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Complicated Crosswalks, More Codes And Stricter Documentation Requirements. But ICD 10 Is Not The Loch Ness Monster !

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Are you ready to get cracking on ICD 10 ?

The deadline for adopting ICD 10 is inching a little closer every day ! It is time for the eternal question. Are you prepared? A study by the Health Revenue Assurance Associates says that 20% of medical practices are yet to start an education or training program on ICD 10.

About half of the medical practices surveyed were way behind timelines set by Medicare and Medicaid. The transition is going to be tough. No matter what mild mannered, reassuring experts say ! And that is why the sooner a practice makes the switch, the better.

Confounding crosswalks…

Medical practitioners who think cross-walking ICD 9 codes with the latest codes is just a matter of few mouse clicks, have a second think coming. The General Equivalence Mappings does offer a detailed crosswalk of both the coding systems.

But the fact that there are very few one to one matches between both coding sets is going to make the transition, tricky.

According to a study by researchers from the University of Michigan and Illinois, mappings for specialists are going to be, especially, complex. Emphasis has to be laid on understanding and managing, mapping categories and networks.

ICD-10-Crosswalk

A little bit of effort from everybody…

It isn’t the coding or billing team alone that is going to struggle with the new codes. It is going to take a bit of effort from all concerned.

As ICD 10 is all about greater specificity and granularity, physicians will have to focus more on the medical documentation they send to the billing team. More documentation could mean just one thing, more revenue !

Have you forgotten your insurer ?

Well, your insurer is a part of your team as well. Ask for a testing plan and send a few “test” claims to the insurer. Coordinate with your payers to make sure you are ready for the D day. Keep in mind that you cannot send ICD 10 claims till the compliance date. But don’t let that stop you, from sending out trial claims, to payers.

Why ICD 10 is not the Loch Ness monster, after all !

The entire hullabaloo surrounding ICD 10 makes the codes look like small, poisonous creatures, out to get physicians. In the long run ICD 10 can prove to be good for practices. It could mean more accurate payment for medical procedures. Fewer miscoded claims. And, a better idea of how much you’d be paid, prior, to a medical treatment.

Don’t Fumble Your Way Through EHR Implementation !

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EHR Implementation ; How To Avoid The Tripwires…

Choosing an EHR is tough. A zillion glossy brochures, well-meaning colleagues and pushy sales persons only make the decision harder. The, fact that almost everybody who owns an ehr hates it with a passion makes the most determined of physicians, back-foot.

According to recent reports physicians are reverting to paper records. And some have started looking out for another EHR. A survey by American EHR partners found that user satisfaction levels dropped from 39% in 2010 to 27% in 2012. How do you ensure your EHR implementation process doesn’t turn out to be a harrowing experience ?ehr-implementation

Know What You Want…

Most physicians rush in to ehr implementation without clear direction or expectation. Analyse your workflow and see how the inclusion of an electronic health record impacts your practice operations. Do not fall for the “you can tweak it” line. Manipulating your ehr can prove to be counter-productive.

Customizing your system is fine as long as you don’t miss out on the features and automated comfort your ehr offers.

What Does Your Front Office Team Think ?

Yes, the mousy girl who sits in the reception needs to know whether the appointment scheduling and insurance eligibility feature, makes the cut. Your coders will have to decide if the coding and scrubbing options are easy to work with.

The end users are many and you have to choose an EHR that makes everyone happy. It will increase productivity and morale.

The Person Who Matters The Most !

Your patients are the lifeline of your medical practice. Ask your EHR vendor whether they offer a patient portal. Check if it is patient friendly and secure. Enquire about the level of training and support offered. Caring for your patients is after all the best investment, ever.

Stay The Course !

Adopting an EHR is like parenting. It does get on the nerves and makes you lose sleep. But being a quitter is not going to help. Vow to yourself no matter how tough it is you will not revert to paper. Scribbling down details is easy but not the best way to work. During the implementation stage itself, promise to yourself, you will stick to your EHR.

Increased Reimbursement For Primary Care Physicians, A Closer Look !

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A welcome respite for primary care physicians !

Everybody knows that primary care physicians are struggling to stay in business. A mandate by the Affordable Care act has announced that Medicaid rates for certain primary care procedures will be paid on par with Medicare rates.

 To receive additional reimbursement physicians will have to fill out, a, state specific Medicaid self-attestation form.

Medicare

Who are covered ?

Family practices, pediatricians and general internal medicine physicians are eligible for increased reimbursement. So are several other sub-specialties and physicians who perform high levels of primary care services. The major criteria are that, physicians should be board certified and have a billing history that indicates that about 60% of their billing is for primary care codes.

The rate increase will be in effect till the end of 2014. Physicians, who’ve registered through MITS and are approved by the Office of Medical Assistance, can see more digits in their pay check from April 2013.

The code to more dollars !

Primary care physicians will be reimbursed in accordance to HCPCS codes related to primary care. Evaluation and management codes from 99201 through 99499 are eligible, as are certain vaccine administration codes.

The rough and tumble of practicing primary care…

Primary care physicians are working under heavy financial pressure. The sequestration cuts of 2013 have taken a heavy toll on medical practices. The sustainable growth rate formula has quickly turned in to a nightmare for physicians.

 Reimbursement cuts, operational pressures and complicated regulations scared the daylights out of physicians.

Quite arguably it was primary care practices that were the hardest hit. Primary care centers were soon shutting their doors as it became increasingly difficult to practice. Primary care practitioners were finding it almost unfeasible to take care of their elderly Medicare patients.

At a time when it was needed the most !

The increase in reimbursement has come at a time when physicians need it the most. The increased Medicaid reimbursement means physicians are offered a reprieve after all the financial pressures they’ve gone to.

Want a few tips to increase the revenue of primary care practices ?

Are Meaningful Use Guidelines Driving Physicians Round The Bend ?

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Are physicians being rushed towards achieving MU ?

According to some strange law in the healthcare universe, there is always going to be someone complaining. EHR adoption rates are up. But before, you feel that doctors have finally made peace with their ehrs. Recent studies indicate that switching to an EHR can lead to loss of revenue.

Research Speak !

A recent study by the University of Michigan shows that only 27% of practices have showed a positive return on the money invested in their EHR.  It cites rather alarmingly, that a physician loses $43,743 over 5 years after EHR adoption.

The research further reveals that the incentives for working with an EHR do help. But in a “very uneven way”

MU

Rushing headlong into EHR adoption can be the reason…

The rapid pace of adopting EHR’s, in the pell-mell to receive incentives, is being blamed for the loss of revenue. EHR adoption rates are increasing at breakneck speed leaving no time for data collection to catch up. It paints a very unhealthy picture. In the race to ace the EHR game, patients it is feared, can be left in the lurch.

Can Stage 3 of Meaningful Use turn out to be a nightmare ?

This seems to be the shared fear of everyone, from the AMA Executive Vice President and CEO James L. Madara. To, the small practice owner, three blocks away. Stage Three MU has additional and stricter measures, for physicians to meet.

Inter-operability continues to be a key issue. With serious flaws in EHR systems and their architecture, MU can prove to be a disaster waiting to happen.

There is reason to chin up !

Though, loss of revenue due to EHR implementation continues to be a haunting dream. Physicians can take heart in the fact that focusing on their revenue cycle maximization that can reverse their fortunes.

The study by the University of Michigan on EHR use, has found that the major difference between practices that lost money, and those that didn’t. Was, how they used their EHR’s, to increase revenue.

Medical practices that, concentrated on patient care, improved their billing process and focused on reducing denied claims, saw a positive change. It is time for medical offices to not just concentrate on achieving MU but also think of ways to improve their billing cycle.

Is Your Medical Practice Ready To Attest For Meaningful use?

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Are You Ready To Attest For Meaningful Use ?

If you are an EP, receiving the MU incentive check is going to top your list of priorities. It is time for physicians to pull up their socks and start working towards meeting the eligibility criteria for MU 2. Before getting down to the brass tacks it is important that you phase out the attestation process.

Meaningful Use

Being Up To Speed On Data Transmission…

Data transmission is a tricky word. It means you need to share data without making compromises on data privacy. To, begin with exchange a clinical document with one of your peers who use a, different EHR. Send out “trial” documents to test the waters. Check whether you are able to transmit clinical data securely.

Shop for a HIE and team up with one, to be able to transmit medical data easily across the care continuum.

Time To Stop Fighting Over Turf  !

Physicians have always felt a little queasy about letting patients access their EHR. A secure patient portal that allows patients to view and download medical information is important to meet the patient engagement criteria.

It is essential that stringent authorization methods are followed to prevent data misuse. And that, patients, are sufficiently educated about data security.

Dial Your Vendor’s Number…

You’ve pulled out all stops to make sure your practice meets MU standards. But is it is of little or no use, if your vendor doesn’t match your pace. Check with your vendor whether your EHR is compliant with the Meaningful Use 2 guidelines. Communicate with your EHR vendor and emphasize that a specific timeline needs to be adhered to.

With data interoperability being one of the key considerations, to attest for MU, it is important that you join forces with your EHR vendor, to reach the finishing line on time.

Have you spoken to your business associates ?

It is important that your business associates are an integral part of your MU attestation efforts. Whip up a plan with your business associates to optimize your workflow and streamline your everyday work processes.

2 hours a day !

Spending as little as two hours a day to work towards achieving MU can put you on the fast track to receiving your check. The key is to coordinate. Make sure that everybody who is involved with your medical practice is on the same boat. And to, make the most important person in the equation, your patients, to get more actively involved.

Should Patients Be Allowed To Access Their Physicians EHRs? Weighing The Pros And Cons

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Whose EHR Is It Anyway ? !

 This far and no further, is the approach physicians are taking when it comes to patient EHR access. Patient electronic access is an important objective of Meaningful Use. It can help physicians to deliver better quality of care.  And to bring everybody across the care continuum in one single, secure platform.

EHR-access

Data security risks is the key reason why the debate on patients access to EHR is still up in the air. Nothing can scare physicians more than a data breach. The average housewife in New Jersey may not be up to date on HIPAA regulations  And there is also the potential threat of patients misinterpreting their medical data.

A physicians understanding of a medical problem is not the same as that of a patients. It could cause unnecessary stress and anguish, and make patients vulnerable to self-medication dangers.

I Don’t Want My Patients In The Drivers Seat…

According to a recent survey conducted by Accenture, around 65% of doctors feel that patients should be given limited access. About 82% of physicians endorse the view that patients should be actively involved in their healthcare. Around 4% of doctors told they’d like to ban patients from having an online access to medical records.

Most physicians were of the opinion that other than demographics, patients shouldn’t be allowed to edit or update any other medical data.

The Way Around This Catch 22 situation !

  • Talk to your EHR vendor about including patient identity proofing and authentication features.
  • Standardize the information you want your patients to access.
  • Educate your patients about your EHR.
  • Work with a  biller who has experience in working with your EHR so patient billing is streamlined to a great extent
  • Follow a clear cut privacy policy and usage guidelines.

Will Doctors Fade Into Oblivion? The Survival Guide For Newyork Physicians !

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Can I Meet A Physician ?

The answer would most probably be “no” in a few years time. It is going to get increasingly hard to find a physician in New York. The State University of New York center (SUNY) has predicted that there will be severe physician shortage in New York by 2030. The study further reveals that the average age of physicians in New York is alarmingly high.

Medical-Billing-Newyork

I Have An Insurance Number, But Not Medical Care…

The huge physician deficit can leave millions of newly insured patients, under Obama-care  have insurance numbers. But it is no guarantee they will get to meet a doctor. The physician workforce is slowly dwindling and finding a doctor can be the biggest challenge, in the years to come.

The problem is steadily getting worse and it is not just the healthcare law that is to be blamed. Proprietary and complicated EHRs and ambiguous reimbursement models are driving physicians out of the business.

84% Docs Feel The Profession Is In Decline !

And nearly 60% wouldn’t recommend medicine as a career choice. About 75% of physicians feel they are being overworked. These are just a few worrying markers of the disillusioning climate the healthcare industry is in.

Doctors Across New York ; The Much Needed Relief For Physicians !

The DANY program offers physicians based in New York the life support they need. It offers physician practice support, physician loan repayment and help for facilities that recruit new doctors. The application process has also been streamlined to help practices based in NY meet the financial pressures they’re under.

Large health plans are also working in tandem with local medical practices and community health centers to bring in more primary care doctors.

Joining Forces…

Nurse practitioners can fill in the void by offering primary care to patients. Physicians and NPs instead of being at loggerheads, can work together to provide better care for patients across the state. As the shortage worsens team based care will act as the most effective solution.

Outsourcing documentation and billing needs will also offer harried Newyork physicians a brief respite in an otherwise blistering healthcare climate !

At 84,000$ Will ICD 10 Sound The Death Knell For Private Practices?

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Will Your Practice Get Caught, In The ICD 10 Quicksand ?

ICD 10 is lurking round the corner. 55,000 more codes and an entirely new coding structure is no stroll in the park.  Medical practitioners might just be thrown of track. It is being feared, that it could be a deathly blow to practices, which operate on small budgets. Small medical practices will be forced to align with hospitals to survive in this tough economic climate.

ICD-10-Medical-Coding-Infographic

Another Nail In The Coffin For Small Practices…

ICD 10 is being likened to Y2K. Though it petered out eventually and died a natural death, the panic and havoc it caused still remains fresh in people’s memories. But with ICD 10 coding we may not be as lucky. It is highly unlikely that ICD 10 will be postponed once again. Or like what most medical practitioners, pray for nowadays, simply disappear.

ICD 10 Comes With An 84,000 $ Price Tag  !

Don’t gasp! That is the figure put down by the MGMA. For the small practice that is barely making ends meet, this is an astronomical amount. Consolidation is the only glimmer of hope. But it can prove to be a double edged sword. As physicians will lose their freedom to decide their working hours and make key clinical decisions, independently.

It seems to be a throwback to the 80’s when there was a mad scramble to partner, align and consolidate.

And The Price Is Not The Only Headache…

If the fear of hogging headlines is the major fear of big hospitals. To keep the lights on in the building is the biggest challenge of small and medium practices. A few of the challenges that ICD 10 throws in the face of medical practitioners are:

  • Loss of productivity.
  • A hit in the coders efficiency and working hours during the transition.
  • Expensive system upgrades.
  • Additional staff to handle the workload especially when both ICD 9 and ICD 10 are used to submit claims.
  • Higher chances of fraud and abuse charges due to the lack of training, knowledge and resources.

Here Is What Small Practices Can Do To Keep Their Head Above The Water !

  • Partner with a medical billing agency to handle the transition.
  • Make use of online resources to the fullest extent.
  • Start early and phase out the implementation to avoid drastic changes and expenses.

Only 38 % of Doctors are Happy with their EMR. Are you one of them?

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EHR-Pros-and-Cons

Have EHR’s Reduced Patients to Faceless Data ?

The jury is still out on this one. Have EHR’s helped in bettering patient engagement or are stealing away the doc’s time? Patients complain that watching a medical practitioner silently collect data is the most frustrating sight on earth! After struggling to get an appointment from your busy neighborhood doc, it can drive you nuts to see that he is busy clicking on templates.

A Crude truth…

CRUD which means Create, Read, Update and Delete is not just another smart abbreviation. It is a sad fact that reflects what goes on in the physician’s office today. Creating information, analyzing it and editing data, eats up an enormous amount of time. Most docs are contemplating retirement to get away from the bureaucratic interference and hum drum of working with systems.

Has Someone lost the Plot ?

There is a growing disillusion with EMR’s because most of them are designed to be high-end data entry machines. A huge doubt is being cast on whether they actually help in bettering healthcare. EMR’s were supposed to reduce clinical documentation mistakes, prescription errors, retrieving data and saving on costs. And according to a few doctors fail on all counts.

Physicians fume that they are doing the same thing, several hundred times a week. Data entry takes time because of the frustrating loading times. E-prescribing is strenuous, as it is one drug at time. The, point, click, wait rigmarole results in point and click errors, and can be a potential hazard for patient safety.

Times they’re a Changing…

This immortal Bob Dylan cult number could well be the anthem of the healthcare industry today. Despite scathing criticism and the flak EHR’s face it is an indisputable fact that there are several upshots to using one. Accountable, traceable care, across all points in the healthcare continuum is a godsend for busy physicians without a photographic memory.

Data structures are improving. Integrated, inter-operable  and more secure data architectures that are more physicians friendly are rolling out. Contrary to what the naysayers complain, this could well be the best time to be a medical practitioner.

Treading with care…

Transitory phases can be tricky. It is the last man standing who comes out at the other end as a winner. Every medical practice should ensure that they sign up for a free trial with the EHR they are planning to use. So it is not the first time they’re handling the system. EHR users must demand better and frequent, tech-support.

It is important that physicians are healthcare IT savvy but we don’t want them to be reduced to impersonal, data collecting, super efficient machines. Do we ?

 

Medical Practice Managers Needn’t Sulk ! Take It One Step At A Time.

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Medical Practice

What are your Plans this 2013 ?

Agreed ! It is probably too late in the year to make a resolution list, and berate yourself the whole year for not following it. But it is never too late for change. The year brings with it lots of changes to the way you work. From working towards Meaningful Use requirements to choosing those nine CQMS you want to qualify for !

Ten Steps you must take to Ensure you roll with the Punches !

1. Being the first one off the block does have its advantages! Whether it is testing ICD-10, or educating patients on your EHR do it now !

2. Choose clinical quality measurements keeping your patient population, practice workflow and specialty in mind.

3. Perform an audit. It needn’t be an extensive one that brings everything to a standstill. But make a vow that you conduct “mock audits” on important processes such as billing, regularly.

4. Try to reduce costs on every aspect of your medical practice’s food chain. From stationary supplies to revenue cycle management.

5. Focus on maintaining accurate clinical documentation. RAC audit might just be around the corner.

6. Hire a financial counselor or if it’s too expensive, train your front office staff on financial counseling to collect self pays. Remember it consists of a significant revenue opportunity.

7. Have a clinical discussion with your pharmacist to reduce drug costs.

8. Analyze your AR reports, revenue cycle management reports and look for ways to optimize your workflow and exploit revenue opportunities.

9. Be active on social networking sites. That could be the easiest way to engage with your patients.

10. Instead of setting an ambitious annual goal, set small, practical and immensely achievable monthly goals to increase collections !