You may have heard some pretty scary talk about how implementing the new ICD-10 coding system could be very expensive, possibly even bankrupting small medical practices. However, if you are smart and well-prepared, you can not only survive the transition, but benefit from fairer reimbursement in the long run.
“Fears of bankruptcy might be extreme, but this transition could have a significant impact on finances,” said Asia Blunt, practice management strategist at the American Academy of Family Physicians.
According to a new analysis from the AMA, the costs of implementing ICD-10 for physician practices could be significantly higher than previously estimated. New estimates range from $56,639 to $226,105 for small practices and $213,364 to $824,735 for a medium-sized practice. Beyond the cost of software upgrades, new paperwork, and staff training, the biggest potential for losses will be denied claims during the early days of the new system. CMS has estimated that claims denial rates could increase 100 percent to 200 percent in the early stages of coding with ICD-10, according to the AMA.
The way to minimize denied claims is by being sure your staff is well-trained. With proper training on the new codes, the learning curve shouldn’t be too steep, but it is essential not to wait until the last minute to start getting ready. “I’m frightened when a practice tells me that they plan to start training in August,” says Brenda Edwards, CPC, an AAPC ICD-10 trainer. “That’s too late. You need to begin training earlier to allow time to become proficient before [the Oct. 1, 2014 deadline].”
Blunt also recommends having a claims denial process in place. When a claim is denied, and many will be at first, locating the problem — asking if it is a coder issue or a payer issue, for example — can make it easier to correct problems and prevent future denials. It’s always a bad idea to not follow-through on denied claims, but that could be disastrous following the ICD-10 transition.
While denied claims might be the source of the biggest losses, they certainly aren’t the only place where an unprepared practice can lose money. A savvy practice will also be prepared for hidden costs or costs they may not have thought of. Some are relatively small. For example, certified AAPC coders will be required to take an ICD-10 proficiency assessment, and there is a fee for this. Other hidden costs are larger and more difficult to quantify, such as the cost of lost productivity while employees are training.
Another unpleasant surprise can come when vendors don’t have the software upgrades completed in time, or if the upgrades aren’t suited to the particular needs of your practice. Edwards recommends getting in touch with both your EHR vendors and your payers to make sure that not only will they be ready on time, they will be ready in time for you to have a trial run of the new systems well ahead of the October 1, 2014 deadline. You don’t want to wait until then to find out that your vendor left out the very codes you need the most.
Even with the best preparation, some things will inevitably go wrong.
“The AAFP is recommending that practices have at least a three-month cash reserve,” said Blunt. “If they have the capability to have additional cash reserves, that would be better. However, if they have at least a three-month reserve, this should be sufficient time to identify any problems with payers and claims transmission and resolve them,” she said.
Ideally, of course, you won’t need that much extra cash. Thorough preparation is the key to sailing through this transition with your finances in good shape. Of course, truly astute practices are taking the long view. Even if they do have to cover some losses in the short term, the ICD-10 codes, with their more specific diagnoses should allow for more accurate claims resulting in more equitable reimbursement in the future.

By: Avery Hurt

– Source: http://www.physicianspractice.com/medical-billing-collections/keep-your-medical-practice-in-the-black-during-icd-10-transition#sthash.lhOq2hFb.dpuf

Only 273 days away from New Year’s Day, medicine as we know it will change drastically. As much as we would hope for another delay, there are promises that ICD-10 will not be delayed any longer. It is really hard to know who and what to believe about ICD-10, but one thing is sure: It’s going to happen and everyone is dreading the transition.
We are all being told to start getting ready. I’m not sure what exactly that means. I have read the articles and listened to talks about getting ready. I just don’t think that it will be real for me until it is really here. I tend to be a hands-on learner. Until a system has actually gone live, it is hard to me to absorb what I must do since it doesn’t actually count (I don’t do well in the theoretic realm).
For pediatrics, I was perversely hoping that we would get some more specific codes because there are many times where I am forced to pick a code, all the time telling the parents that their child doesn’t exactly have that diagnosis but it is the closest I can get. Evidently, the total number of pediatric codes is decreasing. Fabulous! We get to continue putting square pegs into round holes. On the other hand, I really feel sorry for the orthopedic surgeons. Some of their codes are going from a single code, to more than 500 choices. That is really going to slow down their delivery of care. I guess it is feast or famine.

I know that as a provider, I will need to do my part in making sure the codes are accurate to the best of my ability. Then it is up to my coders to confirm that I got it right before sending it out to the insurance companies. We currently have two full-time biller/coders for just over 13 full-time providers. When I lay awake at night thinking about the transition, I fear that we may not have enough coders. A good coder is really hard to find … imagine the difficulty trying to find one for pediatrics!
Most of us have an EHR at this point. Is your EHR provider giving you information and updates about how they are going to comply with the change? Have they let you know how they are going to support you during this transition? Have they shown you their solution for the conversion from ICD-9 to ICD-10 yet? I certainly hope that your EHR company is prepared and ready to help you.
So let’s presume that all the providers, outpatient offices, and electronic records are ready to go with ICD-10 on Oct. 1, 2014. What about the insurance companies? Are they going to be ready to process these claims? Judging by some experiences with HIPAA 5010 implementation, I have my worries that they will be truly ready. And what about all these new plans starting this year as part of healthcare reform? Will they be ready for the transition?
If the payers are not ready, ultimately medical practices will suffer. Cash flow will possibly have a huge slow down. This is occurring during the fourth quarter, at year’s end. This is the worst time. We are planning on budgeting carefully in order to have enough cash on hand for our end-of-year expenses.

And then there are the government based-programs: Medicare and Medicaid. Should we take comfort or fear from the way the introduction to the Affordable Care Act was handled in October of this past year? It took two months to get the website up and running efficiently and that took intense media and political pressure to make it happen. If Medicare and Medicaid are not able to handle the transition, do you think that the public and government will be as worried about our billing challenges as they were with the rollout of healthcare reform?
I think that the most important things is to remain calm (I feel like emblazoning that on T-shirts for all the staff to wear on Oct. 1). Yes, we will all slow down as we wade our way through this new system of passing information from our office to the insurance companies. Yes, the reimbursement will likely be delayed in arriving to our offices. Yes, we will probably all have headaches and heartburn from October through December 31st. But like any transition, we will get through it. And as the head of your practice, keeping a calm demeanor will go a long way to reassuring your staff that “this too will pass.”

By: Rebecca Fox, MD

– Source: http://www.physicianspractice.com/medical-billing-collections/ICD-10-more-questions-than-answers#sthash.afpSyeLd.dpuf

Modifiers. They’re those pesky numbers that coders must append to a code in order to ensure proper reimbursement. What modifier is most appropriate? Does documentation support its use? Could the practice successfully defend its usage during an audit? These are just a few of the questions that coders regularly.

During AAPC’s 22nd annual HEALTHCON conference held earlier this month in Nashville, TN, two healthcare attorneys participating in a legal trends panel discussion cited modifiers as the top compliance concern facing today’s practices. They specifically flagged modifiers -25 and -59 as being particularly challenging.

Katherine Abel, CPC, CPB, CPMA, CPPM, CPC-I, director of curriculum at AAPC, talked about these and other modifiers during a presentation given to a room filled with dozens of physician practice medical coders. Following is some of the advice she provided.

Modifier -25
Modifier -25 denotes a significant, separately identifiable evaluation and management service that a physician or other qualified healthcare professional performs on the same day that he or she performs another procedure or service.

To correctly append modifier -25, coders must know the global period for each CPT code, including the typical pre-, intra-, and post-operative services included with each procedure, as these services are not separately billable, said Abel. Coders can easily search the entire fee schedule for this and other information about specific codes.

When coders append modifier -25 to an E/M code, carriers will pay for both the medically necessary E/M service as well as the procedure. Abel said coders should keep this in mind because the modifier can trigger overpayments if appended improperly. However, the modifier can also increase revenue if used correctly.

She urged coders show providers an example of how small overpayments due to this modifier can add up over time, resulting in thousands of dollars inappropriate payments annually.

For example, when coders report 20610 ($60.90) with 99213-25 ($73.08), they’ll receive a total of $133.98.

“A provider may look at an individual instance of $73.08, but if you annualize it an apply some of the penalties you can get from doing this, it gives [providers] a bigger picture to look at to help them understand what it is their doing and the risk they’re putting themselves at.”

Abel urged coders to keep in mind that E/M services performed on the same date of service as a minor surgical procedure (i.e., a procedure with a global period of 000 or 010 days) are generally included in the payment for that procedure. She cited this example of improper use:

A patient complains of left knee pain. A physician evaluates the knee and determines that the patient would benefit from arthrocentesis. The physician gives the patient an injection and schedules a follow-up visit for one month.

In this scenario, the evaluation and management is not separately billable in addition to the injection, said Abel.

However, she noted that payer policies pertaining to modifier -25 may differ. Each payer may have different criteria for usage as well as items that don’t meet those criteria. For example, BCBS of TN specifies that coders cannot append modifier -25 when a physician performs a minor procedure. BCBS of Alabama states that the decision to perform a minor procedure is a pre-requisite of appending modifier -25. Clearly, these two policies contradict one another.

Aside from checking payer policies, Abel also urged coders to literally separate the documentation of the E/M service from the procedure in order to better understand whether the E/M service could be billed separately. She suggested using a highlighter to identify documentation pertaining to one of the two services. Then ask whether there is enough documentation remaining to support reporting the other service.

“When you separate it out like this, it is very clearly seen,” she said. When appealing denials for modifier -25, coders can then attached this note with highlighted documentation to bolster support for their appeal letter.

Another suggestion was to simply ask physicians what pre- and post-operative services they normally include with certain procedures. This makes it easier to identify instances in which physicians go above and beyond what might normally be considered part of the procedure.

She referred coders to the National Correct Coding Initiative (NCCI) Policy Manual for Medicare Services (revised January 1, 2014) for more information and encouraged them to read through the general chapter. She also stated that coders should review the NCCI edits to determine whether modifier -25 may even be applicable. Download the physician—not hospital—version of these edits.

Modifier 59
Modifier -59 denotes a distinct procedural service, including a different surgical session, different procedure or surgery, different site or organ system, separate excision or incision, or separate lesion or injury.

In addition to reviewing NCCI edits and policy manual, Abel urged coders to review specific payer policies as well as Medically Unlikely Edits. Then ask these questions:

• Was the procedure performed in a separate setting, different time, or different encounter?
• Is there sufficient documentation to support the separateness and distinction of the two procedures?
• Was the procedure truly separate and/or is it unusual to perform these procedures at the same session?

As with modifier -25, Abel suggested using different colored highlighters to highlight documentation pertaining to each procedure to make it clear to the payer that each procedure is separate and distinct.

Author: Lisa Eramo

– Source: http://codapedia.com/article_706_Clearly-separate-documentation-when-appending-modifiers-25-and-59.cfm#sthash.Drby3E2A.dpuf

At the beginning of 2014, family physician Andy Pasternak’s two-physician practice braced for an influx of new patients. But while a few new patients who purchased insurance through the federal and state health insurance exchanges had trickled in by early March, new patient demand was far lower than what Pasternak expected.
“We had sort of been geared up for the large flood of people starting Jan. 1 because there was this whole, ‘Everybody’s going to get signed up and everybody’s going to have health insurance,’ and there was a lot of concern that there were people that maybe were going to have a lot of urgent needs,” says Pasternak, whose practice is located in Reno, Nev. “We’ve had some exchange patients, but it’s certainly not been the large overwhelming flood of patients that we were kind of concerned about.”
Pasternak is not alone in experiencing a slower than anticipated uptick in new patient demand. While several factors may be contributing, technical glitches in both the federal health insurance marketplace and state health insurance exchanges may be a key driver.
Still, by the deadline of March 31, just over 7 million Americans had signed up for health insurance plans via the exchanges, according to the Obama Administration; thanks to a surge in enrollment days before the end of the open enrollment period.
While it’s difficult to determine how this will affect your practice, it’s likely that many of you will begin encountering these new patients — and it’s smart to be prepared. And even if your practice does not experience a surge of new patients, brushing up on how you handle new patients is a smart move. As patient satisfaction plays a growing role in reimbursement, and as more payers ask patients to shoulder more of their healthcare costs, your new patient orientation policies and procedures should change accordingly. Here’s how to ensure that you are efficiently and effectively welcoming new patients to your practice.
Assess and update
Start by assessing whether your new patient orientation documents need to be updated or expanded. These documents should outline your practice’s basic policies — for example, how to schedule appointments, how to request prescription refills, and who to contact when questions arise, says Gail Levy, founder and president of The Levy Advantage consulting firm. They should also outline your practice’s payment policies, letting patients know if you require them to pay copays at time of service, how you handle past due balances, and so on, she says.
If your practice is encountering patients who are newly insured, consider adding a glossary of key health insurance terms to your new patient education materials. A December 2013 study published in Health Affairs found that fewer than 1 in 4 uninsured Americans understands key terms like deductibles, out-of-pocket spending caps, or provider networks. The more informed your patients are about how their insurance works, the easier it will be for your practice to collect what it is owed for services.
Distribute copies of patient orientation materials to your new patients by mail, e-mail, or in person, preferably prior to their first appointment, says Audrey “Christie” McLaughlin, of medical practice consulting firm McLaughlin Sales Group LLC. If you significantly updated these materials, distribute them to all of your patients at their next appointments. Also, post the materials on your website and/or your patient portal so they are readily accessible to patients, she says. “Now is the time, when you have this influx of new patients, to look back and review how you have been orienting new patients to the practice from the get go, and get that information out there.”

By: Aubrey Westgate

– Source: http://www.physicianspractice.com/medical-billing-collections/welcoming-newly-insured-patients-your-medical-practice#sthash.iPUQXiOk.dpuf