Health Hazards in China… Fun with ICD–10
Z77.110 — Contact with and (suspected) exposure to air pollutionnnZ77.128 — Contact with and (suspected) exposure to other hazards in the physical environmentnnK90.1 — Cochin-China diarrhea
R. Todd Welter Visits 5 Beijing Hospitals in 5 Days
Welter Healthcare Partners is thrilled to announce that our own R. Todd Welter recently revisited Beijing, China to work directly with healthcare professionals in providing insight to the American Healthcare System.nnCEO of Welter Healthcare Partners, R. Todd Welter went to visit 5 hospitals in 5 days in a whirlwind trip to Beijing, China (now a city of over 20 million people) to provide area medical professionals with insight to how the American Healthcare System works. Welter spoke on topics of medical coding and revenue cycles… and a bit about American politics.nnWelter visited China back in 2004 for a similar trip, and the hospital associates there were anxious to meet with the American medical billing and healthcare expert again. For insight into his trip, and a review of the 2004 venture, check out an article by Welter, below.n
Third-Party Payer Committee
nBy Todd WelternnBilling and Coding, Medical Records and Managing HealthcarennI am in Beijing China, a city of over 10 million. I was invited by a Swiss company to attend The Chinese Orthopedic Association’s National Congress. Over 2,500 Chinese physicians will attend to hear discussions on the latest surgical procedures, new products, and new ideas on patient care. I have traveled with my friend Dr. Michael Janssen, an internationally known and well-respected orthopedic spine surgeon. Dr. Janssen has an orthopedic spine surgery practice in Thornton, Colorado.nnIn addition to our official duties, the obvious tourist opportunities, and the many complex social events we are invited to, I am determined to learn as much as I can about the Chinese healthcare system, how it is financed, how records are kept, and how the physicians are compensated (who said healthcare business consulting is boring?)nn[vc_toggle title=”CLICK HERE TO READ MORE” size=”sm” el_id=””]The Chinese system for coding is not as specific as ours. Even though they perform essentially the same services and procedures, they record very basic, general service descriptions. They then have a fixed fee schedule for all services. The patient pays for medical care, many times in advance. If it is not paid for, it is simply not done.nnThe Chinese people, those living in the larger cities at least, have insurance. In China, employers pay for the insurance. Most of the time the insurance pays very minimally and the remainder is paid by the patient or their family or outright by their employer.nnI am visiting the Beijing General Military Hospital, a sprawling 1,100 bed facility in the heart of Beijing, a few minutes from Tiananmen Square. Our hosts tell me that this is the best hospital in all of Beijing. I find the facility to be very “1950’s Institutional.” Stark white tiled walls and floors. No patient amenities (televisions, bathrooms in the rooms, etc.). Other than that, the set up is very similar with one very notable exception. In China, the patient’s family is expected to play a big part in the patient’s care. The patient’s family does a lot of what we call nursing care (food, patient comfort, even moderate physical therapy). Every patient room I saw had at least one extra bed in it for a family member.nnI was very privileged to be able to discuss the Chinese systems of record keeping, coding, charges, and reimbursement with the hospital’s Vice President of Finance who is also a gastroenterologist. All the physicians at this hospital are employed by the hospital. Many have apartments on the grounds of the massive complex. Physicians are paid a salary and then receive bonus pay based on their productivity (number of cases, patients seen, etc.). Physicians are also able to receive additional compensation for a wide variety of other efforts, some officially frowned upon but openly accepted.nnThe hospital and physicians use a single electronic medical record. Computers throughout the facility are able to access a patient’s record, charges, physician notes, nursing notes, etc.nnOne area of great difference is the concept of outpatient surgery. The Chinese do not perform “outpatient surgery.” Part of our visit to the facility included a session with the Orthopedic Department to do case reviews. There was a kind of International Grand Rounds done with Dr. Janssen from Denver and a physician from Prague. The Chinese physicians discussed several cases and presented their x-ray results, including MRI. As it turns out, a procedure that could be done in Denver in 30 minutes with a 4-hour stay in an outpatient facility would result in at least a 2-day in-patient stay in China.nnThe Chinese system appeared to equal ours; in fact they perform the same complex procedures we perform (open heart surgery, complex spine and neurosurgery, transplants, etc.) in addition to all the more routine services. Their system was, however, remarkable for it being less efficient than ours. On the provider side, it appeared that their system is hospital-centered rather than physician-centered. They therefore, don’t seem to be as concerned about seeing as many patients as possible, turning around O.R. rooms quickly and getting the patients out of the hospital as soon as possible. I was struck by this difference.nnBased on this trip, other international visits, and even many domestic observations, I am starting to conclude that the American system of healthcare, with all its apparent blemishes, owes its efficiency to American physicians playing such an important role in it. The concept of system efficiency is lost to the Chinese, because it is a hospital-centered system. The lesson in this may be to protect and, in fact, strengthen the physician’s role in healthcare rather than allow it to continually erode. It appears, by observation, that when there is a system which does not allow the physician to initiate care, make decisions, order, admit and discharge while compensating him/her to do so in a way that values this expertise, the system suffers from inefficiencies, lack of creativity, and thus higher costs.nnBeing a coder at heart, I brought a 2004 CPT book with me and showed it to them. Its level of detail mesmerized them. We agreed to exchange pricing information and I was allowed to photograph much of the facility including patient rooms, patients, and even a medical record. (Something we could never do here.) The company who invited me to China is sending me a large package of information on the Chinese healthcare system for follow-up.nnThe President of the Beijing General Military Hospital presented us gifts. He gave Dr. Janssen the title of Honorary Chairman of the Orthopedic Department (a very high honor) and presented me with a traditional Chinese tea set (something we will cherish at my home). I plan to send him a copy of John Fielder’s book of Colorado photographs and, of course, a CPT book.nnThis article originally posted on CMGMA.com.[/vc_toggle]
CTS Thanks to the EMR! — Fun with ICD-10
G56.01 — Carpal tunnel syndrome, right upper limbnnG56.02 — Carpal tunnel syndrome, left upper limbnnZ57.8 — Occupational exposure to other risk factorsnnZ56.6 — Other physical and mental strain related to worknnY92.531 — Health care provider office as the place of occurrence of the external cause
CMS Release — Medicare Reporting and Returning of Self-Identified Overpayments
The Centers for Medicare & Medicaid Services (CMS) has published a final rule that requires Medicare Parts A and B health care providers and suppliers to report and return overpayments by the later of the date that is 60 days after the date an overpayment was identified, or the due date of any corresponding cost report, if applicable. A separate final rule was published in the May 23, 2014 Federal Register (79 FR 29844) that addresses Medicare Parts C and D overpayments.nnSummarynThe requirements in this rule are meant to support compliance with applicable statutes, promote the furnishing of high quality care, and to protect the Medicare Trust Funds against improper payments, including fraudulent payment. This rule clarifies requirements for the reporting and returning of self identified overpayments. Health care providers and suppliers have been and will remain subject to the statutory requirements found in section 1128J(d) of the Social Security Act (the Act) and could face potential False Claims Act (FCA) liability, Civil Monetary Penalties Law (CMPL) liability, and exclusion from federal health care programs for failure to report and return an overpayment. Health care providers and suppliers will also continue to be required to comply with current CMS procedures when we, or our contractors, determine an overpayment exists and issue a demand letter.nnBackgroundnSection 6402(a) of the Affordable Care Act established a new section 1128J(d) of the Act. Section 1128J(d)(1) of the Act requires a person who has received an overpayment to report and return the overpayment to the Secretary, the state, an intermediary, a carrier, or a contractor, as appropriate, at the correct address, and to notify the Secretary, state, intermediary, carrier, or contractor to whom the overpayment was returned in writing of the reason for the overpayment. Section 1128J(d)(2) of the Act requires that an overpayment be reported and returned by the later of: (A) the date which is 60 days after the date on which the overpayment was identified; or (B) the date any corresponding cost report is due, if applicable. Section 1128J(d)(3) of the Act specifies that any overpayment retained by a person after the deadline for reporting and returning an overpayment is an obligation (as defined in 31 U.S.C. 3729(b)(3)) for purposes of 31 U.S.C. 3729. In the February 16, 2012 Federal Register (77 FR 9179),nnCMS published a proposed rule to implement the provisions of section 1128J(d) of the Act for Medicare Parts A and B providers and suppliers.nnMajor ProvisionsnThe major provisions of this final rule include clarifications around: the meaning of overpayment identification; the required lookback period for overpayment identification; and the methods available for reporting and returning identified overpayments to CMS.n
Medicare Meaningful Use Hardship Exception Application Process Changes Released by CMS
On Jan. 22, 2016, CMS issued a new application and sweeping changes to the Medicare Electronic Health Records (EHR) Incentive Program hardship exception application process. The changes are intended to temporarily ease the burden on providers seeking exemption from the 2017 Medicare meaningful use payment adjustments.nnHighlights of CMS’ guidance include:n
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- CMS may accept Medicare Meaningful Use Hardship Exception Applications for the 2015 EHR Reporting Period from EPs thru March 15, and from qualifying hospitals thru April 1, 2016.
- While CMS has not stated it will issue blanket exemptions to EPs and hospitals who failed to attest to meaningful use in 2015, the language in Section 2.2.d. of the revised Hardship Exception Application leaves open the possibility that CMS will categorically grant exemptions to those applicants asserting Section 2.2.d as the reason for their failure to timely attest to meaningful use for the 2015 EHR Reporting Period.
- Multiple providers may apply for a Hardship Exception as a group by submitting a single electronic application to CMS that includes each providers’ NPI and CCN.
- CMS’ revised Hardship Exception Application requires less information from the applicant than the old application, permitting easier filing and processing.
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nThe revised application and instructions, which are both accessible here, implement the Patient Access and Medicare Protection Act, Pub. L. No. 114-115 (Dec. 28, 2015) (PAMPA). PAMPA was passed in the last days of 2015 in the wake of provider frustration created by repeated revisions to the meaningful use criteria and CMS’ delayed release of the Stage 2 Meaningful Use Program Final Rule1 (Final Rule). CMS did not release the Final Rule until early October 2015. Consequently, eligible professionals (physicians and others subject to meaningful use as eligible professionals (EPs)) and qualifying hospitals were left with less than 90 days before year’s end to digest, implement, and attest to meeting the revised program’s criteria; yet, the Final Rule called for a 90 day data reporting period. Many EPs and hospitals also had trouble locating certified EHR technology updated for the new requirements in time to report data for the entire designated 2015 reporting period.n
nThis article originally posted on Polsinelli.com.