Posted on 10/25/16 | Comments
Finding and selecting the right diagnosis code is critical to both patient care and revenue cycle management. The downstream negative impact of using an unspecified code can touch everything from decision support to reimbursement, compliance, and reporting. In addition, unspecified codes are not as useful for other clinicians needing to review the records and for patients themselves as they review their own records.
Topics: ICD-10, clinical documentation, PFT, reinburment, unspecified codes, revenue cycle management, provider friendly terminology, cdi, clinical codes
Posted on 10/19/16 | Comments
Three Must-take Steps to Minimize Risk
On October 1, 2016, the Centers for Medicare and Medicaid Services (CMS) wrapped up its one-year grace period for allowing the use of unspecified codes without consequence. The governing body also rolled out its first update to the coding system in four years, including a mammoth 6,000 new codes.
Both of these moves could negatively impact financial performance if appropriate action is not taken to minimize risk. Providers still engaging in deficient “unspecified” coding practices face short-term revenue cycle exposure in the way of denied claims, increased accounts receivable days, and time-consuming workflows associated with drafting appeals. Over the long term, revenue risk is associated with lower value-based payments.
Specificity is now the name of the game, and HIM departments must educate teams to code at the highest level under ICD-10. With thousands of new codes in play, it’s imperative that healthcare organizations address this issue through three critical steps:
Topics: ICD-10
Posted on 09/14/16 | Comments
In our previous blog, we discussed the importance of leveraging administrative data for better quality assessment. As the wrap-up to this standards blog series, I want to look back at Crossing the Quality Chasm as a foundational work for improving the quality of healthcare delivery. This paper called not only for better quality but also for a reduction in the cost of that care--this at a time when the population is aging, technology is evolving, and research is rapidly expanding evidenced-based medicine. At least eight of the 13 recommendations made by the authors of Crossing the Quality Chasm directly involve the collection, aggregation, and actionable use of healthcare data. The remaining five are supporting those objectives through the development of committees that address quality care and reimbursement models, and in training the workforce to meet the increasing needs of an industry that is becoming more and more reliant on data and analytics.
Topics: ICD-10, SNOMED, LOINC, RxNorm, semantic interoperability, billing, Administrative Data
Posted on 07/20/16 | Comments
It’s an interesting time to be in healthcare, especially medical billing and coding! Over the next few years we will see major changes that will help us spend our healthcare dollars more wisely, and keep people healthier. These changes will have a profound impact on patients’ and physicians’ daily lives.
Topics: ICD-10, Coding Challenges, LOINC & SNOMED, EHR, CPT, ACA, billing, icd-9
Posted on 05/18/16 | Comments
Many were relieved after the ICD-10 implementation deadline. But, though October 1st 2015 is now long past, it does not mean the end of dealing with healthcare terminologies and the complexities set into motion for healthcare providers and payers.
As we all know, healthcare is a constantly changing industry. New medical breakthroughs as well as newly discovered diseases lead to new treatments and innovative solutions. All of these changes must be represented in evolving medical terminologies. Terminologies, standards for treatment and care, and scientific developments are rarely set in stone. Code systems and terminology sets may be updated daily. If you and your organization cannot keep up with all of the changes, your entire organization is at risk.
Topics: ICD-10, terminology, enterprise terminology management
Posted on 03/30/16 | Comments
It has been five years since those of us in the healthcare industry have had to prepare for updates to the ICD code set. During this time, updates were put on hold while the industry prepared for and underwent the ICD-10 transition. Now that ICD-10-CM and ICD-10-PCS have been successfully implemented, it is time to prepare for long-awaited revisions and additions. Beginning October 1, 2016, we can now expect that there will be annual revisions to the ICD-10 code set, bringing the industry back to the regular update cycle.
Topics: ICD-10
Posted on 07/22/15 | Comments
For a clinician in a busy clinical environment, the primary focus is on patient care. The objective of Meaningful Use is, of course, to facilitate efficient and effective patient care. But complex problems of integration sometimes posed by EHRs can slow things down if not managed appropriately, and can even create the opposite of the efficient patient care setting that everyone—patients, clinicians, administrators—wants. For example, in the case of SNOMED CT and ICD-10-CM, we’re required to document problems and diagnoses in two very different languages.
Posted on 07/09/15 | Comments
Anyone on any side of the ICD-10 remediation equation knows that there are a lot of moving parts to the process, and a lot of players in each healthcare ecosystem have a hand insuccessfully navigating the switch from ICD-9 to ICD-10.
Topics: ICD-10
Posted on 06/23/15 | Comments
There has been a great deal of discussion around ICD-10 and how it will impact DRG’s – but what about the outpatient setting?
Topics: ICD-10
Posted on 05/04/15 | Comments
As your healthcare organization prepares to implement ICD-10 codes you’ll need your clinical and IT departments to develop a remediation plan that not only meets the October 1, 2015 deadline, but ensures that your organization realizes the benefits of ICD-10 implementation far beyond the deadline date.
Topics: ICD-10
