The pMD Blog

Welcome to the
pMD Blog...

where we cover interesting and relevant news, insights, events, and more related to the health care industry and pMD. Most importantly, this blog is a fun, engaging way to learn about developments in an ever-changing field that is heavily influenced by technology.

POSTS BY TAG | Medical Billing

Vendors that are strategic partners

 

In 2010 the Centers for Medicare and Medicaid Services began to release Comparative Billing Reports (CBRs). A CBR compares provider to provider billing practices, both regionally and nationally, to determine if a provider is an “outlier”, or billing outside of the expected pattern. If a provider is found to be an outlier, they will receive a notification detailing the analysis and erroneous billing, while offering education on the topic. CBRs review many areas of billing, and even topics outside of billing. Some common topics include; evaluation and management, modifier utilization, and groups of specific codes, for example, radiation modality treatments for oncology providers or dialysis visits for nephrology providers. It's also important to note that CMS is not the only one reviewing billing practices in this manner. Other large commercial payers have similar programs, such as UnitedHealthcare’s Peer Comparison Reports, which functions much like the CBR.

What is a CBR used for?


CMS and other payers perform CBRs and similar reports with the goal of providing educational resources and outreach. This outreach ensures compliance with coding and billing standards and reduces potential fraud, waste, and abuse. CBR’s can also help patients. Most patients are unaware of the many coding and billing rules that exist and therefore have a difficult time identifying when they have been overcharged. This can lead to costly out-of-pocket expenses toward co-insurance and deductibles. Educating providers can offer a real impact on reducing a patient’s financial burden.

What should I do if I received a CBR?


While CMS says “receiving a CBR is not an indication of or precursor to an audit” the receipt of a CBR can still be a stressor, especially if a provider or practice does not have the right tools to internally investigate the CBR findings, or worse, does not know where to begin to address a CBR. The risk of removing focus from the patient care to address these billing practices is high. Additionally, ignoring the report altogether could place the provider and practice at risk for more CBR’s in the future and even potential audits. CBR’s should be promptly reviewed and addressed by taking the following steps:

* Examine the issue identified in the report closely,
* Evaluate the organizations or individuals billing patterns as they relate  to the CBR subject,
* Perform a root cause analysis and address or correct any errors with education,
* Continue to monitor the situation closely.

How do I avoid a CBR?


One of the best defenses for CBRs and other billing challenges is to practice proactive risk analysis, or regular and consistent monitoring to identify potential billing issues before they begin. Proactive risk analysis can easily be achieved by utilizing the data that already exists within your billing software. Reports that visually display information such as charge capture counts or evaluation and management level distribution can be particularly useful. The same reports can then be combined with CMS benchmarking data, allowing a provider or practice to easily identify any variance from expected billing patterns.

These reports should paint a clear and visible picture, providing valuable insight. In the event a CBR is received the reporting can be used as part of the examination and subsequent monitoring following education on the error. Reports can also be supplied to coding/auditing or Clinical Documentation Improvement Departments as a resource to begin analysis for targeted internal education.

Taking a proactive approach to billing patterns can effectively decrease billing errors, support operational excellence and allow providers to spend more time focusing on patient care, which is the heart of pMD’s mission.

If you are interested in learning more about pMD’s Billing & Revenue Cycle Management Services, please contact us here or give us a call at 800-587-4989 x2. We’d love to hear from you!

To find out more about pMD's suite of products, which includes our charge capture and MIPS registry, billing services, telehealthsecure messagingclinical communication, and care navigation software and services, please contact pMD.

 


Claim denied. Ugh! These are two words that make all those involved in the health care revenue cycle cringe. Unfortunately, claim denials are very common, costly, and time-consuming to correct. However, there are strategies to avoid them, with the potential to significantly increase your bottom line and decrease your revenue-related headaches. We’re going to talk about one of those strategies here — real-time eligibility. 

Why Are My Claims Being Denied?


Eligibility verification is one of the first phases in the revenue cycle and by far the most significant. Did you know eligibility issues are one of the top five reasons claims deny? In fact,  nearly 24% of claims submitted are denied for eligibility and registration issues, such as the patient not being eligible for medical benefits on the date of service, or having incorrect demographic information, like date of birth or a misspelled name. 

The eligibility verification process is directly linked to claim denials which can have a variety of unwanted consequences. This includes a hike in the number of days in A/R, an escalation in write-off rates, a standstill of cash flow, inflated costs to collect, and most importantly, delays in a patients' access to treatment. The process of verifying eligibility needs to be both efficient and accurate in order to determine the responsibilities of both the payer and the patient.

How Do I Make Sure My Claims Aren’t Denied?


Most claim denials are avoidable, in fact, 90% of them could be avoided. Research also shows that of those denied claims, approximately 60% of claims are recoverable, meaning they can be corrected and resubmitted for reimbursement. 

This sounds pretty good, right? Well, the reality is that a whopping 65% of denied claims are never reworked, which translates to a huge loss in revenue. The remaining claims that are reworked can be a drain on resources when factoring in both time and overhead costs. The average cost to correct and resubmit a denied claim can range anywhere from $30 - $125 per claim.

By implementing the right tools and processes, such as checking real-time eligibility, the likelihood of having your claims denied decreases significantly. By simply using real-time eligibility tools, you’ll be able to increase the number of  “clean” or error-free claims submitted,  tackling a number of the top reasons claims are denied, such as eligibility, no authorization, or being covered by another insurance plan.

What Is Real-Time Eligibility?


But what exactly is real-time eligibility, and how do I use it to my advantage?

Real-time eligibility is a software tool that allows medical staff to electronically confirm a patient’s insurance coverage by interfacing directly with the insurance carriers. This instant eligibility check provides an up-to-date overview of the patient’s coverage and plan benefits. Real-time eligibility can answer important questions such as if the insurance policy is active, the start and end dates of a policy, deductible amounts, copay coverage, and if prior authorization is required. Verification checks can be done at the time of the patient’s appointment, or even prior, which not only saves both the staff and patient time during check-in but also provides a clear understanding of both the provider and patients’ responsibilities.

Real-time eligibility benefits all those involved in the revenue cycle management process. For example, the amount of time staff spends checking and verifying a patient’s coverage is reduced significantly, as it eliminates back and forth phone calls, and the need to check multiple systems in order to verify coverage. Additionally, verifications are saved to the patient’s record, which provides an audit trail and proof of insurance coverage. Plus, it makes it much easier to submit clean, error-free claims, which facilitates faster payment and improves cash flow, which leads to increased provider satisfaction. Let’s not forget about the most important part of the revenue cycle, the patient. Being able to communicate to the patient their financial responsibility prior to, or at the time of service, makes for a much-improved patient experience.

Claim denials are preventable when identified and addressed early in the revenue cycle process. By implementing real-time eligibility, you can decrease the burden of claim denials, and in turn, enhance revenue, improve the overall patient experience, and let the provider focus on what matters most — patient care.

Learn About pMD Medical Billing & RCM Tools & Services


If you are interested in learning more about pMD’s billing and revenue cycle management services, please contact us here or give us a call at 800-587-4989 x2. We’d love to hear from you!

 

To find out more about pMD's suite of products, which includes our charge capture and MIPS registry, billing services, telehealthsecure messagingclinical communication, and care navigation software and services, please contact pMD.

Related Articles:
* Collecting Patient Payments & Solving the Patient Payment Equation
* When to Consider Breaking Up with Your Medical Billing Company
* Investing in Partnerships Pays Dividends


Welcome to the "Biller’s Corner" of the pMD blog, your trusted source for updates, tips, and tricks provided by seasoned medical billing and coding experts!

Medical coding is often a moving target, especially during a pandemic. But have no fear, we’re here to provide guidance on some recent coding updates you need to know about!

NEW COVID-19 VACCINATION CODE ALERT



Speaking of the pandemic, the AMA recently released the CPT® code 91303 for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative-free, 5×1010 viral particles/0.5mL dosage, for intramuscular use.

Here’s what you need to know:

* This is the code used for the one-dose COVID-19 vaccine developed by Janssen Pharmaceutica, a division of Johnson & Johnson.


* It should be used in conjunction with the CPT code 0031A, Immunization administration by intramuscular injection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) vaccine, DNA, spike protein, adenovirus type 26 (Ad26) vector, preservative-free, 5×1010 viral particles/0.5mL dosage, single dose.


AMA PROVIDES ADDITIONAL CLARITY ON THE UPDATED E/M CODE SET



Another hot topic this year has been the significant updates to E/M office codes (99201-99215). The primary intention behind the changes is to reduce the administrative burden of unnecessary documentation, in turn, allowing for more time to interact with patients. While the intention is great, there has been a lot of confusion surrounding the revisions made to this code set, and many physicians have reported that the ambiguity of the new revisions is actually leading to additional time spent on documenting. This is obviously the opposite of what they were going for, so the AMA is acting on that feedback and has released the following revisions, retroactive to January 1, 2021.

TIME-BASED BILLING

For time-based billing, you should not account the following:

* Performance of other services when reported separately


* Travel time


* Teaching that is not required for the management of the specific patients' care


Also, remember Medicare and private payers’ policies can differ when it comes to reporting prolonged services for time-based billing. Although the AMA has established the CPT 99417,  Medicare has assigned a status indicator of “I” for this code which denotes the code as invalid. Instead, Medicare will accept HCPCS code G2212 when reporting 15 minutes of prolonged care, performed on the same encounter as E/M codes 99205 and 99215. When billing for either code, be sure that it is listed separately in addition to a level 5 office/outpatient E/M service.

MEDICAL DECISION MAKING

When it comes to medical decision making (MDM), you should account for tests that are analyzed as part of MDM and are not reported separately when interpreting the study. These may be counted as ordered or reviewed when selecting an MDM level.  When determining the complexity of problems and the number of problems addressed, also consider the following:

* If the presenting symptoms are likely to represent a highly morbid condition, this may “drive” MDM even when the ultimate diagnosis is not highly morbid. Multiple low severity conditions may equate to a higher risk level due to interaction.


* When determining data reviewed and analyzed, pulse oximetry is not considered a test.


* When considering data elements reviewed, a combination of three data elements can be counted by reporting a unique test ordered, plus a note reviewed and an independent historian. However, it does not require each item type or category to be represented.


* Ordering a test may include those considered, but not selected after shared decision making due to patient health risk or a discussion to forego further testing due to lack of medical necessity.


UNDERSTANDING THE KEY TERMINOLOGY

The AMA has also provided clearer instructions to interpret the definitions that make up the elements of MDM. Understanding the following terms as they are laid out by the AMA is crucial:

* Analyzed: Tests ordered are presumed to be analyzed when the results are reported. Therefore, when they are ordered during an encounter, they are counted in that encounter. Tests that are ordered outside of an encounter may be counted in the encounter in which they are analyzed.


* Discussion:  Discussion requires an interactive exchange. The exchange must be direct and not through intermediaries (eg, clinical staff or trainees). The discussion can be asynchronous and occur on a later date following the encounter but must be completed within a short time period (eg, within a day or two).


* Independent Historian: When collecting the history, it does not need to be obtained in person but does need to be obtained directly from the historian providing the information.


* Risk: The term “risk” as used in these definitions relates to risk from the condition. While condition risk and management risk may often correlate, the risk from the condition is distinct from the risk of the management.


* Surgery (minor or major): The classification of surgery into minor or major is based on the common meaning of such terms when used by trained clinicians, similar to the use of the term “risk.” These terms are not defined by a surgical package classification. Be advised that CPT guidelines indicate that it is the provider's clinical determination whether surgery is considered major or minor and is not dictated by global days. However, if the surgery occurs in an office setting, you will have a hard time justifying it as a major surgery. Major surgeries will most often require the use of an operating room.


* Surgery (elective or emergency): Elective procedures and emergent or urgent procedures describe the timing of a procedure as it relates to the patient’s condition. An elective procedure is typically planned in advance and scheduled, while an emergent procedure is typically performed immediately or with minimal delay to allow for patient stabilization. Both elective and emergent procedures may be minor or major procedures. 


* Surgery (risk factors): Risk factors are those that are relevant to the patient and procedure. Evidence-based risk calculators may be used, but are not required, in assessing patient and procedure risk.


A full list of revisions can be found on the AMA website. Plus, be on the lookout for even more revisions that will become effective in 2023. 

Make sure to check back in soon for more billing and coding updates! And if you are interested in learning more about pMD’s billing and revenue cycle management services, please contact us here or give us a call at 800-587-4989 x2. We’d love to hear from you! 

To find out more about pMD's suite of products, which includes our charge capture and MIPS registry, billing services, telehealthsecure messagingclinical communication, and care navigation software and services, please contact pMD.



You’ve made your way to the physician’s corner of the pMD blog, welcome! Here you’ll find information written for physicians, by physicians. 

This post is written by Richard E Lehman, MD, Pediatric Critical Care Medicine

Ask any physician why they started practicing medicine; I promise you’ll never get the answer “because I love billing and documentation.” That being said, there’s really no way out of it as it’s part of the business of medicine.  It’s an essential part of the job we all have to deal with on a daily basis, but the more you know and understand about what goes on behind the scenes, the better off you are and the easier it is to do. Unfortunately, many physician’s billing questions often go unanswered or are told “if it isn’t broken, don’t fix it.”  Some just do the bare minimum to get by and are fine with the reimbursement, others question the whole system and what we can do to improve it.

Full disclosure, I’m not a biller. I am, however, a pediatric critical care physician who has spent over 20 years asking a lot of questions and identifying ways to minimize my administrative and clerical burdens, while still maximizing potential revenues. I’m here to pass on some of that knowledge and provide answers to a few questions commonly asked by physicians regarding billing and documentation I've heard over the years.

WHAT IS THE FINANCIAL IMPACT OF DIAGNOSIS CODES?



I hear providers asking this question a lot. Will my reimbursement change based on the number of diagnoses codes I use, and if so, how much will it increase per diagnosis? The short answer is no, the number of diagnosis codes won’t change the amount paid for a procedure. But this doesn’t quite tell the whole story. The natural follow-up question from providers is often “then can I save myself some time and only put one diagnosis code?” I asked this same question myself and have been told it’s not a great idea. If we routinely underreport diagnoses, we could find ourselves in some trouble with Medicaid payers if we get audited.  If payers are receiving some bundle of payment from the government based on the patient’s risk profile and they then under-report risk based on our under-reported diagnoses, it can result in hefty fines. So, although it may take a little bit of extra time, it’s usually a best practice to report dx codes accurately, with the most predominant one, typically most severe, first.

WILL I MAKE MORE MONEY THE QUICKER I DO MY BILLING?



This is a really interesting question. Will you actually make more money if a bill is submitted and processed today, versus days or weeks later? Well, one smart director of coding explained it simply, a bird in the hand is worth two in the bush…or so the saying goes. When it comes down to it, the longer it takes to collect, the less the money is worth. While we’ll normally get paid the same per our contracts as long as we file within the claims time limit, which can range from 60-365 days depending on the payer, at the end of the day the money is worth more the longer we have it in our pocket. So, ultimately the quicker you can get your billing submitted and processed, the quicker claims can be collected, and the more the money could potentially be worth.

WHAT ARE THE MOST COMMON DOCUMENTATION MISTAKES THAT AFFECT REVENUE?



Although time-consuming, poor documentation can significantly impact reimbursement amounts. Avoiding some common documentation mistakes can mean the difference between a claim being rejected or achieving maximal reimbursement. For example, failing to completely describe an assessment and plan, can derail a claim. Physicians sometimes assume an auditor can review lab values and understand what they were trying to do. They can’t. Since they’re not physicians, they’re not allowed to make those assumptions. If you’re looking for your maximum reimbursement, it’s important to include what diagnostic values were run and how they factor into your decision making. Document what you were thinking, what you reviewed, and what you plan to do about it. While not an exhaustive list by any means, other common documentation mistakes that can lead to missed revenue include:

* Using an incorrect date of service, which tends to happen when notes are retroactively created late


* Failing to include total time spent for a time-based service


* A sparse history and exam or exam template that wasn’t individualized and conflicts with other areas of the medical record


* Failing to sign a note, although this has become far less common these days


* Providing an incomplete sedation record


Overall, when it comes to maximizing your revenue there’s a ton of variance in best practices depending on your specialty, state, payer contracts, etc. I encourage everyone to ask questions and keep yourself informed as much as possible.

If you are interested in learning more about pMD’s billing and revenue cycle management services, please contact us here or give us a call at 800-587-4989 x2. We’d love to hear from you!

Dr. Rick Lehman is a veteran critical care physician, providing care to pediatric patients across the country. He’s “grown-up” with the changes in health care over the last 20 years related software and has been directly involved with implementing new EMR systems at multiple hospitals, often transitioning them from paper to digital systems. His frustrations surrounding inefficient EMRs while managing his critical care patients have driven his passion for changing these health care systems to create better provider workflows.

 

To find out more about pMD's suite of products, which includes our charge capture and MIPS registry, billing services, telehealthsecure messagingclinical communication, and care navigation software and services, please contact pMD.

Interfacing health care IT systems


Information technology is supposed to make work-life more efficient, accurate, and effective. The promise to eliminate duplication of effort and minimize fat-finger typographic errors is the core reason for adopting much of the IT used in the modern medical office. Nothing delivers on these promises more directly than establishing interfaces among the various computer systems in the health care delivery universe.

SHOULD YOU HAVE TO PAY FOR AN INTERFACE?


At pMD, our stated raison d'être is to save patient lives by reducing the risk of medical errors stemming from miscommunication and non-communication resulting in care gaps.  pMD was created to improve efficiency, accuracy, and information exchange among caregivers and patients.  Since interfacing is so integral and critical to achieving this goal, pMD has never charged our clients for an interface.  

When dining at a restaurant, you are paying for the food, but you are not charged extra for utensils or a plate.  When investing in a system to improve business efficiency and accuracy, getting quality data into and out of it should not cost extra.  This principle is at the core of the pMD approach to interfacing with other systems, including hospitals, practice management, answering services, and billing and revenue cycle management (RCM) services.  

Unfortunately, most other participants in the industry have a different view on the subject.  While pMD does not charge for interfaces, the reality is that most Practice Management (PM) System vendors do charge thousands of dollars for them.  Some hospitals and health systems also charge for data feeds to private practices as well, although can vary with the practice’s relationship with the hospital.

INTEROPERABILITY IS IN OUR DNA


Our commitment to core principles drove the way we designed our interfacing technology and continues to drive our methodology.  While many players in the industry are unwilling or unable to modify the format of the data they send or expect to receive, pMD has developed a system that allows us to be very flexible within the HL7 standard for interfacing.  Not only do we not charge providers, but we will flex to suit the needs of the systems we are exchanging data with.  

We have a huge existing and growing library of interfaces to a large number of systems that allow us to implement many interfaces with off-the-shelf modules quickly.  Our approach allows us to easily make adjustments to those existing interfaces for practices with unique requirements and workflows.  We’re also not limited to the systems we’re currently interfaced, we can adapt existing packages to quickly develop new interfaces with systems we have not previously encountered.  

pMD can process data for new and existing office and hospital patients, appointments scheduled in a practice management system, and can of course send charges in pMD back to the PM or RCM systems, customized to their unique requirements. The best part of it all, it is all included in the complete service that pMD prides itself on.

If you are interested in learning more about our interfacing capabilities, please contact us here or give us a call at 800-587-4989 x2. We’d love to hear from you!

To find out more about pMD's suite of products, which includes our charge capture and MIPS registry, billing services, telehealthsecure messagingclinical communication, and care navigation software and services, please contact pMD.


Related Articles:
* Healthcare Interface Implementation: 2 to Tango, 3 to Interface
* Interoperability in Health Care IT: The New Norm… Eventually
* Investing in Partnerships Pays Dividends

I’ve worked in health care for many years, and while providers face their fair share of challenges, there’s one question that I’ve noticed almost always bubbles to the top - who do I ask about coding questions? This can be especially distracting as they attempt to focus their efforts on providing the best medical care.

Why Coding is So Difficult

Coding appears to be a thorn in everyone’s side. Why is that? Well, imagine having to enter codes on patients 30+ times a day! Currently, to determine whether you’ve made the correct E&M (evaluation and management) code selection, providers must successfully meet each criterion of the 1997 Documentation Guidelines for E&M Services. Yes, you read that correctly, 1997! 

Let’s take a look at charge code 99213 as an example. While this may seem like a straight-forward, low-level subsequent visit, think again! To correctly select this code, you need to meet two of the following three requirements: 1) an expanded problem-focused history; 2) an expanded problem-focused examination; and/or 3) medical decision-making of low complexity. But, that’s not all. Now answer the following question; how do you define and determine expanded and low complexity? Each of the previously required components is broken down even further into several categories and elements that need to be considered.

As you can see there are many variables that go into selecting the correct code. The question many providers are left with is: who has time to reference the various guides and available resources when trying to complete a patient visit? Unfortunately, inaccurate coding can lead to significant penalties and lost revenue.

The Consequences of Medical Coding Errors

The good news is that changes are coming. Starting in 2021, time-based billing will be available for applicable services, dramatically reducing the complexity associated with code selection. CMS alone has reported a 9.2% monetary loss due to incorrect coding and 55.2% loss due to insufficient documentation in the CY of 2019. If you were to submit an incorrect claim to the government, this would violate the Federal Civil False Claims Act (FCA). Penalties may include substantial fines and even possible imprisonment. As frightening as those repercussions are, the most common consequence of medical coding errors is not receiving reimbursement from the insurance carriers. 

It’s about time we actually apply the infamous motto “patients over paperwork” and remove the providers’ burden of having to recite coding guidelines. Thus, eliminating the fear of possible sanctions due to inaccurate coding.

pMD Helps Solve Coding Problems & Meet Medical Billing Needs

At pMD, we can create customized edits designed to prompt providers to select accurate codes based on specific parameters and requirements, such as charge code or diagnosis criteria, NCCI edits, patient demographics, and much more. This is a quick, seamless process that enables the provider and biller to feel confident in their code selection. Just a few extra clicks based on prompts can assist with accurate and timely claims submission. Additionally, it can result in quicker payment turnaround as well as the appropriate utilization of E&M codes. 

pMD is continuously evolving to serve the medical billing needs of practices. Contact us to learn more about how pMD can best assist you and your practice!

Related Articles:
Standardized Code Sets, Their Impact on Providers & the Solutions
Investing in Partnerships Pays Dividends
Electronic Health Records Don’t Reduce Administrative Costs - Mobile Charge Capture Does!

 

To find out more about pMD's suite of products, which includes our charge capture and MIPS registrysecure messagingclinical communication, and care navigation software and services, please contact pMD.


From a financial perspective, one of the benefits of mobile charge capture software is a tremendous reduction in charge entry lag. This is the length of the time between when the patient is seen and when the charge is captured electronically - not on a piece of paper where it could be misplaced or accidentally used as a napkin.

Providers who see patients in an office or clinic setting typically have low charge entry lag. Patients come to them and the provider is always in front of a computer, so they can capture billing information at the same time as they're doing other documentation.

Everything changes the moment the provider heads over to see patients at an outside facility such as a hospital or nursing home. Suddenly they are walking from room to room, and they need to improvise a system (typically a paper system) to track what happens as they go along - or they have to reconstruct it from memory later, when they're in front of a computer. Then they have to figure out how get the paper or spreadsheet back to their billing office. This administrative burden can create a cycle of procrastination that leads to weeks of charge entry lag as busy providers struggle to stay on top of their paperwork.

The statistics tell the story. If you're looking for a mobile charge capture solution, you should ask each vendor what their median charge lag is across their entire customer base for these places of service: Hospital Inpatient, Hospital Outpatient / Surgical Center, and Skilled Nursing Facility. If a vendor tracks these statistics, the answers may reveal whether their charge capture solution is usable in real time. If they don't track these statistics, why not? Charge entry lag is one of the key metrics for charge capture software, and you should choose a vendor that helps its customers measure and improve it.

In February 2017, the median (typical) pMD customer had a charge entry lag of 0.06 days at these remote facilities. In fact, 84.9 percent of pMD’s customers had a charge entry lag of less than one day outside of the clinic setting. Of providers who used pMD to capture charges in February, 90.8 percent used the pMD mobile app to do so, and 91.2 percent of all February charges were created on mobile. These numbers prove that practices are living the dream of real-time mobile charge capture. The fast, intuitive mobile app that works offline is key to achieving this.

What does all this mean for a medical practice? If you start out with a charge entry lag of one week at your remote facilities, and you become a typical pMD customer with a charge entry lag of less than one day, then you immediately recover a full week of revenue that had been floating out there somewhere in paper form. You could bill 372 days worth of revenue in a single calendar year of 365 days.
Finally, and as expected, the announcement medical practices have been waiting for since spring came today. The U.S. Department of Health and Human Services issued a rule this afternoon to finalize the new ICD-10 deadline for October 1, 2015. Shortly after, CMS stated in a press release that this change “allows providers, insurance companies and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready to go on Oct. 1, 2015.”

The deadline was pushed back on March 31 of this year when the U.S. Senate voted on legislation that included a one-year delay to ICD-10. This delay came as a relief to many medical practices that required additional time and resources to implement an effective ICD-10 plan by the mandatory transition date. Even with the one year extension now formally in effect, medical practices are continuing to press on with their ICD-10 implementation strategies. With a good mobile charge capture system in place the ICD-10 transition is smoother and easier, making the countdown to the new disease classification system less daunting.

Marilyn Tanner, Administrator of CMS, contends that the "ICD-10 codes will provide better support for patient care, and improve disease management, quality measurement and analytics.”

Source: CMS.gov

The new ICD-10 code set, originally intended to be implemented in 2008, has now seen yet another delay to the October 2014 go-live date. Last week, the U.S. House of Representatives approved the “Doc Fix” legislation, which includes a one-year delay to ICD-10. Tonight, the Senate confirmed that delay, adding another year onto the ICD-10 countdown.

SEC. 212 DELAY IN THE TRANSITION FROM ICD-9 TO ICD-10 CODE SETS.
The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD-10 code sets as the standard for code sets under section 1173(c) of the Social Security Act (42 U.S.C. 1320d-2(c)) and section 14 162.1002 of title 45, Code of Federal Regulations.


This delay, so close to the October 2014 deadline, comes with mixed reviews from health care groups. There has already been a great amount of resources put into the training and funding of ICD-10 education and transition efforts. Well-prepared health care providers have already begun the process of learning the new level of specificity that will be expected of them for each patient visit, and medical coders have begun learning the complexities of these new codes so as to not interrupt reimbursement from payers. These groups who have already started the transition know how difficult it is and will continue to work diligently in the next year to be ready.

Then there are the medical practices and vendors that simply would not have been ready come October 2014, for which this decision comes as a huge sigh of relief. Those who haven’t begun the transition should use this delay as a wake-up call to get started now and take full advantage of the one year gift they’ve just received.

Still, this decision gives everyone more breathing room to develop an effective and seamless ICD-10 plan. Medical organizations have another year to work through the ICD-10 transition, and it’s a big undertaking that requires time from both health care providers and administrators. Having good software in place, such as a charge capture system, will help shrink the time needed to set aside for the transition, and will make the new October 2015 deadline less daunting.
Transitioning to the new ICD-10 code set without a mobile charge capture strategy is like traversing a snowstorm without a shovel. You will get through it (eventually), but it won’t be easy.

With the ICD-10 transition looming later this year, practices are scrambling to get a plan into place. Mobile charge capture can be an important part of that transition for doctors who see patients in hospitals and other locations outside of their office.

When providers are in the clinic environment, there are practice management and medical billing services to keep them organized and efficient with charge entry. But when providers work outside of their office’s four walls to see patients, they often revert to disorganized and inefficient systems of paper, spreadsheets, phone calls, and text messages… napkins, even. Mobile charge capture replaces these systems with intuitive software. It extends the practice to the hospital and the hospital back to the practice, so providers can stay on top of everything in real-time and communicate efficiently from their smartphones and tablets.

It might seem easier to ignore the snowstorm of ICD-10. But addressing your needs now by applying a good mobile charge capture strategy will make the transition smoother and easier.

Read the full article about how mobile charge capture can feel like a day at the beach with your transition to billing with ICD-10: http://www.athenahealth.com/blog/2014/01/29/icd-10-transition-the-benefits-of-a-mobile-charge-capture-strategy/