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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.

How Can Misinterpreted ERA’s Affect Your Medical Practice?

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Do you understand what your insurer says ?

Being a part of a busy medical practice means there is no time to sit and analyse. Most medical practitioners hardly have enough time to communicate with insurers.Do you know that physicians are leaving most of their money on the table ? The major reason is not comprehending or following closely what the payer says.

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An, ERA consists details, of the final claim adjudication and payment information. Being able to read between the lines is one skill that physicians need to develop to ensure they don’t get underpaid.

There are a lot many times when a physician just doesn’t know why his claim didn’t translate into a check. Blame it on inconsistent and varied payer policies. Or complicated, state specific, medical billing regulations. But the fact remains that an enormous amount of claims are underpaid or unpaid and most physicians don’t even know what went wrong.

Do you deal with workers compensation and auto injury claims ?

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Agreed it can be tough. Trying to deal with workers compensation laws can be cumbersome. The last thing you need is receiving an ERA that you cannot make sense of. The AMA has come to the rescue of physicians.

AMA has launched a new tool to help physicians make sense of ERAs better. The AMA Claims Assistant Workflow tool can aid physicians in puzzling out payment adjustments. It can help medical care providers easily locate reason and remark codes. Tackling non-payments and denied claims is going to be a whole lot easy at the medical practice, from now on.

No longer left in the dark…

What happens inside the insurer’s office has always been a mystery for medical billers. Why it is certain claims get paid and some don’t ? Why was a claim that was perfectly acceptable last summer now been given the thumbs down? Luckily physicians who deal with workers compensation billing will have an answer to these questions and more.

The Claims Assistant Workflow tool will give providers information about how a claim was processed. And what the codes on the ERA mean.

A smart way to e bill !

The tool developed by AMA also guides physicians on receiving accurate payment. And also offers several template appeal letters to help physicians appeal denied claims. It is definitely a welcome relief for over-burdened physicians and billing companies.

11 Ways To Ensure You Join The List Of Successful EHR Implementation Stories !

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Get Off to a Good start !

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To start on shaky ground can sour your relationship with an EHR forever. Being hasty can prove to be disastrous. Imagine working with an EHR that does nothing to improvise your clinical workflow. Or, being stuck with templates that take hours on end to load ? Being careful during the EHR implementation process will lead to a healthy and beneficial experience with your EHR.

Don’t get swamped by sales talk and sagely advice. Grab a piece of paper and jot down what your expectations are. And make a promise to yourself that you will not make a compromise no matter what.

Here goes with the presentation on ways to implement an EHR with successful stories !

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”

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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.

Want To Save $ 23,000 ? Switching To E-Billing Will Improve Your Practice’s Financial Health

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Still Stuck With Paper ?

What is your carbon footprint ? If you are still sending out paper claims, you are felling more trees. Agreed, this is an argument that is as old as fossils. Apart from saving trees there are a lot more advantages to using e bills ! It helps to track claims easily and lessens the amount of time your insurer takes to sign your check.

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Save More Dollars !

According to the American Medical Association submitting claims electronically can save a practice 55% of its claims submission costs. The AMA further states that physicians stand to gain above 23,000 dollars a year by switching to electronic claims.

Electronic billing also reduces the TAT of insurers. The overall efficiency and cost effectiveness of the process is just what overworked medical practitioners need. Paper claims are time consuming to generate, transmit, and maintain a record of. Electronic bills are quite simply put, the smarter way to bill !

Joining The e-club !

According to a recent survey of America’s health insurance plans the usage of billing electronically has doubled. From a measly 44% in 2002 to 94% in 2012 there’s been an exponential increase in providers who are switching to e billing.

Almost 79% of claims are now automatically adjudicated without manual support. Physicians are finding e billing helpful as it helps their staff to focus on patient engagement.

A Huge Relief For Billers…

What is the biggest headache of a medical biller ? No. It is not getting claims paid. The bigger headache is finding out which claim is in what stage of processing. An average medical office sends out dozens of claims per day. Keeping tabs on each one of them can trip up the most determined of medical billers.

ERA’s and EFT’s help medical billers to hasten the pace of the billing process. And make it easier for them to maintain a clear cut billing record.

Ask Your Insurer To Move On From The Stone Ages !

It is time for insurance companies to stop working with paper claims. Physicians need to put their foot down and ask insurers to accept electronic claims! Concerted and continuous effort across the continuum will ensure that the healthcare industry functions a lot more smoothly and efficiently. And yes, save a billion trees in the process !

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.

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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.

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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.

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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 !

The Face-Off Between Doctors And Nurse Practitioners!

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Working, without someone looking over our shoulder, is a secret wish of all of us. And that has led to one of the most heated debates in the healthcare industry. Coming, close on the heels, of the battle between, CRNAs, and, anesthesiologists. It is now physicians and nurse practitioners who are at loggerheads.

Endangering patients…

Physicians fear that working without their supervision can put patients at risk. And lead to fragmented, patchy patient data. Providing longitudinal care and unifying diverse factors across the care continuum is an ongoing challenge. Nurse practitioners functioning independently can lead to increased confusion, is the chief complaint of docs.

It is a known fact that recent regulations and compliance thresholds have put physicians under a lot of stress. To have nurse practitioners challenge their role in the medical fraternity. And compete for patients, is the last thing physicians need.

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End the monopoly !

Do we know how to bill for services ? Yes.

 Do we know how to take care of patients in need of primary care ? Yes.

Do we need a physician to tell us what to do ? No.

This is the war cry of America’s nurse practitioners. They feel practicing under the supervision of physicians is unnecessary and restrictive. Despite being highly qualified and experienced, nurse practitioners feel they are being given a rough deal.

Not a turf war for money !

The request by NP’s to reduce physician interference can surprisingly prove to be beneficial. Obama care is going to result in a sudden influx of thousands of patients. As United States battles severe primary care physician shortage. Qualified nurse practitioners and a newer model of working might just be the right solution.

Once the dust settles down…

It is being hoped that once the storm settles down it will bring a lasting and mutually agreeable solution. The need of the hour is clear cut billing regulations. Reformed, payer policies, that don’t leave room for doubt. And, nurse practitioners and physicians, who work together towards a sustainable solution.

As a nurse practitioner there is enough on your plate already ! Here is the presentation on “Reimbursements guide for nurse practitioners to survive the storms in 2013 !”

Ten Tips For Surgery Centers To Pump In More Greens!

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There you go ! Another rejected claim. Well, running a surgery center billing practice can be demanding, expensive, and on a bad week, thankless! With, surgery centers constantly battling with payers, and, patients who have no idea what their financial liabilities, are. It can be an uphill climb on a snowy day, to get paid !

Here is how you can fight those financial demons and come out at the other end a winner ! And also ensure your clinical documentation is never short of perfect !

10 ways to increase the revenue of your surgery center…

  1. Encourage your surgeons on-board to have a financial stake in your surgery center to avoid losing out on case load.
  2. Create a better atmosphere to work by upgrading to better systems and work processes to attract and retain a strong physician base.
  3. Collect copay’s and deductibles at the front-desk and have multiple payment options.
  4. Compare your staff members’ cost per case with your competitors, and how reimbursement varies across different specialties. Analyze and set benchmarks.
  5. Follow a rigorous claims follow up process and fight denied claims as soon as they reach your table, to increase the revenue and valuation of your center.
  6. Physician documentation plays an important role. Surgeons should dictate clearly, name the procedure. And ensure details and events are sequenced in the operative note.
  7. Don’t put off renegotiating with your insurer. If you put off renegotiating year after year there are little chances of your insurer ever giving you a reimbursement hike !
  8. Collect and verify patient information during the pre-registration stage to avoid fall outs.
  9. Call your patients prior to their appointment and inform them about their financial liabilities.
  10. Have a quick sheet that includes pertinent questions, such as, how many surgeries were performed, the number of co-surgeons etc for physicians to fill out after a surgery.