ICD-10 Moving Forward

Is ICD-10 going to be delayed again?

The answer seems to be a hearty "No." The Senate just passed the Sustainable Growth Rate (SGR) formula bill this week. There were no "additional riders" or other mention of holds listed in there that would in any way indicate any further delay for ICD-10. This bill was the last hold-out people were waiting for, as this is where ICD-10 got surprisingly derailed last year. If you are not on board with ICD-10, you should be buying a ticket fast!

Register for one of our weekly ICD-10 webinars NOW!

New EHR Meaningful Use Webinars

New EHR Meaningful Use (MU) Webinars for Stage 1 and Stage 2 users. Click Here for the New Dates and Times. Additionally... We are in the process of putting a page together for "EHR Meaningful User" under "Resources" where we will have a home for all of the information I'm going to list in a minute, up-to-date schedules for webinars, and a place to put evolving information as it becomes available.

• If you are in Stage 1 Year 1 and started reporting your MU numbers on July 1st, please remember that the end of the reporting period is coming up (October 1st). Additionally, you must attest by Oct 1st to avoid payment adjustments. 
• If you did not start your reporting for MU on July 1st, and are still Stage 1-Year 1, you are still able to receive your incentive payment if you start reporting from Oct1st - Dec 31st.
• If you are Stage 1- year 2,  or Stage 2- year 1, your last reporting period this year is Oct 1st - Dec 31st. If you are a Stage 2 office, it is important that you read up on all the new measures for Stage 2. 
•  It is very important for ALL of you, regardless of what stage you are in, to perform a Security Risk Analysis during their reporting period. This is part of the HIPAA requirements for meaningful use. Here are some good links regarding that measure:

1. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/SecurityRiskAssessment_FactSheet_Updated20131122.pdf 
2. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/14_Protect_Electronic_Health_Information.pdf 

• We have webinars/documents that will help them through whichever stage they are in. (Click here for the webinars and visit the GS website next week for additional information and documents.) 
• Here are some additional helpful links:

1. The decision “Widget” from the CMS website 
2. Available Systems 
3. Also, if your office is "less than prepared" you may qualify for a hardship exemption. Unfortunately, it’s probably too late this year to get it in but just in case for next year - Here is the information.

Senate Passes House Bill 4302

The US Senate passed House Bill 4302 ( a bill) on March 31, 2014.   This is the bill we just told you about and it's primary purpose is to extend (another temporary measure) the 24% Medicare SGR (Sustainable Growth Rate) increase given until they can resolve the SGR in a better way.  Of course this extension would mean that the SGR would again- NOT be fixed.

Somehow, someone was able to also tuck a clause into this bill, that if it passes, it will delay the planned ICD-10 implementation until Oct. 1, 2015. This bill will now proceed to the President for final approval or veto before becoming law.

Unfortunately this quick fix, from not fixing the SGR (WHICH STILL NEEDS TO BE FIXED)- while seemingly getting you your money - will in fact cost millions and then some.  Plus more millions for delaying ICD-10 implementation for another year (CMS had previously estimated another delay may potentially have a price tag of $6.6 billion impact).

I could find nothing that said that there would be any delay on the 1% Medicare take-backs scheduled to being for not meaningfully using an EHR (attesting by this year at latest - within the first 9 mo, for 90 days).  Or that there would be any delays regarding Stage 2 Meaningful Use.  Which makes sense as both of these are tied to the 2009 ARRA "stimulus" act, not the SGR (but considering they managed to throw an ICD-10 delay in there, it was worth a look).

Here is a link to the bill.
Here is a link to another good article discussing what this delay means to you, from EHR Intelligence.
Here is a link to a great Fierce Healthcare article & it has links at the bottom for the AMA, AHIMA, HIMSS.

Genius Healthcare Office Solutions Presents: The 2012 Florida Seminar

   

Genius Healthcare Office Solutions:
The 2012 Florida Seminar

Oct 9th - Register Now!
9am - 5 pm
$99.00 Per Person
@ Crowne Plaza
200 E. Gregory St.
Pensacola, FL 32501
850.433.3336

More Information
586.751.9080 or seminars@geniussolutions.com
Topics Include:

• Office Compliance Plans
• Best Office Practices
• ICD-10
• Tech Talk
• THOMAS Tips & Tricks
• And More!

CMS Threatens to Slash Medicare Payments by 27.4%

Ok, technically CMS just issued a teaser of their final Medicare payments rule which is due to finalized and out November 28, 2011.  But when you really look at it and think about it, it really is a threat of you vs. the federal government.  At the beginning of this month CMS (Center for Medicare & Medicaid Services) released a final rule stating that unless Congress does something by January 1, 2012 physicians and non-physicians (who receive reimbursements under the Medicare Physician Fee Schedule) will have subsequent payments slashed by 27.4%.  Although this number is down from the 29.5% cut CMS had estimated would occur earlier this year (because Medicare physician services have fallen below increased practice costs).

Permanent EHR Certification Program Delayed by ONC

Dr. Farzad Mostashari the coordinator for the Office of the National Coordinator for Heath IT (ONC) announced last week (click here for the posted announcement) that the permanent EHR certification would be delayed about 6 months, from January 1, 2012 to mid-2012.  This shift also coincides, deliberately, with implementation of the Phase 2 meaningful use standards.

Worried about ICD-10? Relax, ICD-11 is on its way!

Picture courtesy of http://icanhascheezburger.com

Yes, just when you thought your life couldn’t get any more complicated and governmentally annoying, someone just had to say it… ICD-11.  Yes, after a 23 year process to integrate ICD-10 codes, from their inception, into our United States vernacular, there are already newer codes looming on the horizon.  Perhaps if we hadn’t waited so long to move into ICD-10, this wouldn’t be like dripping ice water down your sun-warmed backs. 

Stimulus Payments and Meaningful Use, Preparing for 2012

Guess what?
If you haven’t already registered and if you are not meaningfully using your EHR 2011 is no longer an option for you.  You needed to report for 90 days this year and you would have to have registered and been using by the beginning of October to qualify for the 2011 payouts.

Is it worth it?  Really? 
We can’t speak for each of you, but I can direct you to this nifty article “CMS pays out nearly $90M in MU incentives in September” at HealtcareITNews.

ICD-10: Gone are the Days

ICD-10—Potpourri:
General State of Readiness- How you can & should be Preparing for the Inevitable, Part 4 of 4

ICD-10 Heralds the Death of the Superbill 

 
This article goes into a bit more detail, but I think you can gather from the above discussions that a superbill just isn’t going to be super enough to cut it for ICD-10.  Gayl Kirkpatrick, from 3M HIS Consulting Services, gave an example from a hospital her team consulted with. "We took a two-page superbill in ICD-9 and translated that into ICD-10," Kirkpatrick said. "It became a 48-page superbill." (1)

ICD-10: Concerns & Preparations

ICD-10—Potpourri:
General State of Readiness- How you can & should be Preparing for the Inevitable, Part 3 of 4

“When healthcare transitioned to ICD-9 on Oct. 1, 1984, there was still great confusion 18 months later on how to submit the codes. There was great deal of frustration both on the provider side as well as the health plan side. There was also a huge lack of training to prepare the doctors for the transition to ICD-9. As a result, for almost a year, there were large drops in revenue.

I am seeing things now, for ICD-10, that I witnessed back then for ICD-9. A great deal of people have not even started their processes.” Ben Michelson, of Hayes Management Consulting ...(1.)

Why ICD-10?

ICD-10—Potpourri:
General State of Readiness- How you can & should be Preparing for the Inevitable, Part 2 of 4

This article “ICD-10 Implementation: Top concerns for healthcare providers” quotes Jim Jacobs, senior vice president and product management and health information management for QuadraMed. "If you want to understand outcomes and understand the protocols that are working, the protocols that have measured benefits, then you need quite a bit of specificity."

What is ICD-10?

ICD-10—Potpourri:
General State of Readiness- How you can & should be Preparing for the Inevitable, Part 1 of 4

The message is, as always, begin to prepare now and begin making the changes to how you document now, so that you are better prepared as a provider for ICD-10 and so your coders and billers will have the information they need to take care of you and the patients properly.

The International Classification of Diseases system will be updated from the ICD-9 to the ICD-10 standard on October 1, 2013.  These are the codes that are used in healthcare as a common language to describe the diagnosis, condition, or other reasons for a patient visit to the doctor or healthcare facility.  Now around the world ICD-10 has been used for years, the United States is one of the last places to implement this coding.

New Changes to RAC Program

Per an article by Sheri Porter on the AAFP website, Medicare is making a change to the RAC programs that might help out family physicians and their offices, beginning January 3, 2012.

Genius Solutions 5010 Update

Genius Solutions is currently working with BCBS as a 5010 pilot tester (currently in Michigan).   We are working closely with BCSBEDI (MI) in testing 5010 format using 5010 test files.  BCBS is only working with about 100 pilot testers at this point and Genius is one of them.  At this time, only the pilot testers are allowed to submit 5010 test files into BCBSEDI.

Genius Solutions Inc. has sent test files from several of our providers into BCBS (MI) which are currently being tested and checked.  We are also hoping to continue to expand our testing within the next few weeks by starting to work with other payors and clearing houses as they become prepared to test. We will be ready to submit 5010 files come 01/01/2012.

EHR Stuff: All-in-one or Buffet-style? It’s your choice!

I’m sure you know how hard it is to find a good practice management (PM) system (when I say “good”, I mean gets you paid” AND makes your office life easier, not harder).  But now your life has just gotten complicated again.  Now you are being told that you need to have and use an EHR in your office.  Ok, even if you don’t give a hoot about participating in meaningful use.  The fact still remains that Medicare is threatening that if you are not meaningfully using an EHR by 2015 they are going to assess you a 1% penalty, with an additional percent being added each year up to 5% by 2020.  (Of course this could all change with the current state of healthcare and the influx or repeal of Obambacare.)  It is true.  There is a lot on the table with so many variables in play.  It’s more like a game of 52-card pick up than any organized card game.  (Seriously, have you ever tried to play Poker with someone who is playing Go Fish?)  Plus there are additional regional variations for Medicaid and third-party payers (Euchre anyone?). 

ICD-10 Deadline Fast Approaching- Only 28 Months Away?

By Penny Henriksen, Genius Solutions' News Editor

Ok, yes, I can hear you rolling your eyes.  You're thinking, "28 months, are you kidding?  That's 2 years and 2 vacations away...really?" Being out and about over the last year and speaking with many of you I also have actually heard "Yeah, but it's the CMS.  It's going to get bumped."  Let's reason together for a few minutes and reflect on this, shall we?

First Incentive Paychecks Mailing Out to Non-Hospital EPs This Week

Per an Update e-mail from the ONCHIT (the Office of the National Coordinator of Health Information Technology), the first paychecks will be going out this week for individual eligible providers who completed their attestation for having met the meaningful use and other necessary requirements.  Per one of their Twitter messages this week:  “Incentive Programs have paid out $83,294,778.06 since January.”  Up to this point that would be mostly money that has gone out to Hospitals and possibly some Medicaid payments.

The ONCHIT’s newsletter also reiterated some of the money rules that apply to these payments, this year:

• Payment is based on 75% of Medicare allowed charges that are submitted no later than 2 months after the end of 2011 (the charges had to be this year, but you seem to have a grace period for reporting of up to 2 additional months).
• The max allowed incentive charges for this year is $24,000, which will yield a max check of $18,000 incentive payment.
• An eligible professional must meet the minimum threshold of $24000 in Medicare charges before they can be paid the incentive.  (I know they say you only have to report for 90 consecutive days this year, but it sounds like you may have to give yourself a longer than 90-day window if it will take you longer to generate the $24000 minimum Medicare charge threshold.  Bear this in mind as you decide when you want to start your attestation period this year to give yourselves enough time to generate the proper amount of charges.)
• You will receive payment to the TIN (taxpayer identification number) you selected during your registration for the incentive program.

Want to know more?  Check out the Medicare “Path to Payment” Incentive page.

Changes this month…. New National Coordinator at the ONCHIT

Dr. David Blumenthal stepped down as the National Coordinator for Health Information Technology this month, replacing him is Farzad Mostashari, MD, ScM . Dr. Mostashari is not new to the ONCHIT office, he has been working with them and the previous National Coordinator since 2009. He was the Deputy National Coordinator for Programs and Policy when I was reviewing the big ONC HIT 2009 review at the end of last year.

ICD-10 Coding is Coming – Run NOW!

I had the opportunity to sit in on some preliminary ICD-10 training being given by the Practice Management Institute (www.pmiMD.com) last week.  It was their goal to inspire confidence and a “we can do this” attitude, but honestly, the reactions I witnessed (or had myself), looked more like despair that would soon be mixed with alcohol and anti-anxiety meds.  I was a bit disheartened.  I came out of that meeting thinking “ICD-10 coding is coming- Run NOW!”

Chicken Little
I do so hate to sound like Chicken Little shouting that “the sky is falling”.  I was also seeing some benefits to updating the codes and coding.  I mean, yeah, with new technology, new procedures, and new techniques, there needed to be new codes and new code availability to cover them.  It also simplifies some things to have one CPT code, rather than a CPT code plus some DX codes.  The specificity of the codes will also make the data more valuable because you are giving more information.  Disease and treatment patterns can be studied more accurately.   The spread of disease can be studied and possibly better contained.  However, this is a beast with many tentacles, on par with the biggest of government programs and endeavors ever conceived.  Have no doubt, it is going to change the way you document patient encounters and bill out, forever.

Let’s start with the easy stuff and work our way along the ICD-10 trail.

Electronic Patient Data: The Future e-Wave Comes Crashing Down

Four quick, current looks at patient information: Need, Care, Exploitation, and Change 

NEED

Now that hospitals and offices are getting on the EHR bandwagon and they are discovering the pearls, perils, and pitfalls of it, it is coming to light that physicians aren’t the only people who need to be educated about electronic health records and using them. According to a new study by PwC (PricewaterhouseCoopers LLP) and some general “noticing” of things, it is being discovered that patients aren’t quite on the e-records band wagon yet either. PwC surveyed 1000 consumers and found that only 14% of them had gotten their records electronically from their physician (I didn’t see a note that indicated any connection between desiring to get their records electronically, and being able to get them because of the office not being able to issue it.) Setting aside that potential problem- 14% get e-record, 30% said they don’t know why they would ever need them, and 50% requested paper records. When consumers were asked how they would like to interact with their doctors electronically the top three answers were to: follow-up from their doctors, make appointments, learn about treatment information.