HCCs: Don’t Underestimate Their Importance

So there are PPCs and HACs, PPRs and PPAs, PSIs and VBP just to name a few. But please don’t forget or underestimate the importance of HCCs. Why should you care about HCCs? HCCs are Hierarchal Condition Categories (there’s a mouthful). In simpler terms, HCCs are diagnoses/conditions that are present in the patient that complicate their care and management and require more resources to treat. Sounds easy enough right? Continue reading

Why I get excited about APCDs (hint: also a memoir and album by Herbie Hancock)

I love hearing about multi-source or all-payer claims databases (APCDs). I’m not a data scientist, but I know enough about analytics to appreciate the possibilities within an APCD. Each announcement of a new state APCD (or private data alliance) feeds the expectation that someone will discover something new and useful and that maybe, sometime soon, the information will change the healthcare system for better.

I get excited about the possibilities. (Jazz musician Herbie Hancock chose “Possibilities” as the title for his memoir. It’s a tribute to those who aren’t afraid to explore in music and in life.) Continue reading

CMS Clarifies “ICD-10 Families” and Offers Guidance on ICD-10 Flexibilities

The latest from CMS and AMA on July 6, 2015 is a bit confusing – I agree. But a clarification was released yesterday.

In case you missed the July 6, 2015 release, CMS and the AMA announced an effort to work together to help Part B providers under the Physician Fee Schedule prepare for ICD-10. CMS recognized some physician and other professional providers need additional help. To assist in the transition, CMS announced “Medicare review contractors will not deny physician or other practitioner claims billed under Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family. Continue reading

ICD-10: After the Thaw

If you have the slightest inclination to freak out about ICD-10 because change makes you nervous, please ignore this blog.

Okay, now for the rest of you: the code sets have been frozen for more years than is good for them, and once we get to “thaw” the code sets, they need to be updated. How can that be, you say? ICD-10-CM/PCS is brand spanking new. No, not exactly—not new, unused. New and unused are not the same thing. Putting meat in the freezer does not make it fresh—it lets you put off cooking it for a while. Continue reading

HIMagine That! Queries for ICD-10

Donna: You know Sue, I think that people are really stepping up their ICD-10 game as we enter the home stretch.

Sue: The way I look at it, they’ve been stepping up their game for the last five years!

Donna: So true. Still, I’ve received a lot of emails lately from coding and CDI professional requesting assistance with ICD-10 queries that they can use to ensure they have ICD-10 ready documentation.

Sue: So what kinds of queries are they asking about? Continue reading

It’s Time to Redefine an Achievable Triple Aim

This blog offers further commentary on the excellent conversation that Paul Levy began in his column, “The Triple Aimers have Missed the Mark.” In his blog, he provides a succinct definition of the Triple Aim as “improving the individual experience of care; improving the health of populations; and reducing the per capita costs of care for populations.” Continue reading

Taking a Closer Look at the June ICD-10 Coding Challenge

CHALLENGE QUESTION

A 37-year old male with a long-standing history of the diagnosis of gender identity disorder is currently undergoing counseling and medical therapy in an effort to work toward physically modifying his body to better match his psychological gender identity. The patient is scheduled to undergo an orchiectomy penectomy and surgical construction of a vagina in the near future.

Assign the ICD-10-CM code for the diagnosis of gender identity disorder.

What ICD-10-PCS code will be used for the procedure of a surgical construction of a vagina using autologous tissue procedure for this patient? Continue reading

The Logistics of Population Health Under the IHI Triple Aim

The Triple Aim is a construct developed to move past the trade-offs typical in health care improvement: improved quality at the expense of increased costs, decreased costs at the expense of quality or access, improved guideline adherence at the expense of patient experience of care, etc. The Triple Aim defines success as simultaneous improvement in population health and outcomes, patient experience of care, and cost trends. Continue reading

OPPS Proposed Rule for 2016

I hope the publication of the 2016 OPPS proposed rule on July 1st did not dampen anyone’s July 4th celebration. The new rule continues the migration CMS began in 2014 to a more “prospective payment” type system. That means that there continues to be more packaging and fewer APCs.

A few specifics: Continue reading

TMI: How Much Is Too Much Information?

We are in the midst of an information explosion in healthcare, which brings more responsibility to healthcare payers, providers, and patients themselves. Providers must be able to help patients distinguish between information that is useful for achieving important healthcare objectives, such as those espoused by the Triple Aim, and what is just noise. Continue reading