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• Volunteers Sought for ICD-10 End-to-End Testing in January: Forms due October 3
• National Partnership to Improve Dementia Care Exceeds Goal to Reduce Use of Antipsychotic Medications in Nursing Homes: CMS Announces New Goal
• Hospital Appeals Settlement: New FAQs Posted
• Groups: Remember to Register for 2014 PQRS GPRO Participation by September 30
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• Completion and Submission Timeframes for Hospice Item Set Records
• Important Skill Sets for Doctors and Nurses: CME Articles Available on Medscape
• New Resources and Webinars from National Health IT Week
• PQRS: New Quality Reporting Training Modules to Help Ensure Satisfactory 2014 Reporting
• 2014 CAHPS for PQRS Survey
• New PQRS FAQs Available
• New and Updated FAQs for the EHR Incentive Programs

Claims, Pricers, and Codes

• FDG PET for Solid Tumor Claims

Medicare Learning Network® Educational Products

• “Medicare Billing Information for Rural Providers and Suppliers” Booklet — Revised
• “Rural Health Clinic” Fact Sheet — Revised
• “Avoiding Medicare Fraud & Abuse: A Roadmap for Physicians” Fact Sheet — Revised
• “Critical Access Hospital” Fact Sheet — Revised

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Personal stories resonate. They grab our attention and reel us in. For parents who may not know about Medicaid or the Children’s Health Insurance Program (CHIP), hearing about other families – like Shellie’s recently highlighted on the U.S. Department of Health and Human Services blog – who obtained health coverage for their children and teens through these programs can spark interest. It can even drive parents to take the first step toward enrollment by visiting websites such as InsureKidsNow.gov or HealthCare.gov, calling national or local assistance lines for more information or attending an enrollment event.
Parents who have enrolled their children – and themselves – in Medicaid or CHIP can be great ambassadors for your organization’s outreach efforts. A personal story can be especially powerful in bringing program facts to life. See how the Valles family obtained health coverage for their kids when they went grocery shopping and stopped by an enrollment table hosted by the Children’s Defense Fun-TX  (CDF-TX). CDF-TX’s storybanking expertise was featured on a Campaign webinar on April 3, 2014, “Enrolling Eligible Children & Teens in Medicaid and CHIP Year Round.”

Identifying Parents with Personal Stories to Share
Here are a few tips for identifying and vetting families with personal stories:

·         To identify families with compelling personal stories, connect with organizations and trained assisters who help eligible individuals enroll in Medicaid and CHIP. People who help families enroll are likely to have established trust and have a good rapport with them. Ask enrollment assisters for basic information about the family to help you determine if the story is a good fit for your organization’s outreach efforts.
·         Once you identify a family with a story to share, set up a one-on-one conversation to get more information. Ask how the family learned about Medicaid and CHIP and whether they got help enrolling in the program or enrolled on their own. Ask for details that can help others identify with the story – for example, does the enrolled child have any particular health problems? Seek specific examples of how enrollment in Medicaid or CHIP has improved the family’s quality of life. You may have to ask some sensitive questions about their worries before health insurance and how they managed to get through illnesses, along with questions about household income to confirm that they are eligible for Medicaid and CHIP in your state.

Working with Media Outlets
Having at least one or two families that are willing to talk to the media can increase the likelihood that your organization and your issue will be featured by local news outlets. Personal stories, such as this one shared by a parent with a child receiving CHIP coverage during a recent radio interview featuring Positively Kids in Las Vegas, NV, may be a “news hook” and can demonstrate the relevance of the story to the local community. Always obtain the family’s permission before sharing their information with the media, each and every time. Don’t assume that family members will be comfortable meeting the news team at their home, workplace or school. Always confirm with the family before suggesting a location to a reporter. Listen carefully during these conversations, if someone seems uncomfortable, don’t push the person to give the interview.

Before introducing a family spokesperson to a media contact, make sure he or she feels comfortable sharing his or her story and responding to questions. For all media interactions, encourage your spokespeople to speak clearly and with confidence, stay on the topics you practiced and smile when appropriate. When possible, join the family for the interview to help respond to difficult questions about the program and jump in if the spokesperson is struggling for an answer or has veered off topic. Campaign Resources: Check out this Connecting Kids to Coverage Back-to-School Booster, or watch the recorded webinar “Using Media to Amplify Outreach and Enrollment Efforts” for tips on media outreach.

Campaign in Action – Health Care for All (MA)
Health Care for All in Massachusetts uses personal stories to generate media coverage and reach the diverse families in their community. After identifying and confirming the stories of Spanish- and Portuguese-speaking families, Health Care for All features them in language-specific newspapers or on radio shows. Health Care for All helps the families prepare to speak to the media and have their stories featured in written materials and on the news. Families may also attend public events to share their experiences with other eligible families. Campaign Resources: Check out our Outreach Video Library to learn more about how Health Care for All effectively reached out to ethnic media outlets and faith-based communities to execute a successful phone-a-thon.

Other Helpful Resources
Several organizations that have additional tools and helpful ideas on effective storybanking:

·         Community Catalyst has an online guide on storybanking, with resources, such as a sample discussion guide.
·         Families USA has a PDF guide that provides a step-by-step process for gathering stories. If your organization does in-person enrollments, you may also want to listen to Families USA’s May 14, 2014webinar specifically geared to help enrollment assisters start story banks.

Stay Connected With the National Campaign – In 3 Easy Steps
· Follow the Campaign on Facebook and Twitter. Don’t forget to re-tweet or share our messages with your network or use our #Enroll365 hashtag in your posts.
· Share our materials widely. We have more than 50 National Campaign resources available, including translated print materials, to use in outreach and enrollment efforts.
· Contact us to get more involved with the National Campaign at InsureKidsNow@fleishman.com or 1-855-313-KIDS (5437).

Pioneer ACO Model and Medicare Shared Savings Program ACOs part of plan to improve care and lower health costs across the health system
The Centers for Medicare & Medicaid Services (CMS) today issued quality and financial performance results showing that Medicare Accountable Care Organizations (ACOs) have improved patient care and produced hundreds of millions of dollars in savings for the program.
In addition to providing more Americans with access to quality, affordable health care, the Affordable Care Act encourages doctors, hospitals and other health care providers to work together to better coordinate care and keep people healthy rather than treat them when they are sick, which also helps to reduce health care costs. ACOs are one example of the innovative ways to improve care and reduce costs. In an ACO, providers who join these groups become eligible to share savings with Medicare when they deliver that care more efficiently.
ACOs in the Pioneer ACO Model and Medicare Shared Savings Program (Shared Savings Program) generated over $372 million in total program savings for Medicare ACOs. The encouraging news comes from preliminary quality and financial results from the second year of performance for 23 Pioneer ACOs, and final results from the first year of performance for 220 Shared Savings Program ACOs.
Meanwhile, the ACOs outperformed published benchmarks for quality and patient experience last year and improved significantly on almost all measures of quality and patient experience this year. (Please see the accompanying fact sheet for additional details.)
“We all have a stake in improving the quality of care we receive, while spending our dollars more wisely,” Health and Human Services Secretary Sylvia M. Burwell said. “It’s good for businesses, for our middle class, and for our country’s global competitiveness. That’s why at HHS we are committed to partnering across sectors to make progress.”
This news comes as historically slow growth in health care costs is continuing. Health care prices are rising at their lowest rates in nearly 50 years, Medicare spending per beneficiary is currently falling outright, and, according to a major annual survey released last week, employer premiums for family coverage grew just 3.0 percent in 2014, tied with 2010 for the lowest on record back to 1999.
Since passage of the Affordable Care Act, more than 360 Medicare ACOs have been established in 47 states, serving over 5.6 million Americans with Medicare. Medicare ACOs are groups of providers and suppliers of services that work together to coordinate care for the Medicare fee-for-service (FFS) beneficiaries they serve and achieve program goals.
ACOs represent one part of a comprehensive series of initiatives and programs in the Affordable Care Act that are designed to lower costs and improve care by advancing three key strategies for improving care while investing dollars more wisely: incentives, tools, and information.
Incentives
We are interested in advancing efforts to strengthen incentives to reward higher value care rather than higher volume of care. The Center for Medicare and Medicaid Innovation, created by the Affordable Care Act, is testing new models of care in two of the biggest health insurance plans in the world – Medicare and Medicaid. One example is ACOs, where groups of health care providers receive a financial incentive for coordinating care delivery. As we announced today, they are already seeing success. By working with state and private partners, we can drive more improvement through supporting payment models that reward higher quality care.
Tools
We recognize that giving providers and states the tools and capacity for change in the health care delivery system is crucial to the success of these efforts. The HHS Office of the National Coordinator for Health Information Technology and CMS are managing $27 billion in funding from the American Recovery and Reinvestment Act of 2009 and other sources to promote the adoption of electronic health records (EHR) in hospitals and doctor’s offices. More than 75 percent of eligible health care professionals, and over 90 percent of eligible hospitals, have already qualified for EHR incentive payments for using certified EHR technology to meet the objectives and measures of the program.
And HHS is providing technical assistance and grants in areas such as practice design and transformation, supporting states in leveraging state-wide alignment towards value in health spending, and recruiting and training a world-class health care workforce.
Information
The more we empower doctors and patients with information, the better choices they are able to make about their care. HHS has set out to improve the flow of information for consumers, providers, and payers by, for example, releasing more Medicare data, and supporting the ability of health information technology systems to talk to each other for patients’ benefit.
For fact sheets on Pioneer ACO Model and Medicare Shared Savings Program ACOs results, and delivering better care at lower cost, please visit: http://www.cms.gov/Newsroom/Search-Results/index.html?filter=Fact%20Sheets.

Source: http://www.hhs.gov/news/press/2014pres/09/20140916a.html

One year ago, physician practices were singing the praises of tablets, patient portals, and cloud-based EHRs. Not to be outdone, 2013 also brought in some great technology and tools to medical practices. Here’s a look back on what, technology-wise made doctors’ “hot” lists this year.
1. Security: Blame it on the passage of the more-stringent HIPAA Omnibus Rule, the growth in healthcare data breaches, or the influx of tablet-wielding physicians who use theirs to log into their EHR — privacy and security took center stage in 2013. And so did the number of products available to physicians that wanted to make sure protected health information (PHI) stayed protected. “The three biggest security technologies this year that created sighs of relief all over the country were privacy monitoring, data-loss prevention, and encryption [tools],” said Mac McMillan, CEO, CynergisTek. “Those healthcare entities that deployed these technologies in their enterprises learned firsthand the power and confidence of proactive security.”
2. Meaningful use: It’s been a few years since CMS released its EHR Incentive Program, and many physicians are still striving to meet Stage 1 rules for “meaningful use.” Some are even preparing for Stage 2, which will require more proof of patient engagement, care coordination, and information exchange. And technology decisions were largely centered around meeting meaningful use incentives, said Rosemarie Nelson, a Medical Group Management Association consultant. “More practices that had not yet adopted an EHR started down the path because of meaningful use,” said Nelson. “Practices that have used an EHR for several years started to examine their own implementation to determine if indeed it would be the tool to get them through meaningful us. The portal gained traction because of meaningful use, not because it is a great tool for patients and increases efficiencies in the practice.”
3. Patient payment estimation tools: Patients were faced with a greater financial burden in 2013, with larger deductibles and copays, which meant that practices had a tough time collecting payments. The bad news is that paid at your medical practices is only going to get harder, our recent PayerView 2013 data, compiled by athenahealth, revealed. The survey revealed that higher deductibles continue to impact provider collection burden, a measure of how much of the patient’s bill must be collected by the practice. That’s why tools that help patients determine how much they owe saw increasing interest, especially in the second half of 2013. “Tools like patient responsibility estimators help providers begin the financial discussion with patients early, ultimately increasing patient satisfaction and giving the patient a higher propensity to pay their balance,” said Kim Labow, vice president of marketing for ZirMed.
4. Tools to better manage patient health: The past 12 months saw an increased interest tools technology to support higher-quality care. “Our industry continues to emphasize the collection, integration, and analysis of patient data as a means to drive more personalized, impactful care,” said ophthalmologist Jonathan Javitt, who is also the CEO and vice chairman of Telcare. Michael Lee, director of clinical informatics for Massachusetts-based Atrius Health said this year practices truly started implementing tools that support population health, managing panels of patients and quality reporting. “There is a lot of technology needed to care for patients on a large scale,” said Lee.
5. Mobile health monitoring. Telehealth enjoyed big strides this year, and is now being seen as a cost-effective alternative to in-person care for those who live in rural areas. In tandem, mobile-health monitoring systems and mobile applications, which allow patients to engage in their own care and send data to their physicians, are starting to take off. “Mobile-health monitoring in particular has seen explosive growth thanks to the advancement of cellular-enabled platforms that can offer real-time data sharing,” said Javitt.

By: Marisa Torrieri

– Source: http://www.physicianspractice.com/medical-billing-collections/top-healthcare-technology-tools-and-trends-2013#sthash.sJ2I6IyL.dpuf

Primary-Care Exception and Physician Assistants
Q: If a teaching physician is using the primary-care exception (PCE) and he is supervising fewer than four residents, can a physician assistant (PA) be included in the mix of four that the teaching physician is supervising? The teaching physician is using the PCE that allows supervision of a maximum of four residents.
A: I do not think a PA can be included in the mix due to the condition that the attending: “Have no other responsibilities, including the supervision of other personnel, at the time services are furnished by residents.” (See http://go.cms.gov/1d2M9Co).
On one level the PA doesn’t factor into the exception equation because Medicare doesn’t have anything to do with their reimbursement. On the other hand, the “other responsibilities” language above translates pretty directly into a “no” answer to your question. However, as a practical matter I suspect this is violated regularly in the name of efficiency, revenue, and volume.
Preventive Exam and E&M
Q: What do I need to do to better document the Medicare preventive exams when combined with an E&M? I have been told that I am missing things. How do preventive exams and regular annual exams differ?
A: Medicare calls these exams annual wellness visits (AWVs), and they require you to address some very specific items that differ from a typical or historical preventive service.
First off, you called it a “Medicare preventive exam.” Try and be more precise in the terminology. The AWV doesn’t actually include a physical exam, and if you do one for these visits you are going above and beyond somewhat. In that case, Medicare would be happier if you called it an AWV and management of “X.”
If you are providing both the AWV and an E&M service, as more and more providers are doing of late, document the history of present illness associated with the problems assessed first. Then move on with your normal review of systems; past medical, family, and social history; and exam associated with both aspects of the visit. AWVs also require some assessment of cognitive impairment and a couple of other items that are often not stated clearly in the note.
The most commonly overlooked elements are:
• Establishment of a list of current providers and suppliers that are regularly involved in providing medical care to the individual.
• Detection of any cognitive impairment that the individual may have.
• Review of an individual’s potential risk factors for depression, including current or past experiences with depression or other mood disorders, based on the use of an appropriate screening instrument for persons without a current diagnosis of depression, which the health professional may select from various available standardized screening tests designed for this purpose, and recognized by national professional medical organizations.
• Review of the individual’s functional ability and level of safety, based on direct observation of the individual, or the use of appropriate screening questions or a screening questionnaire, which the health professional may select from various available screening questions or standardized questionnaires designed for this purpose, and recognized by national professional medical organizations.
• Establishment of a written screening schedule for the individual, such as a checklist for the next five to 10 years, as appropriate, based on recommendations of the U.S. Preventive Services Task Force and Advisory Committee of Immunizations Practices, the individual’s health status, screening history, and age-appropriate preventive services covered by Medicare.
Although you may have actually addressed these elements in your comprehensive exam and note, use the language CMS uses (i.e., no cognitive impairment detected). There may also be a list of other providers elsewhere in the chart. If so, just reference it.
Ask your administrator to get you a copy of the AWV outline from Medicare.
Health Risk Assessment and Annual Wellness Visit
Q: If a patient does not fill out the health risk assessment (HRA) portion of Medicare’s AWV regarding activities of daily living (ADL) and instrumental activities of daily living (IADL), but the patient does perform the up and go test for the nurse, can we use that test for the HRA requirement of ADL and IADL, as well as using it for the review of the beneficiary’s functional ability and level of safety (ability to successfully perform activities of daily living)?
A: There is no more specific guidance on these elements other than what it says in the Medicare transmittals. They don’t talk about double use, versions of things, or partial things. It is really up to you whether you think one of these services has all its pieces. The elements of the HRAs don’t specify required elements for the HRA, just suggestions. It’s kind of up to you what you think is defensible and thorough. It would be nice if all these things were quantified but such guidance is not always available.
Fracture-Code Time Frames
Q: I’m an orthopedic surgeon and I was recently told that I shouldn’t be using closed fracture treatment codes two weeks or three weeks after the initial injury. Is this the case?
A: The CPT book states that “a physician that provides the definitive fracture care following a treatment to stabilize or protect may bill the fracture care codes” but it gives no time frame for this lapse between initial treatment and “definitive” treatment. An example of when such a time lapse might occur between initial and definitive treatment would be a Friday night ER visit with a cast and follow-up Monday or Tuesday of the next week with a cast replacement.
I can see a good use of the fracture care code within a reasonable proximity to the injury — perhaps up to seven or 10 days — but it would not appear as reasonable beyond that time frame. The real indicator as to whether you should use the treatment code is whether the patient clinically requires the treatment — that will be the ultimate defense.
Facing a coding conundrum? We’re here to help. Send your questions to coding expert Bill Dacey at billdacey@msn.com. He will help clear up the confusion, and you may even see your question featured in the journal.

By: Bill Dacey

– Source: http://www.physicianspractice.com/medical-billing-collections/primary-care-exception-and-pas-preventive-exam-and-em#sthash.J83DVG6D.dpuf

1. Your practice hasn’t spent a dime to get ready.
There are a dozen excuses for this. “If I send her for training, she’ll just want more money or go to another practice.” Or, “We’ll wait and buy the final version of the ICD-10 book when it’s released. It’s still in draft form, you know.” While large systems and groups are well on their way to ICD-10 preparedness, some smaller groups have taken a wait-and-see approach. They hope that CMS will change its mind, and push back the deadline. Or, they tell themselves, “It will get quieter in the spring, we’ll do it then.” Lame excuses. Buy the draft version of ICD-10 and educate key staff members; plan physician training for closer to implementation, either in person or online.

2. Your software vendor tells you not to worry.Well, if your vendor tells you not to worry and has shown you their mapping program and has installed the latest software, then OK. Is your vendor well established and committed to the program you have? There is a shakeout going on in the EHR and practice-management world, partly related to meaningful use. Look in trade journals, talk to your specialty and professional societies, and be sure your vendor will still be in business, supporting your needs, in 2014. I’d still worry. Or better yet, prepare.

3. You’re using a paper encounter form and select diagnosis codes from it.
A long, laudable essay could be written about the benefits and ease of using a paper encounter form. It would need to end with “rest in peace,” however. Circling the most common codes and writing in a code that isn’t on the form — when a more specific code was available — has resulted in many unspecified codes. It wasn’t good practice in ICD-9 and will become impossible in ICD-10. ICD-9 had about 14,000 diagnosis codes and ICD-10 has about 70,000. It is the rare specialty practice that uses a handful of the same codes over and over. Groups using paper encounter forms for diagnosis coding will need a new system.

4. The software upgrade to an ICD-10 compatible version is scheduled for September 2014.
Be on the latest version of your software — get an early upgrade so you can try out the ICD-9 to ICD-10 mappings and begin to educate providers using your system. Worry if the vendor has a late implementation date. At the very least, ask for a test version.

5. Currently, you have claims denied as “not medically necessary” and/or pre-authorizations for diagnostic tests denied because there is “no covered indication.”
These are diagnosis-code problems in ICD-9 and they are only going to get worse in ICD-10, when the volume of diagnosis codes explodes to 70,000 codes. There will always be some of these denials in a practice: The patient may not have a covered indication or the payer policy changed. If your practice is experiencing these now, however, the problem will only grow. Expect some glitches as payers migrate their coverage policies from ICD-9 codes to ICD-10 codes.

6. No cash on hand or available line of credit.
Let’s say your staff is trained, your providers are scheduled for online specialty training, you own ICD-10 books, and your software has a mapping program that you’ve tested thoroughly. You’ve tested with CMS and all went well. There’s one more thing to do. Save some cash. One single fly in the ointment, one payer, one clearinghouse glitch, one binary 0 that should be set to 1 has the potential to slow your payments. For example, if one small insurance company that represents 7 percent of your revenue stops paying, how long can you make payroll and pay bills?

7. You never saw an unspecified diagnosis code you didn’t like.
It is easy to be complacent about diagnosis coding in a medical practice. After all, most ICD-9 codes support the medical necessity for an E&M service, specific or not. Many procedures have an obvious diagnosis: appendicitis for appendectomy. Diagnostic tests and procedures have always required more care in selecting the accurate code. But, if you run a report and find a high frequency of unspecified codes (codes ending in .9), pay attention. Start using specific ICD-9 diagnosis codes now to ease the transition to the more detailed and descriptive ICD-10 system.

8. A bonus worry. If your system allows users to change the definition of an ICD-9 code from the official ICD-9 language to words that are “easier to find” for the clinician, switch back to official ICD-9 language today. Don’t even think of converting to ICD-10 if your current diagnosis descriptions don’t match official language.

By: Betsy Nicoletti

– Source: http://www.physicianspractice.com/medical-billing-collections/eight-warning-signs-your-practice-isnt-ready-icd-10#sthash.CnePc3iP.dpuf

While the decision to change to a direct-pay practice can be the most difficult one a physician can make, there is a second decision that is nearly as difficult: How to charge for services. This decision not only affects the bottom line of the practice, but can greatly affect the type of care that is given.
The main issues to consider are:
1. Do you charge a monthly “subscription fee”? If so, how much do you charge?
2. Do you charge a copay for office visits (or simply charge for visits alone, if you don’t do a subscription fee)?
3. Do you charge extra for labs, immunizations, and other services as an additional revenue source?
While I cannot expertly give all of the pros and cons of each of these options, I can explain how I decided on the route I took, as well as the consequences, good and bad.
1. Monthly fee
I charge a monthly subscription fee, ranging from $30 to $60 per month based on the age of the patient; that includes a $150 monthly maximum for families. I also have a one-time “registration fee” of $50 per person ($200 family maximum). I do not have any discount for people who pay for the year in advance, nor do I require people to commit to any more than a month at a time.
The main reason I chose this method was to keep it simple and affordable. I want it simple because I am a doctor who does not like accounting: I don’t want to chase down money I am owed, nor do I want to refund patients should I somehow not be able to provide the services they have paid for ― for example, if my office burns down or I get sick. The amount I charge is aimed at keeping my services affordable for my patients.
The consequences of this: This has really worked quite well. I have a reliable income that has grown each month I’ve been in practice. The growth of my practice, however, has not been too rapid, nor have I been overwhelmed with workload (so I think the price is not too low). Very few people have left the practice for financial reasons.
2. Copay
I do not charge a copay for visits. When I did the math, the difference between what even a substantial copay would contribute vs. no copay at all was quite small. The vast bulk of my income comes from monthly payments ― regardless of copays. I also felt that charging a copay would make my patients avoid care they needed, which sabotages my “high access” model.
The consequences of this: I was afraid that patients would abuse the no additional cost, open access, but currently (at 400 patients and growing) that has not been the case. The reality is that most people try to avoid going to the doctor, and the majority of their problems can be managed via telephone or secure messaging, so my office is often empty. Because of the monthly fees, I earn just as much with an empty office as I do with a full one. That’s a very welcome change.
3. Additional fees
I do everything possible to give services at, or near, cost to my patients. Immunizations, labs, office tests, and procedures are not marked up. I do this partly because, in the big picture, the income from them would be insignificant; but more importantly, I want to give my patients services they can’t get elsewhere. I want to raise the cost for them to leave my practice ― so they will keep paying me their monthly payment.
The consequences of this: The largest benefit is that my patients trust me much more than they did in my old practice. They know I am not going to “nickel and dime” them for every little additional service. Plus, the drop-out rate in my practice has been very low; indicating that I am giving my patients enough value to keep them paying me each month.
While I am still not certain of exact numbers, I am very optimistic about the straight, monthly fee-payment model I’ve chosen. I have a predictable monthly income (regardless of my patient volume). And more importantly, I am no longer dependent on sickness or clinical problems to get paid. I can now focus on treating patient problems when they are small and using education to help my patients spend their time where they want to be: away from the doctor’s office.

By: Robert Lamberts,

– Source: http://www.physicianspractice.com/medical-billing-collections/what-charge-direct-pay-practice#sthash.7ANIx0JY.dpuf

As healthcare changes, the way many practices and health systems think about revenue cycle solutions will begin changing as well.

That’s according to Elaine Remmlinger, a senior partner and leader of the healthcare IT practice at Kurt Salmon, a global management and strategy consulting firm.
At this year’s Healthcare Information and Management Systems Society (HIMSS) Conference in Orlando, Fla., Remmlinger discussed the state of the revenue cycle solutions market, how it is changing, and how health systems can begin navigating this change during her session entitled “Next Generation Revenue Cycle — Is Now the Time?”
“This is not about just billing, this is about much more, “said Remmlinger. “Depending on your scope, these solutions can help to improve the patient experience, can help enable care coordination, provide the analytics and reporting that we’ve needed for so long, help you move towards your journey in new payment models … make you more efficient inside the business office, inside of the various areas that support the front end to the back end, and help improve your bottom line financial performance.”
Several factors are pushing revenue cycle management vendors to expand their capabilities, said Remmlinger. These factors include new payment models that reward high-quality, low-cost care; increasing integration between practices, hospitals and other health systems; the transition to ICD-10; and the pressure on practices and health systems to operate more efficiently. “The impact of all of this happening at the same time is tipping the marketplace to move forward with these projects,” she said.

Right now, many vendors are focusing on providing more of an “enterprise solution” to revenue cycle, one that can be applied and used throughout the continuum of care (such as within all of the practices and hospitals that are part of an integrated health system). In addition, vendors are exploring more data analytics capabilities and dashboards within their product offerings, said Remmlinger.

Other big changes to the product offerings and the overall market include: fewer add-ons within solutions (because “bolt-ons” are becoming part of the core system) and the push toward more modern technology platforms, she said. In addition, as more vendors provide enterprise solutions with more capabilities, health systems may be working with fewer vendors overall.

“As the needs become more integrated and the lines blur with the clinical environment, it’s clearly way more than just about billing,” said Remmlinger. Revenue goes from the front end to the back end, including patient management. It now includes care management.”

While the scope of revenue cycle solutions is changing, this change will be gradual, she said. Many health systems are reluctant to undergo a conversion due to the scope and financial commitment such a project entails. In addition, many are still focusing on the ICD-10 transition and meeting meaningful use requirements. On the vendor side of things, many of the products simply aren’t yet ready for implementation, said Remmlinger.

“While this transition has been occurring for probably a decade now, it’s probably going to go on for another five years before we see these next generation solutions replace the legacy systems and the enterprise systems mature,” she said.

By: Aubrey Westgate

– Soource: http://www.physicianspractice.com/medical-billing-collections/ongoing-evolution-healthcare-revenue-cycle-solutions#sthash.r5MzNKl1.dpuf

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