Oct 31, 2012 | Uncategorized
The International Classification of Diseases, Tenth Revision (ICD-10), comprises two sets of codes, one for documenting diagnoses (ICD-10-CM) and the other for documenting procedures (ICD-10-PCS). Compared to ICD-9, these codes are more extensive and more numerous. ICD-10-CM codes number close to 68,000 and contain 3–7 characters compared to ICD-9-CM total more than 14,000 3–5 digit codes. Similarly, ICD-10-PCS comprise 7 characters and approximate nearly 87,000 compared to 4,000 ICD-9-CM codes of 3–4 numbers in length.nnGiven the size and scale of ICD-10, the new code set will demand more from hospital staff, not just coders. Unless physicians improve their methods of documenting clinical encounters with patients, they and their hospitals could find themselves in dire financial straits:nnEssentially what’s going to happen is physicians are going to have to have more specific documentation in order to meet medical necessity so that they can even be paid and in order to be able to make sure they’re getting the most appropriate reimbursement when they do get paid, both for the physicians and the hospitals. When a physician is treating a patient in the hospital, you have two patients: one to the physician and one to the hospital. They both are dependent on better documentation with ICD-10.nnTo avoid loss in revenue and uncertainty in productivity, experts recommend that hospitals pay special attention to their clinical documentation as well as the templates used by physicians in their electronic health record (EHR) systems.nnIn this second installment of ICD-10 Best Practices, we address how hospitals undertake an important health information technology project necessary to ensure a smooth transition to ICD-10: identifying and making improvements to EHR templates.nnModifying EHR templates for ICD-10nThe most successful ICD-10 implementations begin with an assessing of current procedures and systems. Considering that ICD-10 demands more information than ICD-9, hospital leadership must first identify where physicians presently fall short in capturing data necessary for ICD-10.nnThose tasked with updating EHR templates need strike the right balance so as to avoid stimulation overload for physicians using the system:nnICD-10 has a lot of detail that you can collect that’s informational only, and it allows you to assign a more specific code. However, that code is not based on or will not lead you to a change in the way a physician manages that patient, and it won’t have an impact financially. Your alerts have to be focused on those areas where you’re improving documentation because it’s going to improve payment or capture of severity of illness and risk of mortality.nnThe real challenge is identifying what’s necessary versus what’s superfluous. And this extends to the details physicians will now have to capture. By and large, many parts of ICD-9 carry over to ICD-10; however, the level of specificity changes greatly:nnMost of things that you have to document for ICD-9 to improve reimbursement are going to still hold true with ICD-10. But there are some additional things in ICD-10 and the problem is that they’re buried. It’s not easy to identify where the shift in payment is going to come from based on all the specificity that we have available, and that’s why you need to have the assessment to really drill down and identify. You take that information to improve the templates you have because some of it is not intuitive. You wouldn’t think that adding this little is going to have a financial impact, but it does.nnWhile the modifications to the EHR templates represent a significant undertaking, they are only successful if preceded by a thorough assessment of ICD-10 and its requirements on physicians and hospitals.nnSource: www.ehrintelligence.com; Kyle Murphy, PhD; October 30. 2012.
Oct 23, 2012 | Uncategorized
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few months ago, we paired with Novitas Solutions, INC. as our new Medicare Administrative Contractor (MAC). Effective October 29, 2012, Novitas Solutions, Inc. will begin handling all fee-for-service claims processing for the Part A providers.nnIn order to facilitate a smooth Part A JH transition, please take note of the following important dates:nnEDI Claims Submissionn
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- TrailBlazer will accept all Part A EDI claims submissions until 4 p.m. CT on October 25, 2012.
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- TrailBlazer will not process Part A EDI claims on Friday, October 26, 2012.
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- Novitas Solutions will begin accepting EDI claims submissions using the new JH contractor ID/payer IDs after 5 p.m. CT on October 26, 2012.
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- Novitas Solutions will accumulate any claims received from 5 p.m., October 26, 2012, through 5 p.m., October 29, 2012, and will enter the accumulated claims into the FISS processing system on October 29, 2012.
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- Part A ERAs will be created during the October 29, 2012 cycle and will be available for mailbox retrieval on October 30, 2012.
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nERA/EFTn
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- Last TrailBlazer Part A ERA/EFT cycle will be October 26, 2012.
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- First Novitas Part A ERA/EFT cycle will be October 30, 2012. Note: The delivery of the ERA may be delayed daily the week of the transition to validate accuracy prior to distribution. A listserv will be sent daily when the files are available for retrieval.
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P.O. Boxes and Mailn
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- The last day to submit Part A paper documents to the TrailBlazer post office boxes is Friday, October 26, 2012.
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- Effective October 29, 2012, all Part A documents must be mailed to the Novitas Solutions facility located in Camp Hill, Pennsylvania, using the specific post office boxes referenced in the Novitas September 24, 2012 JH Transition SIPP IV and V Newsletter.
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- TrailBlazer will continue to accept all other Part A work through Friday, October 26. Any open/pending Part A work as of October 26 will be forwarded to and finalized by Novitas Solutions.
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nContact Centers and IVRn
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- TrailBlazer will continue to answer Part A provider telephone inquiries and offer IVR service through 4 p.m. CT, Friday, October 26, 2012.
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- Due to a system dark day at Novitas Solutions, the Customer Contact Center, including claim corrections, general, EDI and provider enrollment inquiries, will be closed on Monday, October 29.
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- Novitas Solutions will resume normal business hours on Tuesday, October 30. The Novitas Solutions’ Customer Contact Center will be open normal business hours of Monday through Friday, 8 a.m. to 4 p.m. CT.
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- Novitas’ Contact Center toll-free number is (855) 252-8782.
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nPart A Enrollment Application Processing Timelinen
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- TrailBlazer stopped processing Part A enrollment applications October 17, 2012. All applications related to this activity pending or received on or after October 17 will be held and forwarded to Novitas Solutions on October 29, 2012.
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nAudit and Reimbursement Paperwork Processing Timelinen
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- TrailBlazer stopped all Audit and Reimbursement workload activities October 12, 2012. All workload related to this activity pending or received on or after October 12 will be held and forwarded to Novitas on October 29, 2012.
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nClick here to review more details regarding the cutover schedule and impacts, please view Novitas’ Transition Newsletter dated October 15, 2012.
Oct 17, 2012 | Uncategorized
Smartphones and tablets are playing a bigger role in healthcare, and more change will take place when providers connect with patients using mobile apps, healthcare experts say.nnThe number of U.S. adults using mobile phones for health-related activities, including looking up health information, grew from 61 million in 2011 to 75 million in 2012, according to a Manhattan Research survey of 8,745 adults. Meanwhile, the number of people using tablet computers for healthcare nearly doubled from 15 million to 29 million.nnOlder consumers haven’t been left behind: Nearly half of online consumers aged 55 and older who own or use a tablet are using these devices to look up health information or tools. Finally, among the 15% of online consumers who have tablets, smartphones, and desktop computers or laptops, 60% are using all three types of devices for health-related online activities.nn”What we’re witnessing is the rise of a technology that enables people to easily get health information without going to the high priests of healthcare,” Joe Smith, MD, told InformationWeek Healthcare. “The longstanding asymmetry between providers and patients on health information is starting to break down.” Older consumers’ use of tablets for healthcare purposes, he said, “heralds a wonderful change in healthcare. You’re seeing an emboldened, engaged aging population, and the country definitely needs that.”nnAs for the use of multiple devices, he said, “it’s pretty easy to access the information independent of the hardware platform. So I think it’s more representative of the fact that people are using whatever gadget is available to them to find out information about their health.”nnMany consumers are already using standalone mobile health applications to track their fitness, wellness, exercise, and diet. Some are utilizing apps created for people with chronic conditions such as diabetes and hypertension, noted Smith, but there’s still less use of those than there is for fitness and wellness tracking, he said.nnNevertheless, he said, as people get used to mobile technology that reminds them to take their pills or get more exercise, “they’ll start using it to find out whether their asthma is likely to be worse today because of a pollen count, or is my heart rate climbing with my activity today in a different way than it has in the past, and as a result, is my heart failure getting worse?”nnSource: www.informationweek.com; Ken Terry; October 8, 2012.
Oct 10, 2012 | Uncategorized
Despite a one-year extension, many covered entities are still unlikely to achieve compliance with the International Classification of Diseases, 10th Revision(ICD-10), barring a change in their implementation strategy, this according to a recent report from the Health Information and Managements Systems Society (HIMSS). The recently published “Implementing ICD-10 by the Compliance Date: A Call to Action” lays out a plan for achieving ICD-10 compliance by the new deadline: Oct. 1, 2014. In particular, HIMSS G7, the leadership group charged with assessing obstacles in the way of ICD-10 compliance, has identified four areas key to ensure that providers are ready by October 2014.nnCreate and receive support for four regional ICD-10 Solution Centers: “The breadth and scope of ICD-10 changes necessitate the testing of business processes as well as IT systems,” indicate the authors of the G7 Advisory Report. Regional support would enable the sharing of best practices to help implementers of ICD-10 overcome obstacles unique
to their areas of practice. Moreover, covered entities would have the opportunity to participate in end-to-end testing, perhaps the most crucial component of the implementation process and one that is often not afforded enough resources (i.e., time.)n
nnProvide vendors with tools to assess readiness: ICD-10 compliance requires the coordination of providers and vendors. In order to avoid the rejection of their claims, providers must work with vendors capable of processing them. HIMSS G7 calls for an accurate survey of vendor readiness that includes progress milestones and the adoption of ICD-10 readiness tools to measure preparedness and provide collaborative solutions.nnIncrease education for independent physicians and practices: According to a recent survey, HIMSS reported that approximately 90% of responding healthcare organizations expected to meet the original ICD-10 compliance deadline, Oct. 1, 2013. The same can’t be said ofsmall to mid-sized providers, who lag behind in their preparation for and implementation of ICD-10. The thought-leadership group seeks to address “a lack of comprehensive awareness of both the value of ICD-10 and the implementation requirements” by engaging more than 20% of these physicians through the Office of the National Coordinator for Health Information Technology (ONC) regional extension centers (RECs), medical specialty societies, and practice management vendors by year’s end.nnEstablish an authority for providing coding support and resources: The implementation of ICD-10 places strain on covered entities to expand their code base and reconsider their documentation. It’s to be expected that implementers will encounter a whole slew of challenges requiring insight from authoritative resources capable of answering their questions. HIMSS G7 urges groups such as CMS, the National Center for Health Statistics (NCHS), American Hospital Association (AMA), and American Health Information Management Association (AHIMA) to come together as a “single source of truth” for approaches to coding correctly and accurately.nn
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The implementation of ICD-10 will test the entire healthcare industry in terms of cost, time, and technology. Through proper planning and collaboration, more covered entities will achieve compliance and avoid future losses, which they likely can’t afford.
nSource: www.ehrintelligence.com; Kyle Murphy; October 10, 2012.
Oct 3, 2012 | Uncategorized
Below is a portion of Selena Chavis’ article on ICD-10 Testing Strategies, from the publication, For the Record.nnAs hospitals prepare for the new coding system’s arrival, sound testing strategies will be critical to success.nnUnprecedented. That’s how some industry professionals describe the impending impact of ICD-10 on healthcare organizations’ systems and processes. Like the implementation of any new large-scale project, testing will play a critical role in ensuring that the go-live has a minimal effect on patient care and revenue cycles. And it’s hardly going to be as easy as an open-book test, experts say.nn“Testing is going to be incredibly difficult,” says Stephen Stewart, MBA, FACHE, CPHIMS, CHCIO, SHIMSS, chief information officer for Henry County Health Center in Mount Pleasant, Iowa, adding that healthcare organizations should not expect that testing for ICD-10 will mirror that which would typically accompany other implementation initiatives. Industry professionals warn that the impact of the new coding system is expected to go much deeper than previous new-system deployment.nnUrgencynFor some hospitals, the postponement of the ICD-10 go-live date to 2014 is a welcome relief to a full plate of other IT-oriented projects vying for financial and staff resources. Even against competing priorities, Stewart believes the decision to delay ICD-10 has done a disservice to much of the industry because there is a sense of diminished urgency. “I don’t feel the sense of urgency that should be out there,” he notes. “There are those who are still hoping it will go away.”nnVendor and payer readiness are key components for making the puzzle pieces fit together during the testing phase. A 74-bed community-based health center, Henry County’s current payer mix is made up of 50% Medicare, 14% Iowa Medicaid, and about 25% Blue Cross Blue Shield of Iowa. With only three primary payers to consider, Stewart says the facility may be in a much better situation than some hospitals due to the fact that this group of payers appears to be more prepared for the ICD-10 transition than most.nnWhile most vendors initially made the commitment to be ready for testing by this October, Stewart points out that the deadline’s delay has changed the urgency. He believes this shift in attitude is a mistake. “It’s still coming, and it’s still going to happen,” he says. “I know some organizations that haven’t even done an analysis of where their problem areas are. How do they know if their vendors are ready?”nnFor the rest of Chavis’ article, visit fortherecordmag.comnnSource: www.fortherecordmag.com; Selena Chavis; September 24, 2012.
Sep 26, 2012 | Uncategorized
nnThe Centers for Medicare & Medicaid Services (CMS) released an updated interactive map containing information about each state’s Medicaid Recovery Audit Contractor (RAC) program. The Affordable Care Act requires each state to have a RAC program aimed at identifying and recovering overpayments and identifying underpayments made to Medicaid providers. States are at various stages of implementing their programs. For those that have selected RACs, the map includes detailed information, including the name and contact information of the RAC medical director. It also contains information about the contingency fee paid to the RAC.
