Presentation on theme: "ICD 10 Administration Staff Back Office Physicians Tools."— Presentation transcript:
ICD 10 Administration Staff Back Office Physicians Tools
ICD-10 will be one of the most monumental transformations our medical communities will see in many of our management careers. Each of us, whether we are providers, staff members, or managers is responsible for ensuring our practices remain solvent and that we can manage successfully through this epic transition. “Knowledge is Power” and doing it together will be so much easier than trying to manage everything alone. If it takes a village to raise a child, then we believe it will take a community to assist each other in transitioning to the ICD-10 model. We hope the information in this presentation is beneficial to many and that we are able to exchange information, communicate with each other, and grow our medical communities together. Here is to the hope that October 1, 2014, is as lame as Y2K! Continue
ICD 10 Defined The International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) is a revision to the ICD-9-CM system used by physicians and other health care providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital care in the United States. Like ICD-9-CM, the ICD-10-CM is based upon the International Classification of Diseases, which is published by the World Health Organization (WHO) and which uses unique alphanumeric codes to identify known diseases and other health problems. According to WHO, the ICD assists in the storage and retrieval of diagnostic information and in the compilation of national mortality and morbidity statistics.WHO The ICD-10-CM revision includes more than 68,000 diagnostic codes, compared to 13,000 in ICD-9-CM. In addition, ICD-10-CM includes twice as many categories and introduces alphanumeric category classifications for the first time. Preparation for ICD-10 varies widelyPreparation for ICD-10 varies widely among health care providers. American Medical Association opposes implementing ICD-10.opposes implementing ICD-10 ICD-10 preparationICD-10 preparation combines technology, testing. Find answers to FAQs about ICD-10 CM.FAQs about ICD-10 CM Related glossary terms: serious reportable event (SRE), American Health Information Management Association (AHIMA), ICD-10, ICD-10-PCS, ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification), ICD-11serious reportable event (SRE)American Health Information Management Association (AHIMA)ICD-10ICD-10-PCSICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) ICD Eight Warning Signs Your Practice Is Not Ready for ICD Eight Warning Signs Your Practice Is Not Ready for ICD 10
PHYSICIANS CMS: “Road to 10” eHealthUniversity : ICD-10 eHealthUniversity : ICD-10 Clinical Documentation; Supporting Good Patient Care and Proper Coding in an ICD-10 Environment-VIDEO Clinical Documentation; Supporting Good Patient Care and Proper Coding in an ICD-10 Environment
Staff Laboratory and Diagnostic Testing Services-ICD-10 Implementation Needs Laboratory and Diagnostic Testing Services-ICD-10 Implementation Needs Clinical Documentation; Supporting Good Patient Care and Proper Coding in an ICD-10 Environment-VIDEO Clinical Documentation; Supporting Good Patient Care and Proper Coding in an ICD-10 Environment
Staff Laboratory & Diagnostic Testing Services - ICD-10 Implementation Needs One thing that will not change is the fact that labs will be completely dependent on physicians to provide accurate diagnosis codes on test orders. As an example, under Medicare, electronic reimbursement claims for (let’s say clinical lab tests) a claim must contain valid and specific diagnosis codes that explain the reason the tests were performed. Proper diagnosis codes are especially important in cases when Medicare establishes a National Coverage Determination (NCD) or Local Coverage Determination (LCD) that limits reimbursement to only certain situations. In 2003, an NCD was implemented which limits glycated hemoglobin tests to once every 3 months for a controlled diabetic patient. In order for the lab to receive reimbursement for a fifth glycated hemoglobin tests for this type of patient in the same year, the ordering physician would need to indicate with an appropriate diagnosis code that the patient’s diabetes was not well controlled. It is important to note! that unlike anatomic pathology, radiology, or other diagnostic providers, clinical labs may not code their own claims, nor can they fill in the blanks without consulting the ordering physician. This will be the single greatest challenge labs face in handling a new, more complicated universe of diagnosis codes. Industry leaders have been quoted as stating that “For years, labs have been tasked by Medicare to teach physicians how to code for limited coverage tests, so with ICD-10 labs are going to have to go into a rigorous education campaign with their physicians,” and “I’m sure there will be many visits where the lab will try to help the physician and office staff train on lab-specific ICD-10 codes. And it’s going to be difficult.” Once the ICD-10 codes for NCDs and LCDs are published later this year, labs should be going full-throttle with their education campaigns and one can anticipate regular visits and educational materials/tools to aid in proper utilization and documentation of ICD-10 code sets Listed below are a number of resources (with additional ones being included as they become available) offering insight and guidance to further maintain and enhance your working relationship with these entities during and after ICD-10 implementation? https://www.labcorp.com/.../L0lDU0lKSWdrbUEhIS9JRFJBQUlpQ2dBehttps://www.labcorp.com/.../L0lDU0lKSWdrbUEhIS9JRFJBQUlpQ2dBe https://www.questdiagnostics.com/...icd/planning-for-ic...www.aacc.org › Publications › Clinical Laboratory News › 2011 › June Prepare Now for ICD-10-CM and ICD-10-PCS Implementation...www.acr.org ›...American College of Radiology ICD-10-CM - Centers for Disease Control and PreventionPublicationsClinical Laboratory News2011 JunePrepare Now for ICD-10-CM and ICD-10-PCS Implementation...ICD-10-CM - Centers for Disease Control and Prevention Return to Staff Slide
BACK OFFICE/BILLING o The Transition of Medical Records to ICD-10 Starts Now The Transition of Medical Records to ICD-10 Starts Now o Precyse-Why We Love ICD-10 and so will you! Precyse-Why We Love ICD-10 and so will you! o ICD-10-CM Official Guidelines for Coding and Reporting 2014 ICD-10-CM Official Guidelines for Coding and Reporting 2014 o Guidelines Most Significantly Affected Under ICD-10-CM Guidelines Most Significantly Affected Under ICD-10-CM o ICD-10 Conversion-Keeping in the Black ICD-10 Conversion-Keeping in the Black o ICD-10 CODING BASICS-VIDEO ICD-10 CODING BASICS o CMS Presents-ICD-10 Training to Assist Small Physician PracticesICD-10 Training to Assist Small Physician Practices o ICD-10 Code Set-Struck by a Bird - VIDEO ICD-10 Code Set-Struck by a Bird o Funny ICD-10 Codes- VIDEO Funny ICD-10 Codes
Staff Avery Hurt is a freelance writer based in Birmingham, Ala. Her work has appeared in publications including Newsweek, The New Physician, Muse, Parents, USA Today, and the Washington Post. E- mail her at - See more at: Return to Back Office/Billing Keep Your Medical Practice in the Black During the ICD-10 Transition February 13, 2014 | ICD-10, Coding, Medical Billing & Collections, Overhead, Revenue Cycle Management, Staff, Training By Avery Hurt You may have heard some pretty scary talk about how implementing the new ICD-10 coding system could be very expensive, possibly even bankrupting small medical practices. However, if you are smart and well-prepared, you can not only survive the transition, but benefit from fairer reimbursement in the long run. Looking for more information on preparing your practice for the ICD-10 transition? Learn what to expect and how to be ready for Oct. 1 from our experts at Practice Rx, a new conference for physicians and office administrators. Join us May 2 & 3 in Newport Beach, Calif. "Fears of bankruptcy might be extreme, but this transition could have a significant impact on finances," said Asia Blunt, practice management strategist at the American Academy of Family Physicians. According to a new analysis from the AMA, the costs of implementing ICD-10 for physician practices could be significantly higher than previously estimated. New estimates range from $56,639 to $226,105 for small practices and $213,364 to $824,735 for a medium-sized practice. Beyond the cost of software upgrades, new paperwork, and staff training, the biggest potential for losses will be denied claims during the early days of the new system. CMS has estimated that claims denial rates could increase 100 percent to 200 percent in the early stages of coding with ICD-10, according to the AMA. The way to minimize denied claims is by being sure your staff is well-trained. With proper training on the new codes, the learning curve shouldn't be too steep, but it is essential not to wait until the last minute to start getting ready. "I'm frightened when a practice tells me that they plan to start training in August," says Brenda Edwards, CPC, an AAPC ICD-10 trainer. "That's too late. You need to begin training earlier to allow time to become proficient before [the Oct. 1, 2014 deadline]." Blunt also recommends having a claims denial process in place. When a claim is denied, and many will be at first, locating the problem — asking if it is a coder issue or a payer issue, for example — can make it easier to correct problems and prevent future denials. It's always a bad idea to not follow-through on denied claims, but that could be disastrous following the ICD-10 transition. While denied claims might be the source of the biggest losses, they certainly aren't the only place where an unprepared practice can lose money. A savvy practice will also be prepared for hidden costs or costs they may not have thought of. Some are relatively small. For example, certified AAPC coders will be required to take an ICD-10 proficiency assessment, and there is a fee for this. Other hidden costs are larger and more difficult to quantify, such as the cost of lost productivity while employees are training. Another unpleasant surprise can come when vendors don't have the software upgrades completed in time, or if the upgrades aren't suited to the particular needs of your practice. Edwards recommends getting in touch with both your EHR vendors and your payers to make sure that not only will they be ready on time, they will be ready in time for you to have a trial run of the new systems well ahead of the October 1, 2014 deadline. You don't want to wait until then to find out that your vendor left out the very codes you need the most. Even with the best preparation, some things will inevitably go wrong. "The AAFP is recommending that practices have at least a three-month cash reserve," said Blunt. "If they have the capability to have additional cash reserves, that would be better. However, if they have at least a three-month reserve, this should be sufficient time to identify any problems with payers and claims transmission and resolve them," she said. Ideally, of course, you won't need that much extra cash. Thorough preparation is the key to sailing through this transition with your finances in good shape. Of course, truly astute practices are taking the long view. Even if they do have to cover some losses in the short term, the ICD-10 codes, with their more specific diagnoses should allow for more accurate claims resulting in more equitable reimbursement in the future.
ADMINISTRATION MGMA ICD-10 and 5010 Implementation MGMA ICD-10 and 5010 Implementation ICD-10 Six Months Out—Are You On Target? ICD-10 Six Months Out—Are You On Target? A R MA-ICD-10: Are you ReadyICD-10: Are you Ready ICD-10 Conversion-Keeping in the Black ICD-10 Conversion-Keeping in the Black The Cost of Implementing ICD-10 for Physician Practices The Cost of Implementing ICD-10 for Physician Practices AMA Letter to Kathleen Sebelius-Secretary, US Dept. of HHSLetter to Kathleen Sebelius-Secretary, US Dept. of HHS CMS Presents-ICD-10 Training to Assist Small Physician PracticesICD-10 Training to Assist Small Physician Practices ICD 10 Financial Planning Tips-Lisa Enright for AAPC ICD 10 Financial Planning Tips-Lisa Enright for AAPC
TOOLS AMA ICD-10 Project Plan Template: assn.org/resources/doc/washington/icd10-checklist.pdf assn.org/resources/doc/washington/icd10-checklist.pdf Precyse University-Why We Love ICD-10 and so will you! Precyse University Mobile Apps ICD-10 Doc GuideICD-10 Doc Guide
Staff Lisa M. Enright is a Senior Vice President and Manager of the HealthCare Practice Banking Division for RBS Citizens Financial Banking. She can be reached at (860) or at Return to Administration March 3rd, 2014 By Lisa M. Enright for AAPC As healthcare providers across the nation prepare for the upcoming implementation of ICD-10, planning should factor in the financial impact on your practice. As you prepare for the conversion, the magnitude of the changes on your employees, your patients and your bottom line should not be underestimated. There are practical expenses – as well as potentially hidden costs – you should be planning for today. These five tips will help you identify items you need to consider and actions you need to take in anticipation of expanding capital and increased cash flow flexibility that will affect your practice both before and following the October conversion. Like many aspects surrounding the transition, to be fully prepared, it is prudent to address finances three to six months in advance of October. 1.Understand Capital Needs –The complexity of the ICD-10 implementation will require software upgrades and extensive staff training in advance of the conversion. Your bank can construct term loans to address these capital expenditures. 2.Arrange Working Capital – Understand the average time it takes today to collect receivables, and expect the average time to lengthen significantly as practitioners learn the new codes. To backstop a longer receivables cycle, you should have access to three to six months of working capital reserves. Although you cannot control whether your payers will be ready and whether they are fluent in the new codes, an expansion of your working capital line of credit will help your practice manage available cash reserves through a period of delayed receivables. In advance of the conversion, talk to your banker about how to obtain or increase an existing line of credit. 3.Before You Meet with Your Banker – Compiling essential documents before meeting with your bank will expedite the credit review and result in a fuller discussion of the practice’s financial needs. These documents should include tax returns for the prior three years for the practice and the principals, year-to-date interim financials, current Accounts Receivable Aging Report and an updated personal financial statement. 4.Work with a Bank that Understands Your Needs – As the healthcare industry becomes more complex, it is important to work with a bank that understands the specialized financing requirements of healthcare practitioners. Some banks have specialized units dedicated to the healthcare professional. A knowledgeable banking partner who understands the full scope of your industry and operation – from posting and managing your receivables to establishing loans and lines of credit – can design financing plans that anticipate your short- and long-term needs. 5.Widen Your Cash Flow Window – Rather than writing checks to pay for monthly operating expenses, use a business credit card to stretch out payments. Some banks offer extended 50 day billing cycles which can provide additional cash flow flexibility. To avoid interest payments, pay your credit card bill in full each month.
Eight Warning Signs Your Practice Isn't Ready for ICD-10 PearlPearl | January 29, 2014 | ICD-10, Managers Administrators, Medical Billing & Collections, PearlsICD-10Managers AdministratorsMedical Billing & CollectionsPearls By Betsy NicolettiBetsy Nicoletti 1. Your practice hasn't spent a dime to get ready. There are a dozen excuses for this. "If I send her for training, she'll just want more money or go to another practice." Or, "We'll wait and buy the final version of the ICD-10 book when it's released. It's still in draft form, you know." While large systems and groups are well on their way to ICD- 10 preparedness, some smaller groups have taken a wait-and-see approach. They hope that CMS will change its mind, and push back the deadline. Or, they tell themselves, "It will get quieter in the spring, we'll do it then." Lame excuses. Buy the draft version of ICD-10 and educate key staff members; plan physician training for closer to implementation, either in person or online. Looking for more hands-on guidance on preparing your medical practice for the ICD-10 transition? Join us for Practice Rx, a new conference for physicians and administrators, on May 2 & 3 in Newport Beach, Calif. Our experts will help prepare your staff for this major medical coding shift without damaging your bottom line.Practice Rx 2. Your software vendor tells you not to worry. Well, if your vendor tells you not to worry and has shown you their mapping program and has installed the latest software, then OK. Is your vendor well established and committed to the program you have? There is a shakeout going on in the EHR and practice-management world, partly related to meaningful use. Look in trade journals, talk to your specialty and professional societies, and be sure your vendor will still be in business, supporting your needs, in I'd still worry. Or better yet, prepare. 3. You're using a paper encounter form and select diagnosis codes from it. A long, laudable essay could be written about the benefits and ease of using a paper encounter form. It would need to end with "rest in peace," however. Circling the most common codes and writing in a code that isn't on the form — when a more specific code was available — has resulted in many unspecified codes. It wasn't good practice in ICD-9 and will become impossible in ICD-10. ICD-9 had about 14,000 diagnosis codes and ICD-10 has about 70,000. It is the rare specialty practice that uses a handful of the same codes over and over. Groups using paper encounter forms for diagnosis coding will need a new system. 4. The software upgrade to an ICD-10 compatible version is scheduled for September Be on the latest version of your software — get an early upgrade so you can try out the ICD-9 to ICD-10 mappings and begin to educate providers using your system. Worry if the vendor has a late implementation date. At the very least, ask for a test version. Continue
5. Currently, you have claims denied as "not medically necessary" and/or pre-authorizations for diagnostic tests denied because there is "no covered indication." These are diagnosis-code problems in ICD-9 and they are only going to get worse in ICD-10, when the volume of diagnosis codes explodes to 70,000 codes. There will always be some of these denials in a practice: The patient may not have a covered indication or the payer policy changed. If your practice is experiencing these now, however, the problem will only grow. Expect some glitches as payers migrate their coverage policies from ICD-9 codes to ICD-10 codes. 6. No cash on hand or available line of credit. Let's say your staff is trained, your providers are scheduled for online specialty training, you own ICD-10 books, and your software has a mapping program that you've tested thoroughly. You've tested with CMS and all went well. There's one more thing to do. Save some cash. One single fly in the ointment, one payer, one clearinghouse glitch, one binary 0 that should be set to 1 has the potential to slow your payments. For example, if one small insurance company that represents 7 percent of your revenue stops paying, how long can you make payroll and pay bills? 7. You never saw an unspecified diagnosis code you didn't like. It is easy to be complacent about diagnosis coding in a medical practice. After all, most ICD-9 codes support the medical necessity for an E&M service, specific or not. Many procedures have an obvious diagnosis: appendicitis for appendectomy. Diagnostic tests and procedures have always required more care in selecting the accurate code. But, if you run a report and find a high frequency of unspecified codes (codes ending in.9), pay attention. Start using specific ICD-9 diagnosis codes now to ease the transition to the more detailed and descriptive ICD-10 system. 8. A bonus worry. If your system allows users to change the definition of an ICD-9 code from the official ICD-9 language to words that are "easier to find" for the clinician, switch back to official ICD-9 language today. Don't even think of converting to ICD-10 if your current diagnosis descriptions don't match official language WE have changed the language of icd 9 to match what our docs call the disease to make the correct dx selection MAY NOT BE THE RIGHT THING FOR ICD 10????. Betsy Nicoletti is the founder of Codapedia.com. She is the author of "A Field Guide to Physician Coding." She believes all physicians can improve their compliance and increase their revenue through better coding. She may be reached at or Eight Warning Signs Your Practice Isn't Ready for ICD-10