The number of medical billing errors that occur each year in the United States is alarming: According to an article in the Wall Street Journal, anywhere from 30% to a whopping 80% of medical bills may contain errors, and the number of practices experiencing errors in their own billing processes is expected to climb as more and more of them implement their own in-practice EHR programs and fail to thoroughly train their staff in system use. There are many reasons why claims may be rejected, but no matter the reason, billing errors can be costly both to patients and medical practices. Not only can errors delay payment, but they can also raise red flags that can result in an RAC audit.
Here are five tips to help ensure your medical billing process is accurate:
1. Verify insurance benefits. The lion’s share of errors could be avoided if providers would take this critical step each time a patient receives services. Especially when a patient returns on a regular basis, it can be tempting to use information that was recently entered; the patient’s insurance company have changed, terms of service may have changed or the policy limit may have been reached. For each patient – returning and new – it’s imperative to check with the insurer to confirm coverage dates and allowed benefits, as well as co-payments, the need for authorizations and other pertinent information that can affect your billing or result in an error.
2. Verify patient information. Even small errors in a patient’s name, birthdate or gender can result in a claim being denied. If the patient isn’t the primary policyholder, the relationship to the policyholder should be checked for accuracy, as well as policy and group number when required.
3. Check – and then re-check – diagnosis and procedure codes. Using the wrong diagnosis or procedure code can cause the claim to be rejected because the insurer believes, based on the incorrect code, there is a lack of medical necessity or the procedure performed does not match the authorization received. Make sure your office staff is using the most recent coding books and that all billing staff are properly trained in the coding process. Providing ongoing training and purchasing new editions of coding books as they are released may seem costly, but taking these steps can avoid much more costly errors in the future.
4. Write clearly – or implement an EHR system. It may be an old joke that physicians’ handwriting is pretty bad, but the joke stops being funny when claims are rejected due to poor penmanship. If the physician resists cleaning up his or her act, billing staff should be trained to question any codes that seem inaccurate or hard to read. Another option: Use an automated system for billing, but be sure your staff is properly trained in its use. Poor training is the leading cause of EHR billing errors.
5. Make sure you haven’t already billed for the service. Chart audits are an effective way to make sure bills are not submitted twice. In some cases, bills may erroneously be submitted for procedures or tests that have been cancelled or rescheduled. Chart audits also can usually catch these errors as well.
Proper training and extra care and attention by billing staff are the most effective ways to eliminate medical billing errors. Take the time to implement quality-control policies and programs and make sure your staff understands the steps they need to take to keep your practice’s billing and coding procedures as error-free as possible.
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For those looking for top ICD-10 educational resources for in preparation for the October 1, 2014 coding changeover, this guide may help. Practitioners as well as medical billing and coding services must have the updated coding training before October 1, 2014, when it is scheduled to go into effect.
What are the ICD-10 changes?
The older ICD-9 Codes have been updated to reflect the advances in healthcare that have impacted the code sets used for reporting medical diagnoses and procedures. These changes will affect everything from provider contracts, software and billing systems, changes in vendor relations, budgeting and training issues and organizing the entire implementation process from top to bottom in your office or department.
ICD-10 training and other resources
Here are some of the best– including several, such as AHIMA, that offer courses designed to train your office’s trainers:
AHIMA – The American Health Information Management Association’s website is one of the main go-to places for anyone who is involved in medical billing, records management, and related health information support. AHIMA not can only help you with obtaining training and certification but offers a list of top ICD-10 seminars and workshops around the country that will get you or your staff up to speed on the latest updates and advances in your industry.
Among the ICD-10 online and in-person training and other workshops and course offerings through AHIMA are:
- ICD-10 Overview and readiness assessments
- Training pathways tailored to your role and setting, including home health, LTC, and physician practice
- Training for non-coding personnel involved in the transitioning
AAPC – Founded in 1988 to provide both training and certification for physician-office medical coders, the American Association of Professional Coders now offers a full spectrum of educational and credentialing resources including training in auditing, compliance, and practice management.
Their courses for ICD-10 training include online, a two-day ‘Boot Camp’ taught in a group setting in locations around the country, as well as on-site training.
Boot Camp courses include:
- Introduction to ICD-10 Coding
- Hands-on Coding Exercises
- Organizing the Implementation Plan
CMS – The Centers for Medicare and Medicaid Services government website offers a wealth of official free resources for provides, payers and vendors looking for help with Medicare and Medicaid ICD-10 implementation timelines and planning as well as updates on the latest regulations, and other information. Some of the resources available include:
- ICD-10 fact sheet and FAQ pages
- Tips to ensure a smooth transition to the new coding
Other recommended sites for ICD-10 educational resources are:
HIMSS – Healthcare Information and Management Systems, an organization for health information professionals, offers a PlayBook page on its website with information about transitioning to ICD-10 for practitioners, hospitals, clinics and staff. Topics include:
- Planning and Implementation Advice
- An ICD-10 Financial Risk Calculator tool
- Vendor Readiness
WHO – World Health Organization – offers full ICD-10 training modules with Interactive Self learning tools on their website.
Medscape – As an online medical information and education website, they offer several resources for ICD-10 education and implementation for clinicians, group practices and other health-provider organizations. The site is free to join and offers regular updates on timely medical topics and education opportunities.
WEDI – The Workgroup for Electronic Data Interchange has information about various vendors offering education and other resources for ICD-10 coding.
Elsevier – Healthcare publisher Elsevier offers online ICD-10 training modules and manuals, prepared by leading coding educators.
ICD-10-CM Code Lookup and Translation - Physician-created free website with ICD-19-CM and PCS codes, conversion tool and other information.
Medical practices needing help with ICD-10 transitioning may contact M-Scribe for expert assessments and implementation strategies tailored for your practice.
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Physician Quality Reporting System (PQRS) Overview
This federal reporting program enables qualified providers to receive a combination of adjustments and incentive payments inorder to improve the reporting quality of eligible professionals. Those who provide satisfactory quality measures for Medicare Part B Fee-for-Service can be compensated.
It is not necessary to sign up for this program; however specific criteria must be met to be eligible for CMS incentive payments. Here is a list of eligible professionals.
Physician Quality Reporting Measure Selection Considerations
You can begin measure selection by reviewing the 2012 Physician Quality Reporting System Measures List to identify which measures may be of greatest interest to your practice. At a minimum, the following factors should be considered when selecting reporting measures:
• Typical clinical conditions treated
• Care typically provided
• Normal care settings
• Quality improvement
2013 Physician Quality Reporting System (PQRS): Registry Reporting
Reporting on a minimum of 80 percent of qualified instances for more than 2 measures or reporting on a patient sample of 20 is required to qualify for the 2013 PQRS incentive payment.
You can escape the 2015 PQRS payment adjustment by fulfilling one of the following criteria:
1. Meet required reporting criteria for the 2013 PQRS incentive
2. Report on an individual valid measure or measures group
3. Agree to administrative claims-based analysis
Useful information on avoiding future PQRS payment adjustments is available on the CMS PQRS website.
Individual Measures
• For measure specifications, reference the 2013 Physician Quality Reporting System (PQRS) Measure Specifications Manual for Claims and Registry.
• Choose two or more measures for submission that will positively impact practice quality.
• Group Practice Reporting Organizations using registry should make use of the 2013 Physician Quality Reporting System (PQRS) Measure Specifications Manual for Claims and Registry Reporting of Individual Measures.
Individual measures with a 0% performance rate are not considered satisfactory for reporting. To be included at least one patient for each individual measure must be reported.
Measures Groups (not for GPRO)
• Reference the 2013 Physician Quality Reporting System Measures Groups Specifications for measure groups. Measures groups specifications are different from those of the individual measures that form the group. Therefore, the instructions and instructions for measures group reporting are documented in a separate manual.
• Choose a minimum of one measures group for submission to qualify for an incentive payment.
• With 20 patients in the measures group only the majority have to be Medicare Part B FFS patients.
• Take a look at Getting Started with 2013 PQRS Reporting of Measures Groups. This document provides a series of options for reporting measures groups and can be used as a guideline for 2013 PQRS measures groups implementation.
Measure Specification Format
The measure specification format provides a great deal of flexibility for detailed explanation of reporting information.
1. Measure title – A list of codes and titles can be found in the 2013 PQRS Measure Specifications Manual for Claims and Registry.
2. Available reporting option for each measure – Enter C for Claims or R for Registry
3. Describe the measure
4. Reporting instructions include applicability, timeframes and frequency
5.Denominator statement, includes coding – CPT I code + ICD-9 code(s)
6.Numerator statement and coding options - CPT II code and/or G-code + CPT II modifier if applicable
7. Definition of terms when necessary
8. Measure rationale statement –Contact measure owner for further information.
9. Clinical evidence or clinical recommendations providing a basis of supporting criteria for the measure - Contact measure owner for further information.
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No matter how careful you are in maintaining and managing your records, since the establishment of the national Recovery Audit Program in 2006, the fear of a recovery audit is always looming in the minds of most medical practitioners and practice managers. Although you may believe your records are impeccable, even a seemingly minor or innocent oversight can draw the attention of recovery audit contractors and significantly increase the risk of an audit. Knowing how to identify these audit triggers and take steps to avoid them is one of the best ways to ensure your practice avoids the scrutiny of your local recovery auditor. Here’s a list of the six most common audit triggers to avoid:
1. Know for whom the bell curve tolls. The government loves statistics, and the folks at the Centers for Medicare and Medicaid Services are no exception. For years, they’ve used a simple bell curve to help identify practices that may be under- or over-coding Medicare and Medicaid claims. Ideally, you want to fall somewhere within that nice, bulging area of the curve – the spot where most of your colleagues wind up. If your practice shows up at either end of the curve, you can expect your chances of an audit to rise dramatically. So what does this mean to you? You need to be aware of the patterns of coding in your own practice and watch out for variations in the norm. Make sure more general codes have the documentation to support the code’s use or go the extra mile and review an additional system to see if the next highest code might apply.
2. Monitor patient complaints and handle them ASAP. Unhappy patients who call their payer’s office and complain about billing and charges can draw unwanted attention to your practice. Make sure your patients know that any billing complaints should be directed to your staff right away so charges can be explained and verified.
3. Likewise, make sure your employees are happy. A disenchanted employee can cause significant headaches with just one or two phone calls. Even though their claims may be based on malice and not on facts, you may still find yourself facing an audit. Make sure employees know they are able to discuss their work-related concerns openly and keep an eye out for employees who seem unhappy or disgruntled.
4. Keep an eye on your modifiers. Using a lot of modifiers – especially 25 and 59 – can set red flags waving and cause claims processing to stall. While the use of modifiers is certainly permitted for outliers that are clearly outside the arena of normal coding, they’re not intended for regular and repeated use; applying them in that manner can cause eyebrows to raise.
5. Avoid “cut and paste” when completing records. Having an EHR system does make life easier, but using obvious shortcuts when completing records is a big no-no. Use EHR templates as a guideline for form completion and be sure to include individual comments and descriptions unique to each patient.
6. Review your office’s compliance plans. Having an up-to-date compliance plan, including a robust billing and coding procedure, and making sure everyone follows it doesn’t just avoid potential problems – in case of an audit, it also provides powerful documentation that your practice is operating properly and above board. Don’t have a current compliance plan? There’s never been a better time to draft one.
According to the CMS website, the Recovery Audit Contractor (RAC) program was established to ensure the Medicare and Medicaid systems are used as they were intended to be used, but despite their good intentions, an audit can still be a nerve-wracking experience. Keeping an eye open for these potential triggers may help your practice avoid an audit – and just may help you gain some much--needed peace of mind.
For more information about M-Scribe Billing Services please contact 888-727-4234.
RAC (Recovery Audit Contractor) audits have many additional names, but, because of their purpose--recovering reimbursements from medical practices and other health care providers--are usually aggressive and annoying. Although they are also known as Medicaid Audits and Medicare Audits, health care providers have the sole responsibility for compliance. Unfortunately, except for publishing basic guidelines, Medicare does not offer specific guidance of any kind to health care providers.
Reason #1: You Must Protect Your Practice
RAC audits are inherently onerous, dangerous and all-too-frequent. If you are a Medicare/Medicaid provider, you'll face these regular audits which can be costly. Statistics indicate that many practices average around 62 percent coding errors. Along with billing errors, this all-too-high rate of coding mistakes will trigger more RAC audits, sprinkled with a healthy dose of examiner diligence.
Since RAC examiners' fees depend on the number of errors they find, there is a natural, built-in incentive to find as many overbilling mistakes as possible. Since their fees come right out of your practice bank account, there is an equally strong incentive to help your coding and billing staff avoid coding errors and become a highly efficient--and accurate--team.
Reason #2: Medicare/Medicaid Overpayments Cost You Money
According to an update in April 2011, CMS has recently collected over $300 million thanks to RAC auditors. This recovery is down from the staggering $992 million in overpayments during RAC audits from 2005 to 2008. It's assumed that physicians have taken steps to improve their staffs' coding, billing and documentation submissions. However, $300 million in practice and hospital reimbursements is still too much.
Some RAC audit reform provisions in the bi-partisan Medicare Audit Improvement Act of 2013 (H.R. 1250) may help practices face less zealous audits. Since overpayments trigger more frequent RAC audits, supporting reforms that offer due process to help physicians review and/or appeal denials, can save practice reimbursement money.
Reason #3: Additional Document Requests (ADRs) May Be Reduced
RAC audit reforms, including the proposed federal legislation, would reduce and cap the number of ADRs that auditors can request. These requests for more and more documents strains personnel resources of medical practices and smaller hospitals. The typically overtaxed staff of busy medical practices must dedicate time they simply do not have to locating, copying and emailing, faxing, mailing or delivering the overburdening RAC auditor requests for documents.
The RAC audit reform legislation, as written, would establish a "hard cap" on ADRs to lessen the administrative time required for practice and hospital staff. This feature, if approved, benefits medical practices and hospitals in two ways. First, the administrative time needed to produce these documents would be less. Second, the time savings should result in staff spending their time where it's really needed--delivering quality patient care. Both of these benefits are joined by a third--saving money.
Typically, RAC audits are not pleasant. However, arguments that the built-in incentives for the audit company and the high percentage of coding and billing errors auditors consistently discover contribute to practice staff and physician uncomfortability. While RAC audit reforms, if adopted, will help practices save administrative time, the real money savings result in reducing coding and billing errors. If RAC auditors weren't so successful finding evidence of errors and overbilling, the number and intensity of these audits would decline. All physicians, nurses and practice staff should welcome the proposed RAC audit reforms, as some medical practice and small hospital viability may hang in the balance.
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The advent of the voluntary Physician Quality Reporting System (PQRS), formerly the Physician Quality Reporting Initiative, (PQRI), is intended by the Center for Medicare and Medicaid Services (CMS) to improve the quality of healthcare reporting. For reporting purposes, patient groups are categorized according to condition or illness, age or type of care or medical treatment provided. Individual measures, which generally include all Medicare Part B fee for service (FFS) patients who meet inclusion criteria, fall within these groups for PQRS reporting.
The PQRS program offers two methods of reporting health care data to the CMS: Registry and Claims-based reporting. Not all health professionals are eligible to use the PQRS program, however, so it is important to first know whether a practice qualifies.
What are the eligibility requirements for participation?
According to the CMS website, professional services covered under the PQRS program are paid under or based upon Medicare’s physician Fee Schedule (PFS). Those services are also eligible for PQRS incentive payments and adjustments.
Some of the PSRS-eligible professionals include:
- Doctor of Medicine
- Doctor of Chiropractic
- Physician Assistant
- Clinical Social Worker
- Clinical Psychologist
- Doctor of Optometry
To see additional professionals included in the CMS list of eligible practices, visit their website’s Quality Initiatives Patient Assessment Instruments PDF.
What are the differences between the two methods?
- Registry – Eligible professionals can earn PQRS incentives by reporting electronically-submitted data with quality measures to qualified registries, which must pass stringent criteria. Eligible professionals must report on at least 80% of instances that qualify or, if the reporting includes measure groups, report on a sample of 30 patients. The registry stores the data and then submits the measure/ measures individual or group data to CMS for the providers or professionals. At the end of each reporting period, the registries give the performance rates and other reported data to CMS.
- Claims-based - The measures used are linked with the CPT codes on reported claims. Submission of clinical data is the responsibility of the practice, although a billing company can often help with this for an additional fee. Eligible professionals intending to qualify for the incentive need only report 50% of the qualifying instances, with three measures, compared to the 80% necessary when reporting to registries.
Which reporting method should a practice use?
- With claims-based reporting, the practice controls the data from start to finish, the process of self-audit is tailored to specific clinical needs, fewer (usually 50%) eligible patients need to be reported, and the cost is usually less than registry-reporting.
If the practice is small or has few Medicare or Medicaid-eligible patients, then claims-based reporting is probably a better way to go, provided that there are personnel in the practice who understand the often-tiresome process of audits, the PQRS forms, procedures and reporting requirements. If there are many Medicare or Medicaid patients, this could create a significant workload for billing and accounting personnel.
- Registry reporting may be the preferred method for those practices that have a high volume of Medicare patients or are part of a large practice. The advantages include having the measures automatically updated annually as well as no need for internal audits. Billing and accounting staff do not need to create or submit forms, resulting higher productivity. On the other hand, there is enforced data collection for all eligible patients as well as somewhat higher upfront costs. Using the services of health care billing professionals such as M-Scribe can reduce the time and financial impact of claims coding, documentation and PQRS reporting for professionals and practices of all kinds.
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With hundreds of EHR technology vendors to choose from, here are some criteria for narrowing down your selection to find the very best fit for your practice. The government’s HealthIT.gov website provides some detailed advice on this process.
Overview
Many practices start with a planning process during which the selection criteria are determined. Others make an initial EHR system selection and then work on supporting it. Most practices start by creating a preliminary plan during which key goals are identified and then the EHR system supporting these goals is chosen.
Once a set of objectives has been defined by your practice and the EHRs’ effect on workflows has been analyzed, the EHR system selection team can begin the selection process.
Test drive vendor products when you believe that they will meet your practice needs. You can do this by providing a vendor with some scenarios for them to include in a demonstration for you.
Determine the start-up cost of a proposed EHR system including software, hardware, maintenance, and connecting to a health information exchange.
Criteria
- Integration Capability - Consider the EHR system’s abilities to interface with other systems such as public health systems, billing systems and practice management software.
- Vendor's stability and track record – EHR supports primary business functions. So vendor reliability is of key importance.
3. Federal EHR Certification
The Accreditation authority is the Office of the National Coordinator for Health IT (ONC). Authorized Certification Body (ONC-ATCB) certifies that a given EHR product is compliant with U.S. Department of Health and Human Services definition of EHR technology.
4. Apply criteria based on your practice specialty and size
When selecting a system, be certain it has wide acceptance in your practice specialty. When you find a product you are interested in, verify that companies in your size range are using it.
5. Choose the Right Architecture
Onsite
You have direct control and responsibility for HIPPA enforcement.
You must maintain your software and hardware environment. This includes security and backup.
Remote
You can take advantage of Software as a Service (SaaS) to provide cloud based software and data management with limited in house IT function. Just remember using Cloud services does not de-obligate you from HIPPA compliance requirements, so it’s essential to make certain that the services you acquire must be proven to be compliant. An additional consideration is your internet service. It will be a gating factor in performance so choose a provider that meets your bandwidth needs.
SafeGov.org reports that some Cloud providers now guarantee HIPAA compliance, taking some of the burden from practices implementing cloud based EHR.
6. Diverse Functionality is Available - Choose a system that has everything you need
Seamless integration with support organizations can save time and duplication of effort. Clinical and billing systems can exchange information with external facilities such as labs, hospitals, imaging centers and exchanges.
Automatic transcription of medical notes is efficient and accurate. Software based medical transcription is much faster than typing.
Physician EHR template and workflow design can suit specific enterprise processes.
Software that adapts to the billing system you use and which provides comprehensive functions including:
o Patient demographics
o Charge entry
o ICD-9 and ICD10 coding
o Electronic/paper claims submission
o Payment entry for all payers
o Account reconciliation
o Claims question assistance for patients
o Patient collection
7. Intuitive Design
Intuitive design means having seamless integration with your practice workflow while providing EHR/EMR function with minimal disruption.
At M-Scribe we provide seamless integration with other EHR and PM systems. Our team has the technical expertise to work with billing software services such as Kareo, eClinicalWorks, eMD, Lytec, Medisoft, Mysis, Medisys, Office Ally, Centricity, Medical Manager, AdvancedMD, Athena, Imagine, Allscripts, HealthNautica, Practice Expert, NextGen, SequelMD, Practice Partner, OmniMD and many others. We can also interface with your own billing system in addition to other EHR systems. Request a free demo to see how our solution works with your requirements.
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The ICD-10 is a more detailed and accurate coding system than the ICD-9. It has been in use throughout Europe since 1994 and in Canada since 2000. Beginning on Oct. 1, 2014, The US Department of Health and Human Services has mandated that ICD-9-CM be replaced by ICD-10-CM.
It is essential for administrators and professional staff to participate in ICD-10 training. Medical coders and medical billers must use this new coding when reporting diagnoses and procedures. Individuals and organizations must become proficient before the imminent implementation.
AAPC Boot camp style ICD-10 training is available throughout the US until June 20, 2013. AHIMA and AAPC ICD-10 training schedules are included below.
AAPC ICD-10 Training Schedules
Hyperlink Date State City
Details 4/25/2013 TX San Antonio
Details 5/2/2013 Missouri St. Louis
Details 5/9/2013 California Long Beach
Details 5/16/2013 Minnesota Minneapolis
Details 5/16/2013 Arizona Phoenix
Details 5/30/2013 Maryland Baltimore
Details 6/6/2013 New York, NY
Details 6/20/2013 Virginia Richmond
Details 6/20/2013 Georgia Atlanta
Details 6/20/2013 Illinois Chicago
Details 6/27/2013 Pennsylvania Philadelphia
Details 6/27/2013 Washington Seattle
Details 6/27/2013 Texas Dallas / Ft. Worth
AHIMA ICD-10 Training Events
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ICD-10-CM/PCS and Computer-Assisted Coding (CAC) Summit
Location: Baltimore, MD
Event Details | Register
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4/22/2013 – 4/24/2013
8:00 PM–5:00 PM EST
Understand the best implementation strategies for transitioning from ICD-9-CM to ICD-10-CM/PCS.
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Building Expert Trainers in Diagnosis and Procedure Coding
Columbus, OH
Event Details | Register
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5/20/2013 – 5/22/2013
8:00 AM–3:15 PM CST
Coding professionals learn how to become proficient in the ICD-10-CM and ICD-10-PCS coding systems and learn how to train other professionals.
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Baltimore, MD
Event Details | Register
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6/13/2013 – 6/14/2013
8:00 AM–3:45 PM EST
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One Stop Center for High Performance
New Orleans, LA
Event Details | Register
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6/13/2013 – 6/15/2013
8:00 AM–5:00 PM CST
This interactive program covers all aspects of ICD-10. Multiple educational tracks include applying ICD-10 coding guidelines; identifying necessary documentation changes related to ICD-10 implementation; working with specialty healthcare settings; understanding data management impact.
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Building Expert Trainers in Diagosis and Procedure Coding
Nashville, TN
Event Details | Register
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6/20/2013 – 6/22/2013
8:00 AM–3:15 PM CST
Coding professionals become proficient in the ICD-10-CM and ICD-10-PCS coding systems and prepare to train others.
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Building Expert Trainers in Procedure Coding
Chicago, IL
Event Details | Register
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6/27/2013 – 6/28/2013
8:00 AM–4:00 PM CST
Students interested in learning ICD-10 procedure coding should attend.
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Building Expert Trainers in Diagnosis and Procedure Coding
New Orleans, LA
Event Details | Register
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7/11/2013 – 7/13/2013
8:00 AM–3:15 PM CST
Become proficient in the ICD-10-CM and ICD-10-PCS coding systems and learn how to train others.
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Building Expert Trainers in Diagnosis and Procedure Coding
Phoenix, AZ
Event Details | Register
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7/16/2013 – 7/18/2013
8:00 PM–3:15 PM PST
Become proficient in the ICD-10-CM and ICD-10-PCS coding systems and learn how to train others.
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Building Expert Trainers in Diagnosis and Procedure Coding
Baltimore, MD
Event Details | Register
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7/25/2013 – 7/27/2013
8:00 AM–3:15 PM EST
Experience a dynamic training program that teaches coding professionals how to become proficient in the ICD-10-CM and ICD-10-PCS coding systems while preparing them to train other coding professionals in these systems
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Building Expert Trainers in Diagnosis and Procedure Coding
Location: Louisville, KY
Event Details | Register
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8/5/2013 – 8/7/2013
8:00 AM–3:15 PM EST
Experience a dynamic training program that teaches coding professionals how to become proficient in the ICD-10-CM and ICD-10-PCS coding systems while preparing them to train other coding professionals in these systems.
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Dallas, TX
Event Details | Register
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8/8/2013 – 8/10/2013
8:00 AM–3:15 PM CST
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St. Louis, MO
Event Details | Register
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8/14/2013 – 8/16/2013
8:00 AM–3:15 PM CST
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One Stop Center for High Performance
Las Vegas, NV
Event Details | Register
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8/15/2013 – 8/17/2013
8:00 AM–5:00 PM PST
This interactive program covers all aspects of ICD-10. Multiple educational tracks include applying ICD-10 coding guidelines; identifying necessary documentation changes related to ICD-10 implementation; working with specialty healthcare settings; understanding data management impact.
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Building Expert Trainers in Diagnosis and Procedure Coding
Chicago, IL
Event Details | Register
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8/21/2013 – 8/23/2013
8:00 AM–3:45 PM CST
Learn how to become an ICD-10-CM and ICD-10-CS coding trainer.
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San Francisco, CA
Event Details | Register
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8/23/2013 – 8/25/2013
8:00 AM–3:15 PM PST
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Chicago, IL
Event Details | Register
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9/19/2013 – 9/20/2013
8:00 AM–4:00 PM CST
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Orlando, FL
Event Details | Register
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9/26/2013 – 9/28/2013
8:00 AM–3:15 PM CST
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Atlanta, GA
Event Details
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10/23/2013 – 10/25/2013
8:00 AM–3:15 PM EST
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Philadelphia, PA
Event Details
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11/7/2013 – 11/9/2013
8:00 AM–3:15 PM EST
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Chicago, IL
Event Details | Register
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11/11/2013 – 11/12/2013
8:00 AM–4:00 PM CST
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Seattle, WA
Event Details | Register
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11/13/2013 – 11/15/2013
8:00 AM–3:15 PM PST
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One Stop Center for High Performance
East Coast
Event Details
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11/21/2013 – 11/23/2013
8:00 AM–5:00 PM EST
Comprehensive ICD-10 training includes: applying ICD-10-CM/PCS official coding guidelines to coding scenarios; required documentation changes; specialty healthcare setting issues; data management impact.
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Building Expert Trainers in Diagnosis and Procedure Coding
Omaha, NE
Event Details
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11/21/2013 – 11/23/2013
8:00 AM–3:15 PM EST
Coding professionals are trained to become proficient in the ICD-10-CM and ICD-10-PCS coding systems and learn to train other coding professionals.
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Chicago, IL
Event Details | Register
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12/5/2013 – 12/6/2013
8:00 AM–4:00 PM CST
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Raleigh, NC
Event Details
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12/9/2013 – 12/11/2013
8:00 AM–3:15 PM CST
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Coder Workforce Training for ICD-10
New Orleans, LA
Event Details
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12/12/2013 – 12/14/2013
8:00 AM–3:15 PM CST
Comprehensive basic Coder Workforce Training for ICD--CM and ICD-10-PCS is provided as well as work with advanced cases. It is possible to register for the CM part of this program only.
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Building Expert Trainers in Diagnosis and Procedure Coding
Location: Salt Lake City, UT
Event Details | Register
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12/12/2013 – 12/14/2013
8:00 PM–3:15 PM MST
Become proficient in the ICD-10-CM and ICD-10-PCS coding systems and learn how to train other professionals.
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Building Expert Trainers in Diagnosis and Procedure Coding
Miami, FL
Event Details | Register
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12/13/2013 – 12/15/2013
8:00 AM–3:15 PM EST
Experience a dynamic training program that teaches coding professionals how to become proficient in the ICD-10-CM and ICD-10-PCS coding systems. Learn how to train other professionals.
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Overview
The US Government provides a convenient PowerPoint tool for deciding on applying for Medicaid or Medicare EHR Incentives. You can download it here. You will need to have PowerPoint or a Power Point viewer to access this interactive presentation. Looking at the presentation, you find out that it’s possible for applicants to be qualified for both Medicaid and Medicare incentives. However you can choose to receive only one. Practitioners qualifying for both will receive a higher incentive payment when they select the Medicaid EHR incentive program.
If you are not clear on some of the data presented in the EHR tool, you can find most of the answers you are looking for in the Government’s Comprehensive publication, EHR Incentive Programs.
Eligibility Tool
To see if you are eligible open the presentation and answer some simple questions about:
- The percentage of hospital services you provide
- The percentage of Medicaid services you provide to patients
- The type of practitioner you are
While you are not required to have an EHR system in order to register for the either the Medicare or Medicaid EHR Incentive Programs, you must be able to demonstrate meaningful use of certified EHR technology during the 90 day reporting period.
Incentive Payments
Medicare EHR Incentive Program
Medicaid EHR Incentive Program
EHR Incentive Programs provide incentive payments to eligible providers including professionals, hospitals and critical access hospitals as they implement or upgrade EHR technology. Professionals can receive a maximum of $44,000 through the Medicare EHR Incentive Program. The Medicaid Electronic Health Record Incentive Program pays a maximum of $63,750. You can register now or find out if you're eligible.
Additional Incentive amounts
Medicare eligible professionals who focus on services in a Health Professional Shortage Area will receive a 10 percent increase in incentive payments. Medicaid EHR Incentive Program participants are not eligible.
Penalties for non-compliance
Starting in 2015, Medicare eligible professionals who do not demonstrate meaningful use of EHR technology may receive negative adjustments to their incentive payments. Starting at one percent, the reduction amount increases one percent each year that there is no meaningful use, until reaching five percent.
Conclusion
When you participate in either the Medicaid or Medicare EHR Incentive program, you receive incentive funds to use Electronic Health Records Technology in a meaningful way. You are obligating yourself to obtain the hardware, software and services necessary to implement an effective system in your practice. The criteria for qualifying for Medicaid vs. Medicare programs are quite different, and which type of program you can participate in will be frequently be decided for you. For providers qualifying for both programs, you may choose Medicaid because it is the highest paying or you may choose Medicare because of area demographics.
EHR Programs are encouraged by the federal government and can save a great deal of time by making medical record handling a fast and effective process. Electronic medical health records benefit patients because their information is immediately accessible.
The EHRCR Functional Profile Project is working towards major clinical research objectives. Two of the key project goals are:
- Use of source data from EHR records to validate claims regarding the efficacy and safety of new medical products.
- Expanding EHR systems so that they can support clinical research processes so that new therapies can to be available to patients as quickly and inexpensively as possible.
Using EHR helps you run your practice effectively, protects your patients by providing ready access to their data and can contribute to important research. On top of that you can receive a substantial incentive.
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ICD-10 Transition Payer vs. Provider
HealthcareITNews reports that the transition to ICD-10 may cause disruption for many healthcare organizations with the exception of healthcare payers.
According to HealthEdge payers consider ICD-10 implementation as a non-issue. Most payer organizations have completed ICD-10 transition already or are confidently following a plan to do so. 90 percent of a payer survey group said they will be ready for ICD10 compliance by Oct. 1, 2014. The remaining 10 percent expressed uncertainty. None admitted any inability to meet the October 2014 deadline.
While there is much faith that payers will be ready, there is little faith that health care providers will also be ready. The HealthEdge survey uncovered the provider belief that the deadline is flexible. Here are the results:
- 28 percent said the deadline is firm
- 33 percent said the deadline may be flexible
- 39 percent said the deadline will most likely change
Keeping these figures in mind, it seems likely providers will not be ready. The following Q and A session is based on CMS provided data.
Questions providers should ask payers
1. What does it mean to be ICD-10 compliant?
Everyone covered by HIPAA can conduct health care transactions using ICD-10 codes.
2. Is ICD-10 a replacement for Current Procedural Terminology (CPT) coding?
No. ICD-10-PCS codes are only for hospital inpatient procedures.
3. Does ICD-10 transition apply to me even if I don’t have any Medicare claims?
Everyone covered by HIPAA must use ICD-10 as of October 2014.
4. Do state Medicaid programs need to transition to ICD-10?
Yes. Medicaid programs must comply with ICD-10.
5. What happens if I don’t switch to ICD-10?
Claims failing to use ICD-10 diagnosis and inpatient procedure codes will not be processed. That means providers will NOT get paid.
6. If I implement ICD-10 prior to October 2014, will CMS process my claims?
No. You cannot use ICD-10 until the compliance date.
7. How is the transition to ICD-10 different from annual code changes?
ICD-10 codes have a completely different structure from ICD-9. ICD-9 codes are primarily numeric with 3-5 digits. ICD-10 codes are alphanumeric and contain 3-7 characters.
8. What is the purpose of transitioning to ICD-10?
ICD-9 codes contain limited patients’ medical data. This coding system in over 30 years old and is obsolete and inconsistent with current medical practices. The transition to ICD-10 is essential to a United States health care system that can function effectively. European countries have been using this system since 1994.
9. How can providers get ready to transition to ICD-10?
For those who have begun:
- Plan on testing ICD-10 systems early. Start testing by:
- Test internal ICD-10 systems .
- Coordinate with payers to establish readiness.
- Have data management and IT teams implement the transition.
For those who have not yet started:
- Working with the rest of your organization, develop an implementation plan. All relevant staff needs to understand the extent of the changes.
- Prepare a budget that includes software upgrades, hardware costs, staff training, work flow changes and contingency planning.
- Find out the readiness level of your payers, billing staff, IT staff and vendors.
- Work with your associates on transition plans and review contracts with payers and vendors. Coordinate your ICD-10 transition plans among your business associates and evaluate payers and vendor contracts.
- Create a timeline with critical milestones. See www.cms.gov/ICD10 for guidance.
10. What can I do to ensure financial stability during the transition?
Start saving now or set up a credit line to prevent cash flow problems that may occur during the transition.
Image courtesy of americanmedical.com
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