MGMA Anticipates Problems, Disruptions With ICD-10: Q&A
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
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.
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
S13.4XXA — 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 
Physicians 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
Under 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.nn
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.
S03.1XXA — 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 
W3.9xxA – 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 
On Tuesday, July 9, Health Affairs will host 
T63.611A – 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 
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.nn
W21.04xA – 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 
The 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 
HHS 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
Earlier this week, our very own 
Eyebrows burned off by flare up of barbecue grill: X03.0XXA – Exposure to flames in controlled fire, not in building or structure, initial encounternnBellyflop into swimming pool: W16.512A – Jumping or diving into swimming pool striking water surface causing other injury, initial encounternnFood poisoning from potato salad left too long in the sun: T62.8X1A – Toxic effect of other specified noxious substances eaten as food, accidental, initial encounternn 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 
Bringing down health care costs is a top priority. That’s why the Affordable Care Act contained an historic set of reforms designed to reward higher quality and lower the cost of care. And we know that the best way to do that is the same way leading health care organizations do it: by making care better and more efficient.nnWe also know there are great ideas out there that can help push this work forward and that the kinds of innovative practices that make our health care system work better for everybody can come from any corner of the country. That’s why today we’re launching a $1 billion initiative through a second round of Health Care Innovation Awards.nnThese Innovation Awards will be given to organizations whose creative solutions to our most pressing health care challenges have the potential to serve as models for improving care and lowering costs across the country.nnIn November of 2011, we launched our first round of Health Care Innovation Awards by issuing a challenge to America’s health care providers, businesses, universities, and community groups. We asked them to submit their proposals for how to get the most out of our health care dollars by delivering better care. That challenge resulted in more than 3,000 applications, from which a team of independent experts and HHS officials selected 107 promising innovations with the strongest likelihood of creating larger-scale, sustainable results.nnAnd as we kick off round two of the Innovation Awards today, we’re already seeing encouraging results from a number of our round one recipients. The University of Miami, for example, is transforming school-based health clinics into medical homes to serve vulnerable children. These medical homes are connected to community health care providers and these children are already receiving tele-health consults for dermatology, psychiatry, and nutrition along with dental care.nnAnother recipient, Christiana Care Health Services, has used advanced data analytics to improve preventive care for patients with heart disease. Their comprehensive electronic registry allows providers to more quickly and accurately assess patients’ symptoms and needs based on similar occurrences in the past. This smarter preventive care doesn’t just prevent tragedies before they happen—it also saves money on hospital visits.nnAs with last year’s awards, we’re seeking out innovative practices that have a high likelihood of delivering better care and lower costs on a national scale. The last few years have seen us make tremendous strides towards keeping health care spending in check, and a lot of that is thanks to innovations that have helped improve the quality and efficiency of care delivery and payment systems.nnAcross the country, private and public sector innovators are developing even more great ideas to improve our health care system. And today’s announcement will allow us to take some of the most promising innovations and put them into action for the benefit of all Americans. That’s good news for patients, for providers, for our economy, and for the future of American health care.nn
Allergic Rhinitis due to Pollen — J30.1nnPoison Ivy: Allergic Dermatitis due to plants — L23.7nnBee Sting, accidental, initial encounter — T63.441AnnPoisoning, Larkspur, accidental, initial encounter — T62.2X1AnnAccident caused by contact with garden tool, initial encounter — W27.1xxAnn 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