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Diagnosis And Treatment Of “Epic Finger”

Posted on January 20, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

The following is a summary of an “academic” paper written by Andrew P. Ross, M.D., an emergency physician practicing in Savannah, GA. In the paper, Dr. Ross vents about the state of physician EMR issues and repetitive EMR clicking (in quite witty fashion!). Rather than try and elaborate on what he’s said so well, I leave you with his thoughts.

At long last, medical science has identified a subtle but dangerous condition which could harm generations of clinicians. A paper appearing in the Annals of Emergency Medicine this month has described and listed treatment options for “Epic finger,” an occupational injury similar to black lung, phossy jaw and miner’s nystagmus.

Article author Andrew Ross, MD, describes Epic finger, otherwise known as “Ross’s finger” or “the furious finger of clerical rage,” as a progressive repetitive use injury. Symptoms of Epic finger can include chronic-appearing tender and raised deformities, which may be followed by crepitus and locking of the finger. The joint may become enlarged and erythematous, resembling “a boa constrictor after it has eaten a small woodland mammal.”

Patients with Epic finger may experience severe psychiatric and comorbid conditions. Physical complications may include the inability to hail a cab with one’s finger extended, play a musical instrument or hold a pen due to intractable pain.  Meanwhile, job performance may suffer due to the inability to conduct standard tests such as the digital rectal exam and percussion of the abdomen, leading in turn to depression, unhappiness and increased physician burnout.

Dr. Ross notes that plain film imaging may show findings consistent with osteoarthritic changes of the joint space, and that blood work may show a mild leukocytosis and increased nonspecific markers of inflammation. Ultimately, however, this elusive yet disabling condition must be identified by the treating professional.

To treat Epic finger, Dr. Ross recommends anti-inflammatory medication, aluminum finger splinting and massage, as well as “an unwavering faith in the decency of humanity.”  But ultimately, to reverse this condition more is called for, including a sabbatical “in some magnificent locale with terrible wi-fi and a manageable patient load.”

Having identified the syndrome, Dr. Ross calls for recognition of this condition in the ICD-10 manual. Such recognition would help clinicians win acceptance of such a sabbatical by employers and obtain health and disability insurance coverage for treatment, he notes. In his view, the code for Epic finger would fit well in between “sucked into jet engine, subsequent encounter,” “burn due to water skis on fire” and “dependence on enabling machines and devices, not elsewhere classified.”

Meanwhile, hospitals can do their part by training patients to recognize when their healthcare providers are suffering from Epic finger. Patients can “provide appropriate and timely warnings to hospital administrators through critical Press Ganey patient satisfaction scorecards.”

Unfortunately, the prognosis for patients with Epic finger can be poor if it remains untreated. However, if the condition is recognized promptly, treated early, and bundled with time spent in actual patient care, the author believes that this condition can be reversed and perhaps even cured.

To accomplish this result, clinicians need to stand up for themselves, he suggests: “We as a profession need to recognize this condition as an occult manifestation of our own professional malaise,” he writes. “We must heal ourselves to heal others.”

Will Medical Billing Systems Fail Under ICD-10 Phase 2?

Posted on April 6, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The people at CureMD sent out this tweet and image with a pretty powerful assertion about the future of medical billing systems.
Medical Billing Systems Fail Under ICD-10

I’d like to know where CureMD got the stat in their tweet. That’s a pretty strong assertion about medical billing systems. Based on my knowledge and experience, I’m not sure I agree with them. If they’d have said that ICD-10 in general would cause 50% of medical billing systems to fail, I would have thought it was high but possible. It’s not clear to me how phase 2 of ICD-10 will be so much worse for medical billing systems. Maybe they’ll share in the webinar.

I have seen a bunch of medical billing systems that were running on fumes heading into ICD-10. There was no one really actively developing these systems and they weren’t worrying about ICD-10. They were just sucking whatever revenue they could out of their existing clients and they were going to end of life the product once they ran out of clients. They’re like medical billing system zombies.

Turns out that there are a lot more of these types of systems in healthcare than you probably realized. In fact, I’m surprised we haven’t heard more about their demise after ICD-10’s implementation last year. Whenever I’d talk to doctors, they’d often tell me which EHR they had or which EHR they were considering. Then, I’d ask them which PM system they used and they’d tell me about some software I’d never heard of before. They knew it. They liked it. Many of them would happily say that “you could pull it from their cold dead hands.”

It’s interesting to see CureMD predict that it may be time for us to start doing just that. What are you seeing? Are medical billing systems going to have trouble with the 2nd phase of ICD-10? Will we see a bunch of them finally close up shop? What do you see?

CMS ICD-10 Stats and Metrics

Posted on October 29, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

On October 1, 2015 health systems across the country transitioned to the International Classification of Diseases, 10th Revision – ICD-10. This change will enable providers to capture more details about the health status of their patients to improve patient care and public health surveillance.

CMS has been carefully monitoring the transition and is pleased to report that claims are processing normally. Generally speaking, Medicare claims take several days to be processed and, once processed, Medicare must– by law – wait two weeks before issuing a payment Medicaid claims can take up to 30 days to be submitted and processed by states. For this reason, we will have more information on ICD-10 transition in November.  .

With this in mind, CMS is continuing its vigilant monitoring process of the ICD-10 transition and can share the following metrics detailing Medicare Fee-for-Service claims from 10/1-10/27.

Metrics

October 1-27

Historical Baseline*

Total Claims Submitted

4.6 million per day

4.6 Million per day

Total Claims Rejected due to  incomplete or invalid information

2.0% of total claims submitted

2.0% of total claims submitted

Total Claims Rejected due to invalid ICD-10 codes

0.09% of total claims submitted

0.17% of total claims submitted
(estimated based on end-to-end testing)

Total  Claims Rejected due to invalid ICD-9 codes

0.11% of total claims submitted

0.17% of total claims submitted
(estimated based on end-to-end testing)

Total Claims Denied

10.1% of total claims processed

10% of total claims processed

NOTE: Metrics for total ICD-9 and ICD-10 claims rejections were estimated based on end-to-end testing conducted in 2015 since CMS has not historically collected this data. Other metrics are based on historical claims submissions.

It’s important to know help remains available if you experience issues with ICD-10:

ICD-10 is Worthless

Posted on September 19, 2015 I Written By

Dr. Michael J. Koriwchak received his medical degree from Duke University School of Medicine in 1988. He completed both his Internship in General Surgery and Residency in Otolaryngology-Head and Neck Surgery at Vanderbilt University Medical Center. Dr. Koriwchak continued at Vanderbilt for a fellowship in Laryngology and Care of the Professional Voice. He is board certified by the American Board of Otolaryngology-Head and Neck Surgery. After training Dr. Koriwchak moved to Atlanta in 1995 to become one of the original physicians in Ear, Nose and Throat of Georgia. He has built a thriving practice in Laryngology, Care of the Professional Voice, Thyroid/Parathyroid Surgery, Endoscopic Sinus Surgery and General Otolaryngology. A singer himself, many of his patients are people who depend on their voice for their careers, including some well-known entertainers. Dr. Koriwchak has also performed thousands of thyroid, parathyroid and head and neck cancer operations. Dr. Koriwchak has been working with information technology since 1977. While an undergraduate at Bucknell University he taught a computer-programming course. In medical school he wrote his own software for his laboratory research. In the 1990’s he adapted generic forms software to create one the first electronic prescription applications. Soon afterward he wrote his own chart note templates using visual BASIC script. In 2003 he became the physician champion for ENT of Georgia’s EMR implementation project. This included not only design and implementation strategy but also writing code. In 2008 the EMR implementation earned the e-Technology award from the Medical Association of Georgia. With 7 years EMR experience, 18 years in private medical practice and over 35 years of IT experience, Dr. Koriwchak seeks opportunities to merge the information technology and medical communities, bringing information technology to health care.

Man it’s been a long time since I have been here…but I have been busy fighting the good fight in other places.   The major push for the past year has come from my position as a board member for the Docs4PatientCare Foundation.  With this has come an every other Thursday chat radio hosting gig for a one hour radio show, The Doctors Lounge.  I frequently discuss health IT topics, but not always.

I have been preparing my practice for ICD=10, a disaster coming soon to a doc’s office near you.  I have one article on ICD-10 that has been published in The Heritage Foundation’s The Daily Signal, which follows.  Another more technical article is also in the pipeline which I will share here when it comes out.

 

 

As Oct. 1 approaches my inbox fills more every day with junk mail from health IT vendors offering solutions to my presumed panic.

What panic? Well, as most inside medicine know, Oct. 1, 2015, is a red-letter day that will bring the biggest single change to medical billing in the last 30 years (thanks to Congress).

Although this might not sound too scary, it will most certainly affect every American, and it has the potential to bring chaos to the health care system.

The current medical coding system, which has been in place for decades, has had successive updates built on the one before in a logical sequence. But the new coding system, named ICD-10, will be a complete break from the nine versions before it.

What’s the Big Deal?

For starters, few outside medicine understand the complex process required for doctors to get paid by insurers for their work, but those who don’t understand are nevertheless affected by the process.

To get paid, a doctor must properly log any work done, along with the reason it was done (the diagnosis), with an assigned code chosen from huge manuals containing tens of thousands of codes.

Medical coding is complex and has no room for error (I know; it’s what I do). Pick the wrong code, and a doctor will not get paid. Pick too many wrong codes over time, and a doctor might be investigated by the government. Over the years, an entire industry has sprung up dedicated solely to medical coding.

The number of codes has increased from about 15,000 to almost 70,000, and no code that appears in ICD-9 is valid in ICD-10.

Decades of coding experience will be carelessly tossed out the window, leaving many doctors to spend precious time figuring the new system out rather than actually treating their patients.

Supporters of ICD-10 (insurance companies, bureaucrats, health IT vendors, and academics) assure us doctors that it is worth the sacrifice.

They say that ICD-9 is outdated and lacks the capacity to cover the breadth of modern medicine, and it is true that almost every other country uses ICD-10, so it is time for us to “get with the program.”

How the New Coding System Was Chosen

I have been preparing my practice for ICD-10 since the congressional hearings on it last February.

After watching the farcical proceedings, it was clear to me that the “fix” was in.

The chairman of the committee professed his support of ICD-10 before the first witness uttered a single word. Those who testified were mostly a parade of IT vendors, all of whom stood to profit handsomely from ICD-10.

When I began studying the ICD-10 code structure for my specialty, otolaryngology (ear, nose, and throat, or ENT), I was shocked. ICD-10 codes are indeed increased in number from ICD-9, but there is absolutely no rhyme or reason to the expansion.

Codes for ear problems are obsessively divided into those for the left ear, right ear, or both.

For the diagnosis of dizziness due to a problem in the brain (which by definition does not involve the ears), one must still choose left ear, right ear, or both.

Although those of us in ENT medicine have yet to find any left/right differences in ear pathology, one could argue that with better data collection, maybe we’ll discover something new.

If that’s the case, then similar logic would assume that all ICD-10 codes for ENT are divided into left and right. Apparently not.

Beyond codes for ear diagnoses, almost nothing is coded by side.

For the rest of the article, click here

How Does Your EHR Vendor Solve Challenging Situations?

Posted on July 22, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Today I was asked if I thought a specific EHR feature (in this case it was cloud hosted) was one area practices should consider looking at to avoid having a short sighted view of their EHR vendor. The specific feature and question are interesting, but I think it’s a short sighted way to look at an EHR vendor.

My immediate response was that when I look at an EHR vendor, I look at how they solve challenging situations and if they’re still solving those problems. I’m more interested in the EHR vendors direction and approach than I am any specific feature or function they offer today.

Let’s take them in the inverse order. Is your EHR vendor still solving your problems? This is a hard one to evaluate since meaningful use and EHR certification has hijacked the EHR development process. However, when you dig into an EHR vendor you can tell which ones are really investing in improving their platform and which ones are just doing the minimum necessary to retain their customers. It’s a totally different mindset. A forward thinking EHR vendor is trying to push the envelope, is interested in user feedback and is working towards a brighter future. An EHR vendor that’s doing the minimum necessary is just barely meeting the EHR certification and meaningful use requirements and never really responds to customer requests. Sure, they’ll do a bug fix here or there or fix anything major, but there’s no real investment in the future.

One easy way for you to start evaluating which vendors are investing in their future and which aren’t is to talk to their sales people. Does the salesperson have something new to sell you (like RCM or some other service)? If they do, it’s quite possible your EHR vendor has started focusing (and investing) on some new product and not the EHR anymore. Just remember that it’s really hard for a company to focus and invest in more than one area.

Sadly, I think many EHR users know that their EHR vendor has stopped innovating their product. They know this based on the release cycles of the EHR vendor. When was the last time your EHR vendor put out something that made your life as a clinician or a practice easier and it didn’t have to do with MU?

Related to the above is something that’s even more telling when it comes to the future of your EHR. Ask yourself the question, how does my EHR vendor approach solving challenging situations? If you talk to a lot of EHR vendors like I do, you can pretty quickly tell how an EHR vendor approaches problems. Unfortunately, many of them do the minimum work possible to solve the problem. The best EHR vendors dive deeply into the problem and not only solve the problem, but try to think of a better way to optimize everything surrounding the problem.

I still remember sitting down with an EHR vendor for breakfast one day. As they described their ePrescribing solution, they described how they could have implemented ePrescribing really quickly. However, they didn’t just want to have ePrescribing. They wanted to take the time to really understand ePrescribing and ensure that the doctor could ePrescribe with as few clicks as possible. They wanted to make sure that the process was efficient and accurate. It wasn’t enough to just be able to ePrescribe, but they wanted their doctors to be efficient while doing it too.

Reminds me of many of the ICD-10 implementations I’ve seen. I’d describe EHR vendor implementations as ok, better, and best. The “ok” implementation is that they have a search box which can search by word or code. Theoretically, this works. It just means you’re going to have a big book next to you or an app on your phone which lets you really find the code and then all you’re doing is entering the code. Not good!

The “better” implementation is the vendors that group codes so that when you search you can choose the group of codes and then essentially drill down into the group and find the code you need. In most cases, I’ve seen this type of implementation done by integrating a third party vendor. The EHR vendor often passes that third party cost on to the end user (imagine that). I’ll admit that a third party vendor integration for this feels kine of lazy. I’m all for third party integrations, but your EHR vendor won’t ever be able to take coding to the next level if they’re working with a third party. This kind of “grouping” approach is better, but it’s not the best.

The best type of ICD-10 implementation I’ve seen is one that integrates deeply into the EHR documentation. The documentation essentially narrows down the ICD-10 code list for you as you document the visit. Then, when it’s time to do your assessment, the hard work of identifying the right codes is already done for you. Sure, you’ll need to verify that the machine approach to ICD-10 identification is right, but it’s the best approach I’ve seen to ICD-10.

Hopefully this ICD-10 example gives you a view into what I mean when I say that you have to evaluate how an EHR vendor works to solve a problem. Are they just trying to get by or do they take their solution to the next level of automation? I feel sorry for the doctors who are stuck on EHR software that’s no longer investing in their EHR and just take the minimal necessary approach to EHR development.

Going back to the person’s initial question about cloud hosted EHR, it’s easy today to say that every EHR vendor should be on the cloud. The cloud has won in every industry and it will eventually win in healthcare as well. However, cloud or not is not what concerns me. I’d be more interested in hearing an EHR vendors reason for going cloud or not. Not to mention their reasons for moving to cloud or not. That will tell you how an EHR solves a problem and how an EHR works with new technology. Their direction and approach to those challenges is much more important than the specific choice they make.

Crazy ICD-10 Codes? Let’s Put Them In Perspective

Posted on July 16, 2015 I Written By

The following is a guest blog post by Jennifer Della’Zanna, medical writer and online instructor for Education2Go.
Jen HIM Trainer
Exhibit A: W55.21XA Bitten by a cow, initial encounter

Exhibit B: Y92.241 Hurt at the library

Exhibit C: Y93.D1 Accident while knitting or crocheting

Exhibit D: W56.22 Struck by Orca, initial encounter

These are the kinds of codes trotted out to “prove” how ridiculous moving the ICD-10 coding system is. What do we need these codes for? Everybody seems to be asking this question, from congressmen to physician bloggers to—now—regular people who have never before even known what a medical code was.

Here are a few things you should know about these codes. Some of you actually should know this already, but I’ll review for those who have been sucked into the maelstrom of ridicule swirling about the new code set.

  1. You’ll notice that all those crazy code examples start with the letters V, W, X and Y. These are all “external cause codes,” found in just one of ICD-10’s 21 chapters (Chapter 20). In my version of the manual, that encompasses 76 pages. Out of 848.

    External cause codes are the only ones ever trotted out as ridiculous. Do the math. They make up 9% of the codes. They are used mainly to encode inciting factors and other details about trauma/accident situations. There are some other uses, but not many. Do most people use them in everyday coding? No. That’s not going to change with the new system. If you’re a coder who is not already using external cause coding on a day to day basis, you will likely not have to start now. Most people never look in this chapter—ever.

  2. The reason there are such funny codes is the system allows you to “build” a code using pieces, which is what makes the book so easily expandable in all the right places (which is the point of the entire code change—the external cause codes just came along for the ride). Let’s look at Exhibit A: Bitten by a cow, initial encounter:
    The first three characters of the code indicate the category. Each additional character adds some detail.W55 is the category “Contact with other mammals”The 4th character 2 indicates contact specifically a cow (although included in this code is also a bull). You can change the animal to a cat by using 0 or a horse by using 1. You get the idea, right?

    The 5th character 1 indicates that the injury is a bite. A 2 would mean the patient was struck, not bitten.

    The 6th character X is a placeholder because this code requires a 7th character extension to indicate what encounter this visit was.

    The 7th character A indicates that this was an initial encounter. You could change this to a D if the patient has returned for subsequent visits or an S if the patient ends up with another problem later that could be attributed to this original cow—or bull—bite.

  3. We can code most of those same ridiculous codes with ICD-9, although most times not quite to the same specificity. I’ll match the ones below to the exhibits we have at the top:
    Exhibit A: E906.3 Bite of other animal except arthropod

    This is what we would currently have to use for “bitten by a cow.” There is no way in the current code set to indicate whether this is an initial encounter or a follow-up encounter for this accident, however. Since the code is so vague, this code could actually also be used to mean “bitten by a platypus” or “bitten by a pink fairy armadillo,” so yes, you can still code that in ICD-9, but not as well.

    Exhibit B: E849.6 Accidents occurring in public building

    Do you consider a library a public building? I do. Yep, you can code that with ICD-9, but not as well.

    Exhibit C: E012.0 Activities involving knitting and crocheting

    This is what we call a one-to-one mapping. A specific code for this already exists in ICD-9 with exactly the same description. Next.

    Exhibit D: E906.8 Other specified injury caused by animal

    This is the code we would have to use to indicate an attack by an Orca. Again, no indication of what encounter it is, but this time there is actually no reason to even use this code because, really, what information is it giving you? The patient was injured by an animal. We have no idea what kind of injury or what animal caused it. I’m all for going to a useful code for those rare occurrences of attacks by Orcas (which, as we all know, do occur from time to time!).

The real point is not what kinds of crazy things are now able to be coded, it’s what critical things can be coded with ICD-10 that could not be coded with ICD-9. The most newsworthy one is Ebola. In ICD-9, we have to use 065.8 Other specified arthropod-borne hemorrhagic fever. In ICD-10, we have A98.4 Ebola virus disease. But there are other reasons to go to the new system. There are new concepts in ICD-10 that didn’t exist in ICD-9, like laterality. We now have the ability to indicate which side of the body an injury or other condition occurs. This inclusion is one of the biggest reasons for the book’s code expansion. Each limb and digit has its own code (but, again, it’s the changing of one number in the overall code that indicates left or right, and which digit is affected). With all the complaints about the increased documentation required for the new code set, one would hope that most physicians already document which hand or arm or leg or ear or eye or finger is affected. As I mentioned above with the seventh-character extension, there is the ability to indicate the encounter and, more importantly, to link a prior condition with a current one with the use of the S character that indicates “sequela.”

There’s much evidence that the ICD-10-CM will help make patient records more accurate and reporting of conditions more precise. This will lead to improved research abilities and a healthier worldwide population. And the ridiculing of ICD-10 codes, which I’m sure will continue long after this blog post has disappeared from your newsfeed? Well, they always say that laughter is the best medicine!

About Jennifer Della’Zanna
Jennifer Della’Zanna, MFA, CHDS, CPC, CGSC, CEHRS has worked in the allied health care industry for 20 years. Currently, she writes and edits courses and study guides on medical coding and the use of technology in health care, as well as feature articles for online and print publications.  You can find her at www.facebook.com/HIMTrainer and on Twitter @HIMTrainer.

Great ICD-10 Image and Poll

Posted on March 25, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I saw this great graphic on Twitter today which made me laugh:

I have friends in DC with AHIMA trying to make the case to their representatives in Congress that they shouldn’t delay ICD-10. Word on the street is that as of now (subject to change as we saw last year), the SGR fix bill doesn’t contain an ICD-10 delay. Of course, the real challenge with ICD-10 now is the uncertainty of it all.

I thought it might be interesting to see what the readers of EMR and EHR predict for ICD-10. So, here’s a simple ICD-10 poll about whether ICD-10 will be delayed or not.

5 Features to Look for in a Medical Billing Company

Posted on March 4, 2015 I Written By

The following is a guest blog post by Harold R Gibson, Chief Financial Officer at M-Scribe Technologies, LLC.
Harold Gibson
A full-service medical billing company does more than code and file medical insurance claims. While that may still make up the bulk of a company’s output, a good medical billing company should offer additional services to help a practice achieve both profitability and compliance goals. Look for the following main features in a medical billing company:

  1. With the transition from ICD-9 to the new ICD-10 coding system in place, a billing company’s coding, billing and other EHR staff should be trained and experienced to ensure optimum accuracy – the foundation of compliance, and therefore improved timely payment. Since many practices have less time or budget for training billing staff in all aspects of the newer, more complex coding system, it falls to the medical claims processing service to fill in any gaps in the EHR process. A company which carefully monitors the EHR content entered will improve the accuracy of the codes and therefore ensure better compliance and payment as well as lessen the chances of an audit. Duplicate claims, payments included in a previously-billed service or procedure already adjudicated and non-covered charges are some of the most common reasons for claim denials. Make sure your practice doesn’t make these billing mistakes by letting a professional medical billing services company handle the workload.
  1. Accurate medical documentation is critical to having claims paid on time, with no rejection due to errors or incomplete filings. This is especially true of Medicare claims, whereby a Certificate of Medical Necessity and other required documentation must be correct and current to merit payment without multiple resubmissions. The right medical billing services company should use  technology and experience when entering only claim-relevant content data, correct procedure (CPT) and diagnosis codes (ICD-9 and ICD-10). These should then be entered into the EHR charts, providing convenience, increased efficiency and cost reduction.
  1. Specialty-specific billing services are available to group practices and clinics as well as individual physicians. Whether your practice uses billings systems such as eClinicalWorks, Greenway, Kareo, NextGen or other popular systems, the right service should be able to help. Whether your practice specializes in Surgical, Dermatology, Nephrology, Orthopedic, Radiology or anything else this should not be a problem for your billing provider. As a bonus, full-service billing companies can provide other services to you, including patient scheduling, verification of eligibility, performing patient demographics, coding and claims submission.
  1. Pre-RAC audit-related support: Complying with the complexities of Medicare and Medicaid regulations can be challenging even for an experienced billing staff in many practices – even more so for smaller or solo practitioners, who often have just one or two staffers handing billing as well as other duties. On the other hand, offering pre-audit support can be tricky for smaller, less experienced billing companies.  An experienced medical billing company can help with preparing a pre-audit checklist to supply requested audit information.
  1. Training webinars for billing and coding staff are another service designed to reduce the chance of errors caused by unfamiliarity with the new coding system as well as keeping abreast of regulatory and other changes. Offered free of charge, these webinars explore the history of ICDs, a comparison of ICD-9 and ICD-10, coding guidelines and formats as well as a step-by-step plan for implementation. These webinars can help solve the dilemma of not enough time or money to send busy staff to expensive, days-long ICD-10 training classes.

If you are looking for a medical billing company, it is important to choose a company that houses the above five features and remember to look for a company that will help with profitability and compliance goals.

About Harold R Gibson
Harold R Gibson is the Chief Financial Officer at M-Scribe Technologies, LLC, an accomplished healthcare professional with extensive experience in the medical billing and coding industry. You can find him on Twitter @mscribetech. He is interested to get your feedback/suggestions. Please email him at H.Gibson@m-scribe.com.

BREAKING: Possible ICD-10 Delay … Again – AHIMA Call for Action

Posted on March 26, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

UPDATE: It looks like this bill has passed the house with a voice vote. I believe it still needs to be passed by Congress and not be vetoed by the President.

UPDATE 2: Late on 3/31/14, the Senate passed the bill which delays ICD-10 by a vote of 64 – 35. Barring a veto from the President, the bill will go forth and the ICD-10 implementation date will be moved to October 1, 2015. All of the discussion for the bill was around the SGR fix with no conversation around the ICD-10 delay. It’s unlikely that the President would even consider a veto of this bill.

A bill that would adjust the SGR (Sustainable Growth Rate) was introduced to the US House and Senate with a 7 line provision that would effectively delay ICD-10 another year until October 1, 2015. Here’s the section of the bill:

The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD–10 code sets as the standard for code sets under section 1173(c) of the 13 Social Security Act (42 U.S.C. 1320d–2(c)) and section 14 162.1002 of title 45, Code of Federal Regulations.

This is really interesting news after the discussion we’ve been having in this Why ICD-10? post. No doubt there are a lot of strong feelings on both sides. Some really want a delay and some really want it to keep going forward. I wonder if Congress will get a mix bag of calls from both sides of the debate which won’t sway them either way.

AHIMA is definitely on the side of those calling for no delay to ICD-10. They sent out the following call to action to their community:

Call Congress Now to Request Removal of Delay Provision

Again, this bill is expected to go to the House floor tomorrow for a vote. AHIMA urges members and other stakeholders to contact their representatives in Congress today and ask them to take the ICD-10 provision out of the SGR bill.

Go to our website now and use your zip code to look up phone numbers for your representatives and senators in Congress. http://capwiz.com/ahima/callalert/index.tt?alertid=63161891

Phone Script Available Below for Use in Contacting Your Legislator:

“Hello Representative XX/Senator XX, my name is XXX and I am a concerned member in your district, as well as a healthcare professional. I am calling to voice my opposition to the language in the SGR patch that would delay ICD-10 implementation until October, 2015. CMS estimates that a 1 year delay could cost between $1 billion to $6.6 billion. This is approximately 10-30% of what has already been invested by providers, payers, vendors and academic programs in your district. Without ICD-10, the return on investment in EHRs and health data exchange will be greatly diminished. I urge you, Representative XX/ Senator XX to oppose the ICD-10 delay and let Speaker Boehner and Senate Majority Leader Reid know that a delay in ICD-10 will substantially increase total implementation costs in your district as well as delay the positive impact for patient care.”

My question is if they delay ICD-10, will ICD-10 ever happen? A strong argument will then be made to move straight to ICD-11. Although, all of those people who spent hours coding their applications for ICD-10 won’t like that change.

Like many people, I’m somewhere in the middle on this. Some certainty would be the most valuable thing. I’m certain that HHS wants ICD-10 to go forward. That’s certain. However, congress may have different ideas.

ICD-10 Frequently Asked Questions (Including Update on Revised CMS-1500 Form)

Posted on March 24, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The following is a guest blog post by Dana Deardorff.

Are you concerned about the upcoming changes in coding? The following are answers to frequently asked questions that will help you prepare for the changes ahead. Please note the deadline for the first significant change is April 1, 2014.

What does ICD-10 stand for?

ICD-10 is an abbreviation. It stands for the International Classification of Diseases, 10th Revision. It is used when referring to either the Clinical Modification (ICD-10-CM) or Procedure Coding System (ICD-10-PCS).

How will ICD-10-CM be used?

ICD-10-CM will replace ICD-9-CM codes, Volumes 1 and 2. It will be used when reporting clinical setting diagnoses.

How will ICD-10-PCS be used?

ICD-10-PCS will be used by hospitals to report inpatient procedures.

Who has to convert to ICD-10?

Health care providers, clearinghouses, payers and physicians all are required to convert to ICD-10. This is not optional and includes any HIPAA covered entity.

What will happen if I don’t convert to ICD-10 by the October 1st deadline?

If you submit ICD-9 codes after October 1, 2014, those transactions will not be accepted. Those transactions will be denied. This will cause you to lose out on reimbursements. You may need to apply for a line of credit to prepare for cash flow disruptions that may occur due to noncompliance problems. This will help protect you from negative impact if your medical practice partners do not convert to ICD-10 in time.

What is the deadline for the ICD-10 conversion?

The deadline is October 1, 2014.

What is this April 1, 2014 deadline I keep hearing about?

The April 1 deadline is for the revised CMS-1500 form used for submission of paper claims. The CMS-1500 form is an intricate part of the ICD coding system. The new form (version 02/12) is replacing version 08/05. As of April 1, 2014 providers need to use version 02/12 of the CMS-1500 form. The old form will no longer be accepted.

How is the revised CMS-1500 form tied into the ICD-10 transition?

Physicians will notice that the revised CMS-1500 form provides fields for the new ICD-10 codes. However, your payors may not have made the transition from ICD-9 to ICD-10. Physicians should use ICD-9 codes until you have confirmed that the payor has made the transition to ICD-10. After October 1, 2014, your payors should have all made the transition to ICD-10, and you should be able to use the new codes from that date forward.

What is different about the revised CMS-1500 form?

The revised CMS-1500 form:

* Provides fields and indicators for both ICD-9 and ICD-10 codes

* Provides documentation space for up to 12 diagnosis codes

* Offers qualifiers to aid in the identification of provider roles in the furnishing of services

* Uses letters instead of numbers as diagnosis code printers

You will want to upgrade your practice management software or order 02/12 forms immediately if you have not done so already. Discard any 08/05 forms after April 1, 2014.

When should physicians start using the revised CMS-1500 form?

Providers can start using the revised form on January 1, 2014, but all providers must switch to using the revised form as of April 1, 2014. Your (PM) Practice Management/EMR/EHR practice vendor can help you determine what you need to do to remain in compliance as you transition to ICD-10.

About Dana Deardorff of MediPro
MediPro is a full-service medical billing software company offering practice management (PM) software, electronic health records (EHR) and electronic medical records (EMR) from McKesson and IMS.

Since 1995, MediPro, Inc. has been a nationally recognized, award-winning medical billing software company offering practice management systems and electronic health record solutions. MediPro’s mission is to deliver and support integrated solutions to the healthcare community. MediPro recognizes the need for a comprehensive, interactive and cost-effective suite of applications that are customized to address the specific needs of healthcare offices.