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.
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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.
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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Q: One of my colleagues says that only “credentialed medical assistants” are permitted to enter orders in electronic health records (EHR) per Meaningful Use Stage 2. Can you explain?nnA: As of January 2013, only credentialed medical assistants have been permitted to enter medication, radiology, and laboratory orders into the EHR to count toward meeting the Meaningful Use thresholds under the Medicare and Medicaid EHR Incentive programs.nnAccording to Meaningful Use 2 core measure 1, any licensed healthcare professionals can enter orders into the medical record for purposes of including the order in the numerator for the objective of computerized physician order entry (CPOE).nnThe order must be entered by someone who could exercise clinical judgment in the event that the entry generates any alerts about possible interactions or other clinical decision support aids. This necessitates having the CPOE occur when the order first becomes part of the patient’s medical record, and before any action can be taken on the order.nnThe Centers for Medicare and Medicaid Services (CMS) did not specify any particular credentialing agency for medical assistants, but did say that the credentialing would have to be obtained from an organization other than the employing agency.nnMany working medical assistants have not graduated from an accredited program and thus are not eligible to sit for a certification examination offered by some agencies. The American Association of Medical Assistants (AAMA), the certifying agency for medical assistants, says these individuals are not eligible for certification by the AAMA, but they may be eligible for certification through other agencies.nnAccording to CMS, a non-certified individual, such as a scribe, is not qualified to enter these orders in the computerized provider order entry because there is no licensing or credentialing of scribes, so there is no guarantee of their qualifications for accuracy in such a position.nn
Documentation requirednnTo qualify for payments under the EHR incentive programs, providers will be required to present documentation of all entries, many of whom are automatically entered by the EHR system.nnCMS auditors have the authority to determine the entry of medication. Laboratory and radiology orders have been made by the licensed healthcare professional or credentialed medical assistant.nnIf the auditors find that the order entry was performed by an individual other than a licensed professional or credential medical assistant, it could constitute a violation. In that case it is possible that the order entry by the individual would not be counted toward meeting the Meaningful Use thresholds.nnConsequently, the eligible professional may not meet all the core objectives and as a result would not receive the incentive.nnSource: www.modernmedicine.com; Maxine Lewis; March 10, 2014.
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