Friday, May 8, 2015

Five more facts about ICD-10 Facts from CMS

Five More Facts about ICD-10

1.  If you cannot submit ICD-10 claims electronically, Medicare offers several options
CMS encourages you to prepare for the transition and be ready to submit ICD-10 claims electronically for all services provided on or after October 1, 2015. But, if you are not ready, Medicare has several options for providers who are unable to submit claims with ICD-10 diagnosis codes due to problems with the provider’s system. Each of these requires that the provider be able to code in ICD-10:
  • Free billing software that can be downloaded at any time from every Medicare Administrative Contractor (MAC)
  • In about half of the MAC jurisdictions, Part B claims submission functionality on the MAC’s provider internet portal
  • Submitting paper claims, if the Administrative Simplification Compliance Act waiver provisions are met
If you take this route, be sure to allot time for you or your staff to prepare and complete training on free billing software or portals before the compliance date.
2.  Practices that do not prepare for ICD-10 will not be able to submit claims for services performed on or after October 1, 2015
Unless your practice is able to submit ICD-10 claims, whether using the alternate methods described above or electronically, your claims will not be accepted. Only claims coded with ICD-10 can be accepted for services provided on or after October 1, 2015.
3.  Reimbursement for outpatient and physician office procedures will not be determined by ICD-10 codes
Outpatient and physician office claims are not paid based on ICD-10 diagnosis codes but on Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) procedure codes, which are not changing. However, ICD-10-PCS codes will be used for hospital inpatient procedures, just as ICD-9 codes are used for such procedures today. Also, ICD diagnosis codes are sometimes used to determine medical necessity, regardless of care setting.
4.  Costs could be substantially lower than projected earlier.
Recent studies by 3M and the Professional Association of Health Care Office Management have found many Electronic Health Record (EHR) vendors are including ICD-10 in their systems or upgrades—at little or no cost to their customers. As a result, software and systems costs for ICD-10 could be minimal for many providers.
5.  It’s time to transition to ICD-10
ICD-10 is foundational to modernizing health care and improving quality. ICD-10 serves as a building block that allows for greater specificity and standardized data that can:
  • Improve coordination of a patient’s care across providers over time
  • Advance public health research, public health surveillance, and emergency response through detection of disease outbreaks and adverse drug events
  • Support innovative payment models that drive quality of care
  • Enhance fraud detection efforts
Keep Up to Date on ICD-10: Visit the ICD-10 website for the latest news and resources to help you prepare.

Physician Query Process: Physician Query Basics And When To Query

Hi again... this is a copy of a blog post from Libman Inc.  You can find the entire 11 part series at Libman Education...  Good Stuff!

by Christopher G. Richards, RHIA, CCS, Senior Associate, Barry Libman, Inc.
As part of a continuing series of discussions relevant to the coding community, Libman Education presents this 11-part series on the importance of a well implemented physician query process. 

What is a physician query?
Simply put, a physician query is a written communication tool that will allow coders to improve the accuracy of coding by actively involving the physician in the documentation clarification process. Full and complete documentation is the essential key to accurate coding. A physician query should present specific facts derived from the medical record and convey clearly to the physician why additional clinical clarification is needed.

Does a physician query have an exact definition?
A physician query is defined as a written question to a physician to obtain additional, clarifying documentation to improve the specificity and completeness of the data used to assign diagnosis and procedure codes in the patient’s health record.

Why do you query a physician?
As stated, you would query a physician to ensure complete and accurate health record documentation. Querying a physician is a vital part of that documentation process.

When do you query a physician?
This is important to ensure an appropriate query and also to avoid unnecessary queries. If coding a record is difficult, ask yourself if the patient’s health record has any:
  • Conflicting information
  • Ambiguous information
  • Incomplete information
  • Clinically relevant information not addressed
  • Significant reportable condition or procedure
If you answered “yes” to any of the above you should consider a physician query.
But – know when NOT to queryDo not query
  • to question a provider’s clinical judgment
    e.g. chest x-ray is negative but the provider documents clinical pneumonia
  • when the benefit is strictly for reimbursement
  • when there is clinically insignificant findings or irrelevant information
  • when the improvement to data quality is negligible
Value the physician’s time! Know when to NOT initiate a formal query.

Describe General Aspects Of A Compliant Physician Query

For more information contact:
Christopher G. Richards, RHIA, CCS
Senior Associate, Barry Libman, Inc.
Pamela Haney, MS, RHIA, CCS, CIC, COC
Director of Education and Training, Libman Education
  • AHIMA Practice Brief: Managing an Effective Query Process, 2008
  • AHIMA Practice Brief: Ensuring Legibility of Patient Records, 2003
  • AHIMA Practice Brief: Guidance for Clinical Documentation Improvement Programs, 2010
- See more at:

Thursday, May 7, 2015

CMS: Five Facts about ICD-10 -

Five Facts about ICD-10

To help dispel some of the myths surrounding ICD-10, CMS recently talked with providers to identify common misperceptions about the transition to ICD-10. These five facts address some of the common questions and concerns CMS has heard about ICD-10:
  1. The ICD-10 transition date is October 1, 2015. The government, payers, and large providers alike have made a substantial investment in ICD-10. This cost will rise if the transition is delayed, and further ICD-10 delays will lead to an unnecessary rise in health care costs. Get ready now for ICD-10.
  2. You don’t have to use 68,000 codes. Your practice does not use all 13,000 diagnosis codes available in ICD-9, nor will it be required to use the 68,000 codes that ICD-10 offers. As you do now, your practice will use a very small subset of the codes.
  3. You will use a similar process to look up ICD-10 codes that you use with ICD-9. Increasing the number of diagnosis codes does not necessarily make ICD-10 harder to use. As with ICD-9, an alphabetic index and electronic tools are available to help you with code selection.
  4. Outpatient and office procedure codes aren’t changing. The transition to ICD-10 for diagnosis coding and inpatient procedure coding does not affect the use of Current Procedural
    Terminology (CPT) for outpatient and office coding. Your practice will continue to use CPT.
  5. All Medicare Fee-For-Service providers have the opportunity to conduct testing with CMS before the ICD-10 transition. Your practice or clearinghouse can conduct acknowledgement testing at any time with your Medicare Administrative Contractor (MAC). Testing will ensure that you can submit claims with ICD-10 codes. During a special acknowledgement testing week to be held in June 2015, you will have access to real-time help desk support. Contact your MAC for details about testing plans and opportunities.
Keep Up to Date on ICD-10: Visit the ICD-10 website for the latest news and resources to help you prepare.

CMS offers Free ICD-10 training in Idaho in May11, 13, 15, 2015

CMS is offering three free ICD-10 training sessions in Idaho, designed for physicians and practice managers.
The dates, times, and locations are listed below.  Registration required (link is within the training brochure below).
May 11, 2015
5:00 p.m. – 7:00 p.m.
Coeur d’Alene
Kootenai Health
2003 Kootenai Health Way
May 13, 2015
9:00 a.m. – 11:00 a.m.

Idaho Division of Medicaid
3232 W. Elder Street
May 13, 2015
5:00 p.m. – 7:00 p.m.
ISU Student Union Building (Snake River Room)
981 S. 8th Avenue
Click here to see the training brochure for complete details.