What’s In Your Wallet?
The ACA, declining and slow reimbursement, billing and coding challenges including the ICD-10 transition, ongoing changes in the healthcare landscape, new payment methodologies, etc. are all obstacles (and in some cases, opportunities!) that EVERY physician and healthcare organization is facing.nnAdvanced Medical Revenue Specialists (AMRS) is your complete Revenue Management Service and a leading provider of Billing, Coding and Revenue Cycle Management services for practices across the country. AMRS can increase your revenue and provide unique expertise, knowledge, and experience in the healthcare arena. AMRS provides complete revenue management for the following specialties:n
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- Orthopedics including Spine
- OB/GYN
- Neurosurgery
- General Surgery
- Cardiology and Interventional Cardiology
- Ophthalmology including General, Surgical including refractive surgery, Retina, Cataracts, Cornea, and Oculoplastics – WE HAVE OVER 20 YEARS OF EXPERTISE IN CODING, BILLING, A/R and REVENUE MANAGEMENT for Ophthalmologic practices! We know the tricks of the trade!
- Dermatology
- Physical Medicine and Rehabilitation
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nAMRS is not just another medical billing service! AMRS’ services encompass the entire revenue cycle management for your practice! Let AMRS simplify your practice and deliver the financial results you deserve!n
Coding Services – Maximize Revenue on the Services You Provide!
nWe provide complete coding services including CPT, ICD-9, and HCPCS assignment, surgical coding, coding and documentation audits, and provider training. We also provide ICD-10 Training for Physicians, Hospitals and Staff!n
Payer Relationship Management – Managed Care Contracting and Credentialing Services:
nIn the ever-changing managed care world, with new lines of business, new amendments and new payment methodologies frequently hitting your desk, it is crucial to have knowledge and information at all times. Like the game of chess, in order to be successful you need to plan ahead and make strategic decisions. We provide complete independent research and strategic assistance with managed care contracting issues.nnFailure to stay on top of provider credentialing requirements, incomplete applications, or a failure to respond to requests can create a domino effect of negative actions including disruptions in your cash flow, claims denials, and improper reimbursement that your practice simply cannot afford. Our dedicated credentialing department will keep your providers and practice on track!n
What Makes AMRS Unique:
nWe are a Complete Revenue Service – we understand the nuts and bolts of all reimbursement issues!nnFlexible to Meet YOUR Needs! We work off multiple billing and EMR systems and will create a custom arrangement that fits your practice perfectly!nnCPC’s and AHIMA-Approved ICD-10-CM/PCS on staff! More than 50% of our staff are Certified Coders to help ensure your charges and payments are maximized!nnComplete Management of the Landscape of Healthcare! Our healthcare knowledge is full-circle. We will be your partner in strategy, growth, and development!nnWant increased revenue and profitability? What’s in your wallet?n
The transition to ICD-10 will cost healthcare organizations and providers in a number of ways, not just in dollars and cents.nn“The cost is not necessarily in dollars,” says Sandra Macica, MS, RHIA, CCS, ROCC, product specialist for the Revenue Cycle, Coding and Compliance at MC Strategies, a segment of Elsevier. “It’s cost of time, too. Some of our clients over a year ago mapped out three hours of training a week, starting over a year ago. It’s not real dollars per se, but it’s the time that they’re having to take away from the job that they already have to do in order to learn the new coding.”nnThat’s not to say that financial resources are any less significant in terms of the cost associated with moving to ICD-10. Costs can escalate if it is determined that staff requires different forms of education. Limited budgets can easily become strained.nn“Learners don’t always learn one best way,” Macica explains. “Some people want online learning because then everyone has access to it, and other folks still want another component where they have actual live training with the speaker in front of the students, or combinations such.”nnWhile it’s common to look at leading healthcare organizations for examples of best practices, it’s not necessarily possible for other healthcare organizations and providers to follow their models.nnTake, for instance, one hospital that Macica is working with which is in the process of implementing dual coding.nn“They feel it’s necessary and certainly that would put them way more ahead of anyone else,” she observes. “But that surely is going to take a whole lot more time, and it might only be where they do a couple records or maybe want to date or just a few a week. At least they’re starting it. I don’t know what the investment in that is, but it certainly seems like a huge one.”nnIn the end, those required to be complaint with ICD-10 by Oct. 1, 2014, need to use whatever resources they have to get their affected staff some form of hands-on training. “Without actually working with it — you can read books you can listen to people talk and you can do lessons — but until you actually try to do it yourself (those were actual workers in the trenches), that’s where you see where you’re going to run into your issues,” argues Macica.nnAccording to Macica, that’s where you get to the heart of the matter. ICD-10 is a new experience for the industry. There is no history lesson to turn to. In this end, it comes down to be practical. “That’s not there right now, those support systems, so you just have to rely on commonsense sometimes,” she says.nnSource: www.ehrintelligence.com; Kyle Murphy, September 26, 2013.nn
CHIEF ICD-10 Implementation Plan: 5 Steps to Success!( for Physicians and Outpatient Coding)
S02.2XXA – Fracture of nasal bones, initial encounter for closed fracturennW18.39XA – Other fall on same level, initial encounternnY93.B2 – Activity, push-ups, pull-ups, sit-upsnnY92.39 – Other specified sports and athletic area as the place of occurrence of the external causennY99.8 – Other external cause statusnnIn 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 
ICD-10 Training – List of Medical Specialties:
S92.411A — Displaced fracture of proximal phalanx of right great toe, initial encounter for closed fracturennW20.8XXA — Other cause of strike by thrown, projected or falling object, initial encounternnY93.E6 — Activity, residential relocationnnY92.014 — Private driveway to single-family (private) house 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, 2014 implementation date. Please don’t hesitate to 
Todd Welter laughs about it now. When first approached about offering his “Fundamentals of Managed Care” course online for students in Regis’ Division of Health Services Administration, he admits he was resistant.nn”Back then – it seems kind of silly nowadays – I thought teaching online was just a fad,” said Welter, an affiliate faculty member. “It’s amazing how fast that has taken off.”nnNow more than 10 years into teaching his signature course and more than 75 percent of that time teaching it online, he can’t imagine it any other way.nnWelter’s teaching philosophy is simple: Engage online students no differently than those in a campus-based class. He maintains regular contact by jumping online frequently throughout the day, responding promptly to questions and making himself available away from the computer – whether by phone or even in-person to work through material face to face.nnClass discussions are still energetic. Personal attention is still a focal point. And everyone, Welter included, comes away from each session learning something new.nnStudents also gain the benefit of his more than 25 years of health care industry experience. He is president and founder of Welter Healthcare Partners, Inc., which works with providers, hospitals, public health agencies and other facilities around the world on the business side of health care. Welter, who earned a Master of Science in Organization Leadership and Management, credits his own Regis education with helping him see the big picture, think outside the box and find solutions. Those skills are what give Regis graduates an edge in the job market and help them excel in a field that is exploding with opportunity, including the ability to join in efforts to move health care forward, he said.nn”I am part of changing health care,” he said. “And I want to drag students into it. I want to tell them, ‘Get in the storm and be part of the change.'”nn
The U.S. Health and Human Services (HHS) Centers for Medicare and Medicaid (CMS) announced on Thursday that Medicare will begin accepting a revised CMS-1500 form (
S93.411A – Sprain of calcaneofibular ligament of right ankle, initial encounter.nnW03.XXXA – Other fall on same level due to collision with another person, initial encounter.nnY93.61 – Activity, American tackle football.nnY92.126 – Garden or yard of nursing home as the place of occurrence of the external cause.
For the ICD-10 transition to be successful, there will need to be a huge effort on the part of medical coders, IT staff, and physicians to put all the pieces together. However, the new code set also presents an opportunity for healthcare organizations to make some big-picture decisions about the future of data governance and the role of healthcare analytics. 2011 AHIMA President Bonnie Cassidy, MPA, RHIA, FAHIMA, FHIMSS, Senior Director of HIM Innovation for Nuance, sat down with EHRintelligence to explain how the ICD-10 decisions you make now can affect your organization in the months and years after October 1, 2014.n
T20.16XA – Burn of first degree of forehead and cheek, initial encounternnX03.0XXA – Exposure to flames in controlled fire, not in building or structure, initial encounternnY93.G2 – Activity, grilling and smoking foodnnY92.017 – Garden or yard in single-family (private) house as the place of occurrence of the external cause.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 
Under the current fee-for-service (FFS) payment system, specialists developed practice styles and business models that flourished by maximizing the delivery of highly reimbursed services. Specialists today, however, are likely to be concerned about forthcoming global payment models that are designed to reduce the inexorable increase in health care expenditures by promoting high-value services, eliminating low-value services, and improving care coordination and integration. For many specialists, this new world of global payments is slowly evolving from an amorphous concern to a potential threat to their livelihoods.nnThis disruption to the current norms of specialty practice, and both the concerns and opportunities presented by global payments, are evident in discussions occurring throughout the country, although likely with greater urgency in physician organizations already transitioning to global payment systems such as those participating in the Medicare accountable care organization programs. As this transition accelerates, even though much of the clinical revenue from specialists will continue to be generated from standard FFS payments, increasing numbers of patients will be covered under global budgets, even if in many cases another care system is “at risk.”nnNationwide, specialists likely are considering potential innovations to better manage patients under global risk arrangements.For instance, specialists in some areas can envision designing aggressive team-based programs aimed at reducing hospitalizations for high-risk cases of diabetes or chronic obstructive pulmonary disease with the assistance of a nurse or case manager. Others might note the opportunity for improved coordination with primary care. While currently specialists might be seeing patients with chronic medical conditions such as asthma or kidney disease 3 or 4 times per year (often with diagnostic testing that provides additional revenue, but little new information), they may recognize that many of these cases could easily be sent back to primary care physicians for the majority of their care, which would free up specialists’ schedules so that they could offer more timely access to those who truly needed their specialized knowledge and consultative services.Yet current incentives and financial models are not in place to support these innovations, which would all result in decreased FFS revenue. Additionally,and perhaps more importantly, there currently are financial disincentives to innovate, to hire practice extenders, or to offer additional consultative services, by phone or e-mail. Neither in the current FFS payment model nor in most global payment models with incentives targeted solely for primary care practitioners are there mechanisms to support such innovations in care delivery.nnThe current systemic constraints and contradicting incentives beg the question, how should the delivery of and compensation for specialty services be structured under global payments? Specialists ideally would be motivated to not only provide optimized patient care and enhanced consultative services to their primary care colleagues but also be actively involved in redesigning practices, coordinating care, reducing unnecessary care, and improving efficiency. To achieve these goals, however, specialists must be incentivized to provide timely, thoughtful,and value-added care,even if it means changing the way that care is delivered. Such change will require overcoming years, if not decades, of deeply ingrained (and currently lucrative) behaviors that have evolved under the current FFS system.nnFor both patients and primary care practitioners, a key need is to obtain appropriate specialty input, but that input need not be in the form of face-to-face visits.The medium for this message may vary widely ranging from telephone consultations to e-mail or other messaging platforms, as well as asynchronous web- or video-based interactions. Traditional visits likely will remain the norm, but increasingly interactions may involve such non–visit based encounters. Thus,under these models,job descriptions and the day-to-day activities of many specialists will change markedly, and specialist compensation methods must account for these new activities. Several likely outcomes may result, although the extent to which each of these becomes common in individual practices, organizations, and markets will vary considerably.nnFirst, in more integrated delivery markets with prior experience with risk contracting, there is likely to be resurgence of risk-based models of specialty compensation wherein groups of specialists receive a fixed per-member-per-month fee to provide specialty care.These fees (or budgets) can be based on an entire enrolled population or can be triggered when a patient first sees a specialist. Specialist physicians may continue to receive FFS payments with intermittent reconciliation, or they might shift to mixed compensation models with salary or specific remuneration for currently uncompensated activities. Under such models, specialists will have more freedom to allocate their fixed resources to providing higher-value services and will have less incentive to see patients more frequently or perform procedures. Organizations,however, will need to put systems in place to ensure continued clinical productivity.nnSecond,when used,the current FFS system compensation models will need to be adapted to cover unreimbursed activities that may be valuable. Compensating physicians for services such as e-mail,telephone,and curbside consultations will need to be paired with new metrics documenting the value of these services. In addition, specialists also will need to be responsible for and incentivized to improve population-based care (eg, endocrinologists responsible for reducing an entire population’s mean hemoglobin A1C) with active outreach,peer practice review,and physician education on how to determine when, whom, and why to refer to specialty care.nnThird, it is likely that increasing numbers of specialists will become salaried employees of hospitals or health systems and that compensation will become less linked to actual FFS revenue generated by direct physician services. For instance, “cognitive” specialists, such as infectious disease physicians, are crucial to hospitals’ functioning; yet these physicians receive lower pay than many other specialties. Thus, to ensure the availability of infectious disease consultants, hospitals may need to supplement their pay beyond the level of typical FFS payments.nnFourth, as care becomes more tightly managed, certain specialists may see substantial decreases in the demand for their services. Low value services will diminish or be eliminated and peer education will allow for care that does not require specialty input to be provided by primary caregivers, possibly leading to less frequent initial and follow-up consultation sand fewer procedures in some specialties. Practice style evolution as described above (eg, e-mail/telephone consults, enhanced disease management, incorporation of mid-level providers such as nurse practitioners or physician assistants,and care managers) will also put downward pressure on demand.nnFifth, specialists also should be prepared to see a reduction in income, particularly when compared with primary care and cognitive specialties that have been under reimbursed in the current FFS system. Current relative payment levels have been codified in the fee schedule used by Medicare that also serves as a model for FFS payment by most private health plans. Even capitated systems that do not use FFS reimbursementmust pay market-level salaries to attract qualified specialists.Many health policy experts have long noted the current inequities,and current Medicare Payment Advisory Commission (MedPAC) recommendations call for a rebalancing of primary care and specialty pay to address these inequities. 1-3 Combined with the likely decreased demand noted above, it is difficult to envision a future in which both payment levels and pay relative to primary care are not adjusted down for many specialties.nnThe coming tide of payment reform as well as continued, if not escalating, cost pressures as the Affordable Care Act is implemented and an additional 30 million individuals obtain some form of health insurance present great opportunities for innovations in how health care services are organized and delivered. For the first time in US history, more patients and physicians will operate in a system in which there are defined boundaries for costs. There may be substantial shifts in how resources are spent, whether shifting from specialists to primary care physicians or from inpatient to outpatient settings. These changes will have dramatic effects on specialist practice, with implications both for how specialists practice as well as for the forms and levels of their compensation. Although changes in specialist roles and responsibilities will better align specialists with the goals of integrated care systems, with likely benefit to the health care system overall, these changes are also likely to result in substantial changes in specialist pay and number.n
S61.452A — Open bite of left hand, initial encounter.nnW55.21XA — Bitten by cow, initial encounter.nnY93.K2 — Activity, milking an animal.nnY92.73 — Farm 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 
S93.431A — 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 
WASHINGTON — 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 
Health 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.”nn
The 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
S00.83XA — 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 
In 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
S90.871A — 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 
When 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
Are you going to be conducting external testing?
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 
House Energy and Commerce Health Subcommittee drafts bill to repeal the Medicare sustainable growth rate payment formula