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.
Sep 4, 2015 | Uncategorized
S05.51XA — Penetrating wound with foreign body of right eyeball, initial encounternW39.XXXA — Discharge of firework, initial encounternY92.833 — Campsite as the place of occurrence of the external causennIn 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 4, 2015 | Uncategorized
Most reimbursement, one way or another, directly or indirectly is based on the RBRVS. The RBRVS updates and changes. It is doing so now quite rapidly! If you have not updated your billed charges in the last year or so, it is time to do so! Compare your billed charges to the current RBRVS and see if it is consistent. Be sure to adjust for site of service location! If your fees are wildly inconsistent or (OMG) below what you should be paid, it is time for an update!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.
Jul 22, 2015 | Uncategorized
L55.0 —Sunburn of first degreenL55.1 —Sunburn of second degreenL55.2 — Sunburn of third degreenL55.9 — Sunburn, unspecifiednnIn 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!
Jul 22, 2015 | Uncategorized
Remember: fraud exists and it is amazingly/sadly common in healthcare. Tighten up your processes and procedures for paying bills, credit card usage and permissions. Differentiation of duties, cross checks and transparent reporting are great ways, all be it not ironclad ways, to stop or discourage fraud. It is ALWAYS the last person you would expect! “Why didn’t I see that” and “I was such a fool” seem to be the response after the F word shows up. Look for it, before it looks for you!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.
Jul 22, 2015 | Uncategorized
CMS announced earlier this month that it will provide greater flexibility during the transition to ICD-10 billing codes, easing physicians’ trepidation about the move by incorporating several changes that the AAFP urged the agency to adopt.nnWhen CMS introduced plans for ICD-10, family physicians raised concerns that moving to a new set of codes required additional time for staff training and the possibility of mistakes was too great to implement the codes so quickly. After all, the new system includes more than 68,000 codes — a far cry from the 13,000 ICD-9 uses. So primary care physicians and others sought an extension to prepare for the transition.nnCMS got that message loud and clear, and the agency has taken steps to ensure physicians don’t summarily fall victim to claims denials or audits for making innocent mistakes in coding.nn”The AAFP applauds CMS for taking actions to ease the transition to ICD-10,” said AAFP President Robert Wergin, M.D., of Milford, Neb., in a prepared statement. “Taken together, these provisions will enable family physicians to bill accurately, be paid appropriately and provide continued access to care for patients.”nnAlso during the grace period, Medicare claims will not be audited based on the specificity of the diagnosis codes used as long as they are from an appropriate family of codes.nnCMS is releasing additional guidance on flexibility in the auditing and quality reporting process as the medical community gains experience using the new set of codes.nn
In addition, physicians and allied health professionals who participate in CMS quality programs such as the Physician Quality Reporting System, the value-based payment modifier initiative and/or meaningful use of electronic health records will not be penalized during the 2015 reporting year for failure to select a specific code, as long as they have selected one from an appropriate family of codes. Moreover, practices will not be penalized if CMS encounters trouble in accurately calculating quality scores.nn”We have called for additional appeals and agency monitoring for reporting systems that determine appropriate payment for medical services based on quality measures and meaningful use of electronic health records,” Wergin said.nnPhysician practices can receive an upfront payment from Medicare administrative contractors as an option to protect against mistakes that could occur in coding.nn”The AAFP urged CMS to expand advance payment options for physicians, which will ensure that physician practices have an adequate revenue flow to maintain financial stability during the transition,” Wergin said.nnPhysicians should be aware that after Sept. 30, Medicare will no longer accept ICD-9 codes for service. Neither will it accept claims using both ICD-9 and ICD-10 codes.nnCMS will appoint an ombudsman in each regional office to handle ICD-10 questions, and the agency said it will announce ways to contact the ombudsmen as the October implementation date approaches.nnThe International Classification of Diseases, or ICD, was developed to standardize codes for medical conditions and procedures. The codes used in the United States have not been updated in more than 35 years and contain outdated terms.nn
ICD-10 was introduced with the intent of improving public health research and emergency response times by facilitating early detection of disease outbreaks and tracking adverse drug events. The new codes are also meant to support innovative payment models that improve overall quality of care.nThe grace period to adjust to the exclusive use of the ICD-10 codes is a welcome relief, and our academy deserves credit for representing our interests and concerns. I think that also goes for those of us who have had a hands-on course with the new codes, not because the use of these codes is in itself such a great challenge, but because the central problem is how to find the additional time needed to sort through 5 times as many codes. I think this is particularly so, when confirmation of a definitive diagnosis is pending further tests.nnNow, while we may be the last major country in the world to adopt usage of the ICD-10, I understand from speaking with primary care physicians in Canada, that they do not do the coding themselves because it decreases necessary time spent with the patient. So, all coding is deferred to trained support staff.nnAs practice demands on our time have already seriously decreased necessary visit time with our patients, I suggest that during the 12-month grace period, our academy develop and implement a plan together with CMS, to take this burden off of our shoulders and replace it with supportive training for competent coding by our office staff.nnThis article was originally published on AAFP.org
Jun 26, 2015 | Uncategorized
The U.S. Supreme Court upheld a core component of President Barack Obama’s health-care law, backing tax credits used by millions of Americans to buy insurance and preserving the landmark measure that will define his legacy.nnThe 6-3 ruling eliminates the most potent legal challenge to a law designed to cover at least 30 million uninsured people and averts a collapse in state insurance markets. Chief Justice John Roberts and Justice Anthony Kennedy joined the court’s four Democratic appointees in the majority. They said the 2010 Affordable Care Act allows tax credits in all 50 states, not just the 16 that have authorized their own online insurance exchanges.nn“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” Roberts wrote. “If at all possible, we must interpret the act in a way that is consistent with the former, and avoids the latter.”nnThe ruling is the high court’s second in three years to preserve Obamacare in the face of Republican-backed legal attacks. Republican opponents now must look to winning the White House in the 2016 election if they hope to roll back the law.nn
The Affordable Care Act “is here to stay,” Obama said at the White House. “What we’re not going to do is unravel what has now been woven into the fabric of America,” the president said. “I can work with Republicans and Democrats to move forward. Let’s join together. Make health care in America even better.”nnHospitals led a rally among health-care companies after the ruling. HCA Holdings Inc., the largest for-profit hospital chain, gained 8.8 percent to $90.72 at 4 p.m. in New York. Tenet Healthcare Corp. jumped 12.2 percent and Community Health Systems Inc. added 13.0 percent.nnStock gains at insurers were smaller, in part because subsidized customers make up a small proportion of the total at the biggest firms. UnitedHealth Group Inc., the largest U.S. health insurer, rose 2.7 percent to $122.33.nnThe decision also helps ease the path to dealmaking among health insurers. Bloomberg News reported today that Aetna Inc. could reach a deal to acquire Humana Inc. as early as this weekend. Anthem Inc. went public with a bid for Cigna Corp. on June 20 that Cigna rejected. Groups representing hospitals and doctors praised the ruling. Steven Stack, the president of the American Medical Association, said his group is “relieved.” The American Hospital Association said the decision was a “significant victory for protecting access to care for many of those who need it.”n
CLICK HERE TO READ MORE
nThis article originally posted on Bloomberg.com.
Jun 19, 2015 | Uncategorized
Last week, we reviewed a new bill that would allow for a new two-year “grace period” for accepting the new set of ICD-10CM/PCS code that was presented to the US House of Representatives. Now, we will examine its potential for negative impact on implementation.nnNew legislation that calls for a grace period or transition period to ICD-10 is misguided and could have negative impacts on implementation of the new code set, according to proponents of ICD-10.nnA safe harbor would compromise the ability of Medicare to monitor quality of care, the Coalition for ICD-10 writes in a post on its website.nnThe coalition says recent bills asking for transition or grace periods focus on the assumption that coding in ICD-10 impacts physician payments and will be a burden on providers. These assumptions, the coalition says, are false.nnIn addition, a two-year transition period could be a massive risk when it comes to audits, said Juliet Santos in an opinion piece at ICD-10 Monitor.nnThe comments are in response to a bill proposed by Rep. Gary Palmer (R-Ala.) that would provide a grace period of two years for providers set to transition from ICD-9 to ICD-10 this October. During the grace period, physicians and other providers would not be “penalized for errors, mistakes and malfunctions relating to the transition,” FierceHealthIT previously reported.nnThat’s in addition to legislation brought forth by Rep. Diane Black (R-Tenn.) that would require the Health and Human Services Department to offer end-to-end testing of the code set, as well as an 18-month transition period.nn
These bills, the Coalition for ICD-10 says, could:n
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- Restrict Medicare’s ability to determine coverage, medical necessity and quality of care
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- Ignore Medicare’s “fiduciary responsibility to ensure proper payment”
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- Raise fears about the possibility of fraud and abuse
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- Encourage incomplete documentation
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nSantos adds that if Palmer’s bill is passed, it will void any audit-protective effects of ICD-10.nnThe Centers for Medicare & Medicaid Services “surely cannot afford a bill that condones ‘runaway costs’ through lenient reimbursement strategies at a time when fraud and abuse seem to be so rampant in healthcare,” she says.nnHowever, despite the chance problems could arise from legislation that calls for a transition period, there are some who want to take it even farther–Rep. Ted Poe (R-Texas) recently introduced a bill to Congress that would ban ICD-10 outright.nnThis article originally posted on FierceHealthIT.com.
Jun 19, 2015 | Uncategorized
American Airlines, back in 2008, started charging for checked baggage (really, I looked it up!). Up to that point, and even today, most of us have thought that the cost of the ticket should include the cost of checking a bag! As it turns out, the ticket price is only for getting us safely (not even necessarily comfortably) from point A to point B. The rest (food, bags, drinks, in-flight entertainment, etc.) is an up charge.nnIs ambulatory medical care really that much different? The contracted reimbursement rate is for safe, quality and effective medical care. Could everything else (some things) be an up charge? Think about all those administrative services your practice provides to make the health care system work: filling out paperwork, making referral authorizations.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.
Jun 19, 2015 | Uncategorized
T75.1XXA — Swimmer’s crampnnH60.331 — Swimmer’s ear, right earnnB65.3 — Swimmer’s itchnnIn 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!
Jun 10, 2015 | Uncategorized
The Sustainable Growth Rate (SGR) has been repealed! However, (and there is always a however) it has been replaced with a potentially much more caustic new scheme. The Feds are going to force providers into the quality reporting, clinical practice improvement and EHR MU world. They call it MIPS. Not participating will cost you up to a 9% reduction in Medicare reimbursement by 2022. It’s time to get serious about measuring and improving quality, etc. If you are not on a MU EMR, it’s time! Doing so will potentially get you an additional 9% by 2022.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.
Jun 10, 2015 | Uncategorized
W56.01XA — Bitten by dolphin, initial encounternW56.12XS — Struck by sea lion, sequelanW56.22XA — Struck by orca, initial encounternW56.31XA — Bitten by other marine mammals, initial encounternnIn 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!
Jun 10, 2015 | Uncategorized
A new two-year “grace period” for accepting the new set of ICD-10CM/PCS codes has been presented in the form of a new bill to the US House of Representatives.nnThe bill, H.R. 2652, Protecting Patients and Physicians Against Coding Act of 2015, was introduced by Representative Gary Palmer (R-AL-6) on June 4.nnThe legislation is the third ICD-10-related bill to be introduced into the House of Representatives in the last five weeks. On May 12, H.R. 2247, the Increasing Clarity for Doctors by Transitioning Effectively Now Act (ICD-TEN Act) was introduced by Rep. Diane Black (R-TN-6) calling for an ICD-10 transition period. On April 30, H.R. 2126, the Cutting Costly Codes Act of 2015, was introduced by Rep. Ted Poe (R-TX-2) seeking to outright stop the replacement of ICD-9 with ICD-10. Neither bill has gained much traction since being introduced. Black’s bill currently has only five cosponsors, and Poe’s bill has nine—much lower than the 46 sponsors this same bill had when Poe first introduced it in 2013.nnH.R.2652 would create a two-year grace period where healthcare providers’ ICD-10-based claims submitted to Medicare and Medicaid would not be denied due to coding errors. Implementing this grace period would ensure physicians are not negatively impacted while ICD-10 is “fully implemented within the healthcare system,” according to a letter sent by Palmer to fellow Congressmen asking for their support of the bill.nnSimilar to the Black bill, H.R. 2652 would not delay the October 1, 2015 implementation deadline for ICD-10 use, but would require the Centers for Medicare and Medicaid Services (CMS) to pay for claims even if inaccurately coded. Palmer states in the letter that this grace period would create a “true transition” to the new code set, and is needed in order to allow physicians “to grow accustomed to ICD-10 over a period of time without being penalized for unintentional errors.”nn
During the two-year grace period physicians would not be penalized and their payments would not be withheld by CMS due to “coding errors, mistakes, and/or malfunctions of the system,” according to the bill. The Department of Health and Human Services (HHS) would also be required to conduct a study on how the transition to ICD-10 has affected physicians and other healthcare providers, and state how well HHS has helped physicians transition to the new code set.nnThe bill is needed, Palmer said, because small and rural physicians have not had adequate time or resources to transition to ICD-10, and that learning to do so by October would harm their ability to provide quality patient care and receive proper reimbursement.nnOther healthcare stakeholders have argued that the transition time from ICD-9 to ICD-10 has been ample enough. Also, ICD-10 advocates have pointed out that currently CMS offers numerous resources to help physicians and other providers with the transition, including fact sheets, checklists, guides, timelines, teleconferences, videos, and local training programs, through their Road to ICD-10 website located at www.cms.gov/Medicare/Coding/ICD10/index.html.nn“Although another delay would assist many in the medical community, if ICD-10 is to be implemented on October 1, patient care should not suffer,” Palmer’s letter states.nnThis is not the first time Palmer has tried to stop ICD-10’s outright October 1 implementation. In March he unsuccessfully tried to introduce a delay amendment into the Sustainable Growth Rate replacement bill during the House Rules Committee process.nnH.R. 2652 had 32 co-sponsors as of June 8, and has been referred to the House Committee on Energy and Commerce as well as the Committee on Ways and Means.n
AHIMA Against H.R. 2652
nAHIMA officials have said they are against this bill since the grace period would lead to inaccurate coding, improper payments, and potential medical billing fraud. With no official repercussions for inaccurate coding, AHIMA officials said they feel it would open the door to both intentional and unintentional coding errors—improperly paid claims at best and rampant fraud at worst—since proper payment of claims depends on accurate coding. Coverage determinations and validation of medical necessity of healthcare services also depend on codes submitted on claims, and would be impacted.nnAlso, claims data are used for many purposes beyond payment, including health policy decisions, assessment of quality of care, patient outcomes and safety, and evaluation of costs. Allowance of miscoding on claims will render claims data useless for any purpose, AHIMA officials said.nnThere are already appropriate mechanisms built into ICD-10-CM for reporting less specific codes when necessary and appropriate. There are “unspecified” codes in both ICD-9 and ICD-10, and unspecified ICD-9 codes are currently already allowed in Medicare fee-for-service payment systems, AHIMA officials said. There is no indication that allowance of unspecified codes will change under ICD-10.nn
While this bill implies that the increase in the number of codes in ICD-10 will cause hardship for physicians trying to find the right code, AHIMA officials counter that physicians and any other medical biller won’t need to learn every ICD-10 code in order to properly bill.nnJust as no healthcare provider uses every code in ICD-9-CM today, physicians and other providers will not use all the codes in ICD-10-CM, AHIMA stated in an ICD-10 FAQ.nnPhysicians should use a subset of codes based on their practice and patient population. “The ICD-10-CM code set is like a dictionary that has thousands of words, but individuals use some words very commonly while other words are never used,” the FAQ states. “Also, laterality accounts for nearly half of the increase in the number of codes in ICD-10-CM–information that is typically already documented in patients’ medical records.nnAHIMA officials have said the grace period is unnecessary since CMS end-to-end testing has shown that only two percent of claims were rejected due to ICD-10 coding errors during the most recent testing period, which ran April 27 to May 1. This is actually lower than the number of claims, 3 percent, currently rejected by CMS after annual ICD-9-CM code updates.nn Welter Healthcare Partners is now listed as an Industry Leader and primary resource for ICD-10 Implementation by United Healthcare, alongside AHIMA ICD-10, AMA, Center for Medicare and Medicaid Services “Road to ICD-10″, HIMSS, and more.n
Click Here To Learn More About ICD-10 Training with Welter Healthcare Partners
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Click Here To Learn About Our Upcoming ICD-10 Coder Academies
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Click Here For More Resources from Welter Healthcare Partners
nThis article originally posted on AHIMA.org.
Jun 3, 2015 | Uncategorized
Y93.41 — Activity, dancingnY93.49 — Activity, other involving dancing and other rhythmic movementsnW01.0XXA — Fall on same level from slipping, tripping and stumbling without subsequent striking against object, initial encounternnIn 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!
Jun 3, 2015 | Uncategorized
Payer Agreements are changing, and the language is getting much more aggressive. I just saw new language that allows the payer to LOWER a provider’s reimbursement by 20% if referrals are made to other providers who are Out of Network. For example, your reimbursement would be taxed 20% if you take a case to an out of network ASC, or use an out of network surgical assistant.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.
