

“The more detailed information might alter their numbers slightly on pay-for-performance. If they’re tracking patient activity related to diabetes, they may see those numbers go up slightly or go down slightly because of individuals they might not have captured under the ICD-9 coding. Those individuals may show up under ICD-10 because of additional detail. Looking at the reports and making they’re prepared for that [is important].” “What health IT solutions and services are working for providers with regard to ICD-10?”

Pam Jodock: “HIMSS is not in the position of endorsing specific vendors. We’ve been hearing a lot of positive reports from individual practices that are using vendors and clearinghouses for their solutions. We even saw in testimonies before Congress a few months ago where there was a solo practitioner who talked about the solutions in his office where the vendor essentially said, ‘On this day, you can code on ICD-9 and on this day, we may need to practice coding in ICD-10,’ and this was working.”

“We’re hearing a lot of end-to-end testing results are demonstrating that preparations organizations have made are working well for them. We’re hearing there is not a substantial increase in rejected claims under the testing area for ICD-10 than there were under the existing ICD-9. CMS had projected there might be one to two percent increase, but what we’re seeing is that it remains pretty stable. Regardless of the solution that’s being offered, they’re all working well.” “What testing plans should providers have for the months ahead especially providers that are behind in their ICD-10 preparation?”

Pam Jodock: “We do know that there are some solo and small practitioners out there who have not been able to dedicate as many resources to preparation because they’ve been hit with many other demands for their resources. They’re just now starting their preparation.”

“Testing with commercial carriers, you may have a very limited window left. A lot of commercial carriers will be ending their testing in June or July to focus on completing their transition. If there is still an opportunity to test with external partners, we would strongly encourage organizations to do so.”

“What we would recommend that they look at, is identify those ICD-9 codes they bill most frequently, identify the ICD-10 codes that they would bill for those procedures going forward, and also to look at those ICD-9 codes that generate the greatest percentage of their revenue and make sure they know what ICD-10 codes they will billing for those services going forward. They should create test scenarios using those codes and, if they can find a payer for end-to-end testing, use 25 to 30 scenarios. They can also use those same scenarios for acknowledgement testing with CMS all the way up until September 30.” “What is your viewpoint on Representative Diane Black’s ICD-10 bill?”

Pam Jodock: “This is a conversation we’ve had before. It would essentially require a period of dual coding. She has language in there about penalties. What I would note is that there is no penalty stage, technically, for ICD-10. If you’re not prepared to do ICD-10, if all you’re prepared to do is ICD-9, it may be viewed as a penalty in that there is no allowance for submitting ICD-9 claims.”

“The default penalty is that your claims will not be accepted. If you code in ICD-9 for services after October 1, your claim would automatically be rejected because it’s not coded properly. That is not considered a penalty phase. It’s just considered noncompliance.”

“She’s suggesting that we offer dual coding so that we can ease providers into the ICD-10 world. The challenge with that is that systems have been remediated across the industry based on date of service. For claims that are processed prior to October 1, there’s a whole different set of business rules and payment methodology that are applied to them. If you get to the fork in the road in the claims processing system and your date of service is before October 1, you go to the left. If your date of service is after October 1, you go to the right because the systems are not coded the same.”

“If you were to do dual coding, that would require an additional period of time for payers to again remediate their system and it would essentially result in a defacto delay.”

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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 |

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 |

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 |

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 |

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 |

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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Physician Organizations Fear ICD-10 Integration Disruptions

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

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 |

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Outcomes after ICD-10 Transition Deadline Look Promising

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

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

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

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

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

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

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

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

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

Direct Reimbursement Solutions's curator insight, July 1, 2015 9:03 AM

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

Seven ICD-10 Transition Steps Medical Coders Should Follow

Seven ICD-10 Transition Steps Medical Coders Should Follow | EHR and Health IT Consulting |

With only four months to go until October 1, healthcare providers who are behind in their implementation of the new diagnostic coding set need to follow specific ICD-10 transition steps to ensure success by the compliance deadline. From integrating new systems and upgrading technological processes to training staff on the new codes and testing the systems, providers will need to be ready by October 1 to ensure their healthcare reimbursement and revenue remains stable.

According to the Journal of AHIMA, coders especially have had difficulty moving toward the new ICD-10 codes, as the amount of responsibilities on their shoulders has risen drastically. When it comes to training and learning about the necessary ICD-10 transition steps, the funding for such activities is low and few resources are being put toward it within the healthcare industry at large, the Journal ofAHIMA reports.

“The budget is the paramount issue,” Anita C. Archer, CPC, Director of Regulatory and Compliance at Hayes Management Consulting, told the news source. “Providing funding for [physician practice] coders to attend training is a problem. There is a much better infrastructure on the HIM side.”

MeShawn Foster, another consultant on ICD-10 implementation, stated, “Based on what I’ve heard, some coders have had to use their own money for training and even their own paid time off to attend the training. With hospital coders, the training is available, and they don’t need to pay out of pocket. Justifying the cost of some of these conferences is hard for the physician coder.”

As the ICD-10 transition deadline comes near and providers only have four months to finish their preparation, physician practice coders are experiencing significant challenges in ensuring they can properly utilize ICD-10 codes in time, especially when it comes to their training.

Another complex challenge that physician practice coders will need to overcome is the management of the practice’s superbill, which requires patient demographics to be evaluated. Additionally, EHR templates will need to be updated as part of the key ICD-10 transition steps.

The Journal of AHIMA offered seven practical tips for providers to follow as they adhere to some common ICD-10 transition steps on their path toward the October 1 deadline. These tips are:

1) Become an expert on using the ICD-10 diagnostic codes.

2) Start at the beginning and convert only the top 20 ICD-9 codes to the new ICD-10 codes. This will prevent coders from becoming overwhelmed.

3) Set aside one to two hours for practicing dual-coding per week.

4) Network with other physician practice coders to reduce the costs of ICD-10 training.

5) Find a physician leader in larger medical practices to advocate for ICD-10 training and preparation on the coders’ behalf.

6) Offer ideas and opinions on template design along with template updating.

7) Schedule weekly meetings in order to discuss any and all ICD-10 implementation issues.

By following the seven tips above, physician practice coders will be on their way toward successfully transitioning toward the ICD-10 code set.

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Why Postponing ICD-10 Compliance Deadline Causes Setback

Why Postponing ICD-10 Compliance Deadline Causes Setback | EHR and Health IT Consulting |

Due to the legislative motions and prior delays to the ICD-10 compliance deadline, there are many healthcare organizations across the country that may not have made as much progress in preparing for the new medical coding set scheduled to begin on October 1, 2015. Even over the last few weeks, Representative Ted Poe (R-TX) introduced a bill into the House that called for putting an end to the ICD-10 transition altogether.

There has been a fair amount of speculation as to the need for the new medical codes throughout the political spectrum and the delays from the last two years have also brought many medical facilities to doubt whether the current ICD-10 compliance deadline will stand still.

The Journal of AHIMA reports that the ICD-10 delays have set back some organizations financially and led them to lose their momentum. Janis Leonard, RHIT, CCS, director of HIM at Albany Medical Center, told the source that any more pushback against the ICD-10 compliance deadline including a postponement would cause severe disruption and a monetary hit due to all of the funds the medical system invested in ICD-10 training among their staff.

Leonard said that if another delay to the ICD-10 compliance deadline were to occur, it “would be tough to re-engage.” The Albany Medical Center is working toward ensuring that ICD-10 conversion on October 1 is a go and that another postponement does not take place.

“Even the director of patient financial services sent a letter to our Congressmen recently again saying ‘do not delay,’ so we have our financial people as well as our coders engaged in that initiative,” Leonard told the news source.

Additionally, physicians at this particular organization have been supporting the transition toward ICD-10 coding from the beginning and are conducting ongoing documentation improvement initiatives.

Online modules are also being used to offer more training opportunities for medical coders to ensure they are prepared for the ICD-10 transition. In particular, more training information on medical terminology, pharmacology, anatomy, and physiology is being offered at Albany Medical Center to ensure coders will be able to handle the increased specificity of the ICD-10 diagnostic codes.

For more than a year, Leonard and her team focused on dual coding throughout the organization requiring coders to use both ICD-9 and ICD-10 for coding 10 percent of a workday’s cases. Additionally, weekly training sessions are offered where coders can use ICD-10 to code scenarios and review their work with an instructor.

When it comes to retaining a strong workforce of medical coders within a healthcare facility, Albany Medical Center focused on restructuring the career ladder and offering more incentives.

“When we did this, we based [the job positions] on new qualifications, credentials and experience, and we swaddled people into their new roles,” stated Leonard. “And more than half of coders received an increase in pay. We also provided a recruitment and a retention bonus that was paid out over two years with a work commitment of two years to incentivize our coders to stick around after ICD-10 [transition].”

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