Part B News | Part B News

Breaking news: Fewer objectives in stage 2, more interoperability in stage 3

10/06/2015

CMS has scaled back some objectives in stage 2 of the electronic health records (EHR) meaningful use program but plowed ahead with stage 3, according to a final rule released Oct. 6.

A bad ICD-10 day one: ‘Several people were in tears'

10/05/2015

by: Roy Edroso

Not every ICD-10 launch day story was happy. The day was “extremely stressful” for Terry Schaefer, office manager for Raymond H. Schaerf M.D., a thoracic and cardiothoracic surgeon in Burbank, Calif.

It wasn’t her staff that was the trouble; they were all prepared. But “our billing program and electronic record systems were having trouble accepting the ICD 10 codes,” says Schaefer. “The consults were so complicated, we couldn't code them as we saw the patients,” and they piled up throughout the day.

Also, several of Dr. Schaerf’s surgery referrals were coded to ICD-9, which made it necessary to translate them before patients could be seen – “the surgery schedulers were having problems finding the ICD 10 codes necessary for the surgeries,” Schaefer said.

“Several people were in tears. Everyone was so far behind,” says Schaefer. “We finally had to resort to ordering food for our staff so we could stay late to catch up.”

Schaefer says she’s learned her lesson: “Starting today, no referral will be accepted without proper ICD 10 codes.”

Volume of ICD-10 claims low; real test could be next week

10/05/2015

by: Laura Evans

At the clearinghouse Navicure, in Duluth, Ga., the volume of claims arriving from providers remained at its usual high level – about 1 million claims a day – on Oct. 1, reports Ken Bradley, Navicure’s vice president for strategic planning and regulatory compliance.

But the volume of claims with ICD-10 codes was relatively low – around one quarter of the total volume, he says.

“I am hopeful that we won’t see a significant drop in the number of claims received due to ICD-10,” Bradley adds. “My fear is that some smaller practices have decided to wait a few days before deciding to submit claims with ICD-10 codes.” Decreasing claim volume could be an indication that practices are having trouble with the codes, technical or otherwise, he explains.

On the payer side, no payers have rejected claims because of ICD-10 codes, but that too could change once the ICD-10 code volume increases, Bradley says.

On day one of ICD-10, Navicure noticed some practices filing claims with ICD-10 codes right out of the gate, shortly after midnight. Bradley figures those were most likely test claims.

No one has yet used the Navicure portal to file claims directly – one of the contingencies practices may use if, for example, their electronic health records (EHRs) are unable to transmit ICD-10 coded claims. However, they have been using the portal to recode claims prior to resubmitting them.

That was the case for a number of providers who jumped the gun and tried to send ICD-10 claims with a date of service prior to Oct. 1, Bradley reports. That was “the No. 1 reason for Navicare rejections” Oct. 1, he adds. Normally, most clearinghouse-level rejections are related to eligibility.

A small percentage of practices – around 1.24% – continued to try to submit claims in an incorrect electronic format, despite an “aggressive” education campaign the clearinghouse has carried out for the last 18 months, Bradley says. Some even tried to include ICD-10 codes on those claims.

“We’re still continuing that effort today to reach out to those clients,” he adds.

Early training may require a refresher course to keep ICD-10 coding on track

10/05/2015

by: Julia Kyles, CPC-A

Your practice was on top of ICD-10 from day one, you started training well in advance and then the delays began. That’s what happened to Pollux Systems Inc., a health care revenue cycle management company in Evansville, Ind., says Elizabeth Reger, vice president of operations.

Pollux started training two years ago. The company purchased training, which included module training. After the first delay, everyone reviewed the webinars again, Reger explains. Finally, in June, coders started dual-coding.

If your organization started early training, you might need a refresher course. Check with your payers and Medicare administrative contractors, look for targeted training from webinars and review information in newsletters such as Part B News’ sibling publications, the specialty coders’ pink sheets.

Your vendors also may be able to help. When Canadian Valley Family Care of Yukon, Okla., was preparing for the transition, a trainer from the practice’s electronic medical records vendor came in to help, says Office Manager Teresa Kilpatrick, who adds that another certified trainer also provided training.

Practices, consultants take a wait–and-watch attitude toward ICD-10 transition

10/05/2015

by: Julia Kyles

Cautiously optimistic is one way to describe the attitude toward the launch of ICD-10.

The additional specificity required by the code set did slow down claims processing for coders and clinicians alike on day one. “A lot of them had the code numbers in their heads; now they’re having to look them up. But they’re all dealing with it,” says Teresa Kilpatrick, office manager, Canadian Valley Family Care, Yukon, Okla.

At the practice, the physician transmits the diagnosis codes and billing staff check it, Kilpatrick explains.

Pollux Systems Inc. tested with payers, staffed for the drop in productivity and planned for wrinkles, says Elizabeth Reger, vice president of operations for theEvansville, Ind., company.

If necessary, the revenue cycle management company will pay overtime to make sure client claims are processed in a timely manner.

However, both Kilpatrick and Reger say it’s too early to tell how their organizations fared in the transition. It will take a few weeks for claims to cycle through the various payers.

Reger advises keeping an eye on denial trends. Anything over 15% a day for several days in a row would be a sign of serious trouble. “I think that if anything is going to happen, it will be glaring and easy to see.”

Get a leg up on ICD-10 with a practice-specific, quick-glance guide

10/05/2015

by: Richard Scott

Create a coding shortcut to get your staff cranking out accurate ICD-10 codes in no time.

Leading up to the ICD-10 launch date, one physician practice in Jacksonville, Fla., constructed a list of its 25 most common diagnoses. The list includes an ICD-9 to ICD-10 crosswalk and a description of the diagnosis to make it easy for the staff – from physicians to billing professionals – to pinpoint the correct code.

Staff physicians and medical assistants were "extremely happy" to have the quick reference guides, says Tina Allen, CPC, billing manager at First Coast Mohs Skin Cancer & Reconstructive Surgery, who spearheaded the program.

"[The launch date] went by with no problems," recounts Allen about the historic Oct. 1 date on which ICD-10 debuted. Allen created the reference guide in a spreadsheet and then distributed a printed copy to her staff.

If you haven't created a quick-look guide yet, simply pull together your most common diagnoses, ascertain the crosswalk (using your go-to coding tool, such as SelectCoder), and get it into the hands of your staff. If your practice is like Allen's, they'll be thanking you in no time.

Log in to see the full the example below from First Coast Mohs Skin Cancer & Reconstructive Surgery.

Here's a preview:

ICD-10 launch: Some MAC LCDs behind but providers successfully submit claims

10/05/2015

by: Part B News staff

Far from calls of distress, the early markers of the ICD-10 transition appear favorable, according to coding and billing professionals Part B News spoke with on the morning of Oct. 1.

“The physicians are smiling,” reports Alix Petersen, director of revenue cycle management at Tennessee Orthopaedic Alliance in Nashville. With one or two exceptions, most of her doctors remembered to look up and write ICD-10 codes on their charge tickets Oct. 1, she adds.

But one issue with local coverage determinations (LCDs) could cause confusion.

Move quickly to abjure wrongdoing as biller gets prison time for fraud

10/05/2015

by: Roy Edroso

Distance yourself if you expect fraud is happening at your practice to avoid a fate similar to that of a medical biller who received a 45-month prison sentence.

CMS gives green light to bill hyperbaric oxygen therapy with E/M, limits others

10/05/2015

by: Richard Scott

Elevate your patients’ oxygen levels through hyperbaric oxygen therapy (99183) and breathe easy knowing you’ll get paid for an E/M service on the same date — provided you prove medical necessity.

New credit card rule comes with hefty compliance price for practices

10/05/2015

by: Marla Durben Hirsch

Warning: If your practice accepts credit cards, you have to upgrade to new credit card payment terminals. If you don’t and fraudulent activity or a security lapse occurs with your patients’ new credit cards, you — not the bank — will be liable for the losses after Oct. 1.

Login

User Name:
Password:
Remember me Forgot password
Welcome to the new Part B News Online. If you are a returning user having trouble logging in, please click here.