Posts Tagged ICD-10

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What Tools Will You Need for the ICD-10 Transition? Q & A with Swiftaudit

Learn How to Crosswalk Your ICD-9s to ICD-10s

 

 

October 1, 2015 is a date that looms large for everyone involved in the operational and financial functions of any medical practice. At the time of this post’s publishing, practice administrators, managers, billers and coders have less than three months to make sure they have the processes and systems in place to minimize the business disruption from the changeover. As we talked to clients and readers about the challenges they are facing with the ICD-10 upgrade over the past several years, we started looking for tools that could help practices ease the transition.

One tool really stood out more than the others. Swiftaudit Search is a web-based coding conversion and look-up tool for both ICD-9 and ICD-10 code sets that we strongly endorse for its ability to supercharge ICD-10 coding, audits and upgrade preparations. We’ve been using Swiftaudit Search here at Manage My Practice for months now and we are very excited about how it can help our readers and clients.

We sat down with the creators of Swiftaudit Search, Chicago’s SpringSoft to ask them more about how practices can prepare for the upgrade.

Manage My Practice: Tell us about SpringSoft and how you starting working in the healthcare software market.

SpringSoft: We’ve provided software to the healthcare coding and compliance market since 1995. Our first product was E&M Coder™ for evaluation and management coding and audits. It all started when a few forward thinking doctors told us “the auditors are coming.” Given our background in corporate business systems, our research provided a couple of interesting observations at that time. One – physician offices had few easy to use software applications. Two – from a business point of view, physician offices needed help with coding and compliance. So we tackled a challenging little-understood coding issue in 1994 – the introduction of evaluation and management codes.

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Manage My Practice: Your product that is designed for medical coding has gone through several iterations since the ICD-10 mandate was first announced – how did your product evolve?

SpringSoft: We started designing what is now Swiftaudit Pro several years ago. As we designed the coding components, we realized that our ICD-10 Search features would benefit physicians during the transition to ICD-10. Again, we took on a daunting challenge. We knew we had to design an intuitive ICD-10 Search Feature. Once you find a group of codes, the next problem was to be present all of the ICD-10 coding information to describe the patient’s health condition. So now, as Swiftaudit evolves, our goal is to present the ICD-10 coding guidelines in a quick and straightforward way.

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Manage My Practice: We‘ve seen a wide variety of encoder-type products designed for hospitals and large organizations, and some designed for billing companies and consultants. What target market is the best fit for your products and why?

SpringSoft: Currently, we see our market as physician offices. Hospital and large organization coding systems have to address ‘packet’ coding, such as DRG (Diagnosis Related Groups) and HCCs (Hierarchical Condition Categories). Hospitals and large organizations will benefit from our auditing platform – SwiftAudit Pro. Providers who need to code ICD-10s will benefit from Swiftaudit Search. They can use our product to learn how code their common ICD-9 diagnosis in ICD-10 language.

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Manage My Practice: What do you hear are the biggest challenges faced by practices in making the transition to I-10?

SpringSoft: We hear that immediacy and time are the biggest challenges. Immediacy – it is always easier to learn new methods when you can consistently work in the new method. A baseline understanding helps provide context and what the changes are. We will all learn when everyone starts coding in ICD-10. Time – the change to ICD-10 is not trivial. It impacts the office’s income. Everyone will need to spend a little more time – coding in ICD-10, and time in improving their coding as payers respond to codes submitted. A practice can reduce frustration if they understand and prepare for their learning curve. Like all new methods, it takes practice to perfect.

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Manage My Practice: For many practices, their ability to utilize ICD-10 will come down to the support the EHR or Practice Management vendor has built into the software, yet many practices have not even seen how their software will work with ICD-10. What do recommend for practices whose software has not yet been updated to I-10, or whose software makes no useful correlation between I-9 and I-10?

SpringSoft: We agree with many consultants and trainers. Transition your top ICD-9 codes to specific ICD-10 codes. Be cautious of depending on published crosswalks. ICD-9s which describe ‘unspecified’ elements often are crosswalked to ‘unspecified’ ICD-10s. Experts in the industry are cautioning that ‘unspecified’ ICD-10s may not be paid. Ask your EMR vendor, will you handle all of the ICD-10 coding guidelines, such as Code First, Code Also, Use Additional Codes? Will you map to ‘unspecified’ ICD-10 codes or warn me of ‘unspecified’ ICD-10 codes? How will you help me find more specific codes? You can use Swiftaudit Search to build your Favorites Lists. We will provide you the ICD-10 coding guidelines, and provide a communication platform for your expert coders to provide you with coding tips and alerts.

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Manage My Practice: What are some of the features in Swiftaudit Search that your product has that others you’ve seen do not?

SpringSoft: We feel that our ease of use and screen design makes us stand out from the crowd. The ICD-10 code set is overwhelming. We’ve worked very hard to provide the information you need at a glance.

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Manage My Practice: Swiftaudit Pro (as opposed to Swiftaudit Search) is more for the coding and billing side of the practice. How do you see coders and billers using this product in their practices?

SpringSoft: Our background is in coding and compliance. Managers and auditors can use Swiftaudit Pro to improve their coding accuracy and educate their providers. We built Swiftaudit Pro to be a communication platform to aid discovery and process improvement between a practice’s providers and expert coders.

Readers who would like more information or would like to try Swiftaudit Search for free for 30-days can click here.

NOTE: We’ve heard of so many practices that have not started preparations for ICD-10 that that we made the 20-minute webinar “ICD-10 CM: Getting Started Today.” The video addresses strategies for the first step – crosswalking your most used ICD-9 codes into ICD-10.

Photo Credit: PrivatePit via Compfight cc

Posted in: Collections, Billing & Coding, Day-to-Day Operations, Electronic Medical Records, Headlines, ICD-10, Medicare & Reimbursement

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New 1500 Claim Form Approved to Accommodate ICD-9 or ICD-10 Diagnosis Codes

NUCC Announces Approval of New 2/12 1500 Form for ICD-9 and ICD-10 Accommodation

On June 17, 2013, the National Uniform Claim Committee (NUCC ) announced the approval of Version 02/12 1500 Health Insurance Claim Form (1500 Claim Form) that accommodates reporting needs for ICD-10. The Office of Management and Budget (OMB) has approved the 1500 Claim Form under OMB Number 0938-1197.

During its work, the NUCC was made aware by the health care industry of two priorities that were included in the revisionsto the 1500 Claim Form. The first was the addition of an indicator in Item Number 21 to identify the version of the diagnosis code set being report, i.e., ICD-9 or ICD-10.

The need to identify which version of the code set is being reported will be important during the implementation period of ICD-10.

The second priority was to expand the number of diagnosis codes that can be reported in Item Number 21, which was increased from 4 to 12. Additional revisions will improve the accuracy of the data reported, such as being able to identify the role of the provider reported in Item Number 17 and the specific dates reported in Item Number 14.

Frequently Asked Questions (as of 6/17/13)

1. Why was the 1500 Claim Form changed?

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Posted in: Collections, Billing & Coding, ICD-10, Medicare & Reimbursement

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A Guide to Healthcare Buzzwords and What They Mean: Part One (A through L)

Welcome to our guide to Healthcare Buzzwords!

Understanding Healthcare Jargon

ACO

An acronym for “Accountable Care Organization”, an ACO is a model of healthcare delivery in which a group of healthcare providers agree to accept payment for their services based on the aggregated health outcomes of the patients they see, as opposed to the total number of services performed. ACOs reward providers in a “fee for health” model, as opposed to a traditional “fee for service” model. Although the term ACO can apply to a variety of types of organizations, regulations for establishing ACOs to participate in the Medicare Shared Savings Program specifically were included in the Patient Protection and Affordable Care Act of 2010.

Big Data

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Posted in: Day-to-Day Operations, Headlines

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Medical Coding Expert Doug Palmer Talks About the Future: Computer-Assisted Coding, and ICD-10

Doug Palmer is a practice management, billing and coding and revenue cycle consultant with over 17 years of experience in the industry. He was nice enough to answer some questions for our readers about his experiences and where he sees coding going in the future.

Medical Records

 MMP: How did you get started in coding?

Doug:  I started in the industry as a medical biller with a billing company in NY City. In a rather short period of time, I became familiar with the coding systems (COT, ICD-9, and HCPCS) and began to want to know more. I also wanted to know more about the overall Revenue Cycle Process. That starting point in billing led me to coding for several reasons. Aside from personal and professional development, I realized that I would be more marketable with that skill set. I was right. As I learned more and more about coding…more and more opportunities seemed to come my way.

MMP: What type of coding education and certification do you have?

Doug: I have gotten most of my education in coding “on the job”. I have attended many seminars, CEU courses, internal education opportunities with employers, etc., however, I have never matriculated into any formal or long term courses of study in coding other than a BS in Health Administration which did not specifically focus on coding. At the same time, with my CCS-P Certification through AHIMA, I have taught coding and related courses both in a formal classroom environment in several adult education schools as well as providing on site education as well as web based instruction to other coders as well as medical providers across the country.

MMP: What was your first coding consultant position and how did it come about?

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Posted in: Collections, Billing & Coding, Compliance

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Deciding When and How to Start the ICD-10 Conversion? Ideas Here.

Road Sign with text "Change Ahead"

The proposed, but not finalized, deadline for ICD-10 is October 2014. Most coding experts recommend training staff 6 months before the deadline. What’s a practice to do with the other 18 months?

Who chooses the ICD-9s in your practice today?

There are many methods physicians/providers use to choose a diagnosis code:

  1. Encounter forms (AKA superbills, fee slips, routing slips, etc.) are used in many practices, even those with EMRs, for the physician/provider to choose the service and the corresponding diagnosis. Some encounter forms have the most common diagnoses printed on the back and the physician/provider is required to choose one or more diagnoses and “map” them to the service provided. In some practices, medical assistants or nurses may complete the encounter form with the physician’s instructions.
  2. Physicians/providers may write out their diagnoses and leave staff to translate it into a code.
  3. Surgical practices may have encounter forms for non-office surgeries, or they may use other means to communicate to the biller what actually was done in the OR. Surgeons may use smartphone or iPad charge capture, dictation or surgery cards or duplicate-form tear sheets. Coders may abstract the codes from the dictation the physician completed in the hospital.
  4. Electronic Medical Record packages may offer physicians choices of diagnoses based on those most-used in the practice, and/or related to the documentation entered and those CPTs and ICD-9s, once chosen, are interfaced to the billing system.
  5. Some physicians may use both an EMR and an encounter form.
  6. Coders may abstract the diagnosis straight from the documentation without any intervention on the physician/provider’s part.

Regardless of who chooses the ICD-9 today, realize that much more specific descriptions of the diagnoses will be required to document the correct diagnosis in ICD-10. If the physician/provider is doing the choosing (always my recommendation for non-surgical services), the documentation must support the diagnosis code just the same as if a coder is abstracting the code.

Physicians could, but probably won’t, start improving their diagnosis documentation now. Closer to the October 2014 deadline, your practice may want to have an audit of your diagnosis documentation to see how you would fare in ICD-10 world, and to assist physicians in improving their documentation skills.

Take this opportunity to make your current system better.

A host of changes can potentially use ICD-10 as a scapegoat! For groups using EMR and relying on encounter forms “because it’s comfortable”, the move to ICD-10 is an excellent reason to get rid of the encounter forms. Pushing the code straight from the EMR to the practice management or billing system is the most efficient method overall.

For groups using paper charts, there are a number of free and pay ICD-9 smartphone apps for all brands of phones. You know there will be apps that crosswalk ICD-9 to ICD-10, so get started now getting comfortable with searching for and bookmarking your most used diagnoses on your phone or iPad.

Physicians, does your EMR do this?

Some EMRs already have ICD-10 information in place and available for use now. If it does, start looking at the ICD-10 information provided and begin compiling your new list now. Start your own internal crosswalk to help train your brain for the future.

Think about the life of an ICD-9 code in your practice today.

Make a list of every place and every process an ICD-9 touches. Think beyond attaching a diagnosis to the patient visit, and consider other ways you use ICD-9s. Referrals, test ordering, registries, research…

Consider who in your practice might become the ICD-10 specialist.

It could be a physician, a nurse, a coder or a biller. Someone in your practice should attend webinars or classes to understand the structure of ICD-10 and take on the mentor role for the practice. It may be your coder, or if your coder doesn’t have formal anatomy & physiology training, it might be someone else in the practice. Who should it be?

Is there a possibility ICD-10 will be further delayed or even go away?

Absolutely! Anything is possible. Personally, I don’t think it will and I would rather hedge my bets by spending some time between now and October 2014 preparing for it, then be taken by surprise and try to ramp up in a very short amount of time.

If you start thinking about it now, you’ll have about 2 years to budget and train for the conversion. You can make ICD-10 a standing item in your board and staff meetings. You can start your “life of an ICD-9 code” list. And you can start evaluating physicians, providers, clinical staff and administrative staff (maybe it’s you!) for a starring role in the Big Change.

Start the walk, the crosswalk, that is.

Some ICD-9 codes will have one ICD-10 code only. The rest will have more than one possible ICD-10 . Start by running a report from your billing system or EMR on your top twenty ICD-9s and check to see which of your top twenty ICD-9s have more than one possible ICD-10.

Resources from CMS – Implementation Guides

CMS has developed implementation handbooks to assist with the transition from ICD-9 to ICD-10 codes. Each guide provides detailed information for planning and executing the ICD-10 transition.  Use the guides as a reference whether you’re in the midst of the transition or just beginning.

The appendix of each handbook has templates that are available for download in both Excel and PDF files.  The templates are customizable and have been created to help entities clarify staff roles, set internal deadlines/responsibilities and assess vendor readiness.

View the tailored step-by-step plans and relevant templates for each of the following audiences impacted by the transition:

Large Practices [PDF, 2,773KB]
1. Templates

Small Hospitals [PDF, 3,548KB]
1. Templates

Small/Medium Provider Practices [PDF, 3,116KB]
1. Templates

 

Posted in: Collections, Billing & Coding, Electronic Medical Records, Medicare & Reimbursement

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Medicare This Week: Private E/M Billing Reports, Two Free Calls on eRx and 5010, Revised Medicare Conditions of Participation

  • CMS to Start Accepting Suggestions for PQRS Measures and Measure Groups (jump to story)

  • New Rules Finalized by Health and Human Services to Cut Regulations for Hospitals and Health Care Providers  (jump to story)

  • Denise Buenning from CMS Answers the Industry’s Top Questions about the Version 5010 Upgrade (jump to story)

  • Last Chance to Register for National Provider Call – Physician Quality Reporting System & Electronic Prescribing (eRx) (jump to story)

  • CMS to Release a Comparative Billing Report on Evaluation and Management Services (jump to story)

  • May is Hepatitis Awareness Month and May 19 is National Hepatitis Testing Day (jump to story)

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Posted in: Day-to-Day Operations, Medicare & Reimbursement, Medicare This Week

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The Medicare News You Can Use This Week: eRx Exemptions for 2012 and 2013, Billing Education, and eSignatures

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Posted in: Compliance, Day-to-Day Operations, Electronic Medical Records, Headlines, Medicare & Reimbursement, Medicare This Week, PECOS

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Digging Into the Details of “Certified EMR” & Tips For Buying an EMR

Steps to digging under the meaning of EMR certification: 

Cocker Spaniel digging

Image via Wikipedia

  1. Click to see the most recent alphabetical list (by product name not company) of all products certified here.
  2. Find the company or companies you are using or are considering using.
  3. Check that the exact name of the product is what you have or might purchase.
  4. Check to find out if a module or part of the product is certified or if the complete product is certified.
  5. Check to make sure the version of the product is the version you have or will have.

If you have questions about each company’s exact criteria met, you are in luck!  On the ONC site here, you can click on each company’s detail (“View Criteria”) on the far right column labeled “Certification Status” to see what they have and don’t have.  Compare this to how you are anticipating using your EMR to meet meaningful use.  The more check marks a company has, the better-equipped they are (and more flexible) to meet your practice needs and to qualify for the stimulus money.

The ONC site with the Certified Health IT Product List (CHPL) is Version 1.0.  Version 2.0 is now being developed and will provide the Clinical Quality Measures each product was tested on, and the capability to query and sort the data for viewing. The next version will also provide the reporting number that will be accepted by CMS for purposes of attestation under the EHR (“meaningful use”) incentives programs.

You can tell ONC what you think would be helpful in the new version by emailing your ideas to ONC.certification@hhs.gov, with “CHPL” in the subject line.

If you’d like a list of just outpatient/medical practice EMR products or just inpatient / hospital products, I’ve split the big list into two smaller printable lists here:

Medical Practice / Outpatient

Hospital / Outpatient

Tips On Buying An EMR

To-do list book.

Remember that meeting meaningful use does not tell the whole story – if you are shopping for an EMR be prepared to go beyond a product’s certification status to consider:

  • Flexibility – does it make the practice conform to it or can it conform to the practice? How?
  • Templates and best practices – are you starting from scratch in developing protocols, templates and cheat sheets for your practice, or does it have a storehouse of examples to choose from or tweak?
  • Built for the physician, or the billing office, or the nurses, but doesn’t really meet the needs of all three? Make sure the functionality is not too skewed to one user group, but if it is, it should be somewhat skewed to the provider.
  • Interface and integration with your practice management system. Does the information flow both ways? Do you ever have to re-enter information because one side doesn’t speak to the other?
  • Interface with other inside and outside systems: Labs, imaging, hospital systems, ambulatory surgical center systems?
  • Built-in Resources: annual upgrade of HCPCS and ICD codes, drug compendium (Epocrates), comparative effectiveness prompting?
  • Mobile applications – EMR on your providers’ phones?
  • Data entry systems – laptops, notebooks, tablets, iPads, smartphones, voice recognition?
  • Hosting – in your office? at the hospital? at the vendor’s data center? in the cloud of your choice?
  • What’s the plan for ICD-10? Will they provide practice support and education for the change or will they just change the number of characters in the diagnosis code field?
  • Price, including annual maintenance and additional costs for training, implementation, on-site support during go-live, and additional licenses for providers or staff.

Posted in: Electronic Medical Records, Headlines, Medicare & Reimbursement

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CMS Never Sleeps! Version 5010, ICD-10, an Education Call, Twitter and YouTube

I am fortunate to be serving on the North Carolina MGMA Medicare Committee this year.  When we met yesterday, the members were asked why we wanted to be on the committee.  I said I couldn’t believe any practice manager wouldn’t want to be on the Medicare Committee!  I want to be on the front lines, asking questions and trying to understand the massive changes hitting our practices daily.  Don’t you? If you’re not a member of your local or state manager’s group and you’re not volunteering on one or more committees, why not?

Important Information and Reminders About the Upcoming Version 5010 and ICD-10 Transitions

CMS has resources for providers, vendors, and payers to prepare for the transition. Fact sheets available for educating staff and others about the transition include:

The ICD-10 Transition: An Introduction

Talking to Your Vendors About ICD-10 and Version 5010: Tips for Medical Practices

Talking to Your Customers About ICD-10 and Version 5010: Tips for Software Vendors

Compliance timelines, materials from CMS-sponsored calls and conferences, links to resources and sign up for email updates here

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Medicare FFS 5010 Program: Taking EDI to the Next Level- Ninth National Education Call on Medicare Fee-For-Service (FFS) Implementation of HIPAA Version 5010 and D.0 Transactions

August 25, 2010
2:00pm To 3:30pm EST

The Centers for Medicare & Medicaid Services (CMS) will host its ninth national education call regarding Medicare FFS’s implementation of HIPAA Version 5010 and D.0 transaction standards on August 25, 2010.  This session will focus on the 835 Electronic Remittance Advice transaction.  Subject matter experts will review Medicare FFS specific changes as well as general information to help the audience prepare for the transition; the presentation will be followed by a Q&A session.

Registration will close at 2:00 p.m. EST on August 24, 2010, or when available space has been filled.

Target Audience: Vendors, clearinghouses, and providers who will need to make Medicare FFS specific changes in compliance with HIPAA version 5010 requirements.

Subject: Medicare Fee-For-Service (FFS) Implementation of HIPAA Version 5010 835 Electronic Remittance Advice Transaction

Agenda:

* General Overview

* Medicare Specific Changes

* Timelines and Deadlines

* What you need to do to prepare

* Transaction Specific Issues

* Q & A

Conference call details:

Date: August 25, 2010

Conference Title: Ninth National Education Call on Medicare Fee-For-Service (FFS) Implementation of HIPAA Version 5010 and D.0 Transactions

Time: 2:00 p.m. – 3:30 p.m. ET

In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data.  This registration is solely to reserve a phone line, NOT to allow participation.

Registration will close at 2:00 p.m. ET on August 24, 2010, or when available space has been filled.  No exceptions will be made, so please be sure to register prior to this time.

1. To register for the call participants click here.

2. Fill in all required data.

3. Verify your time zone is displayed correctly the drop down box.

4. Click “Register”.

5. You will be taken to the “Thank you for registering” page and will receive a confirmation email shortly thereafter.   Note: Please print and save this page, in the event that your server blocks the confirmation emails.  If you do not receive the confirmation email, please check your spam/junk mail filter as it may have been directed there.

6. If assistance for hearing impaired services is needed the request must be sent to medicare.ttt@palmettogba.com no later than 3 business day before the event.

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Social Media

The Centers for Medicare & Medicaid Services (CMS) continues to break new ground and to enhance their outreach efforts to the public. CMS is now using social media outlets to get information out to their audience as fast as possible.

Twitter: For CMS & Medicare Learning Network updates, click here.   You’ll need a Twitter account first if you don’t already have one – here are instructions:

  • Go to www.twitter.com and sign up for FREE (choose a name and a password)
  • You can use Twitter on the web or on your phone ”“ you can look at it once a day (you don’t have to look at it and respond to it instantly.)
  • Once you’re signed up, you can start “following” people and they can “follow” you.  I am following people who have interesting things to say about healthcare, and also people who are writing blogs like me.
  • Start by following me (@mpwhaley) and I’ll be glad to follow you.

YouTube:  Log on to the official CMS YouTube channel to view several videos currently available and more to come in the upcoming months.  See an example of a CMS video below.

Posted in: Medicare & Reimbursement, Social Media

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