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Medicare ICD-10 Questions? We have answers at The Firm Services. On Thursday, CMS Acting Administrator Andy Slavitt offered further details about resources the agency will have in place to help providers with the upcoming switchover to ICD-10 code sets, Health Data Management reports (Slabodkin [1], Health Data Management, 8/28). U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets by Oct. 1 to accommodate codes for new diseases and procedures. Background On July 6, CMS and the American Medical Association jointly announced measures designed to help ease physicians' transition. Among other things, CMS said it would: Appoint an ICD-10 ombudsman to help oversee the transition; Establish a one-year grace period in which it will reimburse physicians under Medicare Part B for claims with incorrect ICD-10 diagnosis codes; Extend the flexibility for quality code errors to the Physician Quality Reporting System, Value-Based Payment Modifier program and meaningful use program so physicians and other eligible professionals are not penalized; and Provide a range of online resources -- including Web conferences and training documents -- to aid providers in the transition. The measures do not signify an ICD-10 delay (iHealthBeat, 7/29). Latest Updates During a national provider call, Slavitt said CMS has created and is staffing an ICD-10 Coordination Center, which will open at the end of September. It will "be responsible for managing and triaging issues and ensuring timely communications" with providers, Slavitt said. In addition, Slavitt announced that William Rogers, a practicing emergency department physician and director of CMS' Physicians Regulatory Issues Team, will serve as ICD-10 ombudsman. He will assess and respond to stakeholder concerns with the transition. Rogers has been an ombudsman for clinicians who work with Medicare [...]

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ICD-10 is coming October 1st. Are you ready? By Virgil Dickson  | July 6, 2015 Modern Healthcare –“The leader in healthcare business news, research & data” The CMS has made a concession in the transition from ICD-9 to ICD-10. For one year past the Oct. 1, 2015 deadline, the CMS will reimburse for wrongly coded claims as long as that erroneous code is in the same broad family as the right one. There had been concerns among providers that they wouldn't be paid if they made minor mistakes trying to implement the new complex coding system. That may be why the American Medical Association had a change of heart recently in getting providers on board. The association, a longtime critic of the Obama administration's mandate to move from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures, has announced its teaming up with the CMS to make the transition easier for providers. The two parties plan to conduct a nationwide outreach effort to educate providers through webinars, on-site training, educational articles and calls to help physicians and other providers get up to speed before the Oct. 1 deadline. Just two months ago, the AMA voiced support for a bill crafted by Republican Texas Rep. Ted Poe that would prohibit HHS from replacing ICD-9 with ICD-10. For years, the organization has questioned the need for the transition and noted that complying with the new codes could cost providers three times more than previous estimates. Texas' state medical association, the largest in the country, has vigorously fought the implementation, arguing that doctors have been subject to a recent onslaught of costly government edicts that threaten to drive more physicians out of business. An AMA spokesperson said the change of [...]

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Medical Identity Theft Thieves use stolen personal data to get treatment, drugs, medical equipment By WSJ- STEPHANIE ARMOUR- Updated Aug. 7, 2015 7:08 p.m. ET Kathleen Meiners was puzzled when a note arrived last year thanking her son Bill for visiting Centerpoint Medical Center in Independence, Mo. Soon, bills arrived from the hospital for a leg-injury treatment. But her son had never been there. Someone had stolen Bill Meiners’s Social Security and medical-identification numbers, using them to get care in his name. If he had been injured, she would have known: Mr. Meiners, a 39-year-old convenience-store worker with Down syndrome, lives with his parents in south Kansas City. To clear things up, Mrs. Meiners, who turns 74 on Saturday, took him to the hospital to show he was fine. It didn’t work: She says she spent months fighting collection notices and trying to fix his medical records. In a twist on identity theft, crooks are using personal data stolen from millions of Americans to get health care, prescriptions and medical equipment. Victims sometimes only find out when they get a bill or a call from a debt collector. They can wind up with the thief’s health data folded into their own medical charts. A patient’s record may show she has diabetes when she doesn’t, say, or list a blood type that isn’t hers—errors that can lead to dangerous diagnoses or treatments. Adding insult to injury, a victim often can’t fully examine his own records because the thief’s health data, now folded into his, are protected by medical- privacy laws. And hospitals sometimes continue to hound victims for payments they didn’t incur. Fueling medical identity theft is the surge in electronic medical records and data breaches [...]

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Firm Services provides Physician Credentialing and Revalidation Thousands of doctors who bill Medicare used questionable addresses, GAO report finds By CHRISTOPHER WEAVER :Updated July 21, 2015 8:09 p.m. ET Thousands of medical providers signed up to bill Medicare using questionable addresses, and dozens of doctors enrolled despite disciplinary actions by state medical boards, according to a congressional probe of the $600 billion-a-year taxpayer-funded program. Medicare records listed doctors and other providers as practicing at invalid addresses, such as commercial mailbox stores, construction sites and, in one case, a fast-food restaurant, according to a report by the Government Accountability Office that examined data through March 2013. Over the past five years, the federal Centers for Medicare and Medicaid Services, which runs Medicare, has been revamping its enrollment system and verifying provider information, such as addresses and licensure. The overhaul is partly due to requirements of the 2010 Affordable Care Act. The CMS said Tuesday that as a result of its enhanced screening efforts, it has kicked more than 34,000 providers out of the program since February 2011. The GAO says that some screening problems persist, however, among the 1.8 million providers enrolled to bill Medicare from nearly a million addresses. The report estimated that about 23,400 addresses might be invalid. The 2.3% of provider addresses the GAO estimated might be invalid could be the results of data-entry errors, according to written responses to the GAO by Jim Esquea, the assistant secretary for legislation for the federal Department of Health and Human Services. CMS said some provider locations flagged in the GAO report didn’t turn out to be fraudulent. For instance, the provider who listed the fast-food location had a valid medical office elsewhere and [...]

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