MTBC – Learning Center

ICD-10: The Disaster Hoax

With the ICD-10 implementation deadline looming around, most people conceive the idea as a serious threat or potential disaster for the healthcare industry. The perspective predominantly prevalent is that of the concept promoting ICD-10 as a very serious challenge to the physicians, practices and hospitals. No doubt it is a challenge from a psychological stand point; but in fact it is just another regular update to your everyday coding tasks. Logically, it is evident that every major update in our workflows and technology comes as a means of convenience and comprehensiveness in our systems and processes and making our lives easier.

Anticipation of newer versions of operating systems and updates to the tools, gadgets and technology are mostly linked with excitement and welcomed with enthusiasm. Why so in case of a coding upgrade that all IT vendors are presenting it as a threatening upgrade with expectations of losing revenues and workflow effectiveness. Most of the giants in the EHR, practice management and revenue cycle management space are promoting ICD-10 as a scary monster inflicting goose bumps to every soul that comes across this phenomenon.

ICD-10 is a coding system that has already been established by the regulators of International Classification of Diseases providing more comprehensive codes for every diagnosis that is done by the doctors. In short – a single code will cover many aspects of a specific disease or injury. Insurance payers will be more convinced through the new system of coding done at every practice. It will be an easier decision for accepting claims with a thorough explanation and to-the-point codes governing every procedure. Most physicians are not ready for the change primarily due to psychological reasons and unwillingness to accept the changes. In reality, it is a very simple change for every 100 most-used ICD-9 codes at your practice; you will have an option of using maybe an additional couple of hundred ICD-10 codes at your practice. A cardiologist who uses 40 frequent codes in super bills will end up familiarizing himself with 5-10 codes against each ICD-9 code, which should be a matter of only a week’s training to cover it all. There is no rocket science involved, just grab your copy of the specialty-specific ICD-10 codes guide which is easily available online, and practice creating new super bills with ICD-10 codes. It is eventually going to be easier to choose a code for any specific diagnosis that is being concluded. Mostly it is the physicians who will be making the call to use these codes.

For the first couple of months you might be fumbling around for your ICD-9 to 10 thesaurus and would get used to it very soon and might even throw away the guide you had paid for the all-so-hyped-up ICD-10 transition. The sooner you give it a try the earlier it will be over for you and your revenues would come in at an even greater pace.

Eventually it is a matter of just preparing yourself for a little change in what codes you were using, and there is no reason why your transition can’t be done smoothly. We at MTBC are ready to help you out with our easy-to-use tools for ICD-10 transition at your practice. Contact icd10@mtbc.com or call us at 866.266.6822 right now to grab your ticket to the ICD-10 flight.

Disclaimer: The information contained within the MTBC® Learning Center is provided for general educational and informational purposes only and should not be construed as legal advice. The author of the Learning Center does not represent the Web site user or the individual submitting a particular question. Please seek the advice of legal counsel to address any specific questions you may have regarding your particular facts or circumstances.

What is Meaningful Use? What are the stages of Meaningful Use?

Electronic health records (EHR) can provide many benefits for providers and their patients, but the benefits rely on its usage. One provider may use it as a glorified word processor, while another provider may utilize all its features to make his practice efficient. To establish this way of utilization for efficient practice, Centers for Medicare & Medicaid Services developed a set of standards which, if followed, will define the usage of EHR to be meaningful. Meaningful use standards govern the use of electronic health records and allow eligible providers and hospitals to earn incentive payments by meeting specific criteria.

The goal of meaningful use is to promote the spread of electronic health records to improve health care in the United States.

The benefits of the meaningful use of EHR include:

●     Complete and accurate information. With electronic health records, it is assumed that providers have the information they need at point of care to provide the best possible care. Providers will be better prepared to see their patients as walk-in-the-room, having access to patient lab, imaging studies, consults, etc. at point of care.

●     Better access to information. EHR allow providers to have increased access to the patients’ health information at point-of-care which in turn helps diagnose health conditions earlier and improves patient care quality and outcomes. EHR also allow information to be easily shared with other providers, hospitals and across the health system, leading to improved patient care.

●     Patient empowerment. EHR will empower patients to take a more active role in the care of their health and the health of their families. Via the patient portal, patients can access their health information securely and communicate with their providers for better provider-patient interactions.

Stages of Meaningful Use

In order to achieve meaningful use, eligible providers and hospitals must adopt certified EHR technology and use it to achieve specific objectives.

These meaningful use objectives and measures will evolve in three stages over the next five years:

MU Stages

Achieving meaningful use during Stage 1 requires meeting both core and menu objectives. All of the core objectives are required. EPs and hospitals may choose which objectives to meet from the menu set.

In coming weeks/months, we will learn about these Stages in detail. Visit next week to learn about timelines for the Stages and regulatory deadlines in 2014 for providers to meet.

What is a meaningful consent? Why we need to know?

With the increasing use of health information technology and electronic health records, health care provider’s share and access health information using their computers. There are multiple ways a provider can share patient information with another entity. One way is to provide data from one EMR in a portable format that the patient can take to another provider, which is then uploaded into the second provider’s EMR. Another way is to exchange patient data through the electronic Health Information Exchange (eHIE). Health information exchange (HIE) is a third-party organization that helps route information among various participating providers. In some HIEs, a provider can request information about a particular patient from all the provider participants’ patient database, and if any participating provider has any information about that specific patient, it will be relayed to another participating provider.

As eHIEs increase, patients must be made aware of these entities and their trust in HIEs must be ensured. This brings us to a question of the patient’s agreement to share his/her information from one participating provider to the other. The patient should now be asked to make a “consent decision.” This consent decision concerns the sharing and accessing of the patient’s health information through an HIE for treatment, payment, and health care operations purposes. When patients are asked to make consent decisions, the providers, HIEs, and other health IT implementers need to help patients make the consent decisions meaningful.

A Meaningful Consent

Consent is meant to be meaningful when you make sure that the patient considers the key parts – Patient education and engagement, Technology, and Law & policy while making their decision.

Patient Education and Engagement

This involves educating patients about their rights in the consent process – what options they have, what they are consenting to, who may see their information and what the significance of their consent choice is.

Technology

This component is a particularly important and evolving one. It involves utilizing technology that can provide proper security for sensitive health information and the option to limit access to particular health information per patient’s wish. Patients need to be made aware of the existence of such technology to ensure that their consent decisions are properly captured and maintained such that the sensitive portions of patient information remain restricted from access and these restrictions are properly communicated electronically with others.

Law and Policy

This component involves assurance to patients that the entity obtaining consent is following federal and state law that govern protection of the individuals’ health information and that their policies are in alignment with HIPAA and Privacy Laws whichever is more stringent.

Finally, consent should not be a “check-the-box” exercise. Meaningful consent is said to occur when patients understand their rights, risks and benefits, and make informed decisions, and where the choice is properly recorded and maintained.

Reference: HealthIT.gov (http://www.healthit.gov/providers-professionals/patient-consent-electronic-health-information-exchange/meaningful-consent-overview)

Challenges of Converting an ICD-9 Superbill to ICD-10

The U.S. healthcare system is now 10 months away from the ICD-10 “live” date and physician practices around the U.S. are currently deciding on whether or not to convert their current ICD-9 superbill to an ICD-10 superbill. Of course, there are several physicians who currently capture ICD-9s and CPTs through an EMR or practice management system. However, there are several physicians who would prefer to use a superbill with ICD-10 codes; there will be a larger number of codes on an ICD-10 superbill, and the superbill could be multiple pages.

It is well known that if a practice tries to convert their entire 1 page ICD-9 superbill (up to 200 ICD-9 codes) to an ICD-10 superbill, they could have up to a 15 page ICD-10 superbill, depending on the specialty and the number of the ICD-9 codes you choose to convert. To show the added complexity that providers will face when using ICD-10-CM, the Blue Cross Blue Shield Association converted a superbill from ICD-9-CM to ICD-10-CM.

1)      Blue Cross Blue Shield Association started with a model superbill created by the American Academy of Family Practitioner’s practice management journal, Family Practice Management (FPM). The back of the superbill showed 164 ICD-9 diagnosis codes identified by FPM as being those most commonly used by family physicians.

2)      About half of the 164 ICD-9 codes on the superbill were general codes such as “unspecified” or “not otherwise specified.” While these “unspecified” codes lack the specificity necessary to infer diagnosis details, they are often used on superbills due to space limitations. Continuing their use in ICD-10 will only further prevent ICD-10 code set’s increased granularity.

3)      BCBSA used CMS’ GEMS (General Equivalence Mapping) crosswalks to convert each ICD-9 code on the superbill to its equivalent ICD-10 code or codes.

4)      The superbill went from a 1 page ICD-9 superbill to an almost 9 page ICD-10 superbill.

MTBC recommends that physicians who want to continue to use a multi-page ICD-10 superbill begin to “dual code” clinic encounters and procedures using ICD-9 and ICD-10 codes. Practice managers should then track how much longer it takes a physician to find and circle codes on a 5 or 10 page ICD-10 superbill than it does on an ICD-9 superbill. This exercise will allow practices to decide whether the more cumbersome ICD-10 superbill is compromising the efficiency of the charge capture process that currently runs smoothly with a 1 page ICD-9 superbill.

Practices need to be open that an electronic charge capture may be the best solution in an ICD-10 coding environment. Use these next few months to decide whether or not your practice will continue to use an ICD-10 superbill.

ICD-10 Readiness Guidelines for Physicians

ICD-10 is being compared to the “Y2K” of the Healthcare industry. With that in mind, it is critical that physician practices be prepared for ICD-10 coding to minimize revenue flow disruption and ensure clinical documentation matches ICD-10 specificity.

According to an April 2013 survey of 500 physician practices conducted by Navicure, practices consider physician/staff training and payer readiness to be the two biggest challenges concerning the ICD-10 transition. One third of practices surveyed anticipate a productivity drop between 20 and 40% in the 4th quarter of 2014 (the initial 3 month period of ICD-10 coding).

Navicure recommends the following 7 steps to prepare for ICD-10 coding:

1)       Build an ICD-10 team internally (in a small practice, this could be every staff member)

2)       Review clinical documentation to ensure it supports ICD-10 granularity.

3)       Conduct a gap analysis to map your most commonly used ICD-9 codes to ICD-10 codes.

4)       Update your technology (EMR,PMS,Clearinghouse solutions) to support ICD-10.

5)       Provide internal support (budget for training, testing, etc.).

6)       Provide targeted ICD-10 education to physicians, coders/billers, and clinical staff.

7)       Test and monitor ICD-10 coding several months prior to Oct 1, 2014 to validate the efficiency of ICD-10 charge capture and the accuracy of the ICD-10 codes selected by your practice.

Historically, there has been a lack of payer preparedness with previous industry transitions, such as the transition from 4010 to 5010 electronic claims transactions. Larger payers (Medicare, BCBS, Aetna, UnitedHealthCare, etc.) are more likely to be ready for ICD-10 than smaller payers. MTBC recommends working closely with your billing vendor and/or clearinghouse to verify when payers will be ready to test ICD-10 codes and if payers will be ready to accept “live” ICD-10 codes on October 1, 2014.

MTBC will work very closely with its clients to test ICD-10 claims with payers and ensure minimal cash flow disruption related to ICD-10 payer and clearinghouse denials. MTBC is committed to identify and fix any client concerns that arise during ICD-10 testing to ensure a smooth ICD-10 transition.

The key to success for physicians practice regarding the ICD-10 transition will be:

1)       Developing an Internal ICD-10 transition project plan

2)       Comprehensive training for providers and affected staff

3)       Coordinating testing and implementation with your vendors, clearinghouse, and payers