Employees as the Teachers: What an Organization Can Learn

As a compliance officer I have the opportunity to publish training on various compliance topics to our workforce. We just completed a required training and I think I learned as much about how the organization works as the workforce may have learned from the training.

From an employee’s perspective, completing a required compliance training course may be the last thing they want to do, yet from the organization’s standpoint, it’s one of the most important things for them to do. Protecting the privacy and security of patient data is of utmost concern for any compliance officer in health care. The Ponemon Institute just published its Fourth Annual Benchmark Study on Patient Privacy and Data Security which emphasized the role employees have in detecting data breaches, while at the same time noted that employee negligence is considered a worry by many of the respondents to their survey. Organizations in the Ponemon study reported that they rely upon policies and procedures to achieve compliance and secure data. What this tells us is that training employees on proper security methods, policies and our code of conduct, as well as guidelines for how to report an issue is paramount. Continue reading

DIY ICD-10 conversion – Part 10

The time has come to talk about clusters. Back in Part 3 we defined them and in Part 7 we separated the GEMs into single-code and cluster tables. But we haven’t yet looked at them closely. We can’t put it off any longer.

Clusters come into play when something that you can say with one code in one system requires more than one code to say the same thing in the other system. A couple of examples will get us started.

Example 1: One ICD-9 diagnosis

073.0, Ornithosis with pneumonia Continue reading

Taking a Closer Look at the February ICD-10 Coding Contest

Blog by Julia Palmer and Sue Belley

The results are in for the latest scenario in the ICD-10 coding contest! This month we asked you which 7th character qualifier should be selected when assigning the ICD-10-PCS code for an amputation of the 5th toe at mid-shaft of the metatarsal.

Contest Scenario: Continue reading

Don’t Blame ICD-10

Lately, OIG is reminding us we can’t seem to comply in ICD-9. I suggest that whatever happens by this time next year, don’t blame ICD-10. Coding is complicated with tons of rules and regulations. And yes, as soon as one learns something new the regulations change and even newer codes, modifiers, documentation, and incantitations are required. It’s been this way for years; and for years there has been noncompliance regardless of the code version. Not news you say? Where am I going with this? I just read another OIG audit report on yet another large provider. It makes me sad to learn they will have to pay back upwards of 1.6 million dollars in over payments for both inpatient and outpatient coding and billing issues. According to OIG, “The errors occurred primarily because they did not have adequate controls to prevent the incorrect billing of Medicare claims within the selected risk areas.” Continue reading

Payment policy bias against high Disproportionate Share Hospitals (DSH)

In its June 2013 report to Congress, MedPAC offered ways to refine the CMS Hospital Readmissions Reduction Program (HRRP). These included issues of stability (and efficiency) due to dealing with multiple condition-specific measures, the calculation of the existing CMS payment penalty, the inverse relationship between readmission and mortality for heart failure rates, and the topic of socioeconomic status (SES) and risk adjustment.

The bias against high Disproportionate Share Hospitals (DSH) apparent in the CMS payment policy is particularly concerning. This comes at a time when Medicare DSH payments are being directly adjusted as part of ongoing reforms and Medicaid DSH payments are being cut nationally in accordance with the Affordable Care Act. This heightened sensitivity brings urgency to the discussion of how to correct for the perceived SES bias, specifically whether measures reflecting SES should be included in the current risk-adjustment formula. If additional measures reflecting SES are to be considered, it will be important to separate the effects that may be attributed to generally lower performance in low income areas from those attributable to the complexities of treating a challenging population. In other words, can the risk adjustment method help us distinguish whether hospitals that care for poorer patients perform worse because they don’t do a good job, or because their patients are more difficult to care for?

Is it advisable to assign providers to risk groups for the purposes of risk adjustment? This blog hopes to answer that question.  Continue reading

Behind the scenes at HIMSS14

We’re back to our “normal” routine after attending HIMSS last week in Orlando, Florida. The show is growing every year, and the number of cities capable of handling its size seems to be down to 3: Orlando, Las Vegas, and Chicago.

As usual, the 3M booth and its staff were kept busy with a steady stream of walk-up visitors interested in our terminology, computer-assisted coding, consulting, and other products and services. We also had many productive, scheduled meetings with vendor partners and potential customers. Stage 2 of Meaningful Use and ICD-10 seemed to be on many people’s minds. Continue reading

Want to Improve Safety? Choose the Right Metrics for Avoidable Readmissions and Complications

In January the Minnesota RARE campaign received the prestigious Eisenberg Award for reducing avoidable readmissions. Over an 18-month period, the campaign helped hospitals and community partners prevent more than six thousand hospital readmissions.

Although each hospital faces its own unique challenges in managing readmissions, the RARE campaign demonstrates what a supportive and collaborative effort can achieve. It involves 82 hospitals, 100 community partners, and 3 operating partners, including the Minnesota Hospital Association. Continue reading

The Healthcare Provider Relay: Why We Need a Patient-focused Episode Payment System

An alien watching a 500 meter relay would think the race is all about the baton. Why else would these beings dedicate themselves to getting this object to its destination as quickly and flawlessly as possible? A relay race would not exist without the baton to bind the individuals together and create a team event. Although each team member’s leg of the race is important, the requirement that the baton be handed from one team member to the next turns four separate runs into a single, unified performance that can be evaluated and rewarded for its overall excellence.

In the relay that is the U.S. healthcare system, the patient is the baton—and the patient baton is not as fortunate as the white plastic one. In the current healthcare set-up, the hospital discharges its responsibility for the patient’s care once it discharges the patient. Then the patient is passed like a baton from one set of provider hands to the next, wobbles and all. Continue reading

Healthcare’s Efficiency Challenge

I’ve started reading a book by William Baumol called The Cost Disease, which raises an interesting question. Why in 2014 can I buy a laptop computer that is smaller, more powerful, and most of all, much cheaper than one I could have bought just ten years ago, but healthcare costs have risen from ten years ago? Why are some industries able to become more efficient, and produce more of their goods or services, faster and cheaper, while other industries are stuck in a spiral or are continually raising costs with stagnant efficiency?

I won’t give a full, in-depth review of the book, but in short, the analysis lays out the premise that in some industries, such as with computers or automobiles, manufacturers are able to continually improve on both their manufacturing processes and the quality of the goods they are manufacturing. This enables these manufacturers to produce better goods at lower costs. These lower costs then enable them to pass some of these savings on to their customers, as well as to pay their employees more money. Continue reading

DIY ICD-10 conversion – Part 9

In Part 8 we translated a policy by looking up each ICD-9 code in the policy in the “10-to-9 singles map with reverse index” and entered into our ICD-10 version of the policy the ICD-10 codes that were found there. We discovered that not all of our ICD-9 codes were found, and we put them on an “ICD-9 Orphan” list. Now we consider what to do with those ICD-9 codes.

Start by looking them up in the 9-to-10 singles table. If there are one or more entries for the ICD-9 code, it means one or more ICD-10 codes might be appropriate for the policy, given the definition of the ICD-9 code. The emphasis is on “might be” because the GEMs do not know the information in a patient’s chart used to assign the ICD-9 code. Those ICD-10 codes could contain additional meaning that may have been true for a patient, or not, and the ICD-9 code doesn’t specify either way. Continue reading