Risk adjustment is an actuarial tool used to predict healthcare costs and adjust payments to healthcare plans to cover expected relative costs for providing coverage to enrollees. Risk adjustment ensures that health insurance plans have adequate funding to provide care to people who are likely to have high healthcare costs while at the same time preventing overcompensation for healthy patients. Insurance plans compete on the basis of quality and service, which are the foundation of value-based purchasing (VBP) and healthcare reform.... Read more...
ICD-10 will impact nearly all of the processes in your practice or organization, and using that fact as the starting point for your ICD-10 testing will make the process smoother and more worthwhile for everyone involved. Although it may not be possible to coordinate or synchronize all aspects of the testing, the more comprehensive your testing plan is, the better prepared your organization will be on Oct. 1, 2015....Read more...
Despite a decline in participation and some lingering issues still affecting providers, Centers for Medicare & Medicaid Services Provider Billing Group Director Diane Kovach told Talk-Ten-Tuesday listeners last week that she was pleased with the results from the second of four scheduled acknowledgement testing weeks being planned and coordinated by the agency....Read more...
As I reflect on the many comments from physicians, coders, educators, auditors, and various organizations, a message of frustration keeps creeping into the conversation. Physicians aren’t cooperating. Physicians don’t want to hear about ICD-10. I can’t get my doctors interested. As I reflect on the reasons that might exist for this perception of frustration, I thought actually investigating the message might shed light on the topic. Although the findings are not statistically valid, I believe they provide perspectives that can prove valuable... Read more...
October, 15 2013 / Kim Carr
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. Measuring, monitoring, and tracking dual-coding data ensures that investments in time, money, and staff produce a solid return. Business intelligence gleaned from dual-coding data helps accurately measure ICD-10’s productivity, quality, and financial impacts. With dual coding already underway, now is the time to build your arsenal of ICD-10 data... Read more...
November 21, 2014 / Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CEMC, CPMA, CCS-P, CDIP
As I continue on my journey assisting hospital systems and medical practices transitioning to ICD-10, it has become evident that clinical documentation is at the core of this transition. But as I read so many articles about ICD-10 initiatives and clinical documentation improvement, I wonder if we really grasp the true impact. Many feel it is only important as a hospital initiative, but that really is not true. Other pieces I have read focus on auditing, which... Read more...
August 19, 2014 / Paul Weygandt, MD, JD, MPH, MBA, CPE
Recently I was asked to respond to physician criticism of the transition to ICD-10. While there are legitimate concerns regarding the costs of the transition, the majority of issues being raised by physicians of late reflect a lack of knowledge about the system. Such criticism reminds me of the now-infamous quote from Nancy Pelosi, the U.S. House of Representatives Minority Leader in 2010, regarding President Obama’s landmark healthcare legislation... Read more...
November 21, 2014 / Mark Spivey
The countdown is on. With less than a year to go before the scheduled implementation of ICD-10, healthcare industry chatter about the new code set is reaching a fever pitch. Because ICD-10 is about overall system readiness, the discussion focuses mostly on how to get ready, what barriers to overall readiness exist, and what the industry can do to remove those barriers. Problems will inevitably arise if only part of the industry... Read more...
November 25, 2014 / Wilbur Lo, MD, CDIP, CCA
According to the National Institute of Mental Health, Autism Spectrum Disorder (ASD) is characterized by a wide range of symptoms and levels of impairment or disability that are typically recognized during the first two years of life. ASD is a complex clinical diagnosis and includes deficits in social communication and social interaction, as well as restricted, repetitive patterns of behavior, interests, or activities. The symptoms will cause... Read more...
August 21, 2014 / Mark Morsch, MS, AHIMA-approved ICD-10 trainer
Technology continues to play an important role in supporting facilities and physicians engaged in the transition to ICD-10. Many organizations have purchased technology such as computer-assisted coding (CAC), clinical documentation improvement systems, natural language processing (NLP) and/or coding workflow solutions. These technologies hold the promise of significant benefits to key functions such as clinical ... Read more...
September 15, 2014 / Billy Richburg, M.S., FHFMA
Honestly, have you noticed how almost everyone around you seems “comfortable?” Most of us live and work in environments where everything is systematized, laid out as rules or policies or (the worst) “best practices.” And then, on top of the things we do to ourselves, we have local, state, and federal governments applying their own rules and policies and (dare I say it) “best practices,” except they call them “ordinances,” “statutes,” “regulations,” “policy statements,” and “laws.” (We interrupt this essay with an appeal to whomever/whatever you hold in your belief set: “Deliver us from bureaucrats... Read more...
July 9, 2013 / Lauri Gray, RHIT, CPC
Transient cerebral ischemia is defined as a temporary loss of blood flow to an area in the brain. In ICD-9-CM, codes for transient cerebral ischemia are classified under circulatory system diseases and are found in Chapter 7, Diseases of the Circulatory System. Conditions classified as transient cerebral ischemia are listed in category 435 and include basilar artery syndrome (435.0), vertebral artery syndrome (435.1), subclavian steal syndrome (435.2), and vertebro-basilar artery syndrome (435.3)... Read more
June 03, 2014 / Joseph C. Nichols, MD
There is a widely held belief that ICD-10-CM is much more “granular” and will require much greater specificity. It is true that ICD-10-CM will support the reporting of much more specific and detailed information about risk, severity, complexity, comorbidities, and complications, and other key parameters of patient evaluation. There’s a little secret that is seldom mentioned, however: You can be just as vague in ICD-10 as you were in ICD-9... Read more
August 19, 2014 / Holly Louie, RN, CHBME, PCS
Recently, an article was published ridiculing ICD-10 by profiling the most obscure (and frankly, ridiculous) coding combinations that could be identified. “There’s a code for that” has become synonymous with these highly publicized codes, which cover scenarios such as turtle bites, water skis on fire, being hit by meteors, and other circumstances widely considered preposterous. Obviously, these authors are focused on things that are truly irrelevant, though entertaining... Read more
October 27, 2014 / Juliet Santos
As we continue to move toward the new ICD-10 coding and reimbursement system, new challenges are facing healthcare providers above and beyond those associated with other high-profile federal mandates. New focuses demanding our attention and resources include the fearsome Ebola virus and Enterovirus D68 (EV-D68), which is more easily communicable than Ebola and appears to have spread to children in 45 states and the District of Columbia (as well as other humanitarian crises overseas that now are impacting the U.S.) Although we often prefer to distance ourselves from diseases that we’ve not treated in the past, the reality is that many of these diseases could eventually find their way to the U.S. if we’re not able to contain... Read more...
November 10, 2014 / Rhonda Taller, MHA
During the Nov. 5 MLN Connects™ national provider call on transitioning to ICD-10, Centers for Medicare & Medicaid Services (CMS) speakers covered a variety of topics, providing very useful information to audience members preparing for the Oct. 1, 2015 compliance date. A transcript of the call will be available at a later date, while slides used during the session are available on the MLN Connects website now. Denesecia Green with the CMS Administrative Simplification Group focused her remarks on CMS readiness efforts (including an update on CMS industry partnerships, such as training collaborations with the American Health Information Management Association, or AHIMA, the American Academy of Professional Coders, or AAPC), the Professional Association of Health Care Office Management, or PAHCOM, plus the National Association of Community Health Centers). Green said the purpose of the training arrangement... Read more
Career Step has over 20 years of experience successfully training healthcare professionals. This experience in online adult learning has been combined with the ICD-10 expertise of YES HIM Consulting, Inc. in the development of The ICD-10 Solution, which is... Read more
November 26, 2013 / Lolita M. Jones, RHIA, CCS
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.... Read more
August 21, 2013 / Sherry Wilson and Tina Greene
Just like “Where’s Waldo?” the property & casualty (P&C) industry that includes workers’ compensation and auto billing also requires the tracking of state healthcare requirements to highlight whether ICD-9 or ICD-10 is required when submitting bills to payers. Payers, vendors, and providers that bill P&C across states are required to comply with each state’s requirements. There are numerous... Read more
March 19, 2013 / Rebecca DeGrosky, RHIT
In the Medical and Surgical section (first character 0), there are 31 root operations with standardized terminology and no procedure names, no diagnostic information, and no eponyms. So far, we have covered 24 of them, and today will bring us to the remaining ones. We have gone over the notion that a fracture reduction is the root operation reposition, and that there is no appendectomy listing in ICD-10-PCS. Coders... Read more
July 1, 2014 / Tim McMullen, JD, CAE
Whether you were annoyed or relieved by the announcement of another delayed implementation of ICD-10, the benefit of having additional time to ensure a smooth transition can work to your favor. The expertise that is held by your practice management system (PMS) vendor is a key component that can contribute to a smooth transition. Many PMS vendors have integrated ICD-10 within their systems, so these vendors are ready and have the ability to test now. You likely have been getting updates from your vendor... Read more
December 8, 2014 / Lolita M. Jones, RHIA, CCS
The process of constructing codes in ICD-10-PCS is designed to be logical and consistent: individual letters and numbers, called "values," are selected in sequence to occupy the seven spaces of the code, called "characters." ..... Read more
MS-DRG Validation: The Proven Process for Coding Accuracy
If you're experiencing incorrect code and MS-DRG assignment now in ICD-9 you'll be lost in ICD-10. So now's the perfect time to perform MS-DRG validation! And the results will have a positive impact at your facility on patient care, regulatory compliance and reimbursement.
2015 Surgical and E/M Coding Update
In 2015, you will be confronted with over 194 surgical and evaluation and management (E/M) code changes of which nearly half are totally new codes. These changes—nearly 200—will impact patient care, reimbursement and compliance and affect your performance.
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