February, 2016 |

ICD-10 Works, but Concerns Remain Over Audits, Productivity

Let The Firm services assist you. By James Swann Feb. 24 — The switch to ICD-10 five months ago was uneventful, but concerns about provider productivity using the new codes and the threat of increased government audits remain among industry stakeholders. Specifically, providers need to make sure their claims contain enough detail to support the selected ICD-10 code, George B. Breen, an attorney with Epstein Becker & Green, in Washington, said. While Breen said it's too early to expect federal enforcement action involving ICD-10 coding, providers should expect the government to be focusing on appropriate clinical documentation to support claims coding. Providers need to look at ICD-10 through the prism of the increasing government focus on value-based payments, Breen said. “Health-care entities also need to anticipate and be prepared to respond to aggressive payer audits, both private and public,” Breen said. Providers are currently operating under a one-year grace period from the Centers for Medicare & Medicaid Services during which Medicare contractors won't deny claims as long as a valid ICD-10 code from the right coding family is used. The grace period means that a claim won't be denied if it isn't as specific as required under ICD-10. Breen said providers should take advantage of the time to create effective audit protocols that can address ICD-10 issues. “An open question that providers must determine an answer to is whether the grace period also permits that same flexibility in an overpayment analysis,” Breen said. While the grace period will prevent outright claims denials, Breen said, it's uncertain whether the CMS will offer a similar dispensation for any nonspecific ICD-10 claims that result in overpayments. The International Classification of Diseases, 10th Revision (ICD-10), which took [...]

By kristian|February 26th, 2016|Blog, Commercial Insurance, Consulting, Credentialing, Healthcare Changes, Healthcare Professionals, ICD-10, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Medicare, medicare claims, Physician Credentialing, Verification|Comments Off

Will the ICD-10 transition continue smoothly once CMS demands more specificity?

The Firm Services can help your office comply to ICD-10 February 22, 2016 | Carl Natale, Editor, ICD10Watch It's only a guess, but the ICD-10 transition doesn't look like it is taking down the U.S. healthcare system. So far, there are reports of minimal productivity drops and denial rate increases. But some reimbursement delays are being reported. It's not a perfect environment, but it doesn't appear to be a toxic one either. There's an argument to be made that close enough now counts in horseshoes, hand grenades and ICD-10 coding for Medicare. Since the Centers for Medicare and Medicaid Services (CMS) accepts codes from the correct ICD-10 family, some healthcare payers have followed suit. Reports suggest that as many as 25 percent of codes include the term unspecificied -- and that could be keeping denial rates in check. What's more, it's reducing pressure on healthcare providers to document a high degree of specificity. And they may be skipping some secondary diagnoses that don't affect reimbursement, according to Katherine Rushlau. Which would help physicians and medical coders keep records moving. There's a way to keep productivity up. (Or prevent it from sinking.) But is this going to work after Oct. 1, 2016? That's when CMS plans to require ICD-10 specificity. We don't know when private healthcare payers will want providers to get more specific. That's why Amy Sullivan, vice president of revenue cycle sales at PatientKeeper, is worried about more vigorous complaining and animosity when the specificity deadline approaches. The only way seen to prevent worse reimbursement problems is to improve clinical documentation that supports ICD-10 specificity and other healthcare payer initiatives that are coming. Questions about ICD-10 reimbursement? Physician Credentialing and Revalidation ? [...]

By kristian|February 22nd, 2016|Blog, Commercial Insurance, Consulting, Credentialing, Doctor, Healthcare Changes, Healthcare Professionals, Medicaid, Medical, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, medicare claims, Physician Credentialing, Podiatrist, Staff Training, Verification|Comments Off

Why ICD-10 preparation did not end Oct. 1

Let The Firm Services help you navigate the ICD-10 waters! by CARL NATALE FEB 16, 2016 - 07:44 PM Despite the "too-soon-to-tell" lens we're using to examine the effects of ICD-10 coding, I'm pretty sure the healthcare providers who invested in preparation are doing the best. Medical practices can continue to "prepare" for successful ICD-10 coding use. Julie Clements addressed this — sort of — when she wrote about the ICD-10 issues encountered in orthopedic injury coding. But she rounds out the post with four tips that can help any medical practice. Be specific Sure. The Centers for Medicare and Medicaid Services (CMS) aren't requiring specificity for Medicare claims. Some healthcare payers seem to be happy with just keeping it in the family. So why worry? But the unspecified holiday will end some time, and Clements warns that unspecified codes could be a sign of insufficient documentation. Run monthly reports Remember that ICD-10 advocates promised a golden age of data to be mined from ICD-10 claims. But that's not going to happen if medical practices are running periodic reports to see what ICD-10 codes are being used. It's a basic analytics step. Don't rely on EHRs Depending on how good of an IT purchase made, the EHRs may be relying on maps that produce unspecified ICD-10 codes. Clements advises relying on experienced medical coders who can apply the proper ICD-10 codes to the conditions. Communicate Allow medical coders and physicians to share information that will help them arrive at the proper ICD-10 diagnoses. This will work way better than queries. If the physicians groan, remind them that they didn't stop learning medicine when they left medical school. If they can keep up in [...]

By kristian|February 17th, 2016|Blog, Commercial Insurance, Consulting, Credentialing, Healthcare Changes, Healthcare Professionals, ICD-10, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Medicare, medicare claims, Physician Credentialing|Comments Off

An ICD-10 crisis might still be coming — for some

Firm Services has the answers to all your ICD-10 issues. Carl Natale -FEB 3, 2016 - 06:28 AM Guest post by John Kelly and Jay Sultan This past year the healthcare industry finally saw the long delayed transition to ICD-10 coding. Not only was the implementation a leading focus in healthcare headlines of 2015, organizations didn’t delay in taking to the airwaves to predict exactly what the outcome of the transition would mean for the industry. There was initial cause for concern – some experts worried about how implementing codes would affect doctor retirement, physician practice revenue and even productivity. But ultimately, the transition happened without too much disruption, and some organizations were quick to deem it a success. According to a KPMG LLP survey, only 11 percent of healthcare organizations described the ICD-10 transition as a “failure to operate in an ICD-10 environment.” On the other hand, 80 percent found the transition to be smooth. While this is good news for the industry, it might be too soon to call the transition a success. In fact, an ICD-10 crisis might still be a real possibility for some organizations. The reality is this: we really won't know how well organizations are doing until we get through a least a fiscal quarter of claims payment activity in 2016. For some, an enormous increase in appeals or a crippled cash flow might still occur. Worse yet, the level of coding inconsistency among providers may significantly impair the risk adjustment models in place to support a variety of population based payment contracts. Inevitably, there will be at least a few organizations that wake up one day and realize they made bets on bad assumptions related to [...]

By kristian|February 10th, 2016|Blog, Commercial Insurance, Consulting, Credentialing, Healthcare Changes, Healthcare Professionals, ICD-10, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Medicare, medicare claims, Physician Credentialing|Comments Off

ICD-10 follow-up: How is the healthcare system faring?

ICD-10 are you in compliance? Is your credentialing updated? Beckers ACS Review- Written by Mary Rechtoris | February 01, 2016 With the implementation of ICD-10, the number of diagnostic codes increased from 13,000 ICD-9 codes to 68,000 ICD-10 codes. The influx of codes brought a lot of apprehension, and many providers were concerned ICD-10 would cause major delays. Nearly five months later, many healthcare professionals feel the transition went smoothly and cite minimal delays in productivity and reimbursement. Here are 14 things to know: ICD-10 Claims From Oct. 1 to Oct. 27: 1. CMS received a total of 4.6 million claims per day. 2. Two percent of the claims were rejected due to incomplete or invalid information. 3. CMS rejected 0.09 percent of claims due to invalid ICD-10 codes. 4. CMS rejected 0.11 claims due to invalid ICD-9 codes. 5. In total, CMS denied 10.1 percent of processed claims. Provider response to ICD-10 Navicure, a provider of cloud-based healthcare claims management and patient payment solutions, conducted a post-ICD 10 implementation survey in January 2016. Respondents in the survey included practice administrators or billing managers (59 percent), practice executives (17 percent) and billers and coders (16 percent). The results of the survey are as follows: 6. A reported 99 percent of healthcare organizations said they were prepared for the transition date. 7. Most respondents (60 percent) did not experience any impact on monthly revenue following the ICD-10 transition. 8. Thirty-four percent of respondents have seen revenue fall by up to 20 percent. 9. Nearly half of respondents (45 percent) said their denial rates stayed the same. 10. Forty-four percent saw nominal increases for denial rates between 11 percent and 40 percent. 11. Approximately two-thirds of [...]

By kristian|February 4th, 2016|Blog, Commercial Insurance, Consulting, Credentialing, Dentist, Healthcare Changes, ICD-10, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Medicare, medicare claims, Physician Credentialing, Verification|Comments Off