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ICD-10’s Impact to the Worker’s Compensation Industry

The Firm Services has the latest information regarding ICD-10 and its implementation. Written by Sherry Wilson and Tina Greene | Monday, 28 March 2016 04:00 A general assumption had been that states would be aligning their worker’s compensation regulations with the rest of those of the healthcare industry in order to adopt the ICD-10 regulations. As of Oct. 1, 2015, there were only 21 states that had aligned with the Centers for Medicare & Medicaid Services (CMS) ICD-10 requirement, according to the WEDI Property and Casualty ICD-10 State Readiness Resource Center and the International Association of Industrial Accident Boards and Commissions (IAIABC) ICD-10 State Survey results. The states that had aligned with the CMS ICD-10 regulations included Alabama, California, Delaware, Florida, Georgia, Idaho, Illinois, Louisiana, Maryland, Massachusetts, Minnesota, North Carolina, New Hampshire, Nevada, New York, Ohio, Oregon, Pennsylvania, South Dakota, Texas, Washington, and the U.S. Department of Labor. So, what has been the impact to stakeholders post-ICD-10 in the other 29 states? The following is a summary profile of the ICD-10 status of the other 29 states and reported stakeholder impact: Three states with pending ICD-10 regulations post-Oct. 1, 2015 included Alaska, Wyoming, and Tennessee. The following is the reported ICD-10 post-implementation impact: Wyoming is allowing providers to submit ICD-9 and ICD-10 for one year as a transition plan and will adopt ICD-10 when their rulemaking becomes effective. Alaska and Tennessee have encouraged stakeholders to move forward with ICD-10 while their rulemaking process remains pending. Payer Impact: Payers that do business in these states are required to support ICD-10 and ICD-9 codes during the regulatory transition period. Provider Impact: Providers that are submitting ICD-10 claims have reported no impact to their revenue cycle [...]

By kristian|March 31st, 2016|Blog, Commercial Insurance, Consulting, Credentialing, Doctor, doctor, doctor Credentialing, Healthcare Changes, Healthcare Professionals, ICD-10, ICD-10, Medicaid, Medical, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Medicare, medicare claims, Multi-Specialty, Physician Credentialing, Specialties, Staff Training|Comments Off

CMS Announces New ICD-10 Resources, Unveils July Testing Results

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 [...]

By kristian|August 30th, 2015|Blog, Commercial Insurance, Consulting, Credentialing, Doctor, doctor, Healthcare Changes, Healthcare Professionals, ICD-10, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Medicare, medicare claims, Physical Therapy, Physician Credentialing, Staff Training, Verification|Comments Off

CMS will reimburse ICD-10 mistakes for one year after transition deadline

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 [...]

By kristian|August 21st, 2015|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, Press, Staff Training, Verification|Comments Off

How Identity Theft Sticks You With Hospital Bills

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 [...]

By kristian|August 16th, 2015|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, Press, Staff Training, Verification|Comments Off

Government Report Cites Shortfalls in Medicare’s Screening Process for Doctors

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 [...]

By kristian|August 10th, 2015|Blog, Commercial Insurance, Credentialing, Doctor, Healthcare Changes, Healthcare Professionals, ICD-10, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Medicare, medicare claims, Physician Credentialing, Press, Staff Training, Verification|Comments Off

CMS Releases FAQs To Clarify Plan To Ease ICD-10 Transition

ICD-10 is coming October 1st. Are you ready? Wednesday, July 29, 2015 On Monday, CMS released answers to frequently asked questions to help clarify recently announced measures that aim to provide physicians with some flexibility as they transition to the new ICD-10 code sets, EHR Intelligence reports. Background U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets to accommodate codes for new diseases and procedures by Oct. 1. 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. FAQ Details CMS posted a list of 13 FAQs to clarify several aspects of the measures. For example, the agency noted that: The ICD-10 ombudsman will be in place by Oct. 1; The measures do not signify an ICD-10 delay; Submitters whose claims are denied will be notified with an explanation of the rejection; Submitters should follow existing processes for correcting and resubmitting rejected claims (Goedert, Health Data Management, 7/28); The measures only apply to Medicare fee-for-service claims; The guidance does not apply to Medicaid claims, but each state will be "required to process submitted claims that include ICD-10 codes for services furnished [...]

By kristian|July 31st, 2015|Blog, Commercial Insurance, Consulting, Credentialing, Doctor, Healthcare Changes, Healthcare Professionals, ICD-10, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Medicare, medicare claims, Optometrist, Physical Therapy, Physician Credentialing, Podiatrist, Verification|Comments Off

CMS Announced Proposed Rule on the FY16 Medicare Physician Fee Schedule

Credentialing, Revalidation Services professionals at The Firm Services In a press release issued on July 8, the Centers for Medicare and Medicaid Services (CMS) announced its Proposed Rule on the FY16 Medicare Physician Fee Schedule (PFS). This Proposed Rule represents the first update to the PFS since the repeal of the Sustainable Growth Rate (SGR) update methodology earlier this year. Andy Slavitt Administrator of CMS stated “CMS is building on the important work of Congress to shift the Medicare program toward a system that rewards physicians for providing high quality care. Thanks to the recent landmark Medicare and children’s health insurance program legislation, CMS and Congress are working together to achieve a better Medicare payment system for physicians and the American people.”The proposed CY 2016 PFS rule includes but is not limited to the following updates: Payment policies, proposals to implement statutory adjustments to physician payments based on misvalued codes Physician Quality Reporting System Physician Value-Based Payment Modifier CMS is requesting comments by Aug. 31, 2015 on the following: Implementation of certain provisions of the MACRA, including the new Merit-based Incentive payment system Potential expansion of the Comprehensive Primary Care Initiative The Proposed Rule was published today in the Federal Register and can be accessed by clicking here. Questions about 2016 Medicare Fee Schedules or ICD -10 ? or other changes in Medicare, Commercial Insurance, and Medicaid billing, credentialing and payments? Call the Firm Services at 512-243-6844 or credentialing@thefirmservices.com

By kristian|July 25th, 2015|Blog, Chiropractor, Commercial Insurance, Credentialing, Doctor, Healthcare Changes, Healthcare Professionals, ICD-10, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Medicare, medicare claims, Mental Health, Optometrist, Physical Therapy, Physician Credentialing, Podiatrist|Comments Off

CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10

Medicare ICD-10 Questions? We have answers at The Firm Services July 6,2015 CMS and AMA Announce Efforts to Help Providers Get Ready For ICD-10 With less than three months remaining until the nation switches from ICD-9 to ICD-10 coding for medical diagnoses and inpatient hospital procedures, The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) are announcing efforts to continue to help physicians get ready ahead of the October 1 deadline. In response to requests from the provider community, CMS is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set. Recognizing that health care providers need help with the transition, CMS and AMA are working to make sure physicians and other providers are ready ahead of the transition to ICD-10 that will happen on October 1. Reaching out to health care providers all across the country, CMS and AMA will in parallel be educating providers through webinars, on-site training, educational articles and national provider calls to help physicians and other health care providers learn about the updated codes and prepare for the transition “As we work to modernize our nation’s health care infrastructure, the coming implementation of ICD-10 will set the stage for better identification of illness and earlier warning signs of epidemics, such as Ebola or flu pandemics.” said Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services. “With easy to use tools, a new ICD-10 Ombudsman, and added flexibility in our claims audit and quality reporting process, CMS is committed to working with the physician community to work through this transition.” “ICD 10 [...]

By kristian|July 12th, 2015|Blog, Chiropractor, Commercial Insurance, Credentialing, Doctor, Healthcare Changes, Healthcare Professionals, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Mental Health, Physical Therapy, Press, Verification|Comments Off

How Doctors can really cut costs for medicare patients.

The best use of Medicare Oversight? Follow the Real Money Physicians are eyeing the wrong procedures in the quest to cut costs for Medicare patients. By Mark Pauly May 15, 2015 | 4:15 p.m. EDT Physicians have, of late, played an amazingly small role in guiding health policy. They had little to say or do with health insurance reform, which was the major focus of the Affordable Care Act. But to some extent, they have been trying to get on the right side of history by expressing concern about growing medical care spending and identifying services they control or sell that might be eliminated. The "Choosing Wisely" campaign, for example, has recruited physician specialty societies to compile lists of medical treatments that they were formerly choosing unwisely. No one could question efforts to deter care that is harmful or a waste of time. But if physicians expect to enlist consumers and insurers in this campaign, it would help if doctors were doing more than criticizing what other doctors do. It would help if their criticism was based on evidence of actual patterns of care observed in large data sets and if the reasons for such criticism could be well-identified. It would also help if changing the practices they criticize might lead to saving some serious money. The most recent example of physician efforts to document low-value care is a study reported last month in the New England Journal of Medicine, titled "Preoperative Medical Testing in Medicare Patients Undergoing Cataract Surgery." Cataract surgery, to replace a clouded lens in the eye, is the most common elective surgical procedure for elderly people; it is a safe and effective way to improve vision and is usually performed by an [...]

By kristian|July 2nd, 2015|Blog, Chiropractor, Commercial Insurance, Credentialing, Doctor, Healthcare Changes, Healthcare Professionals, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Mental Health, Optometrist, Physical Therapy, Podiatrist|Comments Off

Supreme Court saves Obamacare

Physicians Credentialing Services By Ariane de Vogue and Jeremy Diamond, CNN Washington (CNN) Obamacare has survived -- again. In a 6-3 decision, the Supreme Court saved the controversial health care law that will define President Barack Obama's administration for generations to come. The ruling holds that the Affordable Care Act authorized federal tax credits for eligible Americans living not only in states with their own exchanges but also in the 34 states with federal marketplaces. It staved off a major political showdown and a mad scramble in states that would have needed to act to prevent millions from losing health care coverage. "Five years ago, after nearly a century of talk, decades of trying, a year of bipartisan debate, we finally declared that in America, health care is not a privilege for a few but a right for all," Obama said from the White House. "The Affordable Care Act is here to stay" In a moment of high drama, Chief Justice John Roberts sent a bolt of tension through the Court when he soberly announced that he would issue the majority opinion in the case. About two-thirds of the way through his reading, it became clear that he again would be responsible for rescuing Obamacare. "Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," Roberts wrote in the majority opinion. "If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter." READ: John Roberts' big moment: Will he anger conservatives again? He was joined by Justice Anthony Kennedy -- who is often the Court's swing vote -- and the four liberal justices. Justice Antonin Scalia wrote [...]

By kristian|June 26th, 2015|Chiropractor, Commercial Insurance, Consulting, Credentialing, Doctor, Medicaid, Medical Billing, Medical Coding, Medical Compliance, Medical Credentialing, Medical Insurance, Medicare, Mental Health, Physician Credentialing, Verification|Comments Off

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