Oct 6, 2015 | Uncategorized
The blood that keeps a practice alive:nPick a patient seen one month ago and follow that revenue cycle. Look at the claim, compare it to the notes, has it been paid? Did the patient pay a co-payment or deductible if so when? (Co-payments and deductibles should be paid at the time of service). Did the insurance pay, if a clean claim was sent electronically it should be paid within 30 days. Was it paid properly? How do you know? If it hasn’t been paid, find out why! Revenue Cycle is a Cycle! Follow it! You may be surprised at what you find.nn
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About R. Todd Welter • MS, CPCnFounder and President of Welter Healthcare Partners
nMr. Welter has over 25 years of healthcare industry experience assisting physicians and other providers, hospitals and other facilities with the business side of medicine. Through strategic planning and analysis, Mr. Welter’s main focus is to strategically increase revenues and profitability in this radically changing health care environment.
Mr. Welter has a Masters Degree in Organizational Leadership from Regis University in Denver where he has had an appointment as affiliate faculty in the School for Professional Studies for over ten years. In addition, Mr. Welter holds a faculty appointment at the University of Denver’s University College. In the Health Care Leadership program he teaches Macro Economics in Health Care and Innovative Strategies and Change in Health Care to graduate students.
Oct 5, 2015 | Uncategorized
Once officially completely implemented, the ICD-10 transition will provide infinitely more descriptive codes for use in the realm of medical documentation, to both more accurately document ailments, treatments, and the like, as well as more easily allow for interoperability.nnProductivity DropnFor years, critics have opposed ICD-10 in part out of fears of lost productivity—and few deny that this is a valid concern. Many point to Canada’s often-cited 67% drop in productivity when the country transitioned to ICD-10.nnThe lack of familiarity will come as a shock to many, says Selva. “If memorized codes were something someone was leaning on, this will cut their productivity… the biggest change will be when coders are reviewing physician notes.”nnThere is a concern shared by many that the level of specificity—and the sheer volume of codes—will prevent clinicians and coders from memorizing codes. “It will become much more complicated. There is a lot of fear right now regarding specificity. No one wants to be interrupted [to look something up] over and over again.”nnThere’s no easy solution for this one. The general consensus is that some loss of productivity is inevitable. “I think they’ll be slower,” says Draak.nnBut Buckholtz is more optimistic. “What we’ve seen from the coder standpoint is that after being trained for 40 to 80 hours, they do go back to old level of productivity,” she says. She points out that coders will no longer have to do dual coding, which should be a relief to many departments.nnTime and practice will help clinicians and coders memorize codes they use frequently, and EHR/EMR systems that auto-populate codes will also help. Now, however, might be a good time for hospital leadership to evaluate staffing levels.nnEmory’s Plummer suggests pairing struggling physicians with practices coders to help them adjust to the new system. “If coders are available to work with them, that’s the best thing—tell them, ‘don’t ask another physician, they probably don’t know any more than you do.'”nnPerhaps most importantly, very few experts believe patient care will be impacted by the move to ICD-10. “I can rest assured that at our facility, patient care is our chief concern. We’ll do everything around that as our focus. Our quality won’t go down,” says Draak.nnMost organizations have done their homework and have spent many resources training employees and preparing, and most of them can expect a fairly smooth transition, says Gordon. “I think people are ready.”nnThis article posted on HealthLeadersMedia.com
Sep 21, 2015 | Uncategorized
T22.112A — Burn of first degree of left forearm, initial encounternX08.8XXA — Exposure to fire, initial encounternY93.G2 — Activity, grilling
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In 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!
Sep 21, 2015 | Uncategorized
SCOTUS rules:nnRegardless of your politics, it’s the law of the land. Same sex couples may now legally marry in all 50 states. Be sure your forms and procedures for spousal notification, sharing of information, etc. are up to date and accurate! These societal shifts seem to always follow with high profile missteps and mistakes. Don’t let it be one of yours!nnStay tuned for more Todd’s Tips!nn
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About R. Todd Welter • MS, CPCnFounder and President of Welter Healthcare Partners
nMr. Welter has over 25 years of healthcare industry experience assisting physicians and other providers, hospitals and other facilities with the business side of medicine. Through strategic planning and analysis, Mr. Welter’s main focus is to strategically increase revenues and profitability in this radically changing health care environment.
Mr. Welter has a Masters Degree in Organizational Leadership from Regis University in Denver where he has had an appointment as affiliate faculty in the School for Professional Studies for over ten years. In addition, Mr. Welter holds a faculty appointment at the University of Denver’s University College. In the Health Care Leadership program he teaches Macro Economics in Health Care and Innovative Strategies and Change in Health Care to graduate students.nn
Sep 21, 2015 | Uncategorized
The Centers for Medicare & Medicaid Services is preparing to update eligible professionals and group practices on its plans for 2017 Medicare payment adjustments in an upcoming Medicare Learning Network (MLN) Provider Call on September 24.nnThe call scheduled for later this month — Medicare Quality Reporting Programs: 2017 Payment Adjustments — will focus on the penalties for non-compliance levied against EPs and group practices for falling short of requirements for the Medicare EHR Incentive Program and Physician Quality Reporting System (PQRS).nnCMS applies payment adjustments to Medicare EPs and group practices for their non-participation in these incentive programs during the previous reporting year.nnHere’s what CMS has to say about the upcoming MLN National Provider Call:n
Join CMS experts for the September 24 MLN Connects® National Provider Call to hear guidance and instructions on how individual eligible professionals (EPs) and group practices can avoid the 2017 Physician Quality Reporting System (PQRS) negative payment adjustment, satisfy the clinical quality measure component of the Medicare Electronic Health Record Incentive Program, earn an incentive based on performance, and avoid the automatic 2017 downward payment adjustment under the Value-Based Payment Modifier.nnVarious scenarios on how EPs and group practices will be affected by the 2017 payment adjustments will be presented, along with a preview of the Remittance Advice messaging that affected EPs will receive in 2017. The call will also reserve time for questions and answers.
nThe hour and half call begins at 1:30 ET on Thursday September 24.nnThis article originally posted to Ehrintelligence.com
Sep 4, 2015 | Uncategorized
Below, you will find clarification regarding ICD-10 flexibilities for post-transition (as scheduled for October 1, 2015) from the Centers for Medicare and Medicaid Services (CMS.)nnCMS intended last week’s frequently asked questions (FAQs) on these flexibilities to provide clarification for healthcare organizations and providers. Apparently, two FAQs in particular did not do the trick and themselves required further clarification.nnThe first iteration of FAQs came in response to the July 6 joint announcement by the American Medical Association (AMA) and CMS that Medicare providers will not have claims rejected for 12 months after the ICD-10 compliance deadline “based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a code from the right family.”nnThe first clarification concerns what constitutes a valid ICD-10 code:n
All claims with dates of service of October 1, 2015 or later must be submitted with a valid ICD-10 code; ICD-9 codes will no longer be accepted for these dates of service. ICD-10-CM is composed of codes with 3, 4, 5, 6 or 7 characters. Codes with three characters are included in ICD-10-CM as the heading of a category of codes that may be further subdivided by the use of fourth, fifth, sixth or seventh characters to provide greater specificity. A three-character code is to be used only if it is not further subdivided. While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, if a valid ICD-10 code from the right family (see question 5) is submitted, Medicare will process and not audit valid ICD-10 codes unless such codes fall into the circumstances described in more detail in Questions 6 & 7.
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Many people use the terms “billable codes” and “valid codes” interchangeably. A complete list of the 2016 ICD-10-CM valid codes and code titles is posted on the CMS website, HERE. The codes are listed in tabular order (the order found in the ICD-10-CM code book). This list should assist providers who are unsure as to whether an additional 4th, 5th, 6th or 7th character is nnneeded. Using this free list of valid codes is straightforward. Providers can practice identifying and using valid codes as part of acknowledgement testing with Medicare, available through September 30, 2015. For more information about acknowledgement testing, contact your Medicare Administrative Contractor, and review the Medicare Learning Network articles on testing, such as SE1501.
nCMS has provided a few examples of invalid codes in the update.nnAnother clarification concerns what constitutes a family of codes:n
“Family of codes” is the same as the ICD-10 three-character category. Codes within a category are clinically related and provide differences in capturing specific information on the type of condition. For instance, category H25 (Age-related cataract) contains a number of specific codes that capture information on the type of cataract as well as information on the eye involved. Examples include: H25.031 (Anterior subcapsular polar age-related cataract, right eye), which has six characters; H25.22 (Age-related cataract, morgagnian type, left eye), which has five characters; and H25.9 (Unspecified age-related cataract), which has four characters. One must report a valid code and not a category number. In many instances, the code will require more than 3 characters in order to be valid.
nCMS has offered an additional example for Chrohn’s disease to help provides understand the concept.n
The full update is available here.
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This article originally posted on EHRIntelligence.com.
