Aug 1, 2013 | Uncategorized
When all is said and done, ICD-10 is about the money. On October 1, 2014, providers just want to know if they’ll be getting paid for their services. The question isn’t as easy to answer as many people think, and there are plenty of jitters when it comes to how payers will handle ICD-10 codes, if they will be processed in a timely manner – and if the new version of their claims will even go through. Unfortunately, it’s impossible to predict whether the industry will be ready on time, and if the transition will be a success. But even without a crystal ball, you can get a jump on your preparations by asking your payers this list of important questions about their ICD-10 plans.n
Who is my dedicated contact person?
nJust like with vendors, many health plans are big, bureaucratic organizations, and they have just as much on their plate as you do. They will have hundreds or thousands of physicians asking them the same questions about ICD-10, and you don’t want to get lost in the shuffle. Make sure that you have a dedicated point-person to talk to, and that he or she is capable of giving you timely and meaningful answers.n
Are you going to be conducting external testing?
nWith all the stress that CMS has put on testing, testing, testing, this is still a very important question to ask, because the answer might very well be “no”. Medicare’s official position at the moment is that CMS contractors will not be conducting full external testing with business partners, leaving the vast majority of providers unsure if their claims can be accepted by the biggest payer in the industry. And since many major health plans follow Medicare’s lead, there is widespread concern among providers that they will be left guessing ahead of the implementation date.n
When will you be ready to do so?
nIf some or all of your payers will be conducting testing, be sure to ask when they’re going to be ready to start, how many claims they will want to accept from you, and what kind of feedback you’ll be getting on the quality of your ICD-10 coding. Ensuring that both you and your payer are HIPAA Version 5010 compliant is one of the critical aspects of ICD-10 that hasn’t been stressed enough. ICD-10 is entirely based on 5010, and if you’re one of the providers who haven’t switched over yet, you’re not going to be able to send and receive billing information at all.nnTesting isn’t just a technical necessity. It will also help you figure out if unspecified codes are acceptable to any of your business partners, and if your documentation and medical coders are up to snuff. This extra practice for your staff can help mitigate productivity losses after go-live, and make them more comfortable with the idea that they’re on the right track.n
Will you be dual processing? When will you start?
nMany payers are looking to dual processing – accepting both ICD-9 and ICD-10 codes for a period of time to ease the transition and allow comparisons – as the best way to move forward and keep revenue flowing appropriately. It’s an enormous opportunity for providers, as well: your coders and physicians will have extra time to practice their documentation improvement strategies and ICD-10 coding while seeing exactly what the world after October 1 will look like.n
nWhile CMS has not indicated that dual coding will be accepted for some transition period after October 1, ask your payers if they are planning to take this step, and when they will start so you have the most time to maximize the benefits of side-by-side coding.n
What happens if things go wrong?
nYour payers might not have an answer for you. No one really knows what’s going to happen on October 1, and with a year left on the clock, anything is possible. Thorough, meaningful communication with all your business partners is the best way to ensure that if something does go wrong, you have a contingency plan in place to mitigate the fallout. Both payers and providers stake their entire businesses on making sure that claims are paid quickly, smoothly, and to the fullest extent, so it’s in everyone’s best interests to work together during the crucial time.n
Online ICD-10 specialty-specific provider training modules coming soon!nContact us for more details.
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On-site, custom ICD-10 training for staff and providers – book your ICD-10 trainer now!
nSource: www.ehrintelligence.com; Jennifer Bresnick; July 29, 2013
Jul 25, 2013 | Uncategorized
Z56.5 – Other physical and mental strain related to worknnZ63.1 – Problems in relationship with in-lawsnnZ62.891 – Sibling rivalrynn nnIn 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, 2014 implementation date. Please don’t hesitate to contact us for all of your training and education needs!
Jul 25, 2013 | Uncategorized
House Energy and Commerce Health Subcommittee drafts bill to repeal the Medicare sustainable growth rate payment formula
nYesterday evening, the House Energy and Commerce Health Subcommittee began marking up a bipartisan bill to permanently repeal the Medicare sustainable growth rate (SGR) payment formula. The legislation allows for a transition to new performance-based delivery reforms and incentivizes physicians to begin practicing under those models now. The bill provides an annual 0.5% physician payment update for five years through 2018 to create a period of “stability.” In that period CMS will use existing quality measures such as PQRS and the EHR Incentive Program to provide a quality bonus structure,. Physicians may begin practicing under “Alternative Payment Models,” which may pay bonuses based on existing quality measures.nnBeginning in 2019, updates in fee-for-service beyond 0.5% will be dependent on the development of an Update Incentive Program (UIP) based on new quality measures to be developed by provides and the Secretary of HHS. High performing providers will be eligible for a 1% update based on quality measures. Underperforming providers will be subject to a 1% cut in payment. In the interim, providers will have the option of practicing under APMs to promote better care coordination, such as Primary Care Medical Homes, ACOs, and Bundled payments. The bill provides improved access to Medicare data for providers and creates additional avenues for development of new payment and care delivery models.n
n[vc_toggle title=”Repeal Flawed Medicare Sustainable Growth Rate Formula” size=”sm” el_id=””]For the past decade, Congress had needed to override the SGR formula to undo deep cuts caused by flaws in the formula. This legislation permanently repeals the current Medicare SGR mechanism that places a global cap on Medicare spending on provider services.[/vc_toggle]n[vc_toggle title=”Period of Stability” size=”sm” el_id=””]The legislation provides an annual statutory update of 0.5% per year for 2014 through 2018. During this time, the current law payment incentives, such as the Physician Quality Reporting Program (PQRS) and the Electronic Health Record (EHR) Incentive Program will continue. Quality measure development also will continue to ensure robust availability of measures for rewarding provider performance. Providers will also have the option of using current delivery system reform avenues as well as a new Alternative Payment Models (APM) process to put forward and test new models of care delivery and improvement.[/vc_toggle]n[vc_toggle title=”Rewarding Performance” size=”sm” el_id=””]nnBeginning in 2019, providers will receive an annual update of 0.5%. However, physicians practicing in fee-for-service will receive an additional update adjustment based on quality performance under a new Update Incentive Program (UIP). Performance under the UIP will be assessed based on quality measures and clinical practice improvement activities. These measures and activities may be those currently in use or new measures. Providers and other stakeholders shall be included in the development and selection of measures used in the UIP. Provider performance will be assessed among peer cohorts of like providers providing like services. High performing providers (those that achieve above a threshold) will have the opportunity to earn a 1% bonus payment based on previous performance, while low performing providers (those that are below a threshold) will see a 1% reduction in payments.nnProviders who do not report any quality information will receive the current 2% reduction in payment under PQRS, an additional 3% reduction under UIP. Other incentive programs in title XVIII remain in place.[/vc_toggle]nn nn[vc_toggle title=”Alternative Payment Models (APMs)” size=”sm” el_id=””]Development of new models of care is already underway; many of these new models show great promise for care coordination, keeping people healthy, and encouraging collaboration and shared accountability across the care continuum. This legislation establishes an additional avenue for the development, testing, and approval of APMs beginning in 2015. Under this new process, providers and other stakeholders may submit proposals for new models to an independent entity that will review proposals and make recommendations to the Secretary for models to move forward as either a demonstration or as a permanent program. The independent entity will report at least quarterly on models received and recommendations. Models that are adopted as demonstrations are evaluated by an independent third party for success on improving care or reducing (or not increasing) costs.[/vc_toggle]nn[vc_toggle title=”Supporting Care Coordination and Medical Homes” size=”sm” el_id=””]To support care coordination and development of patient centered medical homes, the legislation establishes new payment codes for complex chronic care management for providers treating individuals with complex chronic conditions. The legislation also ensures that Medicare payment is available for care coordination services performed by physicians who: are certified as a Level III Medical Home by the National Committee on Quality Assurance; are recognized as a patient-centered specialty practice by the National Committee on Quality Assurance; have received equivalent certification; or meet other comparable qualifications.[/vc_toggle]nn[vc_toggle title=”Expanded Data Availability for Care Improvement” size=”sm” el_id=””]To expand the availability of Medicare data for providers to use in developing new models of care and improving quality and patient care, the legislation expands access to Medicare data for certain certified entities. The legislation eliminates the roadblocks that prevented these entities from sharing data directly with providers to facilitate the development of alternative payment models and care improvement.[/vc_toggle]nn[vc_toggle title=”Improving Payment Accuracy” size=”sm” el_id=””]A lack of accurate and meaningful data on costs has hampered the ability of Medicare to review the accuracy of payments for services and identify which services are improperly valued. The legislation would ensure that providers could be compensated for the cost of submitting such data. The legislation also directs Medicare to identify improperly valued services under the fee schedule that would result in a net reduction of 1% of the projected amount of expenditures for a year during 2016 through 2018.[/vc_toggle]nn[vc_toggle title=”Rule of Construction Regarding Standards of Care” size=”sm” el_id=””]This legislation provides that the development, recognition, or implementation of any guideline or other standard under any federal health care provision under the Affordable Care Act, Medicare, and Medicaid shall not be construed to establish the standard of care or duty of care owed by a health care provider to a patient in any medical malpractice or medical product liability action or claim.[/vc_toggle]nnOnline ICD-10 specialty-specific provider training modules coming soon!n
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On-site, custom ICD-10 training for staff and providers – book your ICD-10 trainer now!
nSource: www.fightchronicdisease.com; June 25, 2013.
Jul 19, 2013 | Uncategorized
S13.4XXA — Sprain of ligaments of cervical spine, initial encounter (whiplash injury of cervical spine)nnY93.I1 — Activity, roller coaster ridingnnY92.831 — Amusement park as the place of occurrence of the external cause.nnR11.0 — NauseannIn 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, 2014 implementation date. Please don’t hesitate to contact us for all of your training and education needs!
Jul 19, 2013 | Uncategorized
Physicians have reason to question the timing and value of ICD-10 as they have many competing priorities due to a multitude of concurrent regulatory, technology and industry changes. Many see ICD-10 as “salt in the wound.” However, ICD-10 offers potential value to physicians if leveraged and utilized correctly. Physicians who take decisive steps to fully integrate ICD-10 into their clinical practice stand to benefit in several ways.nnSo, yes, ICD-10 implementation is an investment in time, but it presents physicians with five benefits that have the potential to be major game-changers.n
1. Grow compensation and reimbursement.
nICD-9 codes were not originally developed with reimbursement in mind. ICD-10, however, offers a more decisive system to determine payments by offering greater detail on the quality of the care provided. In turn, government payers, insurers, hospitals, health systems, medical groups and others will use ICD-10’s granular data to determine accurate and fair physician compensation and reimbursement for goods and services.nnSome hospital systems with employed physicians have been offering compensation plans based on performance for several years. For example, Geisinger Health System in Danville, Pa., has a pay- for-performance (P4P) program that bases 40 percent of incentive payments on quality goals (Cheung- Larivee, 2012). The New York City Health and Hospitals Corporation recently announced that more than 3,500 employee physicians will receive bonus payments tied to meeting quality measures, such as lower readmission rates (Caramenico, 2013). With the arrival of ICD-10, quality incentives are in jeopardy if the physician does not document to the level needed to attain the correct and more specific code selection. This is because the code is a reflection of how severely ill that patient was, and a sub-optimal code in ICD-10 will not provide support on why a certain amount of care was needed.nn
Under the government’s Value-Based-Purchasing program, physicians who do not provide precise documentation (e.g., laterality, specificity, anatomic site, etc.) to support the specificity of ICD-10 will experience reduced payments. On the other hand, it is important to note that ICD-10 does not require a change in how physicians practice medicine or treat patients. Rather, it demands more accurate documentation and gives physicians more diagnostic choices to capture new data to ensure they are paid for the complex work they perform.nnAnother example is documentation and payment on new and cutting-edge procedures. New procedures are problematic for coding purposes. In both CPT and Volume 3 of ICD-9, they are often given an unlisted procedure or an unspecified code. With ICD-10-PCS (Procedure Coding System), which will be used for inpatient procedures, the codes are going to be created based on the surgeon’s documentation in the operative report. The code will be built based on the type of surgery, body system, root operation, body part, approach, device and any qualifiers that the surgeon includes in the documentation. So, for inpatient procedures, there are no limitations in code selection because ICD-10-PCS codes accurately reflect the goal, the location, and the steps of each procedure without the restrictions of procedural naming conventions and agreed-upon methodology. Often new procedure codes were not covered by government or private payers, according to an ICD-10 RAND report (Libicki & Brahmakulam, 2004). The upshot: payers may cover more procedures, reject less, pay faster and reimburse more accurately.nnClick Here To Read Moren
Online ICD-10 specialty-specific provider training modules coming soon!nContact us for more details.
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On-site, custom ICD-10 training for staff and providers – book your ICD-10 trainer now!
nSource: www.physbiztech.com; Tom Ormondroyd; July 17, 2013.
Jul 10, 2013 | Uncategorized
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Welter Healthcare Partners does not think this will cause any material effect on the PPACA. It only delays one very important provision of this very complicated law.
nObama administration delays employer mandate for 1 year – July 9, 2013nnThe Affordable Care Act requires businesses with more than 50 employees to provide health insurance for their workers or face a penalty of up to $3,000 per employee. The Obama administration has delayed this requirement until January 2015, due to employers’ concerns about their ability to comply with the complexities of the requirement. While more than 90 percent of companies with at least 50 employees already offer health insurance to their workers, those individuals affected by the delay may obtain coverage through the health insurance exchanges, set to begin in 2014. Additional guidance is expected to be released this week.nnSource: www.naph.org; July 9, 2013.nn
