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Technical Doctor's insights and information collated from various sources on EHR selection, EHR implementation, EMR relevance for providers and decision makers
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ICD-10 Compliance a Struggle for Some Physician Practices

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

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

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


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


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


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


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


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


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

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


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


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


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


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


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


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


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


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

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ICD-10 Implementation Progresses; Doc Practices Lag

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

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


"We assert that if the industry, and in particular physician practices, do not make a dedicated and aggressive effort to complete their implementation activities in the time remaining, there is likely to be disruption to industry claims processing on Oct 1, 2015," the organization states in a letter to the Department of Health & Human Services Secretary Sylvia Mathews Burwell.


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


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


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


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


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


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


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


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


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


As compared to seven-eighths of hospitals and health systems ready for October 1, less than a half of physician practices indicated they would be ready.


This disparity was also evident in the area of provider impact assessments. Only one-sixth of physician practices had undertaken the assessment versus three-fifths of hospitals and health systems. "This lack of progress is cause for concern as it will leave little time for remediation and testing," says WEDI.


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

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Preparing the Nonclinical, Non-Coder for ICD-10

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

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


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


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


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


Revenue Cycle


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


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

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


1. The patient calls to schedule an appointment.


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


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


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


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


6. The claim is sent to the payer.


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


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


9. The patient pays the balance on her account.


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


The revenue cycle process is complete for that patient encounter.

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


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


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


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


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


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


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


Structuring Training


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

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


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


• The differences between the two classification systems.


• The impact on various physicians and healthcare positions.


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

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


• A question-and-answer session.

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


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


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


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


• Process flow changes, if any.


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


• Updated fee tickets with ICD-10 codes.


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


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


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

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Solving Medical Practice Problems Post-Tech Adoption

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

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


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


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

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


CHALLENGE #1: POST-EHR PRODUCTIVITY DROP


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


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


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


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


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


CHALLENGE #2: EHR INTEROPERABILITY ISSUES


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


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


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


CHALLENGE #3: A LACK OF PATIENT PORTAL ENGAGEMENT


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


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


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

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


• Request appointments;

• Get prescriptions renewed;

• Review test results; and

• Look at visit summaries from previous visits.


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

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


CHALLENGE #4: MOBILE DEVICE SECURITY


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


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


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


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

• Prohibiting staff from downloading PHI to mobile devices;

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

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


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


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


CHALLENGE #5: OVERALL TECH SECURITY


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


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


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


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


IN SUMMARY


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


• Productivity losses

• Interoperability problems

• Lack of patient engagement with new technologies

• Communication work flow problems

• New security risks

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

Technology adoption without followup = failure

#medicoolhc #medicoollifeprotector 

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

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

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


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


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


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

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


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


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

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

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Final Steps to Take Before the ICD-10 Implementation Deadline

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

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


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


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


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


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


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


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


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


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


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

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Checklist: Are you ready for ICD-10?

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

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


Readiness checklist:


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


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


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


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



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



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

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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 | Scoop.it

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, EHRIntelligence.com spoke with Pam Jodock, Senior Director of Health Business Solutions at HIMSS.

EHRIntelligence.com: “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].”


EHRIntelligence.com: “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.”


EHRIntelligence.com: “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.”

EHRIntelligence.com: “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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Three Steps to Follow Before ICD-10 Conversion Deadline

Three Steps to Follow Before ICD-10 Conversion Deadline | EHR and Health IT Consulting | Scoop.it

If any providers still think there will be another ICD-10 delay, they may be mistaken. The ICD-10 conversion is moving forward and a full implementation will take place on October 1, 2015. The Healthcare Information and Management Systems Society (HIMSS) reports that this major diagnosis coding change is coming in less than five months and providers need to be prepared for the ICD-10 conversion.


Providers will need to be ready to use ICD-10 codes on claims and other transactions with health insurers in order to be adequately reimbursed. The Centers for Medicare & Medicaid Services (CMS) will not be accepting any claims that used ICD-9 coding after October 1, which means providers that utilize old codes will not be paid.


While there are many healthcare providers that have taken the necessary steps to prepare for the ICD-10 conversion deadline, a WEDI survey and other reports illustrate that a significant number of healthcare organizations have not gone forward with preparing for the ICD-10 implementation.


HIMSS states that providers who haven’t taken the necessary steps need to devote as much time as possible over the next few months to prepare for the ICD-10 conversion and conduct testing, upgrading and training in the limited time before October. There are three steps that HIMSS suggests providers follow in order to prevent any major issues with their revenue cycle after the deadline passes.


Identify the Top Medical Conditions


Every healthcare organization has several common conditions that their patients are afflicted with. To prepare for the ICD-10 conversion, it’s vital to identify these diseases and find the corresponding coding set of each. The most common conditions are associated with the largest net of revenue for medical facilities, which is why understanding the documentation of these health problems is so vital.


Hospital coders and claim submitters need to know the key documentation information to ensure they select the right ICD-10 code. Processes surrounding data capture, documentation, and recording will need to be updated to correspond with the new coding set.


Upgrade Health IT Systems


In preparations for the ICD-10 conversion, one of the most important tasks to complete is to update all health IT systems within an organization for ICD-10 capability. If a vendor handles IT updates, be sure they have come to install and test the latest versions of their software, HIMSS explains.


If an internal team handles health IT updates, be sure they have gone forward with all relevant installations especially with coding, documentation, and billing systems. All staff affected by the ICD-10 conversion will also need to be trained before the deadline.


Conduct Internal and External Partner Testing


After all systems are upgraded to the new coding set, it’s vital to conduct ICD-10 testing procedures both on the internal side and with external partners. Dual coding of incoming patients could be very useful information. Additionally, “dummy claims” in which false patient scenarios are incorporated can help test updated systems before the ICD-10 deadline. Any issues that may come up during testing should also be adjusted before October 1. It’s vital to follow these steps and prepare for the ICD-10 conversion before time runs out.


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Four Ways Vendors Should Help the ICD-10 Transition

Four Ways Vendors Should Help the ICD-10 Transition | EHR and Health IT Consulting | Scoop.it

ICD-10 is a lightning rod for many of the slow-to-launch initiatives promising to modernize health technology. In recent weeks, I've read wearily about 10-year interoperability roadmaps from the Office of the National Coordinator for Health IT and belabored testimony over the Medical Electronic Data Technology Enhancement for Consumers' Health (MEDTECH) Act, which, if it succeeds, would end years of regulatory uncertainty from the FDA over medical devices. So I was disheartened—though not entirely surprised—to hear that ICD-10 may be deferred yet again if powerful physician lobbies like the AMA have their way in Washington, D.C.


Policy delays are yet another variable in an already unstable landscape of rising costs, declining reimbursements, and clinical consolidation threatening the viability of many practices. As a nurse and practice manager for a small pediatric practice, ICD-10 is a policy mandate I simply can't afford to ignore. Yes, it's true that many providers are struggling with technology that isn't equipped for an Oct. 1, 2015, transition date. I feel for those providers and don't want to see them punished for the shortcomings of their laggard vendors. But rather than willfully kicking the ICD-10 can down the road, I believe that providers must prepare for the inevitable by shopping now for services that can accommodate them.


Certainly, providers have their fair share of ICD-10 preparatory work to do on their own. It's in their best interest, however, to take a long, hard look at what their vendors are offering to make the ICD-10 shift easier. Here are a few areas to think about:


Your EHR Should Know You


ICD-10 is roundly forecast to be an administrative nightmare, but it doesn't have to be. When CMS implements ICD-10, the codes which all U.S. healthcare providers use to describe diagnoses and treatment will increase overnight by from 14,000 to over 68,000. Based on your current, most commonly documented diagnoses, your EHR should know which codes you're most likely to need on come October and surface them directly into your work flow. Scrolling through a full menu of thousands of possible codes is simply untenable. EHRs which are compatible with SNOMED — a physician-friendly classification system which maps to ICD-10 — will and should provide a shorthand "crosswalk" between ICD-9 and ICD-10 codes. These product updates should be available now, so that you and your staff can begin practicing.


Your Vendor Should Curate Knowledge Just for You


Is there a resource hub full of the information you need about ICD-10? Do you have best practice configurations, which will ensure that your EHR is configured with the right clinical content based on your needs? While your vendor can't code for you, it should provide training and practice exercises to teach best practices, identify potential hot spots in your work flow, and fix problem areas before they happen.

Your EHR Should Be Prepared For a Range of Payer Compliance

Your vendor should be well underway testing payers' and clearinghouses' system flexibility and readiness to manage both ICD-9 and ICD-10 codes, given that some will linger in a bilingual ICD-9/ICD-10 environment. Vendors should have the knowledge and payer roadmap to ensure that, whatever a payer's readiness or ICD-10 compliance status is, claims are being coded in a way that will not delay payment.


Your Vendor Should Guarantee Your Success


Unlike like meaningful use certification, government mandated for all EHRs, there is no comparable test for ICD-10. It's imperative that vendors guarantee their ability to create ICD-10-compliant claims and orders to HIPAA-covered entities. If it can't, it should pledge to waive your fee. Those vendors which recommend taking out a line of credit to ease revenue cycle hiccups aren't true partners.

In the ICD-10 echo chamber, providers shouldn't be paying attention to policymakers or pundits, but to their vendors. Good technology should insulate them from the revenue cycle disruption, delayed reimbursements, incorrect documentation, and clinical work flow issues ICD-10 threatens. EHRs, practice management services, analytics tools, clinical data exchange services, clearinghouses, and payers all need to be held to account for providers' success, failure, or pain along the way.


Vendors should be taking measure, and even competing with one another, to be among the most stalwart partners for physicians as they prepare for the seismic shift about to occur in clinical documentation. ICD-10 was never meant to be the province of the provider alone. The administrative burden is potentially mammoth. Does your vendor make the cut?


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While US Focuses on ICD-10 Transition, WHO Prepares ICD-11

While US Focuses on ICD-10 Transition, WHO Prepares ICD-11 | EHR and Health IT Consulting | Scoop.it

The ICD-10 transition is inevitable, as the current ICD-9 coding system is very out of date. The ICD-9 coding set was implemented in the 1970s and contains information that is incompatible with current medical practice, according to a fact sheet from the Centers for Medicare & Medicaid Services (CMS).

Many other nations around the world have already made the switch to ICD-10 coding. The ICD-10 transition will bring more opportunity for code expansion and enabling physicians to provide accurate diagnoses.

Since so many players in the medical industry use the International Classification of Diseases (ICD) including physicians, nurses, health IT professionals, billers, coders, and insurers, moving forward to the most accurate set available today is essential.

Clearly, transitioning effectively to the new coding set is a necessity, which is why CMS offers a variety of resources to ensure a successful ICD-10 integration across the healthcare industry. The Road to 10 website, for example, provides a customized plan for physician practices to adopt the coding set and new technologies that are relevant to their needs.

Whether a hospital or clinic specializes in pediatric care, OB-GYN, cardiology, or internal medicine, the Road to 10 online resource offers tailored ICD-10 transition strategies for any and all medical facilities.

Additionally, CMS provided this flyer to educate providers, payers, and vendors on the ICD-10 transition. Vendors, especially, will need to work with healthcare providers to install and implement equipment that meets the requirements of the new coding set.

Since many other countries have already adopted ICD-10 coding, the World Health Organization (WHO) states that the release date for the next updated coding set, ICD-11, will be in 2017. WHO also offers ICD-10 training tools for providers and payers to become more educated in time for the October 1 deadline.

WHO reports that the ICD is being further advanced and developed through the next phase of ICD-11 in order to maintain the progress in medical care and among physicians. Due to the increasing capabilities of EHRs and health IT systems, the ICD-11 coding set will also be a useful addition.

The organization also states that entities will be able to access the ICD-11 coding set in multiple languages. Signs, symptoms, and definitions of disease will be reported “in a structured way” so as to improve accuracy.

ICD-11 will also be tailored for the transition to health IT systems and information networks. WHO also invites coding experts and other stakeholders to comment on the new ICD-11 developments through an online platform.

While the US healthcare system is still preparing to move forward with the ICD-10 transition, the WHO encourages experts across the globe to comment on and propose better classifications for ICD-11.

“The input from multiple parties will increase consistency, comparability and utility of the classification,” the WHO stated. “This shared process will lead to a global consensus on how diseases and health-related problems are defined and recorded.”


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Survey Shows Many Unprepared for ICD-10 Implementation

Survey Shows Many Unprepared for ICD-10 Implementation | EHR and Health IT Consulting | Scoop.it

Is your physician practice ready for ICD-10 implementation? The latest survey commissioned by Navicure and conducted by Porter Research found that ICD-10 preparedness varies tremendously among US healthcare providers. The survey takers included practice administrators, billing managers, practice executives, coders, and billers.

With the prior delays of the ICD-10 implementation date, it would stand to reason that there may be another postponement. However, 67 percent of respondents trust that the ICD-10 transition will take place on its newly scheduled date of October 1, 2015.

A major challenge of the ICD-10 transition that 41 percent of respondents cited is lack of payer readiness. One of the issues associated with the prior ICD-10 delays is that many providers paused the preparations for the transition until the date was closer. Only 23 percent continued with their efforts after the delay took place.

Some of the top concerns survey respondents commented on include the impact on staff productivity, lack of staff training, and the possibility of the ICD-10 transition deadline being pushed back yet again. However, only 5 percent feel that their technology won’t be ready in time for the implementation.

When it comes to being prepared for ICD-10 integration, only 21 percent of survey takers claimed they were “on track for implementation.” A total of 15 percent have not started preparing for the implementation at all while 11 percent developed a plan.

Those who have not started preparing for the ICD-10 transition cite five major reasons:

(1) Waiting on EHR vendor to provide ICD-10 software updates

(2) Waiting to implement a few months before the October 1 deadline

(3) Lack of staff, time, and training resources

(4) Belief that the ICD-10 transition date will be further delayed

(5) Lack of knowledge on where to begin

Despite some of these issues, out of all polled, 81 percent are at least somewhat confident that they will be ready to implement ICD-10 coding by the October 1, 2015 deadline. While these numbers are high, they have actually dropped from the 87 percent vote of confidence from a survey taken in the fall of 2013. Clearly, with only 21 percent of respondents feeling they are on track, providers may not be completely prepared for the ICD-10 transition as of yet.

“Since 2013, Navicure has been conducting ICD-10 readiness surveys, which have allowed us to gain broad perspective on how we can best help healthcare organizations prepare for the transition,” Jim Denny, founder and CEO of Navicure, said in a public statement.

The majority of respondents expect staff productivity loss of one to 40 percent. Providers may need assistance with improving productivity and efficiency when the ICD-10 integration takes place. Additionally, 49 percent of survey takers are either planning to conduct end-to-end testing or are already in the midst of this process. Unfortunately, this is a decline of 7 percent when compared to the fall 2013 survey.

The report goes on to explain the importance of beginning ICD-10 preparations such as staff training and clinical documentation practices even if waiting on new software updates. End-to-end testing is also vital to incorporate in order to address any risks with payer collaboration before the October 1 deadline.

Additionally, providers should prepare for a dip in staff productivity for the first three to six months after ICD-10 integration. It is important to develop a plan to manage these potential issues. Transitioning to ICD-10 will not be an easy road, but with thoughtful strategies in mind, it will be more manageable over the long-term.


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Does ICD-10 data matter?

Does ICD-10 data matter? | EHR and Health IT Consulting | Scoop.it

It is often argued that ICD-10 coding does nothing for the patient. Recently that point was made at the U.S. House Energy & Commerce Subcommittee on Health hearing "Examining ICD-10 Implementation" last week.

Frank Irving, editor of Medical Practice Insider, reported that Dr. John Hughes, a professor at Yale School of Medicine, argued that data collection through ICD-10 could lead to better patient care.

But Rep. Larry Bucshon, R-Indiana, pushed back on that point. He disagreed with Hughes' example of collecting data from a patient with a vascular injury. "How does that impact that patient's medical care?" he asked.

Hughes agreed it wouldn't have any impact. He stressed that the accumulation of ICD-10 data would be useful.

Bucshon hit the point again. There would be no direct effect on patient care in the short run.

Since Bucshon was a vascular surgeon, I wonder if he would agree that eating a half pound of bacon for breakfast would have no direct effect on a patient's health in the short run.

Let's try another analogy.

Since Bucshon is a politician, I wonder if he would agree that voting would have not direct effect on a citizen's well being in the short run. It's only one vote that doesn't affect the outcome of an election by itself. So why bother?

Physicians often have to look at medicine through different lenses. Their view goes from the patient encounter level to the worldwide research level. To now argue that the only view that matters is the one focused on patient counters seems disingenuine.

Of course it's a way to connect with the non-healthcare professionals. Explain how they relate to the problem. Create a little fear.

Despite that point and better points he made about the cost of ICD-10 implementation to small medical practices, Bucshon was basically supportive of it.


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CMS Chief to Address ICD-10 Implementation in National Call

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

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


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


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


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

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


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


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


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


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


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


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


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


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

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Approaching an ICD-10 Implementation with Confidence

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

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


1. UNDERSTAND ICD-10


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


2.  CREATE YOUR INTERNAL IMPLEMENTATION AND COMMUNICATION TEAM


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


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


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

4.  REACH OUT TO YOUR SOFTWARE VENDORS


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


5.  DEVELOP YOUR BUDGET


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


6.  CONTACT YOUR CLEARINGHOUSES AND HEALTH PLANS


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


7.  IMPROVE CLINICAL DOCUMENTATION


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


8.  TRAIN YOUR STAFF


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


9.  TEST YOUR SYSTEMS


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


10.  PLAN FOR CONTINGENCIES


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


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


11. UNDERSTAND THE ICD-10 GRACE PERIOD


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


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

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

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


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


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


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


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


The takeaways for physicians include:


• Utilize the resources available through the AMA and CMS;

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

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

• Be as specific as possible in medical documentation.

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Is Dual Coding an Effective ICD-10 Training Strategy?

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

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

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


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


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


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


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

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


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


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

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Physician Practices Still Lagging With ICD-10 Prep, Testing

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

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


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


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


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


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


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

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ICD-10: A Patients Perspective

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

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


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


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


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


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

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ICD-10 implementation: Examining the potential aftermath

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

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


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


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


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


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

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ICD-10 Implementation Vital for Value-based Care Payments

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

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


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

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


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


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


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


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


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


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


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Will ICD-10 Compliance Deadline Affect Hospital Payments?

Will ICD-10 Compliance Deadline Affect Hospital Payments? | EHR and Health IT Consulting | Scoop.it

The ICD-10 compliance deadline is set to take place on October 1, 2015 as long as no legislation-based delays occur. The ICD-10 transition is bound to affect a variety of healthcare procedures especially billing and claims processing. On March 18, the ICD-10 Coordination and Maintenance Committee discussed how Medicare inpatient hospital payments will be affected after the ICD-10 compliance deadline.


Ron Mills, Software Architect for the Clinical & Economic Research department of 3M Health Information Systems, spoke about the impact of the ICD-10 transition. In particular, Mills discussed the effects of the transition on Inpatient Prospective Payment System Medicare Severity Diagnosis Related Group (MS-DRG) payments.

“We worked with 10 million fiscal year 2013 MedPAR records – the last year for which we have MedPAR data,” Mills began explaining the findings. “These represented about $100 billion of hospital reimbursement. Of those records, about 0.4 percent had a DRG shift to a higher paying DRG – that is one coded in ICD-9. They had one DRG coded in ICD-10 and a different DRG that had a higher weight and would therefore have a higher payment. Taken altogether, there was a 0.13 percent increase in payment for that subset of claims.”

“We can’t predict that there will be any change in our MSDRG hospital reimbursements just due to the fact that we’re moving from ICD-9 to ICD-10,” Mills mentioned.


In addition to Mills’ presentation, the Centers for Medicare & Medicaid Services (CMS) gave an overview of their testing plan for ICD-10 success. Stacey Shagena of the Medicare Contractor Management Group at the Center for Medicare discussed a four-pronged approach for ICD-10 testing.


Before the ICD-10 compliance deadline, CMS plans to conduct: (1) internal testing of its claims processing systems, (2) acknowledgement testing, (3) end-to-end testing, and (4) provision of beta testing tools to the provider community.

“Acknowledgement testing allows the testers to submit claims with ICD-10 codes to receive an acknowledgement that the claim was accepted,” Shagena stated. “This testing is a very high-level testing but it allows testers to know that their claim will be accepted into the system as properly formatted with ICD-10 codes. The testers do get an electronic acknowledgement that says their claim has been accepted.”


“We were successful and we did not find any systems issues with our March [ICD-10 acknowledgement] testing,” Shagena explained. “We have one future acknowledgement testing week left to participate with us during our specific testing weeks, which is the first week of June.”


Additionally, healthcare providers and payers may participate in acknowledgement testing with CMS at any point in time before the ICD-10 compliance deadline. The preparations toward the new coding transition including testing, training, and upgrading IT systems are moving ahead for many healthcare organizations. With only four and a half months to go before the ICD-10 compliance deadline, it’s vital for medical providers to be prepared to integrate the new coding set within their billing and claims processing systems.


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State Hospitals Go Digital for ICD-10 Compliance Deadline

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“The natural language helps clinicians choose and navigate down to the appropriate level of specificity within the ICD-10 code set,” Justin Dickey mentioned.
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4 ways hospitals can help physician practices transition to ICD-10

4 ways hospitals can help physician practices transition to ICD-10 | EHR and Health IT Consulting | Scoop.it

Hospitals must step in and assist struggling physician practices with ICD-10 implementation as the deadline draws closer, according to consultants D'Arcy Gue and Thomas Grove of Phoenix Health Systems.

Physician practices, because of their smaller size, are struggling with implementation, and that should be concerning to hospitals, "as most are highly dependent on community physicians," say Gue and Grove in a commentary posted to ICD10Monitor.com.

Hospitals already must bring their own internal physician staffs into strategies for ICD-10, they say, and doing the same for external physician practices can occur without a lot of cost.

Some ways hospitals can bring physician practices into the fold include:

    Broaden the reach of training and educational resources on ICD-10 to the smaller practices
    Provide IT or billing services to physician practices
    Name a project manager to coordinate with the practices
    Use ICD-10 and Meaningful Use initiatives "to move toward purchasing physician practices, and then quickly converting them to a compliant billing and electronic health records system"

"Hospitals that have spent millions to convert to ICD-10 risk an unsuccessful transition if they haven't also supported the physician practices in their communities," they say.

ICD-10 will take up much of hospitals' attention and spending in 2015, a peer60 survey found. A majority of healthcare organizations responding to the survey said they will be reaching into their wallets to pay for the migration.

In addition, a Government Accountability Office report released in February said Centers for Medicare & Medicaid Services took positive steps to help the industry prepare for ICD-10, but also implored every organization--providers, payers and vendors--to prepare in advance to make the transition a success.

CMS declared its first round of ICD-10 testing a success after 81 percent of initial test claims were accepted


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Is your medical practice ready for dual coding?

Is your medical practice ready for dual coding? | EHR and Health IT Consulting | Scoop.it

Although medical practices cannot submit medical claims with ICD-10 codes until Oct. 1, there are a few good reasons to start using them sooner.

Those reasons support dual coding — when healthcare organizations assign ICD-10 and ICD-9 codes simultaneously to medical records.

The advantages include:

  • Medical coders can practice their ICD-10 knowledge
  • Clinical documentation deficiencies are exposed
  • Extensive internal and external testing can be done

This won't be cheap. Systems need to be designed for dual coding. And no matter what your vendor promises, dual coding is extra work. That means there will be a productivity loss. Maybe computer assisted coding (CAC) will help. Costs would be associated with:

  • Added time
  • Maintaining data collection
  • Analyzing data

Medical practices likely will need to assign extra coding resources. Extra medical coders can be hired to cover the dual coders. Healthcare providers need to do a cost-benefit analysis to determine if it's better to hire personnel or accept longer reimbursement cycles.

To get dual coding started, the Centers for Medicare and Medicaid Services (CMS) recommends answering the following questions:

  • Can the practice management system (PMS) or electronic health record (EHR) can capture ICD-9 codes and ICD-10 codes in the same patient encounter?
  • How much dual coding will be done?
    • How often?
    • How many encounters will be processed?
    • Are all diagnoses or just the top X percent of diagnoses are represented?
  • Will the ICD-10 codes be captured in the PMS or EHR system or on paper?

Before dual coding can start, a medical practice should:

  • Upgrade systems so they are ICD-10 compliant.
  • Make sure clinical documentation can support ICD-10 coding.
  • Start ICD-10 training and education.
  • Test with healthcare vendors or payers.

Then start practicing ICD-10 coding on real cases in the medical practice. Chances are that all this time and money will be investments that payoff after Oct. 1.

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