The pMD Blog

Around this time last year, many medical practices were feeling pretty stressed out; there was a lot uncertainty around the ICD-10 transition. What was going to happen on October 1st, 2015? Would claims stop being paid? Did practices need to set aside funds to keep their businesses afloat? Would the payers be ready? Was an ICD-10 code for a "burn due to your water skis catching on fire" (V91.07) or "getting hurt at the opera" (Y92.253) really necessary?

October 1st, 2015 came and went, largely without a lot of incident. Practices started using ICD-10 codes (to varying degrees), and much of the gloom and doom that was predicted seemed to never come to pass. A lot of this was due to the one year ICD-10 "grace period” that CMS put in place, which stated that they would not deny claims as long as the ICD-10 codes used were in the correct family of codes. This grace period that has been so helpful in easing this transition is coming to an end at the end of this week, and practices are starting to brace themselves.

Some of the most common questions we’ve received from practices that we work with are listed (and answered!) below.

What is changing on October 1st?
The period of “ICD-10 flexibilities,” or the ICD-10 grace period, is ending. CMS will no longer accept unspecified ICD-10 codes on Medicare fee-for-service (FFS) claims when a specific one is warranted by the medical record. CMS is also removing 305 existing ICD-10 codes and adding 1,900 new codes (this number is much higher than most years due to a coding freeze).

What’s a real example?
During the grace period, in order to bill diagnoses for Hodgkin’s Lymphoma, for example, providers were able to choose from the family of C81 codes, including the most general code, “Hodgkin’s Lymphoma, unspecified, unspecified site (C81.90).” This code would have been accepted by CMS even if the clinical documentation supported a more specific code. After October 1st, providers will be required to be more specific, using codes like “Lymphocyte-rich classical Hodgkin lymphoma, spleen (C81.47)” that describe the nature of the lymphoma and the body part.

Will these flexibilities be extended or phased in?
In new guidance released at the end of August, CMS states that the ICD-10 flexibilities will not be extended past October 1st, 2016, and will not take a phased approach to coding at the highest level of specificity.

Can I still use an unspecified ICD-10 code?
Yes, but only when the clinical documentation does not support a more specific diagnoses.

What can I do to prepare?
Run historical reports to identify the usage of unspecified and header codes over the past year. If there are unspecified or header codes that are used in high frequency, work with providers to identify other options to replace those codes when the documentation supports a higher specificity.

It may end up that October 1st, 2016 is a much more important date to remember than its predecessor a year ago. Many practices are gearing up for the denials and rejections that could be coming their way, and searching for ways to educate their providers on these new, stricter rules.

Here at pMD, hospitals and medical practices have been utilizing ICD-10 prompts within our electronic charge capture software. This feature proactively asks providers in real-time for more specific information when selecting an ICD-10 code that requires it. While no one really knows what type of crackdown CMS is going to employ later this year, our customers have put their trust in us to be forward thinking and give them the tools they need to make sure they are compliant.   



Here's The Latest in Health Care:

• A new study from the University of Pittsburgh found that wearable technology does not necessarily lead to more weight loss. In a study that enrolled 470 people of varying age and BMI, the mean weight loss for the group using wearables was 7.7 pounds while the group that did not use wearables lost a mean of 13 pounds. There is more to learn about how these devices impact behavioral change. Read More

• Curavi Health, a new startup in the telehealth industry, enables physicians to remotely interact with their patients and nursing home staff via proprietary software and equipment. Nursing home patients are often transferred to hospital emergency rooms unnecessarily due to lack of proper medical advice to their nurses, driving up medical costs and causing more harm than good to the patient's health. Read More

• Despite improvements in health care, the U.S. maternal mortality rate has risen while the global death rate fell by more than a third from 2000 to 2015. Some researchers argue that the increase is a result of rising ailments such as heart problems and other chronic conditions, like diabetes, in the population. Other factors, such as increased pregnancy rates in older women, better tracking of maternal deaths and even racial disparities have been theorized. Read More

• The ongoing EpiPen saga continues as Mylan CEO, Heather Bresch, met with members of Congress yesterday to testify in response to the unprecedented, six-fold price increase of the life-saving EpiPen auto-injectors and the political firestorm over pharmaceutical profitability. Bresch claims that after rebates, fees and other related costs, the company reaps a profit of $100 per two-pack, attempting to squelch any misconception surrounding the company's high profit margin from the EpiPens. Still, analysts say the margin is quite high. Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news.
It’s September, which means many of us got to enjoy a long weekend for Labor Day, and now school is back in session. At pMD, we don’t get the chance to work with many kindergarteners, but we do encounter medical students, resident physicians, and fellows when implementing our charge capture and secure messaging software at private practices and hospitals.

On a recent implementation trip to Memphis, I met with one of the senior residents, “Dr. M,” for his pMD training. He came into our meeting with a positive attitude but also a bit of confusion. Resident physicians don’t bill directly for the services they perform, so when this doctor heard he had a “charge capture training,” he wasn’t sure what to think!

However, after an in-depth conversation about how this doctor works with the attending physician, the fellow, and the other residents, it turns out that pMD had a lot of use for him outside of “just” helping with hospital billing. Residents are often the first point of contact for their patients, and the whole resident team needs to be on the same page about every patient, even when they have rotating schedules and patients in seven different hospitals. pMD allows Dr. M to capture important clinical information, such as the patient’s current treatment, updates on their condition, and when they next need to be seen, right from his iPhone. This in turn updates the attendings, fellows, and other residents in real-time, no matter where they are.

Dr. M also let me know that it’s both very important and often very difficult for the residency program to report on the various diagnoses treated by their residents. Information such as the specific ICD-10 diagnostic conditions treated by resident physicians and the frequency at which these conditions are seen helps create an important academic repository for the program, but it’s difficult to collect when many of the seven different hospitals use different electronic medical record (EMR) systems and do not provide easily-accessible data sets for a subset of providers. Dr. M was thrilled to find he could not only report this data out of pMD with just a few clicks, but also save, sort, and de-identify this data in a spreadsheet to give back to the residency program for future use.

Dr. M came out of our meeting with a lot of excitement about pMD’s function as a mobile rounding and data capture tool. In fact, he’s currently helping me set up training with four more residents in his program! I’m sure that, just like Dr. M, they will be model students. A+!



Here's The Latest in Health Care:

• Patients are sometimes burdened with the task of gathering their medical records, often finding that their health information is scattered across different states, different electronic systems or different doctors' offices. Between medical records still being in paper form, siloed EHRs and HIPAA compliancy, it can be near impossible for patients to get a full medical history in one fell swoop. Read More

• Leaders in health care met this week in Chicago to discuss the next steps in population health management. Positive patient experience, data collection, telehealth tools and care coordination were just a handful of the topics discussed at this year's Pop Health Forum 2016. Read More

• Cat-scratch disease, which is spread by cats, may have more serious and fatal complications than previously believed. Kissing kittens can increase the risk of being infected. Symptoms typically involve fatigue, fever and swollen lymph nodes but in a few cases, the disease can cause the brain to swell or infect the heart and can prove to be fatal if not treated properly. Read More

• The Census Bureau released some promising economic statistics on Tuesday, one being that only 9.1 percent of Americans do not have health care coverage, the lowest level ever recorded by the agency. About 18 million more people have coverage now than they did in 2013. Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news.
Signor Goat has a secret. It's one he finds highly personal and a little embarrassing. Signor Goat feels strongly that he must keep this secret confidential, but he does share it with a select few people in his life, namely Signora Goat and Dr. Mustachio.

One day, Signora Goat texted Signor Goat about his secret. The conversation went something like this:

****Secret censored in respect for Signor Goat's privacy.

Later that evening, once Signor Goat had a chance to calm down, he sat down to educate his lovely Signora. “Signora,” he began, “I know you didn’t mean to put my secret at risk when you texted me today, but you did.”

“What do you mean, Signor?” Signora replied.

“Well,” Signor continued, “let me tell you what happens when you send me a text message. You were using an SMS, or Short Message Service, format to text me today. SMS text messages are copied with the exact content you wrote and stored in many different locations. At a minimum, a copy of your message outlining the details of my secret is saved on your phone after you finish typing it, another copy is placed on our cell phone provider’s servers, and then a copy of your message is saved on my phone. It’s like writing my secret down on a sticky note three times, and putting one in your purse, mailing one to our cell phone provider, and sticking one in my pocket!”

“Hmphhh,” Signora protested, “It is not like writing your secret on a post it note, because my phone is personal and private and so is yours!”

“You might feel that way, Signora, but what if your phone was stolen? Or lost? What if you decided to upgrade to the new iPhone 7 and gave this one away to your cugino? Would you be sure that my secret was still safe? And, what about my phone? The message is there, too, and it could be lost, stolen, or improperly disposed of!”

“Ok, then I will delete my message from my phone - and,” Signora commented, trying to pre-empt Signor’s counter, “I will make sure you delete the message, too!”

“I’m glad you are willing to go to that much trouble to protect my secret, Signora, but how will you delete the copy of my secret that is now on our cell phone provider’s server?”

“Signor, the cell phone company doesn’t care about your secret!”

“Maybe not, Signora, but the fact is they could see my secret if they wanted to - and what it someone hacked into their servers? The hacker would learn my secret, too!” Signora was finally starting to feel badly about the well-intentioned mistake she had made.

Signora apologized. “I’m sorry, Signor. I did not realize how many ways someone could find out what I texted over my personal phone!”

“I forgive you, Signora. But please remember that text messages do not even use encryption - which means that any one that intercepts our message knows exactly what we are saying to each other!” Signora and Signor hugged, and shared a moment of tenderness, both glad to be finally understanding the other.


Even if you don't have a hyper confidential secret, we can all learn from Signora's mistake and lacking knowledge. Texting is a risky venue for any piece of information you consider confidential - be it a secret, a credit card number, or confidential health information. As Signor Goat explains, there are simply too many copies created by the technologies that send SMS messages. And, those copies typically aren’t encrypted or protected in any other way. This is one major reason text messaging can be a violation of HIPAA; if PHI is sent in a text across an unprotected network, the risk that the data can be inadvertently disclosed - or worse, breached - is very high. In the same way that Signor Goat asked Signora Goat to protect his secret, HIPAA asks our health care community to protect health information about patients. And, generally, text messaging health information does not appropriately protect that information. Luckily, products like pMD’s HIPAA compliant secure messaging provides an easy, convenient way to send messages that work and feel very similar to the text messaging that everyone knows and loves. But, pMD secure messaging offers several other protections like full end to end encryption, the ability to remote wipe content if a device is lost or stolen, and the ability to delete messages from both the locally encrypted device and also from the encrypted server used by pMD to send the message. These tools help providers and practices address risks associated with sending private health information via a text message, thus reinforcing strategies to uphold their overall HIPAA compliance plan.

Source: Susan Biddle/Washington Post/Getty Images


Here's The Latest in Health Care:

• A hepatitis A outbreak has been linked to strawberries at a smoothie chain across seven states and has sickened 89 people, according to the Centers for Disease Control and Prevention. The infected, frozen strawberries were imported from Egypt. Tropical Smoothie Cafe has since switched to another supplier and apologized, in a statement, to the infected persons. Read More

• According to experts, preventing medical errors begins with a shift from a production-based model to an integrated model, focusing on ways to treat the whole patient and promote shared decision-making. In the current industry model, providers are incentivized to churn through patients to make money but are now encouraged to do more and understand that a change  to patient-centered, whole-person care is necessary. Read More

•With the Quality Payment Program under the Medicare Access and CHIP Reauthorization Act set to start on January 1, 2017, CMS chief, Andy Slavitt, outlines four options for clinicians to comply and avoid a negative payment adjustment in 2019. The four options will also be described in detail in the final rule slated for release this November. Read More

• This year, pediatricians recommend giving the flu vaccination in the form of a shot rather than via nasal spray. That's because the CDC's Advisory Committee on Immunization Practices found that the nasal spray vaccination, FluMist, was only 3 percent effective in children aged 2 through 17 during last year's flu season, while injected flu vaccinations protected about two-thirds of children in the same age group. Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news.

Apple announced its latest and greatest suite of new devices today in San Francisco, and we can't wait to get our hands on the hardware. Here's what you can expect from the new smartphones hitting stores later this month:

iPhone 7
• Two models: iPhone 7 (4.7-inch, $649) and iPhone 7 Plus (5.5-inch, $769) in Jet Black, Matte Black, Gold, Silver, and Rose Gold
• Advanced camera with new updates to shoot sharper and more vibrant photos and videos.
• Retina HD display to view your vibrant and colorful photos and videos.
• Best battery life of any previous iPhone with up to two more hours on the iPhone 7 and up to one more hour on the iPhone 7 Plus.
• Very first water and dust resistant iPhones! Apple's fine print states that liquid damage is not covered, so consider not going swimming with your new iPhone.
• Re-designed solid home button that is pressure sensitive and responsive to touch.
• New stereo speaker system that is 2x louder than the iPhone 6s. Your neighbors can thank Apple for this one.
• EarPods with a lightning connector (the same connector you use to charge your phone) to replace the previous headphone jacks. Before you start screaming, an adapter is included for old iPhone ear buds.

If you want to get your hands on one of these the new smartphones, pre-orders begin September 9th and the phones will be available in stores September 16th. We're excited to see how our charge capture and secure messaging users of physicians, physician's assistants, and nurse practitioners will react to these new devices in our upcoming mobile device update in October!

Source: Ted Horowitz/Getty Images


Here's The Latest in Health Care:

• Single-payer insurance may be more feasible than previously believed. In 2016, 71 percent of California's health care expenditures were covered by public funds. Will this publicly-funded, single streamlined, nonprofit system show promise over today's inefficient, profit-oriented, multiple insurance payers? Read More

• The Department of Health and Human Services (HHS) plans to pay $20 million over the next 18 months to Japanese-headquartered company, Takeda Vaccines, to accelerate the development of a Zika vaccine for the U.S. If approved with the FDA, the first clinical trials of the vaccine on humans could begin next year.  Read More

• Low value services, or services that provide little value to patients, given all the costs and alternatives, account for about 0.5% of total medical services spending. While this may not seem significant, this adds up to approximately $32.8 million of spending in 2013 and equates to just under 8 percent of 1.5 million adults with commercial insurance. Read More

• Carfentanil, which is used as an elephant tranquilizer, is causing a record spike in drug overdoses in the Midwest. The synthetic opioid is 100 times more potent than the prescription painkiller, fentanyl. Officials in Ohio have declared a public health emergency. Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news.

While pMD continues to lead the health care industry with our mobile charge capture product, we also offer a standalone secure text messaging app. Due to the nature of our charge capture product, the implementation process can be very complex and can take several weeks to go live. Implementing our secure messaging software is more straightforward, but that doesn’t mean we don’t give the same attention and effort to implement these customers as we would a charge capture customer.

Our secure messaging app is very similar to regular text messaging, but it is completely secure in order to protect patient information. Training users on secure messaging can take as little as five minutes, so implementing new messaging customers can be done without an on-site visit from pMD. So where does our “unparalleled customer service” come to play? Recently, pMD implemented a secure messaging customer of approximately 100 providers in Denver. To ensure full adoption and provide support for such a large group, a small team of pMD’ers set out for a two day on-site visit.

My colleague, Tracy, and I set out early Monday morning and visited every office throughout the Denver area to work with providers to download the pMD messaging app onto their phones. The most common reaction we received from providers was, “You came all the way out here for us?!” To which we gladly said, “Of course!”. Our new customers were excited to be using a texting program that was secure and HIPAA-compliant, and one that would integrate with their paging system that was already in place. A few providers at the first office we met with even noted that they would help make sure everyone in their group had downloaded pMD because it was such a simple and straightforward setup. After being on-site for less than 48 hours, we were able to meet with the COO and the majority of 100 providers.

This is great testament to the people of pMD and our commitment to unparalleled customer service. We treat each customer with the same passion and customer service regardless of the size of the customer or the product they’re using.

Here's The Latest in Health Care:

• The FDA is recommending that all blood donations in the U.S. be screened for the Zika Virus as additional precautionary measures against the spread of the virus. Not all states are required to test blood donations at once. Testing will begin within the next four weeks for 11 states that are within proximity to areas where Zika is actively spreading via mosquitoes. The expansion of blood testing to all states will occur within a 12-week time frame.  Read More

• Physicians are concerned that the new MACRA payment system, which rewards quality over quantity of care based on quality benchmarks, will put small practice or solo practice doctors at high risk of incurring payment penalties or even push thousands of these physicians into larger practices.  With the way this payment model is structured now, larger practices will do well and smaller practices are likely to do worse. Read More

• Less than one-third of ACOs (Accountable Care Organizations) qualified for bonuses from Medicare in 2015, according to CMS. However, ACOs participating in the past two years have improved on 84 percent of the quality performance measures used and have grown 13 percent in savings since 2014.  Read More

• A new ultrasound-enabled genetic therapy called sonoporation may one day be the new cancer and heart disease fighting tool. This strategy involves the use of "microbubbles" and ultrasound energy to poke holes in cells, administering genes on a molecular level. This approach allows researchers to deliver therapeutic agents to the precise location of the disease while sparing its healthy surroundings. Read More

Each Friday, Signor Goat reports the latest from the week in health care. Check back next Friday for your dose of our little medical corner of health care news.