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ICD-10 Claims Monitoring Infographic

Posted on June 30, 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’m told that there are only 92 days left for Congress to delay ICD-10 until the deadline to implement ICD-10. A few weeks ago we published a great post from Vishal Gandhi, CEO of ClinicSpectrum, that talked about a part of ICD-10 preparation that is often forgotten: Claims Monitoring.

I know this is going to be a major problem for many healthcare organizations and is going to cause some major cash flow problems if they don’t get on top of their ICD-10 claims by implementing some sort of ICD-10 claims monitoring process. ICD-10 hiccups are the perfect excuse for a payer not to pay your claims.

For those that prefer a more visual approach to this discussion, Vishal and his team have put together an infographic that shares the same message as his post. Pretty cool. What won’t be cool is if you’re stuck with a lot of unpaid claims thanks to ICD-10. Make sure you and your organization are ready to deal with it.
What Are You Doing to Monitor Your Claims

Full Disclosure: ClinicSpectrum is a sponsor of EMR and HIPAA.

ICD-10 Upgrades – Are We All Systems Go?

Posted on June 5, 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 thought that Brad’s characterization of ICD-10 as an upgrade to a system was pretty intriguing. I don’t think most people view it as an upgrade to a system, but a new layer of regulation. Although, maybe we’re just playing with words.

I recently asked a coding expert whether they thought that ICD-10 was finally going to happen or whether it would be delayed again. His response to me was that the republican leadership now sees last years delay of ICD-10 as a major cost to the US health system. So, he said that there’s no way they’re going to delay ICD-10 again.

I’ve seen some of the verbiage coming out of congress as far as the cost of an ICD-10 delay. I’m not sure I trust those numbers, but there are some in congress who have seen those numbers and believe that another delay in ICD-10 would cost the people in the US a lot of money. That’s a powerful force for keeping the current ICD-10 timeline. However, I still know there are a number of people in congress who see the ICD-10 law as a cost much bigger than any costs thanks to a delay. I don’t see these people letting up.

So, I’m not as confident as my coding expert friend that ICD-10 will not be delayed. I think there’s still some risk that another ICD-10 delay could be tagged on to some other unrelated, but important legislation and slips through. However, if I were a betting man, I’d put my money down on ICD-10 not being delayed any more. The advocates for no more ICD-10 delay are much better organized this year and I think their message is getting across to the right people in Washington.

Either way, I think that a healthcare organization has to be prepared for ICD-10 this year. Not doing to is putting the financial health of your healthcare organization at risk. We’d all love some assurance that indeed ICD-10 won’t be delayed anymore. However, I don’t think we’re going to get it. We have what we have and most signs I’ve seen point to no more delay to ICD-10. My suggestion would be to make sure you and your IT systems are prepared for the change. About time for us to start rolling up our ICD-10 preparation posts again.

Video Demonstration of End-to-End ICD-10 Testing

Posted on May 14, 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’ve heard a lot of people suggest that an organization needed to do end-to-end ICD-10 testing in order to prepare for the switchover to ICD-10 on October 1, 2015 (we think). I came across this video demonstration of Qualitest doing an end-to-end test of ICD-10:

What do you think of the demo? Is this a valuable thing to do? Should this be done with every EHR and PM vendor and with every vendor that connects to that software?

ICD-10 Preparedness

Posted on May 12, 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.

The following is some email comments from Richard D. Tomlinson, RN and Founder of Nuclei Health Consultancy, in reply to my post on ICD-10 Business Areas of Concern. They weren’t intended for posting, but I thought they were quite insightful and so Rick gave me permission to share them.

Wonderful post (as always) relative to our issues driving yet another future-state condition in healthcare, namely ICD-10. If I may, I would like to approach ICD-10 from another perspective.

While everyone knows that ICD-10 is (eventually) a reality for U.S. healthcare organizations, I convey there is much more to addressing ICD-10 CM/PCS than simply “making the conversion” or “dual coding” as benchmarks towards success. My own list of preparedness relative to ICD-10 is somewhat different than yours and designed to combine strategic as well as tactile integration to address ICD-10 CM/PCS.

1. Clinical Documentation Improvement process.
2. Roust education via clinical case studies showing the BUSINESS CASE IMPACTS downstream of inadequate clinical documentation & coding.
3. ICD-10 Gap analysis current-state to include clinical and financial gaps.
4. Validation testing of via test patient build/coding.
5. EHR optimization specific to ICD-10 (MORE is NOT BETTER).
6. Evaluation of CAC (Computer Assisted Coding).
7. Evaluation of alternative coding resources (e.g. outsourcing).
8. Viability Reporting to C-Suite (not simply “on track” reporting. It’s not a project; it’s an initiative. Establish and report on critical success factors).
9. Establishment of robust clinical documentation/ICD-10 ad hoc committees. Include CMIO or provider champion/HIM/financial/quality/informatics/IT
10. Establishment of robust analytics to reverse engineer denials (where/what/whom) and specific identification of mitigation actions (e.g. education, CDI, etc) and processes.

The bottom line in my view is this; any organization treating ICD-10 as a “conversion” is headed for significant problems in terms of denials and missed revenue capture. ICD-10 should be viewed by the C-Suite specifically as a platform to improve patient safety/care, to improve clinical documentation, improve quality measures, and a specific strategy to reduce costs and increase potential revenue capture. Properly deployed, ICD-10 initiatives can actually accomplish all of this. My suggestion to my clients is to approach ICD-10 strategically, not merely as a conversion process, and develop a plan incorporating the measures I’ve indicated above. Serious Measurement of these factors will be required, regardless of facility type or size.

Lastly, I think some organizations are mistakenly treating this not only as a “conversion” but also siloing this to the small HIM or coding backroom as a problem for the coders. This approach will paint the coders into an unfortunate corner, and may create a situation where optimum revenue capture opportunities are lost…forever. For example, improper coding of a patient acquiring bed sores while inpatient may result in denials and reduce certain quality scores inappropriately. When you consider that coding is the final life blood touchpoint of revenue generation, it’s time for the C-Suite to leverage ICD-10 as a strategy to place importance of improved clinical documentation as a business case, and measure the clinical, financial, and operational impacts to the organization.

Top 4 HIT Challenges and Opportunities for Healthcare Organizations in 2015 – Breakaway Thinking

Posted on January 15, 2015 I Written By

The following is a guest blog post by Mitchell Woll, Instructional Designer at The Breakaway Group (A Xerox Company). Check out all of the blog posts in the Breakaway Thinking series.
Mitchell Woll - The Breakaway Group
Healthcare organizations face numerous challenges in 2015: ICD-10 implementation, HIPAA compliance, new Meaningful Use objectives, and the Office of the National Coordinator’s (ONC) interoperability road map.  To adapt successfully, organizations must take advantage of numerous opportunities to prepare.

Healthcare leaders must thoroughly assess, prioritize, prepare, and execute in each area:

  1. Meaningful Use Stage 2 objectives require increased patient engagement and reporting for a full year before earning incentives.
  2. The ONC’s interoperability road map demands a new framework to achieve successful information flow between healthcare systems over the next ten years.
  3. There are 10 months left in which to prepare for the October 1 ICD-10 deadline.
  4. HIPAA compliance will be audited.

1. Meaningful Use
For those who have already implemented an EHR, Meaningful Use Stage 2 focuses new efforts on patient access to personal health data and emphasizes the exchange of health information between patient and providers. Stage 2 also imposes financial penalties for failure to meet requirements.

CMS’s latest deadline for Stage 2 extends through 2016, so healthcare organizations have additional time to fulfill Stage 2 requirements. Stage 3 requirements begin in 2017, so healthcare organizations should take the extra time to build interoperability and foster an internal culture of collaboration between providers and patients. For Stage 3, Medicare incentives will not apply in 2017 and EHR penalties will rise to 3 percent.

CMS has also proposed a 2015 EHR certification, which requests interoperability enhancement to support transitions of care.  Complying with this certification is voluntary, but provides the opportunity to become certified for Medicare and Medicaid EHR incentive programs at the same time.

Meaningful Use Stage 2 and the ONC roadmap require that 2015 efforts concentrate on interoperability. Healthcare organizations should prepare for health information exchange by focusing efforts on building patient portals and integrating communications by automating phone, text, and e-mail messages. After setting up successful exchange methods, healthcare organizations should train staff how to use patient portals. The delay in Stage 2 means providers have more time to become comfortable using the technology to correspond with patients. Hospitals should also educate patients about these resources, describing the benefits of collaboration between providers and patients. Positive collaboration and successful data exchange helps achieve desired health outcomes faster.

2. Interoperability
The three-year goal of the ONC’s 10-year roadmap is for providers and patients to be able to send, receive, find, and use basic health information. The six and ten-year goals then build on the initial objectives, improving interoperability into the future.

Congress has also shown initiative on promoting interoperability asking the ONC to investigate information blocking by EHRs. Most of the ONC’s roadmap for the next three years is similar to Meaningful Use Stage 2 goals.

Sixty-four percent of Americans do not use patient portals, so for 2015 healthcare organizations should focus on creating them, refining their workflows, and encouraging patients to use them. Additionally, 35 percent of patients said they are unaware of patient portals, while 31 percent said their physician has never mentioned them. Fifty-six percent of patients ages 55-64, and 46 percent of patients 65 and older, said they would access medical information more if it were available online. Hospitals need their own staff to use and promote patient portals in order to conquer the challenges of interoperability and Stage 2.

3. HIPAA Compliance
In 2015, the Office of the Inspector General (OIG) will audit EHR use, looking closely at HIPAA security, incentive payments, possible fraud, and contingency plan requirements. Also during the HIPAA compliance audit, the Office of Civil Rights (OCR) will confirm whether hospitals’ policies and procedures meet updated security criteria.  Healthcare organizations should take this opportunity to verify compliance with 2013 HIPAA standards to prepare for upcoming audits. Many helpful resources exist, including HIPAA compliance toolkits, available from several publishers. These kits include advice on privacy and security models. Healthcare organizations and leaders can also take advantage of online education, or hire consultants to help review and implement the necessary measures. It’s important that action be taken now to educate staff about personal health information security and how to remain HIPAA compliant.

4. ICD-10 Deadline
The new ICD-10 deadline comes as no surprise now that it was delayed several times. In July 2014, the US Department of Health and Human Services (HHS) implemented the most recent delay and set a new date of Oct. 1, 2015, giving hospitals a 10-month window to prepare for the eventual ICD-10 rollout. Because healthcare organizations are more adaptable than ever, they can use their practiced flexibility and experience to meet these demands successfully.

As Health Information and Management Systems Society (HIMSS) suggests, communication, education and testing must be part of an ICD-10 implementation plan. Informing internal staff and external partners of the transition is a crucial first step. ICD-10 should be tested internally and externally to verify the system works with the new codes before the transition. Healthcare organizations should outline and develop an ICD-10 training program by selecting a training team and assessing the populations who need ICD-10 education. They should perform a gap analysis to understand the training needed and utilize role-based training to educate the proper populations. Finally, organizations should establish the training delivery method, whether online, in the classroom, one-on-one, or some combination of these to teach different topics or levels of proficiency. In my experience at The Breakaway Group, I’ve seen that the most effective and efficient education is role-based, readily-accessible, and offers learners hands-on experience performing tasks essential to their role. This type of targeted education ensures learners are proficient before the implementation. As with any go-live event, healthcare organizations must prepare and deliver the new environment, providing support throughout the event and beyond.

Facing 2015
These challenges require the same preparation, willingness, and audacity needed for prior HIT successes, including EHR implementation and meeting Meaningful Use Stage 1 requirements. ICD-10, HIPAA compliance, Stage 2, and interoperability all have the element of education in common. Healthcare organizations and leaders should apply the same tenacity and discipline to inform, educate, and prepare clinicians for upcoming obligations.

Targeted role-based education will best ensure proficiency and avoid comprehensive, costly, and time-consuming system training. Through role-based education, healthcare organizations gain more knowledgeable personnel who are up to speed on new applications. These organizations probably already have at least a foundation for 2015 expectations, and they should continue to recall the strategies used for prior go-live events. What was successful? It’s important to plan to replicate successful strategies, alleviating processes that caused problems.  This is great opportunity to capitalize efforts for organizational improvements. Healthcare leaders must let the necessity of 2015 government requirements inspire invention and innovation, ultimately strengthening their organizations.

Xerox is a sponsor of the Breakaway Thinking series of blog posts.

Ring in 2015 – Ring Out MD Myths about ICD-10

Posted on January 7, 2015 I Written By

The following is a guest blog post by Wendy Coplan-Gould, Founder and President of HRS Coding.

Physicians see ICD-10 as a mixed bag of distraction, expense and long-term advantages. They’ve heard grossly exaggerated messages about ICD-10’s complexity and cost. Confusion has led to complacency and obstinacy across physician practices and medical groups.

Conversely, some physician practices and medical groups eagerly await ICD-10’s ability to accurately describe their high-risk patients, improve data mining capabilities, and demonstrate complexity of cases. The opportunity for cleaner data, better quality scores and greater patient safety are three more physician-friendly benefits of ICD-10 as described in my previous ICD-10 post on EMR & HIPAA.

Recent research conducted with a 20-physician focus group, and presented during AHIMA’s 2014 Convention & Exhibit, revealed three common themes with regard to physician perceptions of ICD-10 and its effect on their practices.

Physicians are concerned about the following:

  • How specific their clinical documentation has to be for correct ICD-10 code assignment.
  • Obtaining accurate reimbursement under ICD-10.
  • Receiving ICD-10 training from the hospitals they serve.

With the advent of a new year, now is the time for hospitals and healthcare systems to dispel physician myths about ICD-10 and actively engage practices—one medical group at a time.

Five ICD-10 Realities and Physician Engagement Strategies

Is ICD-10 as difficult for doctors as once portrayed? The resounding answer for 2015 is “no.”

When introduced one physician office at a time, the implementation of ICD-10 is relatively easy. Consider these proven strategies to foster greater physician buy-in for ICD-10.

  • Most physicians will only use a small subset of ICD-10 codes—dramatically decreasing the amount of time required for training and preparation (1-2 days). Target training efforts toward the 80 percent of diagnosis and procedure codes that are used repeatedly within each practice or specialty.
  • When hospitals focus on improving EHR documentation templates, physicians are more productive, efficient and engaged in ICD-10 efforts. Foster inclusion by helping physicians build better documentation templates across all EHR applications.
  • Physicians learn best from other physicians. Find physician documentation champions within each specialty and make ICD-10 learning fun.
  • The best way to minimize claims denials and ensure proper reimbursement for both hospitals and physicians under ICD-10 will be the avoidance of non-specific codes. Focus on helping physicians document better and give them tools such as real-time documentation aides and prompts to create more succinct, accurate and complete clinical documentation.
  • Physician practices must also be included in end-to-end testing for ICD-10. Be sure to include them within your organization-wide testing plans. Even when testing is only for payer acknowledgement, it provides segue for physician practice coding and billing staff to practice submitting ICD-10 codes.

Blaze a New Path with Physicians in 2015

Last year left many hospitals feeling defeated regarding ICD-10 and their physician preparedness efforts. Money was spent and staff resources were exhausted. Congress dealt a devastating blow to ICD-10 budgets, timelines and implementation teams.

But the ship hasn’t sailed. There is still time to actively engage your medical staff in preparing for ICD-10. Erase your original message to physicians that ICD-10 is difficult and expensive. Replace it with knowledge gleaned over the past two years, recent physician research, and new implementation timelines based on specialty.

By focusing on the clinical data advantages of ICD-10 and bolstering physician productivity and efficiency, hospitals can blaze a new path toward the new code set—one practice at a time.

About Wendy Coplan-Gould
Wendy Coplan-Gould is the embodiment of HRS. She has led the HIM consulting and outsourcing company since 1979, through up and down economies and every significant regulatory twist and turn of the last three decades. Long-time clients and new clients alike are on a first-name basis with her and benefit from her focus on excellence, reliability and flexibility. She has been published in the Journal of AHIMA and other recognized publications, as well as conducted countless professional association presentations.

Prior to starting HRS, Wendy served as assistant director, then director, of Health Information Management at Baltimore City Hospital. She also was associate director of the Maryland Resource Center, which provided data for Maryland’s Health Services Cost Review Commission, an early adopter of the Diagnosis Related Group (DRG) methodology. Wendy is available via email: wendy@hrscoding.com.

Top 10 Google Searches in 2014 – What Would Be Healthcare IT’s Top Searches?

Posted on December 16, 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.

Each year Google releases it’s top trending searches in the US and the world. This list isn’t the most frequently searched terms (according to Google the most popular searches don’t change) but is a year versus year comparison of what terms were trending in 2014.

US Trending Searches:
Robin Williams
World Cup
Ebola
Malaysia Airlines
Flappy Bird
ALS Ice Bucket Challenge
ISIS
Ferguson
Frozen
Ukraine

Global Trending Searches:
Robin Williams
World Cup
Ebola
Malaysia Airlines
ALS Ice Bucket Challenge
Flappy Bird
Conchita Wurst
ISIS
Frozen
Sochi Olympics

Pretty interesting look into 2014. Also amazing that a mobile app (Flappy Bird) made the list for the first time. There’s two healthcare terms: Ebola and ALS Ice Bucket Challenge. I wondered what this list would look like for healthcare IT. So, I decide to take a guess at what I think would be the trending healthcare IT terms of 2014:

ICD-10 Delay
EHR Penalties
Wearables
Meaningful Use Stage 2
Epic
Obamacare
FHIR
Cerner-Siemens
HIPAA Breaches
Patient Engagement

What do you think of the list? Would you order it differently? Are there terms you think should be on the list?

Five Commonly Overlooked ICD-10 IT Transition Strategies

Posted on December 1, 2014 I Written By

The following is a guest blog post by Daniel M. Flanagan, Executive Consultant, Beacon Partners.
Daniel M. Flanagan, Executive Consultant, Beacon Partners
While some organizations have relaxed their approach to ICD-10 readiness given the October 1, 2015 extension, recent polls show that the majority of healthcare organizations remain woefully unprepared.  About 60% of healthcare systems and 96% of physician practices have not begun end-to-end testing according to recent surveys conducted by the College of Healthcare Information Management Executives (CHIME) and Navicure, a leading claims clearinghouse. A lack of testing puts the ICD-10 transition at the greatest risk of failure.

ICD-10 readiness planning should remain a top priority because conducting a comprehensive gap analysis and the resulting remediation work will correct system vulnerabilities that will improve revenue cycle performance today.  However, systems performance improvement is time and resource-intensive and cannot be achieved at the last minute.

Below are five often overlooked transition planning steps:

  1. Update and complete your IT system inventory. We have helped several healthcare organizations prepare for ICD-10 and a common vulnerability is the absence of a complete and accurate IT inventory. Nearly one-third of organizations do not keep an inventory, and, of those that do, most are inaccurate. Many contain systems that are no longer in use and fail to reflect new or recently upgraded applications. Only a few organizations have had a complete IT inventory that accurately reflects all systems requiring end-to-end testing.  We often discover code-sensitive “orphan” applications and systems implemented by end-users without the IT department’s review and approval, which must be added to the inventory. An accurate IT inventory is critical to determine the extent of testing required, and to budget the time and expense needed to complete it.
  1. Review the number and functionality of all interfaces. Revenue cycle interfaces often contain the most critical code processing gaps and represent an organization’s greatest transition risk. For example, workflow analysis sometimes reveals unreliable processing of ICD-9 codes by billing system or other interfaces.  Extensive remediation is needed after the readiness assessment is completed in such cases.  Highly unreliable manual systems are also often used to process code, which impacts work that should be handled electronically. When conducting a workflow analysis, we sometimes find that experienced revenue cycle system end-users disagree about the design and functionality of long-standing systems and interfaces. Friction can arise between end-users and IT application specialists when interfaces do not work or appear not to work properly. Such issues can often be resolved quickly and objectively when a workflow analysis is performed early in the readiness planning process.
  1. Enlist the support of system end-users early to identify performance gaps and devise solutions. Readiness requires that any system that stores, processes, or uses diagnosis codes be identified and tested. However, it is easy to overlook some important performance gaps. In the majority of cases, end-users can readily identify performance gaps and recommend potential, practical solutions.  End-users can also be valuable in identifying potential solutions.  Involving end-users as early as possible in transition planning can avert wasted time.  For instance CDI, case management, as well as QA operating and reporting systems are heavily code-driven, but can be tough to “see,” especially if work is performed on paper. Enlisting end-users to identify code-impacted systems is a great way to ensure nothing is missed.
  1. Set a date to begin testing and verify that payers, clearinghouses, IT vendors, and others tied to your revenue cycle are ICD-10 compliant. End-to-end testing is vital to confirm ICD-10 readiness. Without testing, problem areas are not recognized and will not get fixed, which places the transition at the greatest of failure. Request that each payer and vendor confirm system compliance in writing and set a date when testing will begin.  In addition, we always recommend that our clients call and, if possible, visit key payers to confirm their readiness.   A payer’s inability to commit to a testing date is a warning sign that warrants immediate follow-up.
  1. Align transition efforts and resources with top priority goals. Transition planning will highlight performance improvement opportunities across a range of systems — including IT, revenue cycle, clinical documentation, quality assurance, and EMR.  The variety of performance improvement opportunities sometimes results in an organization creating more goals than needed for a successful transition. Supplemental initiatives can be overwhelming to achieve with restricted resources in a limited timeframe.  The key is to identify “mission critical” transition objectives and allocate scarce resources accordingly.  Define clear objectives and create a detailed plan to monitor progress for achieving each goal.  For example:
    • Revenue cycle performance: Create benchmarks and dashboards for Key Performance Indicators (KPIs) that routinely report system performance now and after ICD-10 go-live.
    • IT: Validate system interfaces and upgrades, and perform testing to ensure confirmation of claim submission data flow. Testing results will provide valuable guidance to remediation efforts.
    • Clinical documentation: Establish a Clinical Documentation Improvement Program (CDIP) to audit provider documentation and coding. The initiative should be designed to provide ongoing training, as well as measure progress while ensuring data integrity, medical necessity, and billing compliance.

Although the deadline may have shifted, healthcare organizations need to stay on track to make the necessary IT and systems changes needed to optimize performance now and in the future.

About Daniel M. Flanagan
Daniel M. Flanagan is a seasoned healthcare executive with 28 years of leadership experience in the health system, physician practice and managed care fields. His primary interest has been performance improvement, especially in revenue cycle operations, improvement plan development and implementation and strategic planning, budgeting and implementation. Mr. Flanagan understands the challenges posed by today’s environment and is experienced in helping clients identify and capitalize upon opportunities to improve organizational performance.

Five Reasons to be Thankful for ICD-10

Posted on November 30, 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 Wendy Coplan-Gould, RHIA, Founder and President of HRS Coding.

It’s Thanksgiving weekend—a time for reflection and gratitude. Thoughts typically turn to family, friends, health, and life’s many other blessings. In addition to all of these, this Thanksgiving I suggest that the healthcare industry also include ICD-10 in our list of godsends. Here are five reasons why:

Reason #1:  To Code New Diagnosis, Procedures and Devices

The current ICD-9 coding nomenclature was developed in the 1970s. The healthcare industry can’t afford for this same system to be capturing data in the 21st century. We need the ability to specifically code new diseases, procedures and devices. For example, U.S. healthcare providers are unable to precisely code Ebola in ICD-9. That’s true.

There is no specific code for the diagnosis of Ebola in ICD-9, only a general code 078.89, other specific diseases due to viruses. In ICD-10, the code is A98.4, Ebola virus disease. This is the kind of data specificity that our nation needs and ICD-10 delivers.

Reason #2: To Help Keep Patients Safe through Better Data

ICD-10 also helps the healthcare industry capture and track data, and use it to ensure the safety of our patients. The inability to have specific data at our fingertips can be crippling to an institution and result in erroneous decisions based on faulty or imprecise data. Be thankful for ICD-10’s ability to accurately pinpoint diagnoses—and support more precise, exact patient care.

Reason #3: To Reduce Costs

Hospitals are strapped for money. Costs must be reduced whenever and wherever possible. ICD-10 will help hospitals properly bill for the services they deliver. With ICD-10 fully implemented and clinical documentation more granular, hospitals will experience fewer payer denials, claims audits and reimbursement appeals. Valuable time, money and resources will be saved over the long run.

Physician practices also have reason for thanks. New data published on the Journal of AHIMA website earlier this month suggests that the estimated costs, time and resources for offices to convert are “dramatically lower” than original estimates. According to the article, the actual conversion cost for a small practice ranges from $1,900 to $5,900, which is 92 to 94 percent less than initially predicted, resulting in a faster return on investment for your ICD-10 efforts.

Reason #4: To Improve Quality Scores and Performance Rankings

Setting aside zany codes and implementation barriers, ICD-10 is a blessing for quality reporting and performance scorecards. ICD-10’s code granularity works hand in hand with improved clinical documentation across all disciplines to help organizations achieve more accurate quality scores and competitive rankings. This is good news for hospitals and physicians alike.

For example, in ICD-9-CM, there is only one code (427.31) for atrial fibrillation.  In ICD-10-CM, physicians must specify the atrial fibrillation as paroxysmal (I48.0), persistent (I48.1) or chronic (I48.2), providing the specificity for a secondary diagnosis that can affect severity of illness scores and impact quality measures.

Reason #5: To Strengthen Hospital-Physician Relationships

ICD-10 is a bull’s-eye for governmental delay. And physician groups are usually the archers behind Congressional action against ICD-10. As recently as this week, physicians were pushing legislators to delay ICD-10 yet again. However, the tide may be turning.

In an effort to help their laggard physicians, many hospitals are reaching out to assist practices and groups in four key areas:

  • ICD-10 assessments
  • clinical documentation reviews
  • technology upgrades
  • physician-coder education

Helping physician practices with ICD-10 is an olive branch that must be extended to realize the full potential of ICD-10. Savvy organizations are using ICD-10 as a pathway to better hospital-physician relationships. Finally, AHIMA, MGMA and AMA have offered resources specifically designed to clear up common misconceptions and concerns physicians have about ICD-10.

No More Delays

It is estimated that the last delay cost the healthcare industry approximately $6.8 billion in lost investments, not including the cost associated with missed opportunities for better health data to improve quality of care and patient safety as mentioned above. Everyone from CMS to AHA, AMA, MGMA and HIMSS has endorsed the move to ICD-10 on October 1, 2015.

The rallying cry from hospital executives, IT directors and clinical coders is clear—no more delays! Even payers are pushing for the October 2015 date with a new consortium featuring Blue Cross Blue Shield of Michigan and Humana leading the charge. As Dennis Winkler from Blue Cross Blue Shield of Michigan states, “ICD-10 is good for the industry. . . . It is in everyone’s best interest to work together and ensure readiness across the board.”

Be Thankful

In Mitch Albom’s 2009 New York Times best seller, Have a Little Faith, the author asks an 82-year-old rabbi to identify his secret to happiness. “Be grateful” is what the rabbi repeatedly claims to be the only true route to happiness.

So next time your executives, staff or physicians are complaining about the transition to ICD-10, remember the five reasons described above . . . and be thankful.

About Wendy Coplan-Gould
Wendy Coplan-Gould is the embodiment of HRS. She has led the HIM consulting and outsourcing company since 1979, through up and down economies and every significant regulatory twist and turn of the last three decades. Long-time clients and new clients alike are on a first-name basis with her and benefit from her focus on excellence, reliability and flexibility. She has been published in the Journal of AHIMA and other recognized publications, as well as conducted countless professional association presentations.

Prior to starting HRS, Wendy served as assistant director, then director, of Health Information Management at Baltimore City Hospital. She also was associate director of the Maryland Resource Center, which provided data for Maryland’s Health Services Cost Review Commission, an early adopter of the Diagnosis Related Group (DRG) methodology. Wendy is available via email: wendy@hrscoding.com.

6 Thanksgiving ICD-10 Codes

Posted on November 27, 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.

I thought it fitting that AdvancedMD sent me 6 ICD-10 codes to be thankful for. Healthcare Humor…who doesn’t enjoy that? Happy Thanksgiving!

Y93.G3 Activity, Cooking and Baking
Ah, the turkey is roasting and the potatoes are boiling. And Cousin Carl just chopped the end of his finger off while preparing the veggie tray. He will earn this ICD-10 code, along with W26.0, Contact with Knife, to forever remember this year’s Thanksgiving…and that nasty scar.

W61.42 Struck by Turkey / W71.43 Pecked by Turkey / W61.49 Other Contact with Turkey
Thanksgiving isn’t Thanksgiving without a turkey. If three is a terrible mishandling of dinner’s main dish, or if a still-flapping gobbler enacts revenge, ICD-10 has three codes that are perfect for the season’s avian-related incident.

W21.01 Struck by Football
Another Thanksgiving staple is the good ol’ American sport of football. Usually, unless there is cheering for opposing teams, televised football games are safe enough. But a well-intentioned family flag-football game can result in a quick trip to the emergency room.

R63.2 Polyphagia (Overeating)
Parrots aren’t the only ones to watch out for this season. If a vampire or zombie takes their costume a bit too seriously, this code will record the chomp.

Y04.0 Assault by Unarmed Brawl or Fight
Black Friday shopping has become just as much a part of Thanksgiving as stuffing and pumpkin pie. But this mass hysteria for great deals doesn’t come without risks—especially when there are two shoppers and only one great bargain up for grabs. Get your extreme shopping skills up to snuff or Y04.0 and Y92.59, Other trade areas (mall) as the place of occurrence of external cause, may be jotted in your electronic health records.

W21.01 Lack of Adequate Sleep
No matter how we choose to celebrate Thanksgiving, few of us escape the meal prep, early morning shopping and family togetherness without a mild case of exhaustion. For those who try to do it all, there is an ICD-10 code for that.

Now I’m off to recover from my W21.01 and R63.2. Although, let me tell you, I had one of my best Turkey Bowl days ever. So much fun! Happy Thanksgiving everyone.