Tag Archives | Healthcare Providers

Emergency Care: CDI in the ED Part II

EDITOR’S NOTE: This is the final installment in a two-part series on clinical documentation integrity (CDI) in the emergency department (ED). It is my opinion that investing CDI resources into the neglected stepchild that is the hospital system ED is a worthwhile endeavor. Getting diagnoses captured early and repeatedly creates performance improvement. Even more importantly, […]

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Providers Take Note: These Simple Strategies Will Improve Billing, Patient Satisfaction

Unfortunately, many healthcare providers are missing out on things like electronic billing, email capture. A new survey by the Medical Group Management Association suggests providers, especially hospitals, are missing out on key areas to improve when it comes to patient billing, payments and satisfaction. The Digital Payments Progress report, a product of a partnership with […]

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CMS Targets Heart Disease With New Program

More than 500 healthcare practices have been selected to participate in a new pilot program designed to prevent heart attacks and strokes in Medicare patients, the Centers for Medicare & Medicaid Services announced Thursday. The Million Hearts Cardiovascular Disease Risk Reduction Model is the latest idea from the CMS Innovation Center, which conceptualizes and tests […]

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CMS: Successful April Medicare FFS ICD-10 End-to-End Testing

According to today’s announcement from the Centers for Medicare & Medicaid Services (CMS), ICD-10 implementation success is here.

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10 Questions To Ask Payers Today About ICD-10

There’s more to communicating with healthcare payers than handing them a medical claim and saying, “Pay me.”

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Fact: ICD-10 Will Benefit Medical Coders More Than ICD-9

For the last so many decades, we’ve been using ICD-9. ICD-9, which stands for International Classification of Diseases, 9th edition is the system of codes used to classify every disease and medical condition.

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Two-Midnight Rule Will Short-Change Hospitals, Providers Say

Healthcare providers say Medicare is going to short-change them on patients who spend fewer than two nights in the hospital, and delaying implementation of a new payment policy until October won’t change that.

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Conversion To New Government Codes For Healthcare Providers Could Spark More Confusion

If you think the issue of healthcare is already a big source of confusion, wait till medical providers try to divine the new diagnostic “codes” the government has prescribed to describe diseases and hospital procedures for insurance companies to pay the costs involved.

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The Impact of ICD-10 on Healthcare Providers’ Revenue Cycles

Healthcare Providers to Learn Best Practices for Achieving Financial Neutrality through ICD-10 Transition Bellevue, Washington (PRWEB) September 14, 2011

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Heads Up Coders: 2013 ICD-10 Implementation Date Is Firm

Plus: CMS has proposed freezing the ICD-9 codeset after next year.

If you were hoping that the Oct. 1, 2013 ICD-10 implementation date wasn’t set in stone, you are out of luck. That’s the word from CMS during a June 15 CMS Open Door Forum entitled “ICD-10 Implementation in a 5010 Environment.”

“There will be no delays on this implementation period, and no grace period,” said Pat Brooks, RHIA, with CMS’s Hospital and Ambulatory Policy Group, during the call. “A number of you have contacted us about rumors you’ve heard about postponement of that date or changes to that date, but I can assure you that that is a firm implementation date,” she stressed.

Brooks indicated that the rumor about a potential delay in the implementation date continues to persist throughout the physician community, and recommended that practice managers alert their physicians to the fact that that the rumor is untrue.

The Oct. 1, 2013 date will be in effect for both inpatient and outpatient services. Keep in mind that the ICD-10 implementation will have no impact on CPT and HCPCS coding, Brooks said. You will still continue to bill your CPT and HCPCS procedure codes as before.

You’ll Find Nearly 55,000 Additional Codes

Currently, CMS publishes about 14,000 ICD-9 codes, but there are over 69,000 ICD-10 codes. The additional codes will allow you to provide greater detail in describing diagnoses and procedures, Brooks said.

If you’re wondering which specific codes ICD-10 includes for your specialty, you can check out the entire 2010 ICD-10 codeset, which CMS has posted on its Web site. “Later this year, we’ll be posting the 2011 update,” Brooks said during the call.

@ For more details on CMS’ upcoming plans, subscribe to Part B Insider (Editor: Torrey Kim, CPC).


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Radiology Coding: Bone Scan Rate Benefitting From Healthcare Reform

Don’t let 2006 DXA code references lead you to use wrong codes.
Which codes should you use to reap the benefit of CMS’s new calculations for bone scan payment? During an April 13 CMS Open Door Forum, that’s what one caller wanted to know.
Good ne…

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Billing How-To: Should A Provider Change Tax IDs?

Despite disadvantages, a new tax ID is a must when physicians leave your group.

Question: One of our optometrists wants to stop billing under the group’s tax ID and start billing under his own tax ID. I’m concerned that doing so will confuse the insurance companies and slow down his income, even though he has personally called some to notify them of the change and the effective date. Some payers are now asking for new W9 forms. Is there an easy way to do it?

Answer: Your optometrist can change his tax ID at any time, but you must submit a new W9 to your payers, in addition to a letter explaining that he will no longer be practicing under the group’s tax ID.

Downside: Yes, the optometrist’s income will be slowed. You also run the risk that the payer’s enrollment department does not handle the paperwork properly. Other billers have reported instances of the income being paid to the old tax ID or not being paid at all. Claims can also be lost even though the correct paperwork has been submitted multiple times.

If your optometrist is currently part of a group, and he is leaving the group, he needs his own tax ID. Many legal issues will arise from this. For example, if he is staying in the same office suite, he will have to pay market rent for the offices and staff that he is using. When patients move between the old practice and his new practice, questions will arise about which patients are considered new and which are considered established patients.

Much of this will have to be determined by the legal structure that is set up as he leaves the group. This can be a much more complex change than it appears on the…

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Ophthalmology Coders: Does Old BB-Gun Injury Have Bearing on Coding?

The reason your patient is visiting is key.
Question: We have a patient who came in for a routine eye exam, but reported retinal damage from a BB-gun incident six years ago. What would be the best way to code this? This is a new patient, and I do not h…

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Chiropractic Coding: Avoid This Common Documentation Mistake

Treatment plans are a must, experts say.

You’ve treated your chiropractic patient, you’ve selected the correct codes, and you’ve submitted your claim. All set, right? Not quite. Check out this common mistake that chiropractors make.

“Many chiropractors do not create written chiropractic treatment plans for every new patient,” says Marty Kotlar, DC, CHCC, CBCS, president of Target Coding, a chiropractic coding and billing consulting firm. Use this checklist to ensure you send Medicare the information CMS most wants to see included “with every new patient plan of care,” Kotlar says:

__ The history
__ Present illness
__ Family history
__ The past health history
__ The physical examination
__ The diagnosis
__ The plan — This should include:

  • Therapeutic modalities to effect cure or relief (patient education and exercise training)
  • The level of care that is recommended (the duration and frequency of visits)
  • Specific goals that are to be achieved with treatment
  • The objective measures that will be used to evaluate the effectiveness of treatment
  • Date of initial treatment.

__ Signature/initials to authenticate the records.

@ Part B Insider (Editor: Torrey Kim, CPC).

Sign up for the upcoming live audio conference, Risk Management Strategies for Healthcare Providers, or order the CD/transcripts.

Be a hero. Sign up for Supercoder.com, and join the coding community at the Supercoder.com Facebook Fan Page.

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Medical Records: 5 Reasons Your EMR Transition Will Pay Off

The hard work and hassle of ditching paper documentation is not in vain.

Question: Our office is weighing the pros and cons of transitioning to electronic medical records (EMRs). We know the process is a huge undertaking that often results in even lower productivity and more confusion. So, is making the change really worth it?

Answer: If you haven’t witnessed or lead a conversion from paper records to an electronic medical record (EMR) system, it’s easy to get overwhelmed by the potential downsides. But experts agree that yes, going electronic is worth it. Here are a few reasons why:

1. You Open More Cash Inlets. Many research studies pull their data via electronic records. So, if you can’t tune in to participate, opportunities for cash perks will fly by. “Grant money and incentive programs are available, for example, and they want data in the electronic form,” points out Francine Wheelock, PT, MPA, manager of clinical systems for MaineGeneral Health.

Just look at nationwide push for value-based purchasing and outcome data, and expect to go electronic if you want to be in the loop.

Stay alert: Last year, the federal government launched the Health Information Technology for Economic and Clinical Health (HITECH) Act, which plans to pay eligible healthcare professionals incentives for the “meaningful use” of certain EMRs.

“SLPs, OTs and PTs are not eligible for the incentive payment,” confirms Kate Romanow, director of health care regulatory advocacy for the American Speech-Language Hearing Association. But they may be eligible in the future, so therapists “may want to consider implementing EHRs now,” she says.

Plus, you can enhance coordination of care with healthcare providers who are eligible for HITECH incentives and are adopting EHRs, points out Sarah Nicholls, assistant director for payment policy and advocacy for the American Physical Therapy Association….

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