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We have been living with ICD-10 for nearly 30 days now, and I think things are going fairly well. What I would like to discuss is coder productivity and accuracy in the hospital setting.   I was a bit concerned when I was told that offshore coders are only coding…
EDITOR’S NOTE: The following is a rough transcript of comments made by Jill Finn during the Oct. 12, 2015 broadcast of Talk Ten Tuesdays. The HATA (Healthcare Administrative Technology Association) practice management members as well as our members from organizations like the AMA (American Medical Association) and UnitedHealthcare have been…
Now that ICD-10 is a reality in U.S. healthcare, providers are finding that Oct. 1, 2015 didn’t bring with it the doomsday scenario they thought it might – but they also know that ICD-10-related challenges that aren’t apparent now may manifest themselves in the coming months.  The latest data from…
EDITOR’S NOTE: Dr. Anon is a U.S. physician based overseas who wishes to remain anonymous. Following implementation of ICD-10, what has happened in the coding world as it pertains to outsourcing? The answer is simple: chaos. For those of you old enough to remember, I am not describing a Get…
Many healthcare organizations recently have contracted with coding vendors to provide ICD-9 coding assistance, in part to allow in-house coders to undergo ICD-10 training and participate in dual coding. Some of these vendors employ U.S.-based coders only. However, it’s becoming more common for companies to employ a mix of both…
The healthcare industry may have finally flipped the switch to ICD-10, but many of us know that the hard work has only just begun.  For example, during the first week following implementation, H.I.M. ON CALL has spent considerable time gathering feedback from its coders, monitoring productivity, and keeping lines of…
Astute coders comparing this year’s ICD-10-CM guidelines with those in their 2015 books might be surprised by several changes.  Unmarked and made with no fanfare, the changes are worth noting.   A recent line-by-line comparison by AAPC ICD-10 education staff verified changes mostly in Section I. They include the addition…
EDITOR’S NOTE: The following is the final installment of a two-part series dealing with early signs of challenges facing physicians in their adoption of ICD-10. Many physicians are confused as to when to report the seventh-character extension. Physicians are confusing CPT® guidelines with ICD-10 guidelines. CPT and ICD-10 are two…
After months, and, in some cases, years of training, coders have finally begun to code in ICD-10. However, just because ICD-10 officially went live on Oct. 1, doesn’t mean that coder training should cease. In fact, just the opposite is true.  Remedial training will be critical during the first six…
EDITOR’S NOTE: This article is the first installment in this two-part series. ICD-10 has finally been implemented!
Efforts to fix what has been identified as the first significant issue to emerge under ICD-10 — medical necessity — appear to be underway with Medicare Administrative Contractor (MAC) NGS reporting that it will update its local coverage determination (LCD). The LCD issue surfaced earlier this week, when Laurie Johnson,…
The topic of medical necessity surfaced in the form of National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs) during yesterday's ICD10monitor.com broadcast, "ICD-10: Five Days in Ten." The first to report on the issue was Laurie Johnson, MS, RHIA, FAHIMA, who made the discovery Monday, saying that her "eyes…
The Centers for Medicare & Medicaid Services (CMS) is monitoring the progress America’s healthcare industry is making with the implementation of ICD-10 – but it’s also standing by with a series of contingency plans should there be any significant disruption.
Tony Broyles Tripp Cox In the recent ICD10monitor article ICD-10 is Risky Business, Holly Louie states that “the best way to fix claim errors is to not make them in the first place.” Since the Oct. 1 implementation of ICD-10 has passed, how will your organization know when and where…
The first significant glitch of the ICD-10 era seems to be connected to physician office scripts, as reported during ICD10monitor's War Room live broadcast today. That's the assessment from healthcare consultant and educator Laurie Johnson, MS, RHIA, FAHIMA, who monitored the broadcast.
After multiple delays, ICD-10 is now the national (and to some degree, international) standard for the definition of each patient’s health state.    While there are many different standards in other areas, this is the only standard of its kind for the definition of patient condition that is nationally mandated…
It now has been a few days since ICD-10-CM/PCS was implemented, and these first weeks and months certainly are bringing some excitement and intrigue. 
EDITOR’S NOTE: The following is part one of a two-part series dealing with challenges facing physicians in their adoption of ICD-10. The day finally came and went. I must admit, I am relieved there were no more delays in ICD-10 implementation. It is time to move forward. But ICD-10 anxiety…
Early reports from the first full day of ICD-10 indicate that some of the nation's practice management system (PMS) vendors are giving a thumbs up to implementation of the new coding set — although, of course, they're still waiting for the ultimate verdict: adjudication of claims.  "Our experience is positive…
The operative report is truly a goldmine of information. This is true in ICD-9, and it will be even more important in ICD-10, when coders will need to look for more specific anatomical information, as well as additional details about the procedure itself. They’ll need to read each and every…
The potential for a perfect storm of ICD-10 being implemented and the federal government shutting down on the same day – Oct. 1, less than a week away – is stirring major concerns among providers nationwide. The majority of questions fielded by Centers for Medicare & Medicaid Services (CMS) Principal…
Although many got a laugh (or were completely confused) by former Secretary of Defense Donald Rumsfeld’s infamous convoluted answer to a question, it seems it was prophetic of where we are on the road to ICD-10. “There are known knowns; there are things we know we know. We also know…
The years of preparation, planning, and work are about to pay off: ICD-10 is here. On this coming Thursday, Oct. 1, 2015, the national standardized coding system goes live. For payers, system remediation, end-to-end testing, financial impact analyses, staff training, and risk analysis/contingency planning should be done. But the real…
While the term “countdown” has debatable origins, scholars have attributed it to events as different as space shuttle launches, New Year's celebrations and Cambridge University rowing races, most healthcare insiders agree it now applies to ICD-10. Although many providers have counted down the time remaining until the ICD-10 transition, we…
We are now within two weeks before ICD-10 implementation begins on Oct. 1, 2015. Going through your readiness checklist is a daily process, and at this point we all must ensure that there is nothing forgotten or skipped. The ICD-10 countdown checklist should include several key activities and areas, including…
As we head into the final stretch of ICD-10 preparations, it’s important to review the ICD-10-CM guidelines, some of which include significant changes that affect code completion/validity and sequencing. In fact, many of these changes are ripe for audit and compliance challenges. In this article, I’ve summarized some of the…
EDITOR’S NOTE: Stanley Nachimson, founder of Nachimson Advisors, LLC, is the recipient of the 2015 Ten Leadership Award from ICD10monitor. Nachimson was recognized for his decade-long industry leadership in the adoption of ICD-10. Nachimson is co-chair of the WEDI-SNIP ICD-10 Testing Workgroup. He has been co-chair of the HIMSS ICD-10…
EDITOR’S NOTE: The following is transcription of a segment on Talk Ten Tuesdays by H. Steven Moffic, MD, speaking on the subject of workplace stress and burnout, occasioned by the impending conversation from ICD-9 to ICD-10. Dr. Moffic is nationally renowned and award-winning author, and has blogs published by Behavioral…
September 16, 2015

Lollapalooza 092015

By
https://youtu.be/QO7bUSUBm44
EDITOR’S NOTE: The looming implementation of ICD-10 is bringing symptoms of workplace stress and burnout for healthcare professionals. So ICD10monitor recently asked nationally renowned psychiatrist H. Steven Moffic, MD for some timely advice. Dr. Moffic is an award-winning author and has blogs published by Behavioral Healthcare and Psychiatric Times.
ASSOCIATION NEWS The Electronic Healthcare Network Accreditation Commission (EHNAC) and the Healthcare Billing & Management Association (HBMA) have announced a collaboration to accredit medical billers in the areas of privacy, security, confidentiality, cybersecurity, business best practices and technical operations. 
In these final few weeks prior to ICD-10 implementation, your coding countdown checklist should include several key and critical points to consider. The appropriate steps along this countdown path are important to follow and observe. Make sure you have coding/physician queries on that list.
Have you reviewed your Medicare Administrative Contractors’ (MACs’) new local coverage determinations (LCDs) that include ICD-10 codes instead of ICD-9 codes? Do they include the full range of ICD-10 codes that map from the ICD-9 codes in current or former policies? Some of them don’t, warns JoAnne Glisson, senior vice…
Sometimes people do their homework with setting up a new system, and sometimes they don’t. Sometimes, even when those people do their homework, it may not be adequate, and billions of dollars of avoidable wasteful spending occurs.    But too often “they” won’t listen. 
The countdown continues leading up to the immovable ICD-10 implementation deadline of Oct. 1, 2015. We are down to a couple of weeks to go. Providers across the country are facing the cold reality that delaying is no longer an option. For those who have lived through this for 40 years,…
And so it begins…. It appears that ICD-10 implementation is moving forward on Oct. 1, 2015. It is important to have facility guidelines in place for ICD-9-CM as well as for ICD-10-CM/PCS at the time of implementation. These guidelines frequently are requested by auditors and should be maintained by version…
We are now in the final few weeks before ICD-10 implementation, and it’s critical that coding and health information management (HIM) professionals take the appropriate steps along the way. You need to review your final checklist before Oct. 1 arrives – and to make sure you have in your checklist…
With only 30 days left until ICD-10 implementation, many in the healthcare industry are starting to get nervous. There are ways to ensure that you are prepared on time, but practices need to move fast. Here’s how you can make it happen.
I cannot believe it is finally here. After much debate and two delays ICD-10 is about to become a reality. Many of us are meeting this challenge with excitement and a bit of apprehension. I must admit the fear of the unknown right now is causing me a bit of…
In this age of electronic health records (EHRs) and big data collection, data analytics continues to pique curiosity. With the simple click of a button, organizations can analyze and cross tabulate essentially any data they collect, including productivity data as well as data that is financial or clinical in nature.
What is the difference between delirium and encephalopathy? This is a common discussion among coders and clinical documentation improvement (CDI) professionals alike. Usually when a question like this comes up, the solution is simple: check the literature. Unfortunately, the information is somewhat contradictory, so we continue the debate while Recovery…
When ICD-10 implementation becomes a reality on Oct. 1, 2015, clinical laboratories will continue to experience challenges related to the submission of test requisitions, no matter how prepared they are internally. Administrative problems that exist under ICD-9 will not go away; in fact, they could worsen under ICD-10 if the…
It looks like ICD-10 will indeed keep on trucking, with the American Medical Association (AMA) now on board and the Centers for Medicare & Medicaid Services (CMS) having made an announcement regarding a transition period. Not only was this important to reassure folks that there would be no turning back with…
As organizations continue to search for ways to mitigate coder productivity loss following implementation of ICD-10, they also must consider methods to monitor and enhance coding accuracy. After all, productive coders are only effective when those coders assign accurate and complete codes. A low DNFB doesn’t denote coding compliance, nor…
The risks associated with the changeover to ICD-10 on Oct. 1 have been numerous and varied. Will there be increased allegations of false claims? Did the recent Centers for Medicare & Medicaid Services (CMS) clarification regarding “families” of codes alleviate concerns? Will the change really create a surge in improper…
Despite countless hours of ICD-10 coder training and practice time on the part of their staffs, coding managers often lack access to objective measurements of real-world coder proficiency with ICD-10. While training systems test coders with scenarios and check-the-box exams, organizations often struggle to predict how their coders will perform…
With ICD-10 just two months away, the question I’m asking providers is this: When was the last time you watched the 1999 American comedy Office Space? Not just because we could all use a little more levity in our lives — though that’s certainly reason enough. Rather, it’s because Office…
Sherry Wilson Tina Greene There are less than three months left for effective transition planning prior to the ICD-10 implementation deadline, and there are still unknowns regarding which states are adopting ICD-10 for workers’ compensation. Providers either will need to transition fully to ICD‐10 and/or be required to support both…
Recently, the Healthcare Administrative Technology Association (HATA), the national association for the practice management system (PMS) industry, released the results from a survey on PMS vendors’ ICD-10 readiness as of July 1, 2015.
With the recent Centers for Medicare & Medicaid Services (CMS) announcement of a “grace period” related to ICD-10 coding specificity for Part B physician claims, there is a spotlight on unspecified ICD-10 codes. But how much will health information management (HIM) leaders need to worry about unspecified codes? According to…
If you’re part of a small practice, you’ve no doubt found the past few years in the healthcare industry to be a little overwhelming at times, to say the least. With mounting regulatory challenges, escalating costs, and fewer reimbursements, providers are feeling real strain. And now, with the looming ICD-10…
As I recently traveled around the country interacting with representatives from various clinical documentation improvement (CDI) programs, I began to notice various patterns. What differentiates successful programs from those that struggle in mediocrity or falter and sometimes disintegrate? One factor in particular: an active and expert physician advisor.  An uninvolved…
EDITOR'S NOTE: The following article constitutes a transcript of comments recently made exclusively to ICD10monitor.com by a former representative of an offshore coding entity who requested to remain anonymous. With ICD-10 go live on the horizon and the predicted production drop, many of you have found or are scrambling to…
For years and years, there has been a national shortage of coding professionals – and by that I mean professionals who are well-educated, trained, credentialed, and experienced.
Summer is the most popular time for tying the knot and other celebrations that tend to see people get carried away and sometimes end up with the need for a little medical attention. So to help you prepare for the wonderful season of love, marriage, and the chaos that follows,…
DEVELOPING STORY The Centers for Medicare & Medicaid Services issued new guidance late Monday in an effort to clarify the agency’s joint statement issued on July 6 regarding an agreement reached with the American Medical Association.
A recent announcement from the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) was certainly a welcome surprise to most of us. There were actually three items involved: the announcement, the additional guidance document, and a letter to Medicare providers.  Everyone I’ve talked to has…
I would like to propose that there are two sides to the revenue coin when considering the impact of ICD-10. The first revenue impact, and the one felt more immediately, will be the impact on cash flow (and, correspondingly, revenue). Now, why will there be an impact on revenue? Well,…
Last week the Centers for Medicare & Medicaid Services (CMS) announced, in cooperation with the American Medical Association, an agreement not to audit and penalize practices for incorrect ICD-10 coding as long as a valid code in the correct category is reported for one year after ICD-10 goes live on…
It looks like ICD-10 will indeed keep on trucking, with the American Medical Association (AMA) now on board and the Centers for Medicare & Medicaid Services (CMS) recently having made an announcement regarding a transition period. Not only was this important to reassure folks that there would be no turning back…
With less than three months until ICD-10 go-live, you may still be having trouble engaging providers around the new code set. If so, that’s not surprising.  While we know that patient care will ultimately benefit from ICD-10’s increased specificity and data detail, doctors are focused on the here and now.…
A joint announcement issued on July 6, 2015, by the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS) tackled a number of ICD-10 issues in an effort in ease the burden for physician practices transitioning to ICD-10. While this effort addressed several important issues, at…
Project managers (PMs) understand that the key elements of the ICD-10 project—making a plan, training your clinical staff, updating internal processes, communicating with vendors and payers, testing internal systems, and testing externally are all table stakes: Doing well in these areas is no guarantee of success, regardless of the facility…
When something needs fine-tuning, it’s either near the end of preparation (“Hey, let’s fine-tune the presentation before tomorrow’s meeting”) or in pretty good shape overall (“Fortunately, that squeak is no big deal; your car just needs fine-tuning”). For most providers, both scenarios are likely an accurate reflection of their ICD-10…
“Lately it occurs to me what a long, strange trip it's been.” No sooner had custodians cleaned up the remaining debris from the three-night “Fare Thee Well” concert by the Grateful Dead at Chicago’s Soldier Field last week than the Centers for Medicare & Medicaid Services (CMS) announced last Monday…
Does it seem that the government comes out with major decisions that we in healthcare may not perceive as wise either on a Friday after 5 p.m. or, as in the recent compromise, over a holiday? I can’t help but think of another Great Compromise, which took place on July…
With Oct. 1, 2015, and the final implementation date for ICD-10-CM rapidly approaching, Inpatient Rehabilitation Facilities (IRFs), like all healthcare providers, should be in the final stages of preparation and training for the changes in coding requirements.  While most IRFs have been preparing for the transition for some time, it’s…
Cooperative Exchange (CE), the National Clearinghouse Association recently surveyed its members regarding its recent ICD-10 testing experiences. The CE received informative and helpful feedback on members testing with different types of payers: Medicare; Medicaid; commercial health plans; Tricare; Property and Casualty (P&C); and group health payers. As you can imagine,…
A bill to provide a safe harbor period for the transition from ICD-9 to ICD-10 by allowing healthcare providers to submit claims in both ICD-9 and ICD-10 was introduced today in the House. Today’s action caps a week of policy flurry and set off with the announcement on Monday of…
It looks small – a coding change – but its impact will be far-reaching. Because ICD-10 readiness involves communication between parties, everyone has to change together. To make this change easier for everyone, the industry needs to ensure that the right tools are in the hands of the people who…
Do you have pet peeves? I have many, including those sun-catchers that folks hang on their rear-view mirrors, which on a sunny day blind the drivers behind them. So, what is my PCS pet peeve? Let us discuss the root operations of restriction and occlusion. By PCS definition, “restriction” refers…
Regardless of size, many physician practices are struggling with ICD-10 implementation. Over the last couple of months, much of the industry focus has been on smaller practices. This makes sense, given the financial and operational limitations of these practices. However, large practices (i.e., those with 25 or more physicians, as…
The ICD-10 compliance date is squarely within the sights of the healthcare industry. With less than four months to go until we cross the transition threshold, consider what you've done — and what you can still do — to help your doctors succeed as they move from ICD-9 to ICD-10. …
Earlier this month, the Healthcare Billing and Management Association (HBMA) surveyed members in an effort to assess their experiences regarding commercial payer, Medicaid, and HIPAA-exempt plan ICD-10 readiness. Fifty-four member companies participated. Although that may seem like a small number, the average HBMA member processes 350,000-400,000 claims per year. Most…
It’s one of the most important questions coders must ask while using ICD-10: Is there a single combination code that fully identifies the patient’s relevant conditions, or is it necessary to report two separate codes? This question is also important in ICD-9; however, the volume of combination codes in ICD-10…
With the impending implementation of ICD -10, physicians’ already stressful schedules are about to get even more packed. There is little doubt that the conventions of the ICD-10-CM and PCS systems represent a major paradigm shift in how we track our patients’ health issues and outcomes – or more specifically,…
When said in the company of clinicians, the term “ICD-10” may elicit grumbles or at least concerned looks – a somewhat understandable sentiment. Ranked as a top initiative in numerous provider surveys, ICD-10 requires detailed transition planning, multiple technology upgrades, and a considerable amount of training. The amount of information…
There are so many ICD-10 bills popping up in Congress these days, you may be left wondering what you should do. Many of us might consider the approach of sticking our heads in the sand and hoping it all goes away.
It’s important for coding managers to assess coding accuracy now — while there’s still time to remediate and improve. Defaulting to an unspecified code simply won’t be an option under ICD-10, as many insurers and auditors will be looking for codes that capture the greater specificity inherent in the new…
On June 4, a new bill titled “Protecting Patients and Physicians Against Coding Act of 2015” (H.R. 2652) was introduced by U.S. Rep. Gary Palmer (R-AL) in the U.S. House of Representatives. With 35 co-sponsors as of June 10, the bill proposes a two-year ICD-10 grace period to allow physicians…
I encourage everyone to read the recently published Heritage Foundation position paper on ICD-10, which can be viewed online at http://www.heritage.org/research/reports/2015/05/the-new-disease-classification-icd-10-doctors-and-patients-will-pay. Most of the paper contains information we have all heard before from various studies (Rand, Nolan, Nachimson).  I do agree that there are ICD-10 implementation costs for physicians that…
The Medical Association of Alabama has reported that state lawmakers have passed a Senate Joint Resolution (SJR) urging Congress to delay ICD-10. The medical association, in a blog to its members, quotes State Sen. Tim Melson, MD (R-Florence) as saying, “that the Centers for Medicare & Medicaid Services is forcing…
EDITOR'S NOTE: Kathy Pride is continuing her reporting on diseases that have been covered in the national news media as they relate to ICD-10.The death of Beau Biden, the late son of Vice President Joe Biden, prompted this article. In the news this week was a sad occurrence: Beau Biden,…
We’ve all heard the old adage that “the road to hell is paved with good intentions.” The recent headlines indicating that the American Medical Association (AMA) is pushing for another ICD-10 delay and that a bill with the same aim has been introduced in Congress are indicative of that notion.…
  EDITOR’S NOTE: With the publication of the Heritage Foundation’s position on ICD-10, ICD10monitor asked two physicians to weigh in on the matter. Andres Jimenez, MD, is the co-founder of ImplementHIT. His reaction appears first, followed by that of Joseph C. Nichols, MD, principal of Health Data Consulting. I want to…
Air travel isn’t as simple as it used to be, but if you proactively take advantage of some of the check-in perks offered, it can be a generally smooth experience. After check-in, all parties – the security staff, gate team, and flight crew – know who you are or at…
EDITOR’S NOTE: Kathy Pride is continuing her reporting on diseases that have been covered in the national news media as they relate to ICD-10.The recent death of American mathematician and Nobel Prize winner John Forbes Nash, Jr., in partial recovery from schizophrenia, prompted this article. Dr. John Forbes Nash Jr.,…
Someone recently asked me an interesting question I had not thought about previously – hence the impetus to write this article. The question was “why code immunization to Z23 in ICD-10-CM?” I did some research, and below is an excerpt from the ICD-9-CM/ICD-10-CM/PCS Coordination and Maintenance Committee Meeting Summary of…
  With the sustainable growth rate (SGR) bill now signed into law, it is time for physicians to really focus on their preparations for the upcoming ICD-10 implementation. ICD-10 will affect every aspect of a physician’s practice, including patient encounters, clinical and financial workflow, as well as compensation and reimbursement.…
Coder productivity and quality have always been important, but with ICD-10, the stakes are higher. Insurers and auditors will be looking for the most specific ICD-10 codes to justify medical necessity for services rendered. Nonspecific codes will be denied and targeted by recovery contractors. Coders undoubtedly will feel the added…
On the heels of H.R. 2126, a bill introduced by U.S. Rep. Ted Poe (R-Texas) “to prohibit the Secretary of Health and Human Services (HHS) from replacing ICD-9 with ICD-10 in implementing the HIPAA code set standards,” comes H.R. 2247.
EDITOR’S NOTE: The following is a transcript from Talk Ten Tuesday’s broadcast on May 12 by Betty Bibbins, MD. Physician to physician, we must acknowledge that healthcare is changing. ICD-10 is coming on Oct. 1, 2015, and this will add new depths to the language we use to communicate. As…
A national consortium of health insurers is offering a series of free, hour-long ICD-10 educational webinars to healthcare providers seeking to prepare for the upcoming transition to the new coding set. The Payers Collaboration – a group that includes Humana, Blue Cross Blue Shield of Michigan, UnitedHealthCare, Priority Health, and…
Many across healthcare are continuing to move forward with preparations even despite legislative efforts to delay ICD-10. It’s unfortunate that H.R. 2126, has been introduced, as it doesn’t really represent the majority of our healthcare industry, nor does it recognize the many disease management processes that the new code set…
Everyone is anxious about how ICD-10 may affect coding productivity and quality. Although we won’t have specific answers until we’re in the thick of things after Oct. 1, there are plenty of strategies that health information management (HIM) directors and managers can use today to mitigate potential problems. Many of…
Sure as shootin’, U.S. Rep. Ted Poe (R-Texas) couldn’t resist the temptation of coming back to the table for a second time with his latest distraction, H.R. 2126: a proposed bill “to prohibit the Secretary of Health and Human Services from replacing ICD-9 with ICD-10 in implementing the HIPAA code…
Dictionary.com defines resiliency as “the power or ability to return to the original form, position, etc., after being bent, compressed, or stretched; elasticity.” Many of us surely have seen the movie “Apollo 13.” The movie is about the seventh manned mission to the moon. The mission was aborted after an…
With fewer than five months to go until ICD-10 implementation, many healthcare providers and payers have not completed testing their health information management systems. In fact, a number of providers, especially smaller institutions, have not conducted any systematic ICD-10 testing. For all providers and payers who do not feel comfortable…