A Fun Day At The Themepark
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 contact us for all of your training and education needs!
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 
nnA recent incomplete CMS listing is raising concerns, as the state of Colorado is missing from the listing annltogether, and this leaves no way for providers to check to see if they are due for revalidation. Welter Healthcare Partners works with over 150 providers and has had providers whose PTANs have been deactivated due to non-response to the revalidation request. Representatives at Novitas have stated that they are receiving many phone calls on this concern, and that they have escalated it from the inside. They have further stated that this issue is being addressed at each staff meeting, there has not been a definitive resolution presented. If you have any questions, or need any assistance with this process, 
Cerveza intoxication, uncomplicated — F10.120nnMontezuma’s revenge, bad tacos: T62.8X1A – Toxic effect of other specified noxious substances eaten as food, accidental, initial encounternnInjury due to falling piñata: W20.8xxA — Struck by falling object, initial encounternn nn[hr]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 
While most hospital leaders see the advantages of moving to bundled payments for an episode of care, many are unprepared either for the mindset or the mechanics required to implement the emerging reimbursement model. Here are the concerns and possible strategies you should consider. n
The at-risk nature of bundled payment may leave hospital administrators feeling somewhat unsure about how to proceed, as Casale did in 2005. “We were preparing a presentation for the board of directors about bundled payment, which Geisinger calls ProvenCare,” he says. “We decided to offer one price for a package of services to include everything from the first office visit through the surgery and for 90 days postsurgery.”nnInstitute leaders had two and a half years of data that showed what GHP paid for coronary artery bypass grafts. They also knew that related complications tended to occur within four weeks of the operation and that by 90 days, 99 percent of all complications had occurred. That’s why they set the episode duration at 90 days.nn”Then we had to set a price,” Casale says. “We had never done this and our presentation was the next day. There was no calculus or even any science involved. We just took the average cost and decided to charge half. At the board meeting the next morning, we said, ‘Give us half of the average charges in a package price and we’ll immunize you for the cost of care for any related complications at a Geisinger facility for 90 days.’ “nnSince then, the program has worked so well that it was cited as an example of the effective use of evidence-based protocols in the Institute of Medicine’s report, 
“Many hospitals have yet to determine the best process to allocate fixed costs to an episode to determine a fully loaded cost per episode,” O’Boyle says. “Most hospitals will need to undertake a process like activity-based costing to understand their costs per episode. That costing process will need to include all care providers and settings, which can be cumbersome and time-consuming.”nnMost hospitals have not changed their revenue-cycle management process for many years and have systems that are not designed for bundled payment, says Shannon Dauchot, Parallon’s senior vice president of corporate operations and client relations. Most payers don’t have the systems they need to make bundled payment work either. “That means hospitals might have to use spreadsheets to collect all the numbers they’ll need,” she says. “By starting small, they can sort through each bundle until they figure out what can be automated. But we’re not aware of a one-size-fits-all system that does all that because every bundle and every group of providers will be different.”nnIndeed, when collecting the data it needed for bundled payments for hip and knee replacements, Crozer-Keystone Health System used spreadsheets.nn”We spent an incredible amount of time and resources looking at financial modeling and getting people to help us do the modeling for bundled payment,” says Susan L. Williams, M.D., Crozer-Keystone’s senior physician for clinical integration. “Starting in 2008, our strategy was to build primary care around patient-centered medical homes, and so we had a fair amount of experience with collecting the data and building the data systems required to pull out quality metrics on individual physicians or physician groups for bundled payment. And, our finance people are great at calculating costs. But marrying all the data on costs and quality has been a journey.”nnElizabeth Jaekle, Crozer-Keystone’s vice president for business development, agreed. “There is a level of nuance that we had not counted on with bundled payment,” she says. “Our cost accounting system was not set up to facilitate bundled payment or any kind of gainsharing because it collected data in aggregate and averages, which is fine for most of the work we do. But when you’re compensating for quality improvement, you need to measure the rate of change and differentials at an actual point in time.”nnMost cost accounting and information systems are not oriented to measure and report such data. “So, first we had to use spreadsheets to collect what we needed and then we put the data into various working documents that we could evaluate,” Jaekle adds. “From there, you can start to put together the infrastructure to automate these systems.”nnOvercoming these hurdles helped Crozer-Keystone learn enough that CMS approved its application in January to implement bundles for hip and knee replacements under the BPCI.nnHospitals also face challenges in collecting data on each provider who will deliver care in a bundle, says Joseph J. Fifer. Before he became president and CEO of the Healthcare Financial Management Association last June, Fifer was vice president of hospital finance at Spectrum Health in Grand Rapids, Mich., where he implemented four bundled payment programs.nn”Collecting all the data elements that span across multiple providers might be a bigger hurdle to clear than the accounting issues,” he says. “There aren’t any systems today that can easily gather data on a patient-specific basis and that span the entire episode of care from the first primary care visit to the last exam. By its nature, bundled payment covers everything, meaning you have to include costs for post-acute care, rehabilitation and physical therapy.”nnHaving the data on costs and quality is critical to the success of a bundled payment initiative, agrees James T. Caillouette, M.D., surgeon-in-chief at Hoag Orthopedic Institute in Irvine, Calif. Hoag has a bundled payment program for hip and knee replacement surgery. “The key to success or failure hinges on alignment with the participating physicians,” he says. “Everyone needs full cost transparency because you are going to be accountable for the cost of care in a way that you have never before been accountable. Typically, this kind of accountability is difficult because hospitals and health plans are not readily going to share their costs with physicians and other providers.”nnBefore allowing its doctors to participate in the bundled payment program, Hoag examines physicians’ past results. “We’re looking for costs, infection rates, outcomes and the reasons behind any readmissions. You have to set the bar high because those who can achieve that bar will participate in the bundle and those who haven’t achieved that bar need to work toward it so they can participate,” Caillouette says.nnFor Hoag, gathering information on its physicians is relatively easy because the institute is a collaboration between the orthopedic physicians and Hoag Memorial Hospital Presbyterian.nnWhen separate entities develop bundled payment initiatives, collecting information from outside providers can be difficult, says Caroline Steinberg, vice president of trends analysis for the American Hospital Association. “Hospitals have never had any information on what happens to patients outside their doors,” she explains. “There are a lot of tricky issues with bundled payment because hospitals have never taken on responsibility for care across the continuum.”nnNot only does the hospital need historical data on care for similar patients so that it can decide what to charge, it also needs to know how much to pay each individual physician and other clinicians delivering care in the bundle.nnCollecting that data for each episode of care is just part of the solution. “The real trick to make bundled payment work is that information must be readily available to the various providers on a need-to-know basis virtually in real time as opposed to what we have now,” Fifer says. “You’re pricing based on last year’s numbers but you’re doing the surgery this year and paying out on this year’s numbers. Making all the data available in real time today is a huge challenge.”[/vc_toggle]nn[vc_toggle title=”Fewer Heads In Beds” size=”sm” el_id=””]nOnce a hospital standardizes care and cuts lengths of stay, it could create a new problem: reduced revenue. That’s leading some observers to question whether bundled payment works against a hospital’s best interests. “If we go down this path in any material way, what does that mean about how many beds we need?” Fifer asks. “What does it mean for the pure existence of many hospitals, especially those in small, rural communities?”nnBecoming an early adopter may be one answer. “The hospitals that are the first movers get an advantage by seizing the opportunity to acquire volume,” TriZetto’s Sultan says. “Bundles for cardiac or orthopedic surgery can be the most profitable cases in hospitals, making them crucial for hospital success. Plus, getting a higher fee in a bundled payment is a profound financial incentive for surgeons to refer patients.”nnEarly adoption has another advantage. “Bundled payment not only allows hospitals to transform the delivery of care, but also to solidify their place in the market,” Sultan says. “Once the program is running smoothly, other physicians, such as oncologists, will want to develop bundles. And health plans may start coming to you as well.”nnJoseph Burns is a freelancer writer in Falmouth, Mass., specializing in health care strategies.[/vc_toggle]nn
A January issue brief from the American Hospital Association, Moving Towards Bundled Payment, explains the steps hospitals and health systems would take to develop such programs. By examining how to define an episode of care and how to evaluate the distribution of costs across service lines, the brief offers a starting point and guide for hospital administrators in how to manage costs, risk and unwarranted variation.nn”Understanding where the costs are concentrated helps identify where cost-reduction opportunities are likely to be found and where partnerships with other providers or specific types of interventions may be most important,” the brief states.nn”Bundled payment comes down to the opportunity to improve quality and efficiency,” says the report’s author, Maulik S. Joshi, Dr.P.H. President of the Health Research & Educational Trust and senior vice president of research at the American Hospital Association, Joshi calls bundled payment a vehicle to manage financial risk and care across various care delivery settings. “The triggers that allow bundled payment to succeed are improved quality and improved efficiency. As a natural artifact of those two aims, you have to address unwarranted variation and you have to address care coordination,” he says. Bundled payment also gives hospital administrators a new and perhaps more complete view of the full continuum of care than they normally have. “The fact that hospitals have not looked at the continuum of care is not a knock on hospitals. It’s just a reality,” Joshi comments.nnAnother issue that may be new to hospital administrators is the link between risk and high levels of unwarranted variation. “The ability to identify, understand and eliminate variation in care practices will be critical to success under bundled payment,” the report adds. Hospitals that measure variations in cost may be better able to manage risk. For example, the report shows how the difference in costs between the 25th and 75th percentile (the interquartile range) for a percutaneous cardiovascular procedure with drug-eluting stent is approximately $3,251, or about 28 percent of the median episode cost. But the same difference in costs for chronic obstructive pulmonary disease is about $3,884, or 80 percent of the median episode cost. Administrators may want to select episode types that have enough variation to provide opportunities for cost-reduction, but not so much variation that they pose excessive risk to the organization. “We are still early in our ability to measure risk,” Joshi explains. “Therefore, maybe it’s better to figure out why the variation is so high rather than put it into a bundled payment program.”[/vc_toggle]nnSource: www.hhnmag.com; Joseph Burns; April 4, 2013.
With the news that CMS has started conducting pre-payment audits to monitor