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Medicare ICD-10 Questions? We have answers at The Firm Services By Rina Marie Doctor, Tech Times | October 5, 6:35 AM Just when patients and medical and non-medical staff in hospitals and health care facilities are on the verge of getting crazy from the thousands of currently existing medical codes, the 10th version of the International Classification of Diseases (ICD) has been released. Dubbed as the ICD-10, the said updated list contains about 70,000 codes, which equate to the number of official ways for Americans to get sick, hurt or die. On Thursday, Oct.1, medical providers in the U.S. will start to transition from ICD-9 to ICD-10 in billing government and private insurers for different health care services. However, even before the updated protocol can be implemented, a number of health care staff have already mocked the wide-scope medical diagnoses. Examples of codes include V91.07XA, which is defined as "burn due to water skis on fire," and Z63.1, which is described as "problems in relationship with in-laws." Aside from its large scope, the ICD-10 codes are also said to be highly-precise. For example, if a patient is suspected of ingesting a toxic mushroom, clinicians will have to look at about 18 codes to perfectly fit that patient's case. Another example is leg fracture, which has dozens of types. Despite the seemingly humorous vibe entailed in the changes, this transition is anything but a joke for health care providers, who need to manipulate this coding system with utmost efficiency for payment purposes. The ICD-10 codes are based on the list of official medical diagnoses set by the World Health Organization (WHO). The said coding system delegates a particular code for each patient complaint and medical [...]

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The Firm Services can help your office get ready for ICD-10 by CARL NATALE  SEP 23, 2015 - 12:00 AM There's only a week left before you have to start using ICD-10 codes. That's not a lot of time to do much. Earlier this month, we published an ABC checklist with last minute ICD-10 implementation tips for procrastinating physicians from the Centers for Medicare and Medicaid Services (CMS). It focused on: Assess systems Be sure everything is ready Contact vendors For medical practices that started preparations sooner than this month, there are still some last minute steps. Nelly Leon Chisen writing for Hospitals & Health Networks offers some ideas to add to healthcare providers' ICD-10 check lists: Create a communication plan to report problems. Who gets contacted? How to update everyone. Who to contact at health plans, clearinghouses and vendors for information and help Review contingency plans What is the status of ICD-9 coding backlogs? What will it take to clear them? Test medical coders' skills Plan quick refreshers Assess ICD-10 coding accuracy If you're billing software isn't going to cut it, CMS has these suggestions for patching Medicare billing problems: Free billing software that can be downloaded at any time from every Medicare Administrative Contractor (MAC); In about half of the MAC jurisdictions, Part B claims submission functionality on the MAC’s provider internet portal; Submitting paper claims, if the Administrative Simplification Compliance Act waiver provisions are met. Those ideas should be considered temporary until medical practices get things ironed out with healthcare vendors.[ICD10Watch Poll: Are your vendors ready for Oct. 1?]Even with good plans in place, things could get tense next week. Rebecca Fox, MD, has some ideas for helping medical practices work through the stress [...]

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The Firm Services can help your office get ready for ICD-10 Congress will have just 17 week days to pass legislation killing the conversion. Is ICD-10 finally in the clear? Tom Sullivan, Editor-in-Chief, Healthcare IT News- August 10, 2015 Health IT professionals and policy wonks sleeping with one eye open while watching Capitol Hill for clues about ICD-10's fate can rest easy – at least for now. Congress kicked off its vacation on Monday and, in so doing, effectively hit a pause button of sorts: Before the U.S. Senate and House of Representatives return on September 8 there will not be any legislative action to delay or kill ICD-10. None. Just don't mistake the midsummer truce that the Centers for Medicare & Medicaid Services made with the American Medical Association as any type of guarantee. That was not an act of Congress and insofar as public knowledge goes, CMS was operating under its own recognizance when it agreed to that treaty. What's more, critics say the concessions – CMS won't deny erroneous claims so long as they are submitted in ICD-10 for the first year – are nice but not enough. It doesn't help, either, that the seminal readiness survey conducted by WEDI (Workgroup for Data Interchange) and published just last week found that 10 percent of providers and approximately half of medical practices are unsure whether they'll be ready on time. Yes, the other 90 and 50 percent, respectively, indicated they would meet the mandate, but those who might not triggered enough concern for WEDI to caution that claims disruptions might accompany the transition. The thing about Congressional timing, though, is that Senators and Representatives will have just 17 week days in [...]

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ICD-10 is coming October 1st. Are you ready? By Julie Henry | September 11, 2015 The October 1 deadline for converting from ICD-9 to ICD-10 is fast approaching. As of October 1, ICD-9 codes will no longer be accepted. “At the end of the day, claims for services delivered on or after Oct. 1, must be coded using ICD-10 codes in order for the provider or organization to be paid,” says Pam Jodock, senior director of Health Business Solutions at Healthcare Information & Management Systems Society (HIMSS). “There is no grace period.” So are hospitals and other healthcare providers prepared for the switch? Robin Settle, partner at global management consulting firm Kurt Salmon, says that most, if not all hospitals and large physician groups are ready for ICD-10 and have been ready for well over a year. “Most have made the transition to EHRs to take advantage of the meaningful use incentives and to avoid meaningful use penalties,” she says. “ICD-10 compliant versions of software have been implemented as part of routine maintenance. Many hospitals also provided some ICD-10 training to their employed and community physicians.” Jodock says indications are that the majority of providers will be ready for the conversion on Oct. 1. “However, we do anticipate there will be small pockets of providers – primarily solo or small group practitioners – who may not be fully prepared,” she says. Is your organization prepared for the switch? Dr. Reid Conant, a board-certified emergency physician and CMIO at Tri-City Emergency Medical Group in Oceanside, CA, says he feels like his practice is prepared, but they are not taking the transition lightly. “We have prepared on both an educational level as well as a [...]

White House Takes Aim At Medicare And Medicaid Billing Errors

Physicians Credentialing Doctors for Medicare SEPTEMBER 03, 2015 5:03 AM ET -NPR White House budget director Shaun Donovan called for a "more aggressive strategy" to thwart improper government payments to doctors, hospitals and insurance companies in a previously undisclosed letter to Health and Human Services Secretary Sylvia Mathews Burwell earlier this year. Government health care programs covering millions of Americans waste billions of tax dollars every year through these improper payments, Donovan said in the Feb. 26, 2015 letter. "While some progress has been made on this front," Donovan wrote, "we believe a more aggressive strategy can be implemented to reduce the level of improper payments we are currently seeing." Donovan, director of the Office of Management and Budget, went to say that "we must continue to explore new and innovative ways to address the problem and attack this challenge with every tool at our disposal ... ." Donovan cited problems with traditional Medicare, which pays doctors and hospitals on a fee-for-service basis, as well as Medicare Advantage, its fast-growing, privately run alternative. The private insurance plans are paid a set fee each month for each patient using a billing tool called a risk score. The White House budget chief also noted in his letter that payment errors rose by $3.1 billion last year in Medicaid, the government health care plan for lower income people, which is jointly funded with the states. In addition, he directed HHS to draw up a plan for getting payments right under the Affordable Care Act. The health law has added millions of people to insurance rolls and is slated to undergo payment-accuracy audits for the first time starting this fiscal year. A copy of Donovan's letter, which also directs [...]

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 [...]

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 [...]

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 [...]

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 [...]