ICD-10 Basics: Advancing Healthcare IT

By: Ann Frischkorn Chenoweth

Upgrading to ICD-10 is a necessary step in realizing health IT potential. ICD-10 data are more easily retrieved in electronic format than ICD-9 data.   Because the code set is more robust and up-to-date, it offers better mapping from SNOMED CT.   The full benefits of a reference terminology such as SNOMED CT will not be realized if that system is mapped to an obsolete classification system such as ICD-9-CM.

Computer Assisted Coding (CAC) offers improved coding consistency, efficiency, and accuracy.   The detailed and logical structure of ICD-10 simplifies the development of map rules and algorithms used in CAC applications. As a result, ICD-10 more easily enables CAC.

ICD-10 is a good opportunity to phase out aging and inflexible systems or to modernize legacy systems.  Many CIOs I’ve met with state they are leveraging their ICD-10 readiness/system inventory work to consolidate redundant applications.  Moreover it is giving them an opportunity to look for new platforms and vendor solutions which can be used across the enterprise.

ICD-10 for Busy Doctors

By: Rhonda Butler

This is the first in what I hope will be a useful series of blogs on the subject of ICD-10. Building on a previous blog, my goal is to offer clear, concise information about ICD-10 to physicians and physician practice managers, so they can focus on the key differences between the code sets—differences that actually matter for coding and documentation.

Basically, ICD-10 is a long overdue upgrade. ICD-9 is old as the hills and needs to be replaced. The ICD-9 classification contains notions of disease and treatment from the 1960s that don’t do any of us any good — the antiquated content of ICD-9 means physicians have to spend time answering questions about clinical language that hasn’t been used in a generation or more. If you would like more on this subject, see an earlier blog, “ICD is a System and Systems are Upgraded.”

Initial focus will highlight some general differences between ICD-9 and ICD-10 — not the ones that make for good yellow journalism, like the number of ICD-10 codes for getting bitten by various animals, but differences in clinical  terminology that are interesting from the point of view of good coding and documentation.

Read my latest blog at PhysBizTech.

Data Standards, Natural Language Processing, and Healthcare IT

By: Richard Wolniewicz

With so many healthcare organizations evaluating applications that use natural language processing (NLP), I’m often asked if there is a specific standard that defines NLP best practice. Unstructured Information Management Architecture, or UIMA, is a technical platform that runs inside a computer process and serves to integrate a pipeline of software components, each of which executes a single NLP step (more on NLP processes and steps next time). The UIMA platform is used for NLP across many industries, not just Healthcare.

 

New Year’s Resolution: No More Harping

By: Ron Mills

A well-understood maxim among software developers states that there is generally a difference between:

• what users say they want
• what users want
• what users need

The difference between the first two is one of communication and is easily solved by quickly prototyping what they say they want, so they can say “that isn’t what I want” and start pointing.

The chasm between want and need is much harder to bridge. In the short term, you can make plenty of money giving people what they want, but if you are in the game for the long haul, you ignore the difference at some peril to your reputation. When the system you build fails to solve their problem, are they more likely to come back and say “let’s try again” or will they go somewhere else?

Knowing what the user needs isn’t so easy, of course.

Engaging Expertise for Your Project

By: Jill Devrick

In my last post, I described the primary team members for most technology projects.  But you may occasionally need input or assistance from other individuals.  As needed, the project will sometimes require consulting team members, such as:

HIM support staff. Most of the time, these individuals should be consulted to ask workflow-specific questions that are at a deeper level of detail than the HIM manager handles on a daily basis. For example, you might call upon a transcriptionist to provide a list of advanced shortcut keys she would like to carry over to the new system, or you might ask a release of information staff person how distribution to referring physicians is handled for a specific work type. In addition, these individuals could be utilized to develop functionality wish lists or process maps, or you may want them to assist with testing the new system before go-live.

CMS: RACs to Conduct Prepayment Demonstration Project

By: Barbara Aubry

On November 15, 2011, CMS has announced it intends to have RACs, MACs and CERTS conduct prepayment reviews in states with “historically high rates of improper payments” based on prior audits.  In this category, seven states have been selected for the demonstration: FL, CA, MI, TX, NY, LA and IL. Four states with high volumes of claims for short inpatient stays are also included in the demonstration: PA, OH, NC and MO; adding up to eleven states in total. According to CMS, the goal is to “help lower the error rate by preventing improper payments rather than the traditional ‘pay and chase’ methods of looking for improper payments after they have been made.” The demonstration begins January 1, 2012, and is expected to last for three years.  The project has two areas of focus: the eventual preauthorization of certain DME (temporarily on hold – click here for more) and the second is the ability for hospitals to resubmit claims for 90 percent of Part B charges on an inappropriate short stay.