DIY ICD-10 conversion – Part 7

We are ready to start translating policies. The first step is easy to do, but difficult to believe in. When I “got it,” it was like one of those optical illusions where the cube suddenly turns inside out. I’ve watched other people see the light. I’m going to try to make that happen for you.

Reminding us of our objective: You have a list of ICD-9 codes we are calling a “policy.” This list means something. Whether or not you can express the meaning in English, there is a scientific way of inferring its meaning. If you take a large set of patient records, and you find each record which has one or more codes on the policy list, then the set of patients you have found defines the meaning of the policy. For example, if the list is a complete set of ICD-9 diabetes diagnoses, then the patients it finds are, insofar as possible with ICD-9, all those with diabetes. Your objective is to re-write the policy list in ICD-10 so that, if the same set of patients were to be coded in ICD-10, application of the list to those records would find the same set of patients. This is not always possible, but the recipe I’m advocating generally keeps the discrepancy rate below 1%. Continue reading

CMS: It’s All About Compliance Actually

I’ve spent years reading healthcare rules, regulations, and laws (I know what you are thinking – better you than me!). Often, it’s necessary to connect the dots with the regulations to clearly see their purpose. Lately, everyone in the industry is talking about ‘documentation compliance.’ Actually it’s nothing new – some providers have struggled with documentation for years. I admit, when I worked in the hospital, charting was not the favorite part of my day either. But CMS has been dogged in its documentation improvement efforts which have routinely been ignored by some.

Recalcitrant Providers

On 12/13/13 CMS released Transmittal 495, CR 8394, which became effective 1/15/14. According to CMS, “Any provider referred (to OIG) as a potential recalcitrant provider case should be an ‘outlier,’ meaning a provider who has been the least receptive to changing and has a significant history of non-compliance. Continue reading

Off to HL7 We Go!

Guest blog by Senthil Nachimuthu

The normative release of the HL7 Common Terminology Services version 2 (CTS2) functional specification is about to be completed, and that made my latest expedition to the Alamo city especially enjoyable. This month, the HL7 Working Group Meeting (WGM) was in San Antonio, Texas. The HL7 CTS2 Service Functional Model (SFM) outlines the ‘functional capabilities’ of the next version of HL7 CTS v1.2. If you are new to CTS2, it’s a joint project between HL7, OMG and others under the umbrella of Healthcare Services Specification Project (HSSP), where HL7 publishes the functional specification and OMG publishes the technical specification. I’m a co-author of the HL7 CTS2 SFM and am pleased to see that the standard is about to be published. It’s nice to see the editors and co-authors of the standard in person at the HL7 meetings after talking to them on conference calls week after week. Continue reading

HIMagine That! Practice Coding in ICD-10

Sue: Donna – just think in nine months the I-10 baby is gonna be born!

Donna: Well, at least we won’t have to decide on a name.

Sue: Right! But, you know how first-time parents go to classes to practice before the baby comes?

Donna: Yes… What are you getting at?

Sue: I’m saying that hospitals should be developing plans to have their coding professionals practice coding their medical records well before this baby’s due date.

Donna: I totally agree! There are so many benefits to practicing. Continue reading

ONC: Transforming Health Care, One Connection at a Time

Last week I was fortunate to attend the annual meeting of the Office of the National Coordinator (ONC) for Health Information Technology (HIT) in Washington, DC. The theme for the day was “Transforming Healthcare One Connection at a Time,” indicating a focus on how HIT is impacting the healthcare delivery system through innovation and interoperability.

The agenda for the meeting included remarks from the new National Coordinator, Karen DeSalvo, as well as appearances by the Secretary of Health and Human Services, Kathleen Sebelius, the Secretary of State for Health of the United Kingdom, Jeremy Hunt (via webcast), and the Acting Surgeon General, Rear Admiral Boris Lushniak. All of these heavy hitters spoke broadly about HIT and its impact. DeSalvo cited her experiences in New Orleans, recalling, “(Hurricane) Katrina brought home to me that the EHR is not just an important tool in health care delivery, but also in public health.” Continue reading

Is my custom problem list a problem for ICD-10?

Guest blog by Charlie Bernstein

Remember when your Electronic Health Record (EHR) system was first implemented? Taking advantage of all of the new productivity tools, your organization probably built some customized problem lists. These custom problem lists made it possible to standardize on the codes you use for various departments, conditions, and regulatory submissions.

Now that the ICD-10 clock is ticking down, think back to the hours spent creating those custom lists in ICD-9. Since you developed the lists yourself, expecting an EHR vendor to convert them to ICD-10 for you isn’t really possible. Custom problems lists are just that, custom. How would they know what codes you want on the list for ICD-10? Continue reading

Staying Ahead of the Puck: Six Trends to Follow in Population Health and Payment

Yes, this blog post is about population health, accountable care and the changing economics of healthcare payment. But first, a little bit about ice hockey from Walter Gretzky, father of Wayne “The Great One” Gretzky.

When Wayne was a young boy, Walter encouraged his son’s interest in hockey. In the family’s back yard he built an ice rink, the Wally Coliseum, where he taught Wayne and the neighbor kids to skate. Wayne was obsessed with hockey. Walter recalls seven-year-old Wayne’s fascination during a televised hockey match. On a pad of paper, the boy traced the path of the puck as it careened across the ice. To Walter, the lines on the notepad were scribbles. But to Wayne the pattern showed the places on the ice where the puck was most likely to be at any given time. The intersections, as he called them.

That was part of the Great One’s strategy, to know where the puck was most of the time.

In a way, the same strategy applies to accountable care and population health management. Continue reading

Building Momentum for Outpatient Telemedicine using Financial Incentives

Technology has permeated into nearly every aspect of our daily lives, the realm of medicine being no exception. We are seeing robotics used in surgery, doctors sending X-ray images overseas for second opinions, pharmaceutical delivery through nanotechnology, and computers suggesting diagnosis codes. Noticing a trend? All of these breakthroughs are happening on the provider-side of medicine. The use of integrated technology when it comes to patient interaction with the health care system is still limited. If technology has been embraced by individuals for so many other functions, why have we not better integrated it into the patient-side of health care delivery?

There have been attempts within the past decade to expand telemedicine practice and access. The Federal Government has experimented with demonstration programs such as IDEATel, the efforts of VA Telehealth, and increasing the number of payable telemedicine HCPCS codes. Through these efforts telemedicine has greatly expanded in the Medicare program. In roughly a quarter of states, private payers are also mandated to pay for telehealth services, though not necessarily at the same rate as an equivalent in-office visit. Continue reading

Can EHR convenience features lead to fraud?

Well, it appears that the convenience features in Electronic Health Records (EHRs) can be perceived as a method to cheat the government. In a new report issued by the Office of Inspector General (OIG) on January 8, 2014, the function of copy-paste was highlighted as an area of concern. To conduct the study the OIG surveyed CMS administrative and program integrity contractors about their review methods related to EHRs and reviewed guidance provided by the contractors and CMS related to EHRs and possible vulnerabilities. The OIG found that little had changed in contractors’ practices since the shift to EHRs.

The OIG cited copy-paste functions and overdocumentation as two EHR practices that can be used to commit fraud. The issue with the copy-paste function was that it may be used without updating the information, leading to inaccuracies in the record and inflated payments. Continue reading

Medicare’s Hospital Readmissions Reduction Program: What Happened to Clinical Credibility?

I believe my intentions are good—but probably not. When I download articles from healthcare journals—the meaty ones that can’t be skimmed—to my iPad to read some evening/weekend/plane trip when I run out of other stuff to do, do I really intend to read them? More likely I hope that by some digital alchemy between my documents app and the Amazon Windowshop app next to it I will magically become better informed about my profession.

If you are like me, sort of well intentioned but short on time and motivation to slog through articles that you don’t absolutely have to read, I’ll make you a New Year’s resolution type deal. Each new blog I write, I am going to choose a good-for-you article, read it myself, and tell you about it.

Hopefully this will be good for you and good for me. Good for me since now I have to actually read and understand those articles I never get around to. Good for you since you (if I do my part) will get a decent return on your blog-reading investment: a complex topic made more comprehensible. Continue reading