Posted on Mon, Dec 10, 2012 @ 08:28 AM
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:
Posted on Fri, Oct 12, 2012 @ 05:37 PM
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.
Posted on Fri, Oct 05, 2012 @ 01:30 PM
By Maria T. Bounos, RN, MPM, CPC-H, Business Development Manager, Wolters Kluwer Law & Business
More than ever the burning question remains, “Why ICD-10?”It feels like “heartburn” for most but the increase in hesitancy to adopt this new system appears to be directly related to the
announcement of the impending October 2014 delay in the implementation date. The reason for ICD-10 is more than the frequently-stated reasons: “older data structure” or “we’re running out of space for new codes” and let’s not forget that ICD-9 hasn’t kept pace with current medical practice. All of these reasons are very true and important; but let’s not forget about the reasons like disease management programs, quality outcomes and device recalls.
To better understand where I am going with this, just ask any primary care physician (PCP), “How many asthma patients they have in their practice”? They could easily answer that
question by searching their ICD-9-CM code files. But then ask, “How many of those have persistent asthma that is moderate or severe”? PCPs have no way to answer that question without doing a retrospective record review or prospectively asking every asthma patient clinically oriented questions. If the ICD-10-CM system was already in use in this country, a simple computer search for subcategories J45.4- and J45.5- would provide a quick answer. Unfortunately, to date, there is no cure for the disease of asthma but with ICD-10, asthma patients would benefit from and probably welcome better managing a disease that limits
their physical activity. Other chronic diseases could benefit from the same intervention if it was easier to identify the severity of the “at-risk” patients in the organization, practice or hospital population.
To understand more about why we need ICD-10 and to learn about the author, click here.
Posted on Fri, Aug 31, 2012 @ 05:41 PM
By, Kyle Murphy, PhD, EHR IntelligenceLost 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, 10
th 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.
Posted on Wed, Jul 25, 2012 @ 02:44 PM
By: Dan Cobb, Chief Technology Officer, HealthMEDX
The only constant in life is change. LTPAC providers, which include home care agencies, nursing homes, and rehab facilities, face a number of challenges in the coming months and years. This blog is designed as a heads-up for topics that will impact the industry (in no particular order). There are countless other trends, but we’ll focus on three in this posting:
- ICD-10-CM. The replacement for ICD-9 diagnosis codes was originally to be required by CMS in October 2013. But don’t let the delay to 2014 provide an excuse to put off your conversion project. ICD-10 is an entirely different coding structure from ICD-9. For example, primary pulmonary hypertension is 4160 in ICD-9, but I270 in ICD-10. There are 5 times as many ICD-10 codes and they do not match one-to-one with ICD-9. Your clinicians and billing staff will need the extra time to learn the new language and will likely need to convert existing patient records manually.
- Meaningful use. At first glance, meaningful use doesn’t impact LTPAC providers. Hospitals and physicians are required to demonstrate meaningful use of certified electronic health records to receive adoption incentives and to avoid penalties from CMS. Stage one of ONC-ATCB (Office of the National Coordinator for health IT – Authorized Testing and Certification Body) meaningful use is in place now. Stage two (2014) and three (2016) will likely include the requirement for hospitals and physicians to exchange data electronically with LTPAC providers. LTPAC providers that cannot exchange data that conforms to the meaningful use exchange standards may be shut out from hospital and physician post-acute referrals in the future. LTPAC software companies are beginning to certify their products to ensure compliance with future exchange requirements.
- Care coordination. There is a growing movement to coordinate care among not only LTPAC providers but with hospitals, physicians and other providers. A few movements in this area include:
- The upcoming Continuity Assessment Record and Evaluation (CARE) instrument is designed to eventually replace the MDS for nursing homes, the OASIS for home health and the IRF-PAI for inpatient rehab. The CARE assessment will begin in the hospital upon discharge. In LTPAC, additional CARE assessments will take place upon admission, significant change and discharge.
- Re-hospitalization penalties for hospitals will add focus to care coordination among hospitals and LTPAC providers.
- In addition, Accountable Care Organizations (ACOs) are designed to provide coordinated care for Medicare recipients. Standards-based health information change will be necessary to coordinate care.
New data standards, like the longitudinal care plan will emerge to supplement the information that is currently available for exchange.
ICD-10-CM, meaningful use and care coordination are just a few of the many changes taking place in the LTPAC industry. May we live in interesting times.
Posted on Thu, Apr 05, 2012 @ 01:30 PM
Effective Jan. 1, 2012, healthcare transactions began their journey across the new 5010 transaction format. On March 15, 2012, CMS’ Office of E-Health Standards and Services announced that it would again delay enforcement of the HIPAA Version 5010 transaction standards for three months. Physician practices may therefore continue to submit electronic claims using Version 4010 through June 30, 2012, without penalty. Although CMS will not enforce compliance until July 1, the implementation date for Version 5010 is still Jan. 1, 2012, and all covered entities should continue to make every effort to comply with the new standards.
Physician groups may be experiencing unusual denials, payments sent to an incorrect address or less expedient cash flow since Jan. 1, 2012. These issues should be reported to payers and clearinghouses immediately for resolution; groups can work with their payer representative, clearinghouse or billing agency to ensure these issues are being addressed.
As expected, there have been disruptions in processing claims by some payers. The effects of these disruptions vary among physician practices and depend heavily upon the specific payer mix of each practice and the readiness of those payers. Medical Management Professionals, Inc. (MMP) has observed the following:
- A significant spike in payer denials, directly related to 5010.
- Some payers still have not converted to 5010.
- Payers that did not adequately test prior to the deadline have had significant problems.
- Some payers have had to migrate backwards from 5010 to 4010 in order to process claims.
- Some payers that successfully tested before the deadline had catastrophic claim payment errors when claim payment systems were moved to full production.
- Errors on production claims that were not present in the testing process due to different edits in payers’ production systems.
- Payers that were successful in production one week spiked claim denials in a subsequent week when they turned on additional edits in their production systems.
- The first months of the year are typically difficult cash flow months due to the restart of many patient deductibles as well as the difficulty in collecting patient payments; but preliminary data suggests that 5010 had an additional negative impact on cash flow.
- Please note that these are payment “delays” not payment “losses.”
The ideal response
Daily vigilant monitoring of claim denials for all payers is the most precautionary way to reduce risks in revenue, as well as ensuring ongoing dialogue with billing system vendors, payers and clearinghouses regarding claim denials and corrective actions. Currently, temporary work-arounds and permanent fixes are in development to eliminate 5010 denials. Monitoring industry publications for specific information on problems with specific payers will keep your practice in front of the major issues affecting the change.
The next step: ICD-10-CM
As practices implement 5010 transactions, the next logical step is preparation for ICD-10 code
changes. There are significant issues and potential concerns that hospital-based practices should be aware of with respect to ICD-10 implementation. By preparing early, however, practices can alleviate several operational and budgetary issues. Below are some recommendations for practices as they start the implementation process.
- Keep cost considerations in mind. Practices should consider all facets of their business as they estimate costs for ICD-10 implementation, including size, physician training, technology and overall adaptation.
- Adapt to the changes. Physician practices, hospitals and referring providers must quickly adapt to necessary documentation changes.
- Communicate with vendors. Billing companies such as MMP are currently working with billing system vendors, claims clearinghouses and outsourcing partners to ensure they are ready for ICD-10.
- Stay abreast of payer payment policies. Most commercial insurance carriers have indicated they will “crosswalk” ICD-10 codes back to ICD-9 codes for payment purposes.
- Brace the group for revenue changes. Practices can and should prepare for a potential disruption of cash flow.
Strategic thinking and preparation that involves costs analyses and effective communication with vendors and payers will ensure that practices will be ready to implement these changes by 2013. In many cases, a third-party billing or practice management company can help a practice keep up with 5010 compliance measures and prepare for ICD-10 implementation in regard to the above tactics.
In any case, practices must prepare now for the financial implications that will occur as ICD-10 is implemented.
Written By:
Joseph Degati - Chief Technology Officer, Medical Management Professionals, Inc.
http://www.physbiztech.com/how-to/keep-watchful-eye-5010-claims-denials-while-stepping-toward-icd-10-readiness
Posted on Wed, Mar 21, 2012 @ 10:00 AM
March 08, 2012
http://www.renalandurologynews.com/coping-with-icd-10/article/231160/
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.
Possible delay
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.”
Preparation
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.
Cost
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.
Vendors
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.
Resources
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.
Posted on Tue, Feb 07, 2012 @ 02:00 PM
Many providers, payers, claims clearinghouses and software vendors continue to work toward HIPAA 5010 compliance even as the Jan. 1, 2012, deadline has passed and the federal government has instituted a brief grace period.
A session at HIMSS12 in Las Vegas will examine how some organizations have made a successful 5010 transition, and how lessons from can translate to ICD-10 implementation work.
HIPAA 5010 compliance is a patchwork right now, says Eric Mueller, president of WPC Services, the consulting subsidiary of Washington Publishing Co., which publishes HIPAA implementation guides. Many commercial payers, for instance, are ready for 5010 but most state Medicaid agencies are fall behind. Some clearinghouses have done a good job for large clients but not so good for smaller ones.
A core lesson from 5010 is that when things fail, it’s because of inadequate testing, Mueller says. And that will be magnified a thousand times with ICD-10 implementation, he says.
A 5010 example: A physician practice that uses a clearinghouse to submit claims to all its insurers may have successfully tested 5010 with the clearinghouse. But most clearinghouses do not directly connect with all of their clients’ insurers--the transactions move between two or three clearinghouses to reach all payers.
So, the practice will receive notices of successful submission of 5010 claims to its clearinghouse, but then will get back 835 remittance advice transactions from payers that have wrong or missing data elements. There’s a lot of room in that trail of electronic transactions for things to get screwed up, Mueller says. And that’s why it is important for providers to understand how data moves through all parts of the transaction chain and the types of decisions that payers are making on the data--how they are interpreting 5010 requirements. “Organizations that have been successful have really dug into the data to see test files and results of test files,” Mueller says. “Don’t accept blanket ‘we got it’ test responses.”
Things will get much more complicated with ICD-10. Providers get paid under contracted rates based on diagnostic codes, and when the codes change under ICD-10, the reimbursement will change. Unless a provider organization understands not just how it will handle ICD-10, but also how its software vendors, clearinghouses and payers are doing it, there will be problems, Mueller warns. “You have to dig in and own your project.”
Everyone in the chain--providers, vendors, clearinghouses and insurers--will get dinged if things aren’t right, Mueller says. But the non-providers will still be getting paid for their services. “It’s the provider who risks total disruption.”
Consequently, Mueller hopes to give attendees a number of tips that peers have used to be successful when migrating to different transaction sets and codes, and other lessons being learned about addressing ICD-10. The lasting impression he wants to leave: “Proper preparation prevents poor performance.”
http://www.healthdatamanagement.com/news/hipaa-5010-transactions-icd-10-himss-conference-43953-1.html
Posted on Mon, Jan 23, 2012 @ 08:30 AM
By Carl Natale, ICD10 Watch- Now that it's 2012, and you have reached HIPAA 5010 compliance, it's time to work on your electronic health record (EHR) and Meaningful Use initiatives. Or do you need to start ICD-10 implementation next?
It depends on who you ask. In a recent ICD-10 Watch poll, 23 people responded to the question "Which project needs to be completed first?"
- 30 percent chose EHRs.
- 26 percent chose ICD-10 implementation.
- 43 percent said that both need to be done at the same time.
If you take a look at those numbers, 56 percent of participants said that it's an either/or choice. (It also doesn't add up to 100 percent due to rounding.) There are providers who see the projects as needing to be done one at a time.
George Schwend, president and CEO of Health Language, doesn't see it that way. "I see them as extremely aligned and complimentary initiatives," said Schwend. "I think most of the noise is coming from the folks who are trying to figure out what they're going to do first, second, third. And they're feeling overwhelmed."
But there are strong advantages for making them one project. Schwend sees Meaningful Use as an exercise in language. It translates the vocabulary that physicians use into codes - like ICD. Which is what Health Language does. "We provide tools to manage code sets in healthcare and make it a lot easier to maintain them and operate them and advance them as things change."
"Do Meaningful Use and ICD-10 at the same time because they overlap so greatly. And the requirements for both are intertwined so deeply," said Schwend. "So do them both at the same time so you end up with better results."
And then there is the cost. "I think the cost is reduced because you can do them both at the same time." reduce overlapping exercises and administrative costs. It doesn't make sense to Schwend to tackle them separately unless there resource restrictions that prevent providers from paying for a bigger project in one budget cycle."
Some of those costs will be spent anyway. Some large providers have plans to upgrade systems in place. Meaningful Use and ICD-10 coincide with those timetables. "Things are constantly being changed and upgraded." But Schwend doesn't see it as a mass upgrading movement. HIT departments are on different schedules.
Then there are the federal incentives that can be used to offset the cost of implementing both initiatives. The cost of DC-10 goes down if much of the work is done in conjunction with Meaningful Use.
That isn't Schwend's area to discuss. Those incentives are being pursued separately by clients without involving Health Language. But what Schwend can discuss is where he says is the real savings.
"Where the real issues of cost savings come in is having the ability to have tools that will take a look at cases after cases after cases of how you map from your ICD-9 to to ICD-10 and are you going to lose money or make money," said Schwend. "Because the way you map - legitimately map and correctly map - can vary dramatically and you can either make more money or lose money if you do it one way or the other."
He says Health Language clients are using these tools now to make sure they don't have any surprises in 2013. By using the right tools, Schwend says providers can make sure they get the best returns possible. And by the right tools, Schwend means EHRs that are ICD-10 compatible now.
"You're going to save money in the long run if you do them at the same time. But it's not ust saving money. It's getting it right the first time."
"If you get all the data into Meaningful use, and then into your ICD-10 exercises, you got a plethora of information to really take advantage of better heath care patient safety, all of those things."