Challenges and Benefits of Patient Engagement

Guest post by Lea Chatham, editor-in-chief, Getting Paid, a Kareo Resource.

Lea Chatham
Lea Chatham

Patient engagement has been the hot topic of this past year or two. Everyone agrees that engaging patients more in their healthcare can help reduce costs and improve overall health. A study conducted by HIMSS in 2015 showed that the majority of physicians believe patient engagement is beneficial and should be a part of their job. However, the study also concluded that over 40 percent of physicians worry that there is little reimbursement for engagement activities.

Patient are looking for more ways to connect with providers from online scheduling to text reminder to email follow ups and social media. And while many see these as conveniences, the reality is that they do also improve health and have the potential to reduce costs. Studies have shown that simple follow up communications via text and email can help ensure patients show up for appointments and can reduce hospital re-admissions, which has a big impact on healthcare costs.

Unfortunately, physicians are already stretched thin trying to care for patients, run their practices, adhere to complex programs like meaningful use and PQRS, and navigate changes like ICD-10. Who has the time to do more? And many providers worry that “engagement” means more work with less reimbursement. But it doesn’t have to be that way.

In fact there are many opportunities to automate engagement and provide the tools patients want without adding any time or effort to a provider’s plate. Today, there are solutions that once set up enable easy online scheduling, text and email reminders, follow up patient surveys, and even re-care programs.

This infographic highlights some of the feelings of both patients and providers feel about patient engagement and shows how practices can utilize engagement strategies that benefits both and do have a financial return.

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Infographic: Bizarre Medical Codes, Industry Outlook

These are some of the most out of the ordinary medical codes you might come across if you worked as a medical coder. If you’re a patient and see these on your bill, you might raise an eyebrow once you find out the meanings. Check out the following graphic for all 15 unusual codes.

V97.33XD – Sucked Into Jet Engine

Y93.D: V91.07XD – Burn Due to Water-Skis on Fire

V95.40 – Injured by Spacecraft Collision

R46.1 – Bizarre Personal Appearance

V96.00 – Unspecified Balloon Accident Injuring Occupant

W61.12XA – Struck by Macaw

V94.810 – Civilian Watercraft and Military Watercraft Involved in Water Transport Accident

W56.11 – Bitten by Sea Lion

Y93.D1 – Accident While Knitting or Crocheting

Y92.253 – Hurt at the Opera

If you are interested in being a medical coder, the average salary is $47,870. The job outlook has a 21 percent increase by 2020. Eighty percent of medical coders have some postsecondary education. Medical coders work in both clinical and non-clinical settings, some of which are hospitals, physician offices, long-term care facilities, dental offices, mental health facilities, government agencies, and insurance companies. Graphi provided by Topmedicalcodingschools.com.

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Will ICD-10sion Return this October?

Guest post by Amy Sullivan, vice president of revenue cycle sales, PatientKeeper. 

Amy Sullivan
Amy Sullivan

The multi-year run-up to the ICD-10 cut-over last October had a “Chicken Little” quality to it. There was prolonged hand-wringing and hoopla about the prospect of providers losing revenue and payers not processing and paying claims – the healthcare industry equivalent of “the sky is falling.”

Then CMS helped calm things down by announcing last July (as the AMA reported at the time), “For the first year ICD-10 is in place, Medicare claims will not be denied solely based on the specificity of the diagnosis codes as long as they are from the appropriate family of ICD-10 codes.”

Since ICD-10 is all about specificity – the number of diagnosis codes increased approximately four-fold over ICD-9 – this was a big relief to all involved. And, if you believe new research data, the sky indeed has not fallen: Sixty percent of survey respondents “did not see any impact on their monthly revenue following Oct. 1, 2015… Denial rates have remained the same for 45 percent of respondents. An additional 44 percent have seen an increase of less than 10 percent.”

Still one has to wonder what will happen after Oct. 1, 2016, when the current leniency expires and ICD-10 code specificity is required. Will physicians be in a position to enter their charges completely and accurately once “in the general neighborhood” coding no longer suffices?

They will if their organization has invested in technology that adheres to best practices in electronic charge capture system design. The three watch-words are: specialize, simplify and streamline.

A charge capture system is specialized when it exposes only relevant codes to physicians in a particular specialty or department, and when it provides fine-tuned code edits.  With different types and processes of workflows (and let’s face it, personal preferences), physicians need an intuitive and personalized application that easily fits into their individual work styles. A tailored user experience allows providers to build and display their patient lists in whatever way is most convenient and meaningful to them – down to lists organized by diagnosis and “favorites.”

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How to Avoid an ICD-10 Claims Disaster

Guest post by Michele Hibbert-Iacobacci, CMCO,CCS-P, vice president of information management support, Mitchell International.

Michele Hibbert-Iacobacci
Michele Hibbert-Iacobacci

Recent ICD-10 end-to-end testing conducted by CMS and the American Medical Association yielded an 87 percent claim acceptance rate. This means that of the 29,286 test claims received, only 25,646 were accepted. Imagine thousands of claims denied due to providers submitting improper codes, stalling the bill review process and creating pain for everyone involved.

The one percentage drop in claims accepted from the month prior is a poor indication for the months ahead, as 100 percent of the test participants claimed to be fully ready for the October 1 ICD-10 implementation date. It’s only logical that many carriers and providers wonder what will happen to those that aren’t ready.

The end-to-end testing results also raise complicated questions: Which ICD-10 codes will be seen most frequently post-implementation date? And will these codes match what providers will put on the bills they send?

It’s no secret that ICD-9 has a lot fewer codes than ICD-10 and a situation is simply less complicated with less contextual data to worry about. As a result of the influx of new codes presented by ICD-10, we can expect to see providers assigning way more codes than necessary to bills in a pin the tail on the donkey-type attempt to choose the right code. For example, there are ten codes for a fracture to the tibia in ICD-10, as opposed to one in ICD-9. So many options may lead a provider to place all ten on a bill, to ensure payment is received.

It will be challenging for untrained providers to submit the correct ICD-10 codes, and as such, productivity will decrease alongside increasing reimbursement challenges and potential claim denials. Carriers, on the other side, will be forced to conduct extensive reviews of each bill to determine the actual injury cause and appropriate code.

To handle the huge influx of ICD-10 codes, providers can design a system where the office coders are provided with quick references to the most prevalent codes used in the practice. Over time, the overall billing experience will improve as coders become more skilled in identifying proper codes and carriers become more precise in reviewing bills. At first, carriers will be tolerant toward the reporting of multiple or vague codes. However, with each passing day post-implementation of ICD-10 carriers will become increasingly strict. Providers will be required to submit correct coding pending the value provided by the classification system accurately describes patient conditions.

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Silly ICD-10 Codes: What Will they Say About Us?

Every time a person seeks medical treatment, healthcare professionals are required to use a specific code for billing and tracking purposes. The International Classification of Diseases, Revision 10 (ICD-10), was launched Oct. 1, 2015 — after 20 years of delays.

The new ICD-10 codes multiply the medical coding options available by a factor of five, jumping from roughly 13,000 diagnostics codes under the ICD-9 to more than 69,000 with ICD-10.

ICD-10 attempts to label every possible diagnostic scenario imaginable. Whether you’ve had an initial encounter with an orca whale (W56.21XA, W56.22XA or W56.29XA) or an unlikely repeat orca encounter (W56.21XD, W56.22XD or W56.29XD), been injured by a brass musical instrument (Y93.J4), or walked into a wall (W22.01XA, W22.01XD or W22.01XS), believe it or not ICD-10 has a classification for it.

Don’t believe us? Take a peak for yourself. Check out the ICD-10 Code Lookup Database or you can just look at the entertaining graphic below provided by Quill.com. The graphic illustrates 14 funny examples of ways people injure themselves and how ICD-10 classifies them.

A personal favorite? It has to be V91.07XA: Burn because of to water skis on fire, initial encounter. It’s easy to wonder how this happens once, let alone more than once, V91.07XD: Burn because of water skis on fire, subsequent encounter.

Take a look at the following graphic depicting some of the most bizarre ICD-10 codes, thanks to and provided by Quill.com. What will these codes, when aggregated over the next few years, say about us as a people? That we’re likely into, and injured by, some pretty weird stuff! Perhaps I’ll write a book.

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Hello, ICD-10: A Moment of Silence

It’s here. The day has arrived. The biggest thing to happen to the administration of healthcare in decades is upon us: Today is ICD-10 conversion day.

It’s been a long and winding road. But we’re here. The trip has certainly not been easy and there have been multiple detours. But, the destination has arrived. “Momma, are we there yet?”

Yes.

Take a breath. Stretch your legs and try to find some joy in the tumultuous trip. You’ve earned it. It’s been a long ride.

But the trip is not over yet. Like all road trips, there’s the way back. And that, too, is a long road ahead. There’s still much to see and do, and much to prepare. Much to look forward to on the road ahead.

For a minute, though, on perhaps the most important day, why not take a moment to reflect on the journey and congratulate yourself on a job done well, which you’ve done with integrity and professionalism, in which you have been filled with excitement and glib, where you’ve experienced pain, pressure and perhaps even a little joy as you pushed yourself to the max.

Many of us never thought this day would come. Some of you hoped it never would.

Now, thankfully, we can move on to a new goal, a new destination.

The time has finally come.

It’s been a long road to “here.”

A moment of silence is deserved, if not required.

Weathering the ICD-10 Storm: Some Final Thoughts

Though ICD-10 is upon us and there is little, if anything, that can be done at this point other than wringing your hands in disbelief or praying for peace with the patience of a saint (depending on your religious worldview and personality), we wait for the storm to hit, then pass and roll on a bit for a time. And it will pass. The storm will dissipate.

For some reason, when I think of the current state of ICD-10 and its impact to healthcare I’m reminded of a hurricane. The analogy of a hurricane seems like an apt example of the phase healthcare currently is in in regard to ICD-10.

The road here has been long – there has been much fear and anticipation of the coming storm. Surges of energy, wind and waves have met us and battled at the banks of the beach. The wind and thunder has been loud, the elements seem to have shaken the very foundation of our lives and our “homes.” Pain, fear, struggle and stress have been the order of the day. But at last we’re here. The storm is upon us, in fact it is half over, and we stand in its eye, one of the most beautiful and peaceful times one can ever experience.

Peace, calm expectation and a subtle excitement of the storm’s beauty are in the eye, as is anxiety of the anticipation of what’s to come — the second half of the storm. Having personally stood in the eye of one of the largest hurricanes on US record, and having survived one of the most terrifying storms of my life, I can tell you that the eye of the storm is a brilliant, calm and peaceful place in what is actually an extremely deadly and dangerous place to be.

However, when the eye passes, the storm rages again, even more fierce than the penetrating force of the first half of the storm. Again, there’s more fear; more stress; more panic. Finally, the storm passes, slowly and subtly. The wind disappears, the sun breaks free and among the chaos, birds sing with striking clarify and beauty. It’s as if their songs are the only remaining sound because the storm has sucked all else away. Their song is an encouragement as you assess your losses and determine the first steps required to put your life back together.

Certainly, ICD-10 is not deadly, nor is it as dramatic as surviving a killer storm, but the process has been stressful, and painful and chaotic for millions. We’re in the eye, half way between beginning and end. Much has happened, but there is still a great deal more to come. I image that’s how many of you are feeling today; trying to ride out the storm — in peace, in fear or maybe a combination of the two. So, on this occasion, as we wait, I thought I’d provide a few final thoughts about ICD-10 from those working alongside you, in the trenches, who are also weathering the storm. Hopefully these insights provide you some peace, and help you get through this stressful time.

Matt Dutton, consultant, Freed Associates

With the transition to ICD-10, we expect three types of industry disruption occurring at different times. First, starting in the first few days after the Oct. 1, 2015 cutover, when providers start transmitting claims containing ICD-10 codes (between 10/3 and 10/10), we predict that providers that chose to ignore the ICD-10 mandate will receive a monumental wake-up call when clearinghouses and payers immediately reject their ICD-9 coded claims as non-clean HIPAA transactions. We believe that most of the nonconformists will be smaller, rural professional providers and small practices. They will scramble to get ready in short order if they wish to be paid for their services.

Second, by mid- to late-October, providers will start receiving payments based on claims submitted using ICD-10 codes. Most professional claims are reimbursed based on the CPT/HCPCS codes and therefore are not susceptible to payment shifts. Institutional claims are paid via a wide range of reimbursement mechanisms, mainly due to combinations of both ICD-10 diagnosis as well as procedure codes. ICD-10 testing between providers and payers illustrates that four out of five payment disputes are because of poor coding accuracy from the provider. We see an increase in phone calls to payers and an elongated revenue cycle collection timeframe.

Third, throughout 2016, we see overall data quality issues emerging as the industry stabilizes and acclimates to the new code set. Although CMS relaxed coding accuracy requirements for Medicare fee for service claims, commercial payers have not followed suit. Be prepared for an increase in chart reviews and ongoing adjustments to previously paid claims.

Andrew Wade, information technology manager, Coastal Orthopedics

Andrew Wade
Andrew Wade

Coastal Orthopedics has been serving the coastal South Carolina region for more than 30 years, and has helped countless members of our community regain and maintain a full quality of life. In those years of serving our community, ICD-10 has without a doubt been one of the biggest challenges that our practice has faced to date. With major overhauls to our practice workflow and ultimately our ability to provide the best care to our patients on the horizon, we set out early to meet the demands of the ICD-10 transition proactively.

The success of our transition to ICD-10 has been two-fold. One: our software partners (SRS Soft EHR and Allscripts Practice Management) have continued to deliver exceptional tools that have allowed our practice to leverage the power of healthcare information technology to expand our ability to provide exceptional care exponentially. Two: The dedicated staff and physicians of our practice, who truly love getting to be a part of helping our patients live their best life, have invested countless hours of preparation into being sure that our patients continue to receive only the best care. After months of updating our office systems/processes, working with care partners across the community, working with our software partners to fine tune our systems, and working with insurance companies to ensure that our patients get the most of their benefits, we’re ready to take ICD-10 head-on.

October 1st will be just another day of providing exceptional orthopedic care to our community for Coastal Orthopedics.

Fletcher Lance, managing director of healthcare, NorthHighland Consulting  

Fletcher Lance
Fletcher Lance

The day before, the day of and the day after ICD-10 goes live, it will be too late. But, as we get closer to ICD-10 go live, there are some final preparations that you can do before it does, and some remediation that can be done post go live. Physician practices and hospitals can focus on the procedures and visit types that drive their practices. We call this focus, the Codes that Matter. A very small percentage of procedures and visit types drive 95 percent of revenue so focus on those key areas to protect your revenue.

In addition, the physicians and hospitals need to take a snap shot of financial and revenue cycle performance prior to going live. This is especially critical at this point. The hospitals and physician practices have to know where they are today so they can effectively evaluate their financial and revenue cycle performance post go live. Financial “fire drills” need to be conducted to practice and prepare for revenue cycle impacts. How to prevent 10 percent to 15 percent revenue hits? If we see those issues arising, how do we quickly address and how do we rapidly deploy teams to close the issues.  Waiting until the day before, similar to cramming for the test will not work well for the October go-live. There are a couple of things listed above that can still make a difference so the time is now before the die is cast.

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Quick Training References and Refreshers for ICD-10

Michele Hibbert-Iacobacci, CMCO,CCS-P, vice president of information management support, Mitchell International.

Michele Hibbert-Iacobacci
Michele Hibbert-Iacobacci

With the October 1 implementation date for ICD-10 just around the corner, many providers are in need of a quick, at-a-glance refresher to their training. The implementation of ICD-10 has been delayed twice, so many providers that had solid plans for training in advance are not as prepared as they had intended to be.

Quick reference guides are in even higher demand considering the influx of codes required by ICD-10. Currently, ICD-9 includes 13,800 three to five digit, primarily numeric diagnostic codes. By contrast, the ICD-10 code set will contain roughly five times that number, totaling approximately 69,000 three to seven digit, alphanumeric codes.

To alleviate the last minute training scramble, ICD-10-focused readiness material and courses from widely accepted and well-known organizations may help ensure a smooth transition come October 1.

American Association of Professional Coders (AAPC) have go-at-your-own pace online courses for both ICD-10-CM and PCS.

https://www.aapc.com/icd-10/

Centers for Medicare and Medicaid Services (CMS) offer ICD-10 training and readiness resources for all providers, not just those billing the payer.

https://www.cms.gov/medicare/coding/icd10/providerresources.html and http://www.roadto10.org/quick-references/

American Hospital Associations Coding Clinic Advisor (AHA) is a forum where specific questions can be addressed.

http://www.codingclinicadvisor.com/

American Medical Association (AMA) provides many resources including training which can be accessed on their educational site.

http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/hipaahealth-insurance-portability-accountability-act/transaction-code-set-standards/icd10-code-set.page

American Health Information Management Association (AHIMA) offers training resources that encompass the physician practice.

http://www.ahima.org/education/onlineed/Programs/ICD10

American College of Physicians (ACP) presents resources and information for accessing sites with training and primers.

https://www.acponline.org/running_practice/payment_coding/coding/icd10.htm

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10 Things You Should Know to Get Ready for ICD-10

Are you ready to transition to ICD-10? The countdown is on. As those of us in healthcare know, next week the industry in the United States will (finally) undergo a significant change as we transition from ICD-9 to ICD-10. ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems and is used primarily to document diagnoses in a codified manner. The most recent revision has nearly five times more codes than its predecessor because of its increased complexity and specificity of ICD-10 codes.

Healthcare organizations in the U.S. have been preparing for the ICD-10 transition for nearly five years. Multiple delays, brought on by substantial lobbying efforts against the transition, led to elongated wait time, but the time has come and we’re ready to launch. Personally, I’m glad. I look forward to healthcare moving beyond this conversation; the infighting ICD-10 has caused among members and associations in the community has done us all a disservice. Perhaps, on October 2, the day after the implementation deadline, we can begin to move on to other issues — slowly, of course — so that the brilliant minds in healthcare can once again focus on more pressing, important issues than the dollars and cents of claims and the numbers needed for them to be paid by our payer partners.

As the transition date draws near, make sure you’ve got all your priorities and details in line. ICD-10 is no lightweight matter, as you have likely discovered. Cerner created the following video, “10 Things You Should Know to Get Ready for ICD-10,” that I’m posting here, with the company’s permission. Though my publishing it is a bit last minute, the video offers some tips that might help you prepare for “doomsday.”

This video reviews what Cerner considers the top 10 things you need to do to prepare for ICD-10; it also covers technical pieces related to Cerner’s Millennium solutions, as well as operational pieces to help with the transition. Overall, it’s a nice resource that may provide you a bit of last minute ICD-10 insight and comfort for the change again. Here’s to your ICD-10 health. Enjoy!

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Avoiding Common Billing Errors Crucial During ICD-10 Transition

ICD10 pictureErrors in medical billing are a serious problem in healthcare today. By some estimates, as many as 80 percent of all submitted bills contain some sort of error, which leads to increased costs for Medicare, insurance carriers and patients, but can also lead to coverage denials, reduced reimbursements for providers, and in some cases, impacts on patient care.

While many organizations have placed a priority on avoiding billing errors, they still occur. And with the upcoming transition to ICD-10, home health and hospice providers are under even more pressure to get billing right the first time, every time. By most accounts, providers can expect to see a spike in rejected claims during the first few months of ICD-10 implementation; some estimate that as many as 10 percent of all claims will be rejected as coders get used to the new procedures. That’s bound to have an effect on payments and cash flow, so it’s vital that agencies work with their billing offices to identify common errors now, and look for ways to overcome them.

Preparing for the Transition

Ideally, home health agencies should be in the final stages of preparing for the launch of ICD-10 now. August 3 marked the beginning of the 60-day episode period that would end on October 1, when ICD-10 goes into effect. This means that agencies that are beginning care episodes now are required to submit RAPs in ICD-9, but code them in both ICD-9 and ICD-10, so that when the final bill is submitted to Medicare, it will be in the correct format. In many ways, this gives home health providers an advantage, since they will have two months’ worth of practice with the new codes on almost every chart, where most other providers are only practicing dual coding on some charts.

Because of the dual coding requirements, most home health providers have already switched to an ICD-10 compliant software solution. Now is the time to identify gaps in training, and adjust intake procedures, forms and other resources that affect how services are billed. Mitigating potential obstacles now will prevent denied claims later, and smooth the transition.

The Most Common Errors

While the new coding procedures will undoubtedly be a learning curve for many providers, you can reduce the overall number of denied or delayed claims by paying close attention to the most common errors and taking steps to avoid them. These include:

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