By Marla Durben Hirsch, Fierce EMR
he Centers for Medicare & Medicaid Services continues to shed light on how the Meaningful Use Incentive Program works, issuing a new frequently asked question, and updates to two more last week, according to Health Data Management.
The new FAQ addresses the fact that states must fund 10 percent of the non-federal share of HITECH administrative expenses. In its answer, CMS clarified that states have several funding options: they can fund through legislative appropriations to their Medicaid agency, intergovernmental transfer, certified, public expenditures, permissible healthcare-related taxes and donations. States must submit their proposed strategies to CMS for review and approval.
The two updated answers to FAQs both involve eligible professionals. CMS clarified that the medical specialty codes for the specialty-based determination for granting of the hardship exception are diagnostic radiology (30), nuclear medicine (36) interventional radiology (94), anesthesiology (05) and pathology (22).
Planning for ICD-10: Working with Clearinghouses and Billing Services
All claims for health care services provided on or after October 1, 2014, must contain ICD-10 codes. As you prepare for the ICD-10 transition, contact any third-party billing services that you use to make sure they are actively planning for ICD-10.
As you reach out to your clearinghouse or billing service, you may want to ask:
- Are you prepared to meet the ICD-10 deadline of October 1, 2014? Where is your organization in the transition process?
- Can you verify that you have updated your system to Version 5010 standards for electronic transactions? (Only systems with Version 5010 can accept ICD-10 codes; systems with the older, Version 4010 standards cannot accommodate ICD-10.)
- Who will be my primary contact at your organization for the ICD-10 transition?
- Can we set up regular check-in meetings to keep progress on track?
- What are your plans for testing claims containing ICD-10 codes? How will you involve your clients, such as my practice, in that process?
- Can my practice send testclaims with ICD-10 codes to see if they are accepted? If so, when will you begin accepting test claims?
- Can you provide guidance or training on how my clinical documentation will have to change to support ICD-10 coding?
- Do you anticipate any pricing changes for your services due to the switch to ICD-10?
If you do not currently use a clearinghouse or billing service, you may want to enlist one to help you with your transition. Consider asking other health care providers in your area if they have established relationships or contacts they recommend. Act soon so you have plenty of time to select the service that best meets your ICD-10 needs and budget.
Keep Up to Date on ICD-10
Visit the CMS ICD-10 website for the latest news and resources to help you prepare.
For practical transition tips:
By Frank Irving, PhysBizTech
An update from the Centers for Medicare & Medicaid Services (CMS) reminds providers that you should be meeting regularly with your ICD-10 project team to discuss transition activities, challenges and needs.
CMS offers the following tips for holding in-person or conference calls to check in with your team.
For starters, establish a day and time when the meeting will occur each month (e.g., the first Tuesday of the month at 1 p.m.). Consistency in scheduling will reinforce that ICD-10 is a priority for your practice. Of course, as the transition date approaches, you should consider switching to more frequent meetings – weekly or bi-weekly.
To ensure good use of everyone's time:
- Create an agenda. Distribute it prior to the meeting to help keep the discussion on track. The agenda will also help team members prepare their individual updates.
- Reserve time for questions. Encourage team members to ask questions at the end of the meeting to clear up any uncertainties.
- Take notes and draft action items. Following each meeting, circulate key takeaways and action items. This will keep everyone informed about important decisions and individual responsibilities.
Post-meeting discussions should focus on:
- Progress on transition activities. This will keep the team up to date on assigned tasks. You may also want to use this time to set deadlines and goals for completing task activities.
- Upcoming educational activities. Share information about local events or online training sessions that may benefit the team. Consider sharing ICD-10-related articles to keep team members informed about the latest news.
- Best practices. Perhaps you've heard about a novel way to address part of your transition to ICD-10. Disseminate that information and discuss how it could be applied in your group's implementation plan.
- Challenges. Freely talk about any challenges the team has encountered – and brainstorm ways to overcome those obstacles.
Click here for the original article.
By, Kyle Murphy, PhD, EHR Intelligence
Lost in the fervor of finalized criteria for Stage 2 Meaningful Use
was the another important announcement
last week by the Department of Health and Human Services (HHS) concerning the delay in the transition to the International Classification of Diseases, 10th
Edition (ICD-10). In truth, the news was quite easy to miss — it was part of a rule that focused primarily on unique health plan identifiers. And the Centers for Medicare & Medicaid Services (CMS) was kind enough to send out a reminder yesterday.
Despite the lack of hubbub, the ruling on the compliance date for ICD-10 is perhaps the most important announcement in the last few weeks considering the large number of affected entities. Providers, payers, and vendors will have until October 1, 2014, to comply with the latest set of procedural and diagnostic codes. The one-year delay represents one part of a multi-pronged effort to reduce costs across the healthcare industry.
In anticipation of next month’s AHIMA
2012 Annual Conference, the health information management technologies and services provider Precyse has issued an open letter to the healthcare community
concerning how to prepare for the transition from ICD-9 to ICD-10. As part of its recommendations, the company is advising organizations to take a serious look at their education and implementation plans, particularly in three areas: documentation, education, and remediation.
Documentation: The biggest impact of ICD-10 will be felt by those responsible for clinical documentation, providers. These individuals will require more training to achieve the correct amount of specificity in their documentation in order to avoid rejected claims and improve patient care. “Target high volume specialties in your organization most impacted by ICD-10 and train these specialists in proper documentation while training the coding team on accurate coding; then, move to the next specialty for training,” writes President Chris Powell.
Education: Generally, when an organization moves from one system to the next, it tends to undervalue the importance of training by not providing staff with enough time or resources to get comfortable with the new approach to achieving their tasks. Because coding in most cases falls to staff other than providers, it’s crucial that coders and those using their data are made aware of the major and minor changes in their day-to-day activities. “We found additional training needs related to anatomy, physiology and pathopharmacology, as well as opportunities to improve their understanding of coding system logic and principles,” Powell continues, “So we recommend that you perform side-by-side ICD-9 and ICD-10 coding, assessing the documentation and coding gaps and target training based on these findings.
Remediation: “ICD-10 was never just about re-training medical coders–it was and is about having better data about patients and their treatments, affording vast opportunities for improvement in how data are captured and processed,” Powell observes. The implementation of ICD-10 will bring to light inefficiencies in how an organization dealt with previous coding sets, and these ineffective and wasteful practices should lead health IT staff to identify new technologies and methods enabling rather than further burdening providers and coders. “We must develop workflow platforms and applications that allow health care providers to do their jobs more efficiently and effectively. We do not want to add more time and complexity to an already burdensome process,” asserts Powell.
Preparing for ICD-10 is easier said than done. With the wide-sweeping changes set to take place over the next couple of years, it’s more than likely than many affected entities, namely smaller less resourceful practices, will postpone addressing the ICD-10 challenge for quite some day and end up paying for it later.
By: Steff Deschenes, New Media Producer, Healthcare Finance News
The Centers for Medicare & Medicaid Services will penalize hospitals for readmissions beginning this autumn. As a result, many healthcare providers are taking a cold hard look at their bottom line in an effort to meet or exceed projected targets for the year. The difficult part, of course, is that each healthcare provider has its own unique challenges. There is no "one size fits all" solution.
It's important to examine the quality of the referral processes in place. Are there any patterns? Is your hospital providing enough information in your referral packets in a timely manner? "Healthcare providers should also identify the source of readmissions, looking at discharge referrals and post-acute provider relationships and performance to see which facilities have the best success records," explained Tom Ferry, CEO of Curaspan Heath Group, a company that helps providers, payers and suppliers improve care for patients. "Can your organization meet with underperforming facilities to discuss steps to improve? You need to know your readmission rates and track them regularly."
Ferry has a five-point strategy for the best practices to reduce readmissions.
1. Think globally about technology.
Don't view technology solutions as purchases that the IT department makes. To be effective, they should be considered investments that align with the common goals of internal and external constituents. For lower readmission rates, that means a shared platform with your community-based partners. It should support timely, meaningful two-way communication about the next, best level of care and services that, for instance, will keep a skilled nursing facility or home care patient from being readmitted. This communication should include the exchange of clinical documentation in order to optimize care coordination.
2. Conduct due diligence beyond the four walls of a hospital.
"Since efforts to lower readmissions depend in part on external care partners, don't make a technology decision in a vacuum," said Ferry. Solutions that advance this strategic initiative must reflect feedback from your post-acute providers and payers. After all, whatever you deploy will have an impact on your partners' performance and ultimately your reimbursement as ACOs, value-based purchasing and other new models of care and reimbursement requiring collaboration take root. Your decision making about technologies to support them also requires collaboration.
3. Forget about "one throat to choke."
No one can do everything, never mind do it all well. If there was one silver bullet for cutting healthcare costs, improving care and driving efficiency, readmissions wouldn't be a problem. Go with a best-of-breed solution that integrates with other superior point solutions. From a technical standpoint, it should be interoperable with all HIS. Additionally, it should come from a vendor that knows how to partner with other vendors. After all, if you're going to create a connected universe in which providers from separate but related levels of care not only communicate but collaborate, you should have vendors that know how to collaborate too. Further, if you want to protect your investment should problems surface, look for a strong SLA – not a one-company panacea.
4. Deploy technology that drives utilization.
Input from internal and external stakeholders must include assessing whether a product is easy to use and demonstrates immediate, clear benefits. For example, since making a dent in readmissions requires first identifying the issues underlying the numbers, you'll need a system that users readily adopt, generating data necessary for ongoing root-cause analysis – and action. Knowing whether particular nursing homes or physicians are behind a disproportionate number of readmissions, explained Ferry, equips staff for a discussion with those providers, which should drive better outcomes and create more utilization.
5. Keep cultivating relationships with community-based partners.
Controlling readmissions is an ongoing challenge that requires periodic meetings with your post-acutes and payers to review data about how you're doing. "We know from our own customer base that those organizations that regularly review and respond to data cut their annual readmissions to well below the national average," said Ferry, "improving clinical as well as financial outcomes."
Click here for the original article.
Washington -- Federal officials have extended by an additional 90 days the enforcement deadline for physicians, health plans and claims processors to comply with the 5010 electronic transaction standards under the Health Insurance Portability and Accountability Act.
The decision to delay again the full implementation of the electronic transaction standards used to bill services throughout the health system comes as physician practices continue to report problems with claims processing, creating millions of dollars in unpaid claims. A number of outstanding issues led the Centers for Medicare & Medicaid Services to make the decision to hold off on enforcing the standards through June 30, the agency said in a March 15 statement. In late 2011, CMS had decided to move the enforcement date from Jan. 1 to April 1.
The latest postponement means that electronic submissions using the old 4010 HIPAA transaction format, or using the new 5010 standard but with formatting errors, will continue to be processed and paid without penalty. Despite the initial 90-day grace period at the beginning of 2012, the American Medical Association and others reported that physicians continued to experience payment problems. The organizations asked for an additional 90-day delay.
"CMS made the right call, and we appreciate the considerable effort they made to work with the AMA and respond to our concerns regarding the readiness of the industry," said AMA President Peter W. Carmel, MD. "The key to successful implementation of the industrywide standard is through continued collaboration with all stakeholders."
Health plans, vendors and physician practices have made steady progress by adopting the new standards, CMS said in its statement. The Medicare agency reported processing more than 70% of hospital claims and more than 90% of physician claims in the 5010 format.
But some practices that did attempt to make the switch to 5010 this year -- or whose billing representatives did so -- ran into cash-flow problems as a result.
In February, perinatologist Carlos Fernandez, MD, said revenues were reduced to a trickle at his practice in Toms River, N.J. His clearinghouse and the insurance companies that he bills were not using the same HIPAA format, and his claims were being rejected as a result. Processing improved when services were billed on paper instead of being sent electronically, he said.
Dr. Fernandez said he is not fully confident that his vendors and payers have addressed problems with 5010 to the point where they would be ready for the date CMS starts enforcing the new format. "Hopefully things are squared away, but I don't know if they are still submitting claims on paper."
Delaying enforcement will help the health care industry to continue to address problems, said Robert Tennant, senior policy adviser with the Medical Group Management Assn. He urged physician practices to monitor automated claims acknowledgement transaction reports, or 277CAs, that identify compliance issues with electronic claims.
A practice should lodge a complaint with CMS if a health plan or clearinghouse is not HIPAA-compliant, Tennant said. Physicians also can place market pressure on those causing payment problems by terminating relationships with claims clearinghouses or billing services.
"There are cases of $300,000, $400,000, $500,000 in outstanding claims from a clearinghouse and we said, 'Switch clearinghouses,' " he said. "And, in three days, they had their claims paid."
March 08, 2012
The move from ICD-9-CM to ICD-10 is enough to strike fear into the hearts of physicians and staff alike. Making the leap from 14,000 codes to almost 69,000, topped with the huge cost to make that change, is understandably daunting. The more you know, the better off your practice will be. Following is some information about the new system and tips for preparation.
ICD-10 is a diagnostic classification that has been used since 1994 by many World Health Organization Member states. Aside from being a way in which insurance companies determine billing, it is used for health management and epidemiologic purposes.
The Centers for Medicare & Medicaid Services (CMS) says the move to ICD-10 is being made because its predecessor is outdated, lacks specificity, and does not provide enough details regarding health data (such as disease severity and complexity), thus making it difficult to reimburse accurately.
The original date for the transition to ICD-10 was set for October 1, 2013, but the Department of Health and Human Services is considering extending the deadline. This should not halt the switching process if providers are already working on the transition, said Rhonda Buckholtz, vice president of ICD-10 training and education at AAPC (formally the American Academy of Professional Coders), a credentialing and certification organization.
“We don't know when it will be – it could be months or a year,” she said. “We are in a waiting game right now, so one of the things that we have been telling everyone is that if you have begun preparing, you shouldn't stop.”
According to CMS, this process can be broken down into the following stages:
Planning. CMS recommends creating a project management structure, a plan to communicate with vendors and other partners and understanding risk management.
Communicating with staff. Physicians will need to assess what kind of training is required and develop a training plan. Then they will have to meet with staff to discuss their new responsibilities.
Assessment. Aside from the new staff impact, providers will need to understand how the change will affect their business policy, operations, technology, vendors, and so forth.
Implementation. This includes system migration strategies, business and technical changes, and training. AAPC recommends waiting until late 2012 to begin training so staff will retain the information.
Additionally, there is internal and external testing and the transition to the live environment, which includes ongoing support.
One consideration for switching over is cost. According to a report by the Medical Group Management Association, small practices can expect to spend about $83,000; medium groups will spend $285,000; and large practices can expect to spend $2.7 million to comply with the mandate. The cost will come from six areas: education and training for the staff; analysis of insurance contracts and documentation; superbill changes; IT changes; documentation costs; and cash flow disruption.
Buckholtz has seen with both HIPAA and 5010 that some vendors waited until the last minute and told providers they weren't ready. Don't let this happen to you.
Both hardware and software have to be compatible with the new system. Because ICD-9 may still be around for some time (some entities like worker's compensation are not required under HIPAA to switch), a system needs to have the capacity to accommodate both codes.
Other than compatibility, accommodation for both systems, cost, and system availability, providers should ensure that their vendor will also be available for testing, implementation, training, and customer support.
Physicians can look to practice management organizations and vendors, many of whom are providing free training and webinars on the topic. Researching now will avoid a last-minute crunch to prepare. Following are some places to start.
- CMS provides timelines, vendor information, and handbooks here.
- AAPC provides a free online newsletter on the switch. You can sign up by going here.
- Everything you need to know about choosing a vendor can be found on AHIMA's Web site here.
CMS announced November 17, 2011, that it would not initiate enforcement action with respect to any Health Insurance Portability and Accountability Act (HIPAA)-covered entity that is non-compliant with the ASC X12 Version 5010 (Version 5010), NCPDP Telecom D.0 (NCPDP D.0) and NCPDP Medicaid Subrogation 3.0 (NCPDP 3.0) standards until 90 days after the January 1, 2012, compliance date. Notwithstanding CMS’ discretionary application of its enforcement authority, the compliance date for use of these new standards remains January 1, 2012. The announcement can be found at here .
What the 90-Day Enforcement Discretionary Period Means for
Medicare Fee-for-Service (FFS)
Medicare FFS has experienced significant increases in 5010 production transactions during the last few months. However, there are many submitters that have tested but not taken the step to move into production for 5010 and D.0. In addition, there are many submitters that have not yet initiated testing with their Medicare Administrative Contractor (MAC).Therefore, to ensure that progress continues to be made; Medicare FFS is planning to take the following steps for submitters and receivers of Medicare Part B and Durable Medical Equipment (DME) transactions. Submitters and receivers of Medicare Part A transactions will follow the same action plan starting 30 days after Part B and DME:
- In December 2011, submitters/receivers that have tested and been approved for 5010/D.0 will be notified that they have 30 days to cut over to the 5010/D.0 versions.
- Submitters/receivers that have not yet tested will be notified in December 2011 that they must submit their transition plan and timeline to their MAC in 30 days.
- MACs will notify the submitters/receivers; submitters/receivers have the responsibility to notify the providers they service.
For more information on ASCX12 Version 5010, NCPDP D.0 and NCPDP 3.0, please visit http://www.cms.gov/Versions5010andD0.
The Centers for Medicare & Medicaid Services has created an interactive tool to help guide eligible professionals and others with the requirements of the electronic health record incentive program.
"Introduction to the Medicare EHR Incentive Program for Eligible Professionals" was released December 1 and walks you through each step of the program. Hyperlinks to the CMS website are included throughout to direct you to more information and resources.
The guide takes you through the program basics, the requirements you have to meet, how the program works, the difference between the Medicare and Medicaid programs, what your incentive payment will be, who is eligible to participate, how you register, requirements for Meaningful Use, attestation, and a great resource library.
Although there is not a lot of new information it could be helpful having it all in one place. There is even a section to practice attesting. You can download the guide here.
In our last two posts, we have discussed the first five important questions to ask your current or potential EHR vendor. Today, we wrap up the series with the last few questions to consider.
6. How do you balance innovation, client needs and regulatory changes in your product?
Purchasing a software solution can be a substantial investment for any organization. Looking at the software provider’s ability to continue meeting organizational needs into the future will help ensure the investment has long-term value. Looking at the details behind the percent of staff or resources a software provider allocates to product development is an ideal way to gauge the likelihood the solution will keep the value. Further delving into exactly how a vendor addresses ongoing regulatory changes while also delivering continued product innovation will help as well. Asking about a recent regulatory change the industry has seen and how a vendor handled it is a perfect way to bring up the topic.
7. How do you assist novice or entry level users in becoming proficient quickly with the system?
Navigation is the one major issue new users face when trying to become proficient in a system. Asking a vendor how they address this key barrier is important. While training and reference materials are important, system interface and other tools can also assist with this need. Properly designed systems will create tools that allow a user to do nothing more than choose a process they want to complete within the system. If the system is designed appropriately, the solution should automatically navigate the user through the steps of the process they are completing and prompt them for the documentation or action needed.
8. What tools are available to the client to make system adjustments after implementation?
Even with proper detailed discovery, organizations will continue to grow and their needs will change with this growth. While a system can be designed with the intent to meet the needs of an organization at a specific point in time, no one can predict the exact future needs of a provider. To help ensure the solution will work in the long-term, investigate what tools and options are provided to make adjustments or changes in the future. If it is determined changes to forms or workflow within the system takes significant interaction from the vendor, budget expectations should be set with executive management to plan for these types of future needs. The ideal scenario is to find a product that provides clients the ability to make these types of changes with little to no vendor interaction.
If you would like more info, or would like to view a demo, please let us know!