Summer Concert Collision

Summer Concert CollisionS93.431A — Sprain of tibiofibular ligament of right ankle, initial encounternnW03.XXXA — Other fall on same level due to collision with another person, initial encounternnY93.41 — Activity, dancingnnY92.252 — Music hall as the place of occurrence of the external causenn 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!

A Limit on Consumer Costs Is Delayed in Health Care Law

healthcare-reform2-320x258WASHINGTON — In another setback for President Obama’s health care initiative, the administration has delayed until 2015 a significant consumer protection in the law that limits how much people may have to spend on their own health care.nnThe limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family. But under a little-noticed ruling, federal officials have granted a one-year grace period to some insurers, allowing them to set higher limits, or no limit at all on some costs, in 2014.nnThe grace period has been outlined on the Labor Department’s Web site since February, but was obscured in a maze of legal and bureaucratic language that went largely unnoticed. When asked in recent days about the language — which appeared as an answer to one of 137 “frequently asked questions about Affordable Care Act implementation” — department officials confirmed the policy.nnThe discovery is likely to fuel continuing Republican efforts this fall to discredit the president’s health care law.nnUnder the policy, many group health plans will be able to maintain separate out-of-pocket limits for benefits in 2014. As a result, a consumer may be required to pay $6,350 for doctors’ services and hospital care, and an additional $6,350 for prescription drugs under a plan administered by a pharmacy benefit manager.nnSome consumers may have to pay even more, as some group health plans will not be required to impose any limit on a patient’s out-of-pocket costs for drugs next year. If a drug plan does not currently have a limit on out-of-pocket costs, it will not have to impose one for 2014, federal officials said Monday.nnThe health law, signed more than three years ago by Mr. Obama, clearly established a single overall limit on out-of-pocket costs for each individual or family. But federal officials said that many insurers and employers needed more time to comply because they used separate companies to help administer major medical coverage and drug benefits, with separate limits on out-of-pocket costs.nnIn many cases, the companies have separate computer systems that cannot communicate with one another.nnA senior administration official, speaking on condition of anonymity to discuss internal deliberations, said: “We knew this was an important issue. We had to balance the interests of consumers with the concerns of health plan sponsors and carriers, which told us that their computer systems were not set up to aggregate all of a person’s out-of-pocket costs. They asked for more time to comply.”nninsuranceformHealth plans are free to set out-of-pocket limits lower than the levels allowed by the administration. But many employers and health plans sought the grace period, saying they needed time to upgrade their computer systems. “Benefit managers using different computer systems often cannot keep track of all the out-of-pocket costs incurred by a particular individual,” said Kathryn Wilber, a lawyer at the American Benefits Council, which represents many Fortune 500 companies that provide coverage to employees.nnLast month the White House announced a one-year delay in enforcement of another major provision of the law, which requires larger employers to offer health coverage to full-time employees. Valerie Jarrett, Mr. Obama’s senior adviser, said that the delay of the employer mandate showed “we are listening” to businesses, which had complained about the complexity of federal reporting requirements.nnAlthough the two delays are unrelated, together they underscore the difficulties the Obama administration is facing as it rolls out the health care law.nnAdvocates for people with chronic illnesses said they were dismayed by the policy decision on out-of-pocket costs.nn“The government’s unexpected interpretation of the law will disproportionately harm people with complex chronic conditions and disabilities,” said Myrl Weinberg, the chief executive of the National Health Council, which speaks for more than 50 groups representing patients.nnFor people with serious illnesses like cancer and multiple sclerosis, Ms. Weinberg said, out-of-pocket costs can total tens of thousands of dollars a year.nnDespite the delay, consumers in 2014 will still have many new protections. They cannot be denied health insurance or charged higher premiums because of pre-existing conditions, and many will qualify for subsidies intended to lower their costs.nnIn promoting his health care plan in 2009, Mr. Obama cited the limit on out-of-pocket costs as one of its chief virtues. “We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick,” Mr. Obama told a joint session of Congress in September 2009.nnAdvocates for patients said the promise of the law was being deferred. “We have wonderful new drugs, the biologics, to treat rheumatoid arthritis, but they are extremely expensive,” said Dr. Patience H. White, a vice president of the Arthritis Foundation. “In the past, patients had to live in constant pain, often became disabled and had to leave their jobs. The new drugs can make a huge difference, and we were hoping that the cap on out-of-pocket costs would make them affordable. But now many patients will have to wait another year.”nnimagesThe American Cancer Society shares the concern and noted that some new cancer drugs cost $100,000 a year or more.nn“If a prescription drug plan does not currently have a limit, then it will not have to have one in 2014,” said Molly Daniels, deputy president of the lobbying arm of the American Cancer Society. “Patients who require expensive drugs could continue to have enormous financial exposure, despite the clear intent of the law to limit a patient’s total out-of-pocket exposure.”nnFederal officials said they were offering transition relief to certain health plans in 2014. But, they said, by 2015, health plans must comply with the law and must have an overall limit on out-of-pocket costs for medical, drug and other benefits combined.nnTheodore M. Thompson, a vice president of the National Multiple Sclerosis Society, said: “The promise of out-of-pocket limits was one of the main reasons we supported health care reform. So we are disappointed that some plans will be allowed to have multiple out-of-pocket limits in 2014.”nnThe law also requires coverage of dental care for children, but these benefits can be offered in a separate health plan with its own limit on out-of-pocket costs.nnFederal rules say that a free-standing dental plan must have “a reasonable annual limitation on cost-sharing.” In states where the new health insurance marketplace will be run by the federal government, the limit on out-of-pocket costs for pediatric dental benefits can be no more than $700 for coverage of one child and $1,400 for a plan covering two or more children in the same family.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.nytimes.com; Robert Bear; August 12, 2013.

Take Me Out To The Ball Game

 nnTake Me Out To The Ball GameS00.83XA — Contusion of other part of head, initial encounter.nnY93.82 — Activity, spectator at an eventnnW21.03XA — Struck by baseball, initial encounter.nnY92.320 — Baseball field as the place of occurrence of the external cause.nn 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!

MGMA Anticipates Problems, Disruptions With ICD-10: Q&A

MGMA Anticipates Problems, Disruptions With ICD-10In the wake of several dismal surveys and a disturbing Medicare announcement, providers would be forgiven for thinking that ICD-10 is on life support and fading fast. Will the industry be ready by the October 1, 2014 compliance date? If it isn’t, what will we do? EHRintelligence spoke to Robert M. Tennant, MA, Senior Policy Advisor at the Medical Group Management Association (MGMA), to talk about what the future holds for providers, payers, clearinghouses, and coders as ICD-10 creeps ever closer.nn[toggle title_open=”CMS has stated that Medicare won’t be conducting external end-to-end testing with providers. How will that impact the ICD-10 transition?” title_closed=”CMS has stated that Medicare won’t be conducting external end-to-end testing with providers. How will that impact the ICD-10 transition?” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]nnWith the Version 5010 transition, Medicare conducted National Testing Day and other communications like that to encourage testing, which really helped providers meet that particular challenge. Even with that, about half a dozen state Medicaid agencies were not ready for the transition to Version 5010. So you’ve got that as the foundation, and then we find out that Medicare does not plan to test with providers. We believe that is an absolute recipe for disaster. If practices don’t know if a) the claim will even be accepted for adjudication, and b) whether or not the claim will be paid, then there could be real cash flow issues following the compliance date.nnFrom our perspective, just because Medicare itself may be ready to accept ICD-10 claims, that does not guarantee that they will be paying a particular ICD-10 code that shows up on the claim. That’s the reason why we need to test: so providers know well in advance if a particular code is appropriate, and if it’s not appropriate, they will need to be able to change that code or ensure that they have the documentation that supports that code. And you can only do that prior to the compliance date through testing.nnAs we mentioned in our letter to HHS Secretary Kathleen Sebelius, what kind of message does it send to the industry if Medicare itself says they won’t be testing? Does that give a green light to commercial health plans to say they don’t need to test either? That means that when you flip the switch October 1, 2014, providers literally will have no idea if they’re going to be paid for their services.[/toggle]nn[toggle title_open=”Are other health plans going to be conducting external testing?” title_closed=”Are other health plans going to be conducting external testing?” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]nnWe haven’t heard of any health plans that are testing with their providers right now. So we have no idea. But let’s say you have a claim with an ICD-10 code, and you submit that same claim to a hundred payers. You may have a very wide variation on if they pay it, and at what rate, because each will be driven by a proprietary payment policy. Needless to say, we’ve called on health plans to release those payment policies as quickly as possible, so we can understand the variation.nnMany of the large health plans should be ready to test by the first quarter of 2014…or at least that’s what they’re saying publically. But this is a very heavy lift for everybody, including the health plans, because it’s not just a question of reworking their software to accept a different length of diagnostic code. All their payment policies must be examined and rewritten to accommodate the changes in the codes. I think that has proven to be more challenging than many had anticipated.[/toggle]nn[toggle title_open=”What will happen if the industry doesn’t get ready in time?” title_closed=”What will happen if the industry doesn’t get ready in time?” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]nnThe issue of contingency planning is going to be a critical one, and it’s one that MGMA is going to be looking at very closely as we move into 2014. We’re going to be replicating our survey on a regular basis to track the readiness level of the industry. And let’s say that we do a survey in late Summer or early Fall of 2014 to show that trading partners are not ready, I can assure you that we will be communicating a very robust contingency plan to CMS.nnI would not be surprised if dual processing, or in other words, accepting both ICD-9 and ICD-10 codes, would be part of that. We have heard from other health plans that they don’t want to move in that direction because it’s too much work, but we can’t have services not paid for in this country. That would be disastrous for patient care. Just like every other implementation of a HIPAA standard, there have always been delays and contingencies, so I suspect ICD-10 will be no different.[/toggle]nn[toggle title_open=”What are the key issues that might prevent a successful transition?” title_closed=”What are the key issues that might prevent a successful transition?” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]nnOne thing that has not been discussed much is the role of the clearinghouse. A vast majority of our survey respondents say that they send their claims through a clearinghouse. A clearinghouse, however, typically cannot assign an ICD-10 code. Without the clinical documentation in front of them they can’t take an ICD-9 code and just magically convert it to an ICD-10 code. That has got me concerned – especially when the clearinghouses report that 20% of their clients are still running 4010, which cannot accept an ICD-10 code at all. So right away we have an enormous problem.nnThen we have state Medicaid agencies. If a significant number of them weren’t ready for 5010, how many will not be ready for ICD-10? So dual coding may be forced upon the industry because certain health plans, especially on the Medicaid side, may not be ready in time.[/toggle]nn[toggle title_open=”What should providers be doing right now?” title_closed=”What should providers be doing right now?” hide=”yes” border=”yes” style=”default” excerpt_length=”0″ read_more_text=”Read More” read_less_text=”Read Less” include_excerpt_html=”no”]nnPractices have to run on the assumption that their trading partners may not be ready well in advance of the compliance. Practices can still take steps even their software is not yet updated , and testing can’t occur with your clearinghouse or your health plans. They can take a sample of claims that have already been adjudicated successfully and paid and try to assign an ICD-10 code to that claim based on the existing documentation. During the next year, it is a good exercise to say “What would that ICD-10 code be?”nnAnd the other thing to consider is dual coding to become better acquainted to what is required under ICD-10. The practice assigning both ICD-9 and ICD-10 codes at the same time, of course, is made more challenging because we don’t know what is expected from the health plans. However, but if practices assume that unspecified is generally not going to be accepted for payment, then they will need to focus on ensuring that sufficient clinical documentation in included in the patient record so the physician or coder can assign that more specific code. Doing those two things can arm the practice with knowledge of how their physicians are faring with their encounter documentation and alleviate at least some of the stress of October 1, 2014.[/toggle]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 30, 2013.

Aquatic Adventure

Aquatic AdventureS90.871A — Other superficial bite of right foot, initial encounternnW56.01XA — Bitten by dolphin, initial encounternnY93.15 — Activity, underwater diving and snorkelingnnY92.832 — Beach as the place of occurrence of the external cause.nn 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!

Top Five ICD-10 Readiness Questions To Ask Your Payers

icd-10When 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

icd-10Are 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

ICD-10

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

Is There Anyone Who WOULDN’T Have These Codes Assigned?

Is There Anyone Who WOULDN’T Have These Codes Assigned?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!

House Energy and Commerce Health Subcommittee Release SGR Repeal Legislation

House Energy and Commerce Health SubcommitteeHouse 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

Highlights from the Energy and Commerce Draft Framework:

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

Contact 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.fightchronicdisease.com; June 25, 2013.

A Fun Day At The Themepark

A Fun Day At The ThemeparkS13.4XXA — 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!

How ICD-10 Will Benefit Physicians

ICD-10Physicians 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.nncash_0Under 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.

Obama Administration Delays Employer Mandate

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delay 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

Summer Evening Stroll

Summer Evening StrollS03.1XXA — Dislocation of septal cartilage of nose, initial encounternnW22.02XA — Walked into lamppost, initial encounternnY92.830 — Public park as the place of occurrence of the external causenn 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!

Fourth of July in the Emergency Room

Fourth of July in the Emergency RoomW3.9xxA – Discharge of firework as the external cause of injury,ninitial encounternnW42.9xxA – Exposure to loud noise as the external cause of Injury, initial encounternnX04.xxA – Exposure to ignition of highly flammable material (while attempting to light the barbecue grill), initial encounternn 

Health Information Technology Adoption And Use

Health Information Technology Adoption And UseOn Tuesday, July 9, Health Affairs will host a briefing to report latest trends in health information technology adoption among US health care providers and hospitals.nnThe event will feature remarks from Farzad Mostashari, the National Coordinator for Health Information Technology at the US Department of Health and Human Services, and coincides with the release of three Web First papers from Health Affairs, as well as the Robert Wood Johnson Foundation’s annual report on HIT Adoption. The Foundation has provided support for the briefing.n

When:

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Tuesday July 9, 2013 from 8:30 AM to 11:00 AM EDT

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Where:

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National Press Club

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529 14th Street NWnHoleman Lounge, 13th FloornWashington, DC

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RSVP online.

nFollow live Tweets from the event @HA_Events, and join the conversation with the hashtag #HA_HealthIT.nnAmong the speakers and authors who will discuss trends and present their findings are:n

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  • Julia Adler-Milstein, Assistant Professor, University of Michigan, Health Management and Policy, on Operational Health Information Exchanges Show Substantial Growth But Long-Term Funding Remains A Concern
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  • Catherine M. DesRoches, Senior Scientist, Mathematica Policy Research, on Adoption Of Electronic Health Records Grows Rapidly, But Fewer Than Half Of US Hospitals Had At Least A Basic System In 2012
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  • Chun-Ju Hsiao, Senior Service Fellow, National Center for Health Statistics, Division of Health Care Statistics, Centers for Disease Control and Prevention, on Office-Based Physicians Are Responding To Incentives And Assistance By Adopting And Using Electronic Health Records
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  • Ashish K. Jha, Associate Professor, Harvard School of Public Health, with Summary Observations
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  • Michael Painter, Senior Program Officer, Robert Wood Johnson Foundation, on Health Information Technology In The United States: Driving Toward Delivery System Change, 2013
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nSource: www.healthaffairs.org; Chris Fleming; June 25, 2013.

A Day At The Beach

A Day At The BeachT63.611A – Toxic effect of Portuguese Man-O-War, accidental, initial encounternnV93.21xA – Heat exposure on board passenger shipnnW94.21xA – Exposure to reduction in atmospheric pressure while surfacing from deep-water divingnnIn 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!

My ICD-10-CM Plan? My EMR is Taking Care of That!

My ICD-10-CM Plan? My EMR is Taking Care of That!Many organizations and physicians are implementing electronic medical records (EMR) with the belief that the EMR will take care of their transition to ICD-10. Although the implementation or use of an EMR can help with the documentation challenges providers will be confronted with in the new ICD-10 world, the use of an EMR alone is not a magic bullet.nnWith the expansion of diagnosis codes comes a greater level of detail therefore a greater level of detail will be required in the encounter documentation in order to assign an appropriate diagnosis code. For physicians that document directly in an EMR either manually or through VR, consider how much time this process take in their current workflow. Although the ICD-10-CM codes still contain entries for unspecified codes, Medicare has indicated they are considering not covering services submitted with these codes. This makes the documentation and assignment of the appropriate ICD-10-CM code much more important.nnChallenges for EHRs moving into the ICD-10 world exist with the workflow for assigning and ranking the diagnoses for the patient’s encounter. In the current EMR environment, many providers are completing data elements and selecting diagnosis codes from drop-down lists. Is the physician prepared for the dramatic increase in diagnosis codes now displayed on the drop-down list? How will the physician’s workflow change when more time is needed to assign the appropriate diagnosis code? Will the EMR allow the physician to enter a descriptive diagnosis rather than a specific diagnosis code? Can the EMR support a workflow that sends patient encounters to coders for review and assignment of the most specific diagnosis code based on the physician’s documentation? Many EMRs plan to use the GEMs to crosswalk the existing diagnosis codes to the new ICD-10-CM codes. Although this plan sounds good in theory, the level of detail provided in the ICD-10 codes does not provide a one to one match. Providers who have EMRs that have mapped ICD-9 codes to ICD-10 codes should ask to review the mapping.nnWith the implementation of ICD-10-CM, an EMR has the potential to create more points of pain for the physician than currently exist. With careful planning, training, and education an EMR can help transition physicians into the ICD-10-CM world but it should not be considered the magic bullet.nnClick here to read the original article by Melody W. Mulaik at HIMSS.orgnnSource: www.himss.org; Melody W. Mulaik; February 10. 2012.

A Good Father’s Day

A Good Father's DayW21.04xA – Struck by golf ball, initial encounternnW22.042A – Striking against wall of swimming poolnnV93.22XA – Heat exposure on board fishing boatnn 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!

Healthy Living in the US

Healthy Living in the USThe US would be much healthier if activity code #1 was reported more frequently than code #2:nnY93.02 – Activity, runningnY93.C1 – Activity, computer keyboardingnn 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!

Health IT Use More Than Doubles Since 2012

Health IT Use More Than Doubles Since 2012HHS Secretary Kathleen Sebelius today announced that more than half of all doctors and other eligible providers have received Medicare or Medicaid incentive payments for adopting or meaningfully using electronic health records (EHRs).nnHHS has met and exceeded its goal for 50 percent of doctor offices and 80 percent of eligible hospitals to have EHRs by the end of 2013.nnSince the Obama administration started encouraging providers to adopt electronic health records, usage has increased dramatically. According to the Centers for Disease Control (CDC) survey in 2012, the percent of physicians using an advanced EHR system was just 17 percent in 2008. Today, more than 50 percent of eligible professionals (mostly physicians) have demonstrated meaningful use and received an incentive payment. For hospitals, just nine percent had adopted EHRs in 2008, but today, more than 80 percent have demonstrated meaningful use of EHRs.nn“We have reached a tipping point in adoption of electronic health records,” said Secretary Sebelius. “More than half of eligible professionals and 80 percent of eligible hospitals have adopted these systems, which are critical to modernizing our health care system. Health IT helps providers better coordinate care, which can improve patients’ health and save money at the same time.”nnThe Obama administration has encouraged the adoption of health IT starting with the passage of the Recovery Act in 2009 because it is an integral element of health care quality and efficiency improvements. Doctors, hospitals, and other eligible providers that adopt and meaningfully use certified electronic health records receive incentive payments through the Medicare and Medicaid EHR Incentive Programs. Part of the Recovery Act, these programs began in 2011 and are administered by the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator of Health Information Technology (ONC).nnAdoption of EHRs is also critical to the broader health care improvement efforts that have started as a result of the Affordable Care Act. These efforts – improving care coordination, reducing duplicative tests and procedures, and rewarding hospitals for keeping patients healthier – all made possible by widespread use of EHRs. Health IT systems give doctors, hospitals, and other providers the ability to better coordinate care and reduce errors and readmissions that can cost more money and leave patients less healthy. In turn, efforts to improve care coordination and efficiency create further incentive for providers to adopt health IT.nnAs of the end of April 2013:n

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  • More than 291,000 eligible professionals and over 3,800 eligible hospitals have received incentive payments from the Medicare and Medicaid EHR Incentive Programs.
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  • Approximately 80 percent of all eligible hospitals and critical access hospitals in the U.S. have received an incentive payment for adopting, implementing, upgrading, or meaningfully using an EHR.
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  • More than half of physicians and other eligible professionals in the U.S. have received an incentive payment for adopting, implementing, upgrading, or meaningfully using an EHR.
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nFor more information about the Administration’s efforts to promote implementation, adoption and meaningful use of EHRs and health IT systems, please visit: www.cms.gov and www.healthit.gov.nnSource: www.businesswire.com; May 22, 2013.

R. Todd Welter Presents at the Daniels Health Care Club's Inaugural Event

R. Todd Welter Presents at the Daniels Health Care Club's Inaugural EventEarlier this week, our very own R. Todd Welter presented “How I Got into the Health Care Industry… by Accident!” for the Daniels Health Care Club’s Inaugural Event with the Daniels College of Business of the University of Denver.n

Todd,nnOn behalf of the HCC, I just wanted to thank you again. Some well respected students commented to me about how inspiring your talk was. One even said they never understood health care like they do now. The club is off to a great start.nnLooking forward to plugging you in next year if you’re available.nnBest regards,nPhil S. Of the Daniels College of Business | University of Denver

nPlease join us in wishing Mr. Welter a huge congratulations on such an honor!nnMr. 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 increasing revenues and profitability.  
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 prestigious University of Denver.