Search results
Be part of one of the largest healthcare events in the United States when ICD10monitor brings you three days of broadcast coverage from Orlando, site of this year’s HIMSS. Subject matter experts representing leading healthcare vendors, clearinghouses, and consultants will be calling in live from Orlando to report the latest…
The year ahead is shaping up to be something of a prize fight. You could call it battle of the regulated sectors of the healthcare industry.
One of the biggest challenges we face as we prepare for ICD-10 is getting providers engaged. Too many of my colleagues view this transition as an administrative function or a coding initiative. They lack an appreciation for, and understanding of, how this code set implementation is going to affect their…
As adults, we learn theories in many different ways; however, until we apply those theories or glean “What’s in it for me?” it’s difficult to truly learn much. The opportunity to take knowledge and apply it in practice is a great one, especially when we are talking about ICD-10. I…
Physicians excel at thinking analytically – that is, using a step-by-step clinical decision-making process to arrive at an accurate diagnosis. This logical way of thinking will be a huge asset when it comes to ICD-10. Physicians must ask critical questions of themselves and their staff to determine their “ICD-10 prognosis.”…
Depending on the size of your practice or facility, ICD-10 budgeting requirements and reporting will vary. But one fact still remains: all practices must budget for ICD-10-CM implementation. Most physician-based practices utilize a cash-based accounting system, while larger facilities and hospital-owned clinics utilize accrual-based accounting. Either accounting system will require…
An eponym is defined as the person for whom something is named. In the world of Western science and medicine, eponyms are commonly used to name everything from conditions, drugs, and devices to procedures and techniques. This is a relic from the past, when medicine lacked tools to investigate underlying…
Depending on the publisher, there are about 30 pages of guidelines in the ICD-10-CM code set. The bulk of these guidelines, from section 1.C, are chapter-specific.
In spite of what you may have heard, clearinghouses are indeed ready to facilitate the end-to-end testing of ICD-10 claims between providers and payers. In fact, they have been ready for two years—since implementation of the 5010, according to Gloria Chung, chief operating officer at Office Ally, LLC—one of the…
When preparing for the final steps of ICD-10 implementation, it is suggested that every organization set up a “war room” or “command center” to be available during the transition phase. This technique has been used for years by project management groups and implementation teams in many fields to increase communication…
What if you could tell health plans how they are really doing so they can improve their performance? That’s the intent of a new survey provided by the Cooperative Exchange, a nationally recognized resource and representative of the clearinghouse industry. This confidential online survey provides a means for healthcare electronic…
Just a year ago, the idea of actually being ready for ICD-10 implementation by October 1, 2014, seemed a distant dream, full of confusion and panic. Since then, a lot of people have done a lot of work to get the ball rolling in the right direction, and the guests…
We are in the middle of the rollout of health insurance exchanges of the Patient Protection and Affordable Care Act (PPACA), and there are a few significant lessons the healthcare industry, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) should…
Editor’s Note: Laurie M. Johnson of Peak Health Solutions presented a segment outlining 10 ICD-10 New Year’s resolutions during the Jan. 7 edition of Talk-Ten-Tuesday, the weekly Internet broadcast on www.ICD10monitor.com. The following is a rough transcript of that presentation. January is a month where we all make New Year’s…
Happy New Year! This is a year of significant change. Of course, I am talking about the ICD-10 transition, which will be the most significant change I have seen in the 32 years of my healthcare career. I know many of you are getting very nervous – especially those of…
Physician documentation is of the utmost importance in the healthcare industry, both today and once ICD-10-CM/PCS goes into effect on Oct. 1, 2014. Insufficient physician documentation will continue to be problematic under ICD-10-CM/PCS unless hospitals address the problem now.
EDITOR’S NOTE: Holly Louie is the newest member of the ICD10monitor editorial board. With the final countdown to ICD-10-CM implementation underway, more and more providers are looking for solutions to help them master the looming coding changes. Vendors are investing tremendous resources and marketing various solutions to meet these needs.…
EDITOR’S NOTE: This article originally appeared in the ICD10monitor e-news on Dec. 18, 2012. Just as sure as the menorah is on display at the deli and Santa Claus can be seen stuffing himself down that cheesy cardboard chimney at the hardware store, one day soon you will notice when…
The Workgroup for Electronic Data Interchange (WEDI), in partnership with the 2013 WEDI Report Founding Sponsors, released the 2013 WEDI Report. The culmination of a 7-month public-private effort with more than 200 subject matter expert volunteers, this report will serve as a new roadmap for healthcare IT over the next…
EDITOR’S NOTE: This is the ninth in a series of articles on fast-tracking ICD-10 implementation. This month marks the beginning of the “Countdown to ICD-10.” We have only 10 months left to get ready. Many of my clients have been asking, “What are the top four areas of implementation that…
One of the biggest questions doctors have these days is “which codes will I actually use when ICD-10 kicks in on Oct. 1, 2014?” This is the great mystery. Fortunately, we have access to the same code set that payers will be using as they determine which codes they would…
Every major religion seems to have some sort of festival in the December-January time frame, and as far as I can determine, all of them are positive, upbeat, and “sharing” in nature. If you celebrate such a holiday at this time of year, best wishes to you and yours. One…
An implementation plan without contingency planning is most likely an incomplete plan, according to Joseph C. Nichols, MD. Nichols, in a soon-to-be-released white paper, writes that contingency planning must “be an integral part of the implementation plan in order for it to reduce the risk of failure.” Expressing deep concern…
Many individuals working within the healthcare arena will recognize the above phrase, as it is extracted from the legacy of surgical training. While perhaps overstating a surgical resident’s ability to assimilate information, the principle does, in fact, describe the process of learning within many surgical and medical specialties. As an…
The looming implementation of ICD-10 is doing a great job exposing the gaps that currently exist in our healthcare delivery stream. One such gap can be found in the flow of diagnostic information from a physician to ancillary providers such as labs, imaging centers, and home health providers, just to…
In a survey conducted by the Cooperative Exchange this fall, a large number of clearinghouses report they are well positioned for implementation of ICSD-10 on October 1, 2014. The Cooperative Exchange (CE), established in 2002 to promote and advance electronic data exchange for the healthcare industry by improving efficiency, advocacy,…
Implementing integrated clinical documentation improvement (CDI) and computer-assisted coding (CAC) technology platforms can help hospitals achieve more positive results than would be realized using CAC alone. The most significant impact CDI technology has on the CAC component of an integrated platform is creating high-quality documentation, and documentation has a direct…
Nobody enters a race to finish second, and no team fields just their defense. During recent months there has been a clear business rationale for focusing on essentially defensive strategies for wrapping the ICD-10 transition in revenue neutrality. But as planning for 2014 falls into place, an argument has been…
Below is a case study that identifies some of the subtle differences between the descriptions of ICD-9-CM and ICD-10 codes. Note that the ICD-10 codes provide a higher level of specificity to the code assignment. Postoperative diagnosis: Colloid cyst of the third ventricle Operation: Bi-frontoparietal craniotomy, transcallosal removal of colloid…
Editor’s Note: For another installment of profiles of thought leaders in the healthcare industry, ICD10monitor’s publisher recently interviewed healthcare executive-turned-healthcare consultant Lyman G. Sornberger. Having stunned the healthcare industry with his abrupt departure from the famed Cleveland Clinic Health System (CCHS) in November 2012 for what he told the Cleveland…
EDITOR’S NOTE: This is the first article from Rhonda Buckholtz, vice president of ICD-10 education and training at AAPC, who has joined the ICD10monitor editorial board. We talk about documentation and how it needs to change under ICD-10, but really, the implementation of new codes should not be why documentation…
ICD-10-PCS represents a major departure from ICD-9-CM procedure coding, and as such, many coding specialists find ICD-10-PCS much more challenging to learn than ICD-10-CM (which still shares many similarities with ICD-9-CM). In order to ease the transition from one code set to the other, we are providing tips for coding…
Few providers are aware of the risk adjustment model that is quietly emerging under the Patient Protection and Affordable Care Act (also known as the ACA). That model is known as the Hierarchical Condition Categories (HCCs), and it has been the basis for reimbursement for Medicare Advantage plans (Medicare Part…
The emergency department (ED) is a hospital’s front door to the public. It’s also an open back window for revenue loss. ED volumes continue to rise while reimbursements drop. And according to recent executive surveys, there is no end in sight. Long wait times, primary care shortages, and an underinsured…
In January 2011, Cedars-Sinai Health System engaged a consulting firm to help build an initial project management plan for its global ICD-10 implementation. The plan started as a risk assessment and recommended governance structure. As we started developing a more detailed plan and moved into execution, the need for multidisciplinary…
As I write this, it’s mid-afternoon on Veterans Day. It’s also one of those rare moments when I actually reminisce about my time in the U.S. Air force – more than eight years, actually – and whether I made a difference. Oh, I’m no martyr. I know my time in…
I have a confession: I’ve had a sour attitude about ICD-10 lately. I know I’m not the only one, but I’m usually the champion and cheerleader for the new coding set. It seems like there’s a large amount of negativity surrounding the transition to ICD-10, and the loudest voices seem…
The recent decision by the Centers for Medicare & Medicaid Services (CMS) to set aside the week of March 3-7, 2014 as ICD-10 Testing Week is raising concerns among healthcare industry experts. Amid a flurry of rumors that CMS stakeholders were reconsidering the need for end-to-end testing, the agency issued…
For many, the ICD-10 journey can be compared to running a marathon – and with less than one year until implementation in the United States, all providers should be well into their preparation plans and nearing the finish line. In other words, providers should be in their final stages of…
EDITOR’S NOTE: This is the first in a continuing series of profiles of healthcare thought leaders. Angela Kennedy, EdD, MBA, MED, RHIA, CPHQ, president/chair, AHIMA Board of Directors. Kennedy is also chair of the health informatics and information management department at Louisiana Tech University.  She served two terms as president…
EDITOR’S NOTE: This is the eighth in a series of articles on fast-tracking ICD-10 implementation. As I started developing training plans for hospital facilities and physician practices, I realized it would not be an easy process. It may sound simple, but it isn’t. There is so much to consider: who…
Cooperative Exchange, the national association representing organizations in the healthcare information technology and transaction industry, held its membership meeting last month in San Diego during the MGMA National Conference on October 8. The number one topic of discussion: Transitioning from ICD-9 to ICD-10 on October 1, 2014, and the clearinghouse…
The debt ceiling crisis of 2013 temporarily brought the U.S. government to a halt and pushed both political parties into an arduous, lengthy budget showdown. Just like the U.S. government, hospitals annually struggle to rob Peter to pay Paul. Cost reductions and expenditure cuts are commonplace for healthcare providers.
Basic combat training in the U.S. Military is a 10-week training course that transforms civilians into soldiers. Likewise, basic coder training for ICD-10 turns ICD-9 coders into ICD-10 experts. Or does it? Just like in the military, it’s hands-on experience and day-to-day exposure that turns basic training into ICD-10 expertise.…
Codes in the ICD-10-CM code set are more detailed than the codes included in ICD-9-CM. To assign these detailed codes, physician documentation will need to include more specific and detailed information. There are ICD-10 codes for unspecified conditions, and coders have indicated they could avoid the query process and assign…
I must admit, I’m not much of a hipster and I don’t know what a hashtag really is. I’ve tweeted once in my life, and it was for a very uncool purpose (I was at a conference and they had a gimmick where attendees could tweet songs they wanted to…
We are less than a year away from ICD-10 GO LIVE and we have either not quite started, done a little, are in the throes of moving our plan along, continuing to firm up our documentation, or are getting ready to move into dual coding. That is certainly going from…
ICD-10 is the lollapalooza of healthcare. It’s the curtain going up on a Broadway premiere. It’s the opening seconds of the worldwide telecast of The Oscars. It is the solid clank of the metal safety harness pressed hard against your legs on the Cyclone roller coaster on Coney Island, when…
Greetings, everyone. In this article, first I want to address some “show” business; then I want to talk about the deadline no one seems to know about. Since the AAPC National convention in May, I’ve been to national trade show after show. Most recently it was the Medical Group Management…
A few weeks ago, while teaching an ICD-10 seminar for chiropractic doctors, one physician asked me if ICD-10 solved the sprain/strain issue that exists under ICD-9. Frankly, I was not familiar with the problem, so I did a little digging.
We’re now into our final year of preparation for ICD-10 implementation, and it seemed like a long time coming. Most of us have had a detailed implementation plan with a timeline and deliverables in place for some time now. For those of you working in health information management (HIM) and/or…
Unfortunately, many healthcare leaders do not believe they have time for ICD-10 education with all of the significant operational changes now occurring in the healthcare industry. That’s the view expressed by Greg Adams, president of consulting services at Panacea Healthcare Solutions. Adams was addressing the impact of ICD-10 on education…
While ICD-10 has been touted as “revenue neutral” by CMS, HIM professionals at this week’s 85th annual convention of the American Health Information Management Association (AHIMA) know different.
According to industry experts, there are nearly 200,000 active clinical coders in the U.S. who must be trained within the next 12 months. And once ICD-10 is live, an additional 38,000 coders are required to meet healthcare’s day-to-day productivity needs. If training hasn’t already started for your coding and CDI…
Finally, the critical importance of ICD-10 testing in healthcare has a national stage. The overwhelming evidence that such testing was overlooked and not performed properly is being highlighted during the current U.S. Department of Health and Human Services (HHS) hearings concerning the launch of the healthcare.gov insurance exchange website. As…
The Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS) continue to update the official guidelines related to ICD-10-CM/PCS coding. This article summarizes the ICD-10-PCS guidelines only, including one significant change from the FY 2013 guidelines. A quick review of the introductory section emphasizes…
I have come to the conclusion – no, I have reaffirmed my existing conclusion – that healthcare in these United States of America does battle from no less than five camps. The Four Pillars of Healthcare First there are the providers, both institutional and professional (euphemisms for “bricks and mortar”…
People sometimes ask about my background and what qualifies me to talk about ICD-10. Let me start at the beginning. I was raised by wolves, but ran away to join the circus at 4. Wait, that’s probably going too far back. No, what qualifies me to talk about ICD-10 was…
Oct. 1, 2014 will be here before you know it. Does it seem as though your practice’s ICD-10-CM clock is getting louder by the month? What can you do to reduce the noise? If the clock is thrown out the window, would that work? Not in your dreams! What can…
The convergence of a number of Centers for Medicare & Medicaid Services (CMS) initiatives is intended to improve healthcare quality and therefore will impact all healthcare clinicians significantly, but these initiatives also will result in workflow changes for the coding and reimbursement professionals who support clinicians. Specifically, CMS is driving…
Roseanne Barr once said that she likes facts and data because they help her think clearly. With dual coding, it is easy to rationalize the reasons and justify the means. But what really matters is the output. Dual-coding efforts must produce useful information to prepare your organizations for ICD-10.
How can we retain our coders during the transition to, and following, the ICD-10 system implementation? That’s a question on the minds of many healthcare providers now, and senior leaders at Boca Raton Regional Hospital in Florida have answered this question and others as the implementation date of Oct. 1,…
Now that we are one year out from the ICD-10 implementation deadline, we have to consider that this transition is about something much larger than a change in the way we code. ICD-10 highlights the need for us to change our perspectives on how we think about the quality of…
EDITOR’S NOTE: Today we are day 15 of a partial government shutdown with the distinct possibility of the United States defaulting on its obligations come Thursday. We are one year away and counting from the ICD-10 go-live date of Oct. 1, 2014. Who would have imagined in 1979, when we…
EDITOR’S NOTE: We recently caught up with the newly elected 2014 president and chair for the American Health Information Management Association, Cassi L. Birnbaum. A resident of North County San Diego, Birnbaum was en route from Atlanta to San Diego Friday evening. She is vice president of Peak Health Solutions.…
As the October 1, 2014, implementation date for ICD-10-CM/PCS approaches, facilities are realizing they must mitigate the risks they may be facing as a result of gaps in their documentation. One of the most important steps in mitigating these risks is to conduct an in-depth review of the current state…
Help with ICD-10 implementation is just a click away, according to Matthew Albright, acting director of the Administrative Simplification Group in the Office of E-Health Standards and Services for the Centers for Medicare & Medicaid Services (CMS). Albright joined the Oct. 1 broadcast of “Talk-Ten-Tuesday” to touch base with listeners…
ICD-10-PCS represents a major departure from ICD-9-CM procedure coding, and as such, many coding specialists find ICD-10-PCS much more challenging to learn than ICD-10-CM (which still shares many similarities with ICD-9-CM). In order to ease the transition from one code set to the other, we are providing tips for coding…
Just as the political divide in Congress between Republicans and Democrats became evident at the stroke of midnight with  the partial shut down of the federal government, so too does the divide swell between providers in large metropolitan areas and those located in rural communities as both face the mandatory…
When I first met him, a talkative and enthusiastic Alan Hale seemed as regular a guy as could be. He recently had discovered what he reportedly described as a “fuzzy object” while exploring the universe with his telescope in the driveway of his New Mexico home. His discovery was the…
The transition to ICD-10 is a significant endeavor requiring a tremendous investment of financial capital and human resources. Unfortunately, many providers are approaching the conversion as a “one-and-done” event. While this approach might work in the short term, it will not reap long-term or sustainable value relative to an investment.…
As a result of the upcoming ICD-10 transition, many chief financial officers (CFOs) aren’t sleeping so well as they ponder the single biggest “what if” scenario: cash flow. Speaking during the Sept. 17 broadcast of “Talk-Ten-Tuesday,” former hospital CFO and former Healthcare Financial Management Association (HFMA) chair Greg Adams—now president…
Hindsight, of course, is always 20-20 . . . Before continuing, I need to define “pauser,” the rather odd word in the headline. A “pauser” is, to my knowledge, a made-up term I’ll define as: “An organization that took the potential for, and actual, one-year delay in the ICD-10 implementation…
It’s no secret that ICD-10-CM offers more codes and increased granularity of data for the coding of orthopedic diagnosis and procedures. And it’s also no secret that orthopedic dollars are critical to a hospital’s bottom line—including revenue from treating fractures. Therefore, shoring up orthopedic documentation and coding is a critical…
Popular culture is rife with doomsday scenarios for the end of the world, ranging from televangelist Pat Robertson, who predicted the end of the world in the 1980s, to the Heaven’s Gate cult followers in San Diego, who predicted of demise of the world when the Hale-Bopp comet appeared and…
April 10, 2014, is the “no-later-than” date by which all Medicare contractors must publish on the Medicare coverage database (MCD) their ICD-10 local coverage determinations (LCDs) and associated ICD-10 articles. That’s the official word from the Centers for Medicare & Medicaid Services (CMS) in transmittal and MM8348 (issued on Sept.…
Conditions classified in Chapter 18 of ICD-10-CM include symptoms, signs, and abnormal clinical and laboratory findings that do not have a classifiable diagnosis listed elsewhere in the medical record. However, not all sign and symptom codes are classified in Chapter 18. Some signs and symptoms are classified in the body…
According to the Office of the Inspector General (OIG), which is like the police force for government programs, doctors of chiropractic (DCs) have a less-than-stellar track record when it comes to documentation. The OIG issued a report in 2005 regarding Medicare’s payment for chiropractic services. Based on data from 2001,…
Most of us associate boot camps with a military training program. Just about everyone is familiar with the concept of repetitive drills that are rigorous, intensive and challenging, thus quickly preparing young men and women for military service. Military boot camps, also known as basic training, give our service members…
In the 1996 film Jerry Maguire, an anxious NFL player yells and screams to the titular agent, “Show me the money!” Rod Tidwell’s famous line was his last-ditch effort to motivate Jerry and secure a new contract. In a similar way, today’s hospital CFOs are asking health information management (HIM)…
Many organizations have a plan associated with their commitment to perform dual coding to achieve the widely publicized benefits outlined below. Although there is not an official dual-coding survey that examines the frequency, duration, scope, methodology and outcomes associated with the overall provider plans and experiences, it is clear from…
As many of us have started delving into ICD-10-CM diagnosis coding, we have realized there are many lessons to be learned from the coding of these same disorders currently used in ICD-9-CM. We soon realize the ICD-10-CM coding system has expanded significantly in the specificity of codes and changes made…
The healthcare community has expressed concern about the cost of training and the potential loss of coding productivity due to the implementation of ICD-10-CM and ICD-10-PCS. Some experts have predicted a loss of productivity between 10 and 50 percent. Many facilities are concerned about recruiting and retaining qualified coding professionals…
At this point in the healthcare industry’s push to implement ICD-10, we are inundated with articles that focus on the usual suspects – critical education needs, physician cooperation, systems and documentation assessments, and the elusive end-to-end testing. Any healthcare professional with five minutes and an Internet connection can saturate himself…
Once upon a time, even though Medicare was still the most reliable payer for health services at acute-care hospitals, assignment of ICD-9 codes was not considered to be of any great importance there.
Transitioning from ICD-9 to ICD-10 will involve many hurdles for healthcare organizations, with issues including:     Interruption of the hospital revenue stream Lack of clarity across ICD-10 project portfolios Cost overruns Schedule slippage Inadequate resources Cash flow Increased operating costs The current time period, combined with the Centers for…
Recognizing the need for focused education on PCS — especially education directed toward ancillary service staff, and not mainly for coding professionals and physicians — ICD10monitor will launch an 11-week series of webcasts starting tomorrow.
The Centers for Medicare & Medicaid Services (CMS), through its Medicare Learn Network (MLN), recently provided a presentation titled “ICD-10 Basics.” This was a great review for those of us entrenched in Wonderland, with stars in our eyes as we wish upon the implementation of ICD-10 to soon be over…
ICD-10-PCS represents a major departure from ICD-9-CM procedure coding, and as such, many coding specialists find ICD-10-PCS much more challenging to learn than ICD-10-CM (which still shares many similarities with ICD-9-CM). In order to ease the transition from one code set to the other, we are providing tips for coding…
Nearly every speaker at the recent HIMSS ICD-10 Forum touted the rewards of dual coding with ICD-10. Examples of rationale and anticipated advantages were flying. But something was lacking in each of the conference’s sessions. No one explained the finer nuances of dual coding. Some attendees no doubt walked away…
As hospitals begin to incorporate ICD-10-PCS into their daily operations, a number of issues have become increasingly prevalent. Many complex surgical procedures actually are fairly simple to code in ICD-10, while other simple procedures present a number of coding issues. On the physician side, we are now at an early…
EDITOR’S NOTE: This is the sixth in a series of articles on fast-tracking ICD-10 implementation. I have been traveling the past month, presenting ICD-10 awareness information to various groups, including hospital boards of directors, hospital executives, and physician groups.  I find it interesting that many still don’t understand how ICD-10…
It’s easy to forget now that there was a time not too long ago when people around the world were working feverishly against a ticking clock as “Y2K” approached. We dealt with many of the same issues other types of companies dealt with: resource depletion, software vendors, lack of product…
Good Samaritan Hospital is located in Los Angeles. It was founded in 1885 and is a nonprofit hospital with more than 400 beds. Annually, it has almost 16,000 inpatient discharges, 86,000 ambulatory outpatient visits, and more than 25,000 ER visits. It has 52 residents/fellows and a medical staff of approximately…
As the national focus on the importance of clinical documentation integrity (CDI) relative to coding, billing, quality initiatives, risk management, utilization, medical necessity, etc., has intensified, many healthcare organizations across the continuum of care are initiating efforts to improve documentation. This CDI emphasis can and should be used to refocus…
Approaching the fourth quarter of 2013, which coincidently is the quarter that marked the original ICD-10 implementation date, it might be wise to take a moment to look down the road toward 2014. In thinking and reading about ICD-10, we continually hear about the need for specificity within documentation in…
Many have been keeping up to date on the pulse of ICD-10’s pending rollout with broadcasts such as Talk-Ten-Tuesday and other informative industry insider resources, many of which can be found at ICD10monitor.com. All these offerings provide clarity among the ICD-10 implementation fog. With so many other healthcare changes happening…
Panacea Healthcare Solutions, Inc., publisher of industry-leading ICD10monitor, announces its newest ICD-10 training tool, Webcast Wednesdays, Featuring ICD-10-PCS Solutions with Lolita M. Jones. This 11-week training series is designed to provide hospitals with the necessary knowledge and tools necessary to conduct end-to-end testing of their coding billing systems under ICD-10.…
The Lott QA Group is pleased to announce the launch of the ICD-10 National Testing Program in support of the healthcare industry. ICD-10 is the biggest healthcare change ever to impact the healthcare since the implementation of ICD-9 in 1979. Healthcare entities are now busy preparing their organizations to convert…