Always Read The Instructions…
J00 — Common coldnT48.4X1A — Poisoning by expectorants, accidental (unintentional)nT48.3X5A — Adverse effect of antitussivesnT48.5X6A — Underdosing of other anti-common-cold drugs
Can You Hear That Diagnosis…
R29.4 — Clicking hipnH93.12 — Objective tinnitus, left earnR01.0 — Benign and innocent cardiac murmursnR19.12 — Hyperactive bowel soundsnnIn preparation for the upcoming deadline for ICD-10 implementation, Welter Healthcare Partners presents weekly ICD-10 Codes of the Week! Our goal is to familiarize you with the new and expanded code set and the additional clinical documentation needed from your providers to comply with ICD-10 coding, and more importantly, for accurate and clean claims submission to keep your revenue stream flowing! We are to help YOU prepare for the October 1, 2015 implementation date. Please don’t hesitate to contact us for all of your training and education needs!
Providers Still Lack ICD-10 Testing Plans, Impact Assessments
ICD-10 preparation is still lagging as providers continue to worry about testing, revenue, and productivity.
nA worrying number of providers are still missing some of the basic building blocks of a successful ICD-10 transition plan, AHIMA and the eHealth Initiative found in a new survey, including financial impact assessments and plans for internal and external testing. As the clock ticks down to the latest ICD-10 deadline of October 1, 2015, the industry continues to be plagued by a lack of education, understanding, and action that puts some organizations at risk for reimbursement troubles and revenue woes.n
The survey did reveal a few encouraging statistics, especially around the readiness of many organizations to conduct internal testing during the final months of 2014. Among the hospitals and physician providers who responded to the survey:
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- Of the 65% of providers who believe they will be able to begin end-to-end testing before the October 1, 2015 compliance date, 63% will be ready to start by the end of 2014.
- Most of the larger organizations participating in the survey indicated that they will be testing in 2014, while smaller organizations and physician practices were more likely to be ready later in the preparation period.
- When it comes to revenue cycle impacts, 6% of providers are anticipating a spike in reimbursements. Fourteen percent think ICD-10 will neither increase nor decrease their revenue collections.
- Forty-one percent of providers believe that ICD-10 will improve the accuracy of their claims long-term, while 29% anticipate better quality of care and 27% are looking forward to improvements in patient safety.
- Providers intended to make ICD-10 work for them for quality improvement (63%), performance measurement (52%) and outcome measurement (41%). Sixty-three percent think the increased specificity will have a positive impact on claims processing and billing.
- Organizations are making good use of the one-year delay instituted in April. Sixty-two percent are working on clinical documentation improvement, 47% are dual coding, and 59% will take the opportunity to bolster their educational programs with the extra time available to them.
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The not-so-good news
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Despite the optimism from many organizations, there remains a significant gap between the well-prepared and the lost at sea. Familiar challenges such as clinical documentation improvement, coder productivity, and the scope of financial investment still top the list of worries as the industry moves closer to compliance.n
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- Ten percent of organizations do not have a plan in place for conducting end-to-end testing, and 17% don’t have a clear idea when their organization will be ready to begin the lengthy and cumbersome testing process.
- Among those who have no plans to test, more than a third cited a lack of knowledge as the reason they are stalled. Forty-five percent of those providers are clinics or physician practices that fall on the smaller end of the spectrum.
- Thirty-five percent of providers believe they will take a hit to their revenue cycle from the new code set. Eighteen percent are unsure of how ICD-10 will affect their billings.
- A whopping 27% of providers have not completed financial impact assessments, which is one of the first steps organizations should take in order to chart a course towards compliance.
- Unsurprisingly, the majority of providers believe that coding will become more difficult under ICD-10, while 42% anticipate clinical documentation challenges. Forty-one percent expect that adjudicating reimbursement claims will be harder.
- Barriers to implementation include changes to the clinical workflow and a loss of productivity (56%), inadequate staging, (49%) and effective change management (48%). Just under half of providers are worried that their vendors and business partners won’t be ready on time.
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nSource: www.ehrintelligence.com; Jennifer Bresnick; November 7, 2014.
Colder Weather and Stiffer Joints…
M17.0 — Bilateral primary osteoarthritis of kneenM16.7 — Other unilateral secondary osteoarthritis of hipnM25.662 — Stiffness of left knee, not elsewhere classifiednM25.551 — Pain in right hip
Pervasive Medicare Fraud Proves Hard to Stop
BALTIMORE — The ordinary looking office building in a suburb of Baltimore gives no hint of the high-tech detective work going on inside. A $100 million system churns through complicated medical claims, searching for suspicious patterns and posting the findings on a giant screen.
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Hundreds of miles away in a strip mall north of Miami, more than 60 people — prosecutors, F.B.I. agents, health care investigators, paralegals and even a forensic nurse — sort through documents and telephone logs looking for evidence of Medicare Fraud. A warehouse in the back holds fruits of their efforts: wheelchairs, boxes of knee braces and other medical devices that investigators say amount to props for false claims.
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The Obama administration’s declared war on health care fraud, costing some $600 million a year, has a remarkable new look in places like Baltimore and Miami. But even with the fancy computers and expert teams, the government is not close to defeating the fraudsters. And even the effort designed to combat the fraud may be in large part to blame.
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An array of outside contractors used by the government is poorly managed, rife with conflicts of interest and vulnerable to political winds, according to interviews with current and former government officials, contractors and experts inside and outside of the administration. Authority and responsibilities among the contractors are often unclear and in competition with one another. Private companies — like insurers and technology companies — have responsibility for enforcement, often with little government oversight.
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Fraud and systematic overcharging are estimated at roughly $60 billion, or 10 percent, of Medicare’s costs every year, but the administration recovered only about $4.3 billion last year. The Centers for Medicare and Medicaid Services, which is responsible for overseeing the effort, manually reviews just three million of the estimated 1.2 billion claims it receives each year.
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“It’s pretty dysfunctional because the contractors don’t communicate with each other,” said Orlando Balladares, a fraud investigator who has worked for both the government and private firms.
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Dr. Shantanu Agrawal, who oversees Medicare’s antifraud center, the Center for Program Integrity, said the administration had made fighting fraud a top priority.
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“The focus is higher than it ever has been,” said Dr. Agrawal, an emergency medicine physician and former McKinsey consultant who took the Medicare job this year. But even some of the administration’s successes shed light on the crackdown’s limitations.
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Click here to learn more about Welter Healthcare Partners’s coding and documentation compliance program!
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Source: www.nytimes.com; Reed Abelson, Eric Lichtblau; August 16, 2014.