04/10/2015
ICD-10 PREPARATION
Three-Month Credit Line Recommended In Anticipation of ICD-10 Payment Delays
Dr. Andrew Kleinman would rather spend his time with patients than dealing with billing. The New York plastic surgeon is worried that next fall, when he has to switch to a new medical coding system known as ICD-10, billing issues will overwhelm his practice. "At one of the training sessions, the consultant recommended that everybody who was there have a credit line that would cover three months' income, because you might not get paid if you don't do things 100 percent correctly," said Kleinman.
"ICD-10, on paper, looks like a good idea. We're going to have much better data-gathering capability. It's just in practice," explained Kleinman, who serves as president of the Medical Society of the State of New York, "small practices are very worried about it."
Source: Bertha Coombs, CNBC [4/7/15]
02/26/2015
ICD-10 PREPARATION
6 Key Takeaways for ICD-10 Testing - Part 6
Another Testing Approach
Denver Health last year was not dual-coding live claims because its insurers want primarily claims that they have seen before, recoded in ICD-10 to check their eligibility systems, says Anita Shabazz, applications analyst. Denver Health sent ICD-9 claims to Haugen Consulting, which used 3M Health software to translate them into ICD-10 and then sent the claims back to Denver Health, which submitted them to clearinghouse MedAssets to transmit to insurers for testing. Shabazz expects to use this approach until March, when she anticipates the coding staff will be proficient in dual-coding.
Source: HealthData Management [January 2015]
02/25/2015
ICD-10 PREPARATION
6 Key Takeaways for ICD-10 Testing - Part 5
Testing Live Claims
Some providers are dual-coding dummy claims to test with payers, while others are sending live ICD-10 claims for real patients; it depends on the wishes of both the provider and the payer. University of Utah Health Care learned that using live ICD-10 claims gives a provider real-time data without using an ICD-10 era production environment, which most providers don't yet have. "That was the only way we could be sure the end result was what we really would see if we were live," says Connie Tohara, the provider's HIM director.
Source: HealthData Management [January 2015]
02/24/2015
ICD-10 PREPARATION
6 Key Takeaways for ICD-10 Testing - Part 4
Learn Denial Management
At a conference, Lori Logan, senior vice president at the Provider Solutions clearinghouse unit of payer software vendor TriZetto asked an audience of about 150 physician practice administrators how many were knowledgeable about denial management. 20 percent raised their hands. That has to change quickly, she warns, noting that Medicare has said rejections and denials may increase 100-200 percent, and days in accounts receivables could rise 20-40 percent.
A rejection is when a claim is not accepted by an insurer because something is wrong with the claim, she explains; a denial means an insurer has accepted the claim, but the provider gets only partial or no payment for any of a number of reasons, such as the insurer believing some of the charges were not medically necessary.
Source: HealthData Management [January 2015]
02/23/2015
ICD-10 PREPARATION
6 Key Takeaways for ICD-10 Testing - Part 3
Taking Their Time
Lori Logan, senior vice president at the Provider Solutions clearinghouse unit of payer software vendor TriZetto, believes more insurers are ready for end-to-end testing than they have indicated, but they did not want to bother with it in 2014. Like providers, they used the compliance delay to finish other priority projects. By late 2014, TriZetto had done testing with 177 payers, mostly acknowledgement testing, and Logan expected both acknowledgement and end-to-end testing to increase in the first quarter of 2015.
Source: HealthData Management [January 2015]
02/21/2015
ICD-10 PREPARATION
6 Key Takeaways for ICD-10 Testing - Part 2
Productivity Risks
The more coders dual-code, the more they will feel like it is their regular work pattern and become very proficient, says Mary Beth Haugen, CEO of Haugen Consulting Group. Coders in the ICD-10 era will never get back to their productivity levels under ICD-9, she cautions. But the more proficient coders become, the lower the productivity hit will be--maybe 20 percent instead of 60-70 percent. Consequently, dual-coding throughout 2015 will give practices a good idea of the productivity levels they can expect and aid in setting appropriate coder staff levels.
Source: HealthData Management [January 2015]
02/20/2015
ICD-10 PREPARATION
6 Key Takeaways for ICD-10 Testing - Part 1
End-to-End Testing
Medicare offered end-to-end testing in January and will do so again in April and July 2015, letting about 850 providers participate during each round. While there have been concerns that some Medicare contractors and other payers have not generated remittance advice to complete end-to-end testing, the agency expects to include remittance in these tests. Forms to participate are on regional contractor websites.
Source: HealthData Management [January 2015]
03/19/2012 H. David Gottlieb, DPM
RE: ICD-10 Preparation (Joseph Borreggine, DPM)
First, some history. The ICD-10 [International
Classification of Diseases, v.10] is developed
by the World Health Organization [and can
be downloaded directly from their website at
who.int/classifications/icd/en/. It has nothing
to do with the U.S. government or insurance
companies. It is the standard
international ‘language’ of medicine and allows
for standardization of medical research and
epidemiology. The rest of the world has
essentially already adopted ICD-10.
The first ICD was developed in the late 1800’s.
From the WHO website you will find “ICD-10 was
endorsed by the Forty-third World Health
Assembly in May 1990 and came into use in WHO
Member States as from 1994.” … “The ICD is the
international standard diagnostic classification
for all general epidemiological, many health
management purposes and clinical use.”
It is my understanding that the U.S. is the last
major country to adopt ICD-10, but I may be
premature with that assessment. As example, the
metric system is the official measurement system
in the U.S. even though no one really uses it.
Individual countries modify the ICD for their
particular use if desired. The ICD-10CM
[CM=clinical modifications for the US] expands
the international ICD-10 to over 60,000 choices.
The U.S. government mandated the use of ICD9-CM
for Medicare/Medicaid. Why not ICD10-CM?
H. David Gottlieb, DPM, Baltimore, MD,
hdavidgottliebdpm@gmail.com
03/19/2012 Jack Sasiene, DPM
ICD-10 Preparation (Joseph S. Borreggine, DPM)
I am happy to see some doctors writing in about
what is going on with Medicare/Medicaid and
private insurance. The last postings have quoted
$80K for implementation, training costs, putting
aside anywhere from 6-12 months of overhead
expenses per the expert from UHC and the TPMA
president. That's only about $2,631 per month
extra you need to start setting aside per every
$100K of overhead per year over the next 19
months until Oct 2013. But let's not forget Dr.
Brody's statement here on PM News regarding
Phase 2 of meaningful use on 3-5-12: "You need
to have a fully DICOM- compliant digital x-ray
system."
I think I'll just take my money and invest it
in healthcare with all the cash they will be
holding on claims they just can't seem to
process...without penalty I'm sure. The real
concern is that this "doom and gloom" is not
coming from our fears...but from the "experts"
dealing with this.
The APMA and AMA is just calmly letting us know
about all this as if it were just another day at
the office. It really is a disgrace that they
are treating us like circus animals and teaching
us to jump through more hoops and do more tricks
just to scrape out a living. I feel as if I am
in business just to give my staff a living.
There is no reason to learn new practice
strategies and efficiencies if the real problem
is not under our control. It really is time to
stand up and tell your state components and the
APMA they aren't furthering your practice. That
being on insurance plans is not helping us, but
costing us more money.
All these other things our organizations are
working towards only makes us more dependent
on....insurance....so why. We need the APMA and
AMA to work together, we as individuals can't do
this. They do many good things for us ....but
those won't matter if we can't keep our doors
open.
Jack Sasiene, DPM, Texas City, TX,
Sasiene@aol.com
03/17/2012 Marc Garfield, DPM
ICD-10 Preparation (Arthur Lukoff, DPM)
In 2014/15, there will be few if any uninsured
patients and the cost for a plan to be deemed
acceptable by the government will be $10-15K/yr
reducing disposable income of sole proprietors
and suppressing growth potential of larger
businesses that are not presently covering
employees at the acceptable level as their funds
will be immediately diverted to healthcare
costs.
The notion that we can all opt out of insured
medicine may be misguided unless, you can offer
specialized services not generally sought after
in the insured market. Most people simply will
not have the funds available.
If you look at what happened in Canada after
ICD10 implementation, we can expect many private
practices of many specialties to be out of
business some time after the conversion. Why?
because ICD10 actually makes seeing a moderate
to high volume of patients per day nearly
impossible while seeing fewer patients per day
may not generate enough revenue to keep your
office open.
This is an international effort pushed by the
WHO for the purposes of segregating diagnoses by
extent and paying less for less significant
diagnoses.
In every industrialized nations’ transition to
ICD 10 there have been no crosswalk. That means
there will be no way to directly convert the ICD-
9 codes that you are using now, to ICD 10
codes. You will have to add in several factors
into the diagnosis that will remove the ability
to automate a conversion. Moreover, to
substantiate these factors your documentation
will be much more laborious to support these
claims. “five percent of all ICD10 codes map
directly to ICD9 codes, and only 26% of ICD9
codes map to ICD10 codes( SEE 4) Thus, from the
Canadian model we can expect a permanent
decrease in reimbursement and productivity SEE
3).
The big difference between the U.S. and the rest
of the industrialized world is that we
supposedly do not have socialized medicine and
arguably better care available. So the argument
that the US is “behind” in implementing this
system is highly suspect. Why does the only
hold out on socialized medicine want to follow
the rest of the world’s lead on how to code and
pay for medical services? It is not going to
help you practice better medicine, but it will
severely delay your reimbursement and when it is
fully implemented it will give insurance
companies greater ability to deny your claim or
pay you substantially less for your services.
Pay attention as the AMA lobbies to kill or
postpone ICD 10 (After supporting the
legislation that demanded ICD 10
implementation).
Here are a few links upon googling efficiency
and ICD10 to help give you a better picture of
the storm headed our way.
1. http://www.icd10watch.com/blog/after-icd-
10-will-coders-ever-regain-icd-9-efficiency-
levels
2. http://www.icd10watch.com/blog/will-icd-
10-spark-coder-chaos
3. http://www.beckersasc.com/asc-coding-
billing-and-collections/the-cost-of-moving-to-
icd-10-20-statistics-for-physician-practices.html
4.
http://www.healthcarefinancenews.com/news/icd10-
and-hipaa-5010-game-changers
Marc Garfield, DPM, Williamsburg, VA,
mgarfield1@cox.net
