Happy New Year to all our readers! Before the ball drops in Times Square, catch up on five of our most read blogs of the year: Continue reading
Donna: Sue, can you believe it? We’re going live with ICD-10 in less than two weeks – this has to be the longest pregnancy in history!
Sue: I know. You and I have been blogging about ICD-10 for what is it – three years now? What are we going to talk about after October 1st?
Donna: Plenty! But let’s not worry about that right now. I’m wondering what people are talking about in these last few weeks leading up to go-live. Continue reading
A year ago my family changed to a high deductible health plan and started using a health savings account. Because we expect to pay higher upfront out-of-pocket expenses, we pay careful attention to the network requirements and out-of-pocket thresholds. Our local providers, though, seem to manage patients with high-deductible plans as if they were no different from traditional PPO plans.
There are several things I wish my providers would do differently, and not just to make it easier for me to manage my family’s health care. My providers inadvertently increased administrative time, delayed payment, and resulted in denials and write-offs. They would do better if they adapted their processes in light of the different plan requirements. Here are four suggestions for avoiding the mistakes my doctors made with my high-deductible plan: Continue reading
As more and more hospitals and healthcare organizations convert more and more of their paper medical records to electronic health records (EHRs), an interesting dynamic has begun to emerge, as well as an interesting challenge.
The dynamic is that while the conversion from paper to electronic records was promised to provide time and cost savings for healthcare, the adoption of EHR systems by physicians has led to a number of perhaps unforeseen consequences. One of the chief consequences, which could also be considered a chief complaint, is that physicians who document on their patients electronically make less eye contact with their patients and have lower patient satisfaction ratings, vs. physicians who document on paper. Continue reading
The next time I ran into Dr. Y in the coffee shop, he started right up.
Dr. Y: We put a lot of time and effort into getting our EHR systems up and running. It was grueling. I sat on some of the work groups at the hospital. The EHR vendor needed us to tell them how we think, what we write down when. It was worse for the nurses, I suppose, but in the end we got it going. They tell me that most of what we put in there is represented as SNOMED codes. So why can’t you use those codes for billing instead of forcing us to hire coders and create a whole other ICD-10 system?
Me: The short answer is “maybe we can, someday.” The EHR vendors and the coding-and-reimbursement vendors, including 3M, are all working on it. But it will take decades, or at least years, as computers get faster and our NLP – Natural Language Processing – software gets smarter.
Dr. Y: No, I said why can’t you use the SNOMED codes for billing?
Me: Ah. A common confusion. I think it arises from the overloaded use of the word “code.” A “code” in my business is any string of letters and digits that stands for something, and doesn’t mean anything by itself, out of context. So instead of calling the representations in SNOMED and ICD-10 “codes” we should call them what they are. Continue reading
I ran into my old friend Dr. Y in the coffee shop.
Dr. Y: I read your Imelda blogs. Entertaining, but they miss the point.
Me: What point?
Dr. Y: Here in the U.S. we use codes for payment.
Me: I know. I couldn’t think of a way to work that in without making the analogy too complicated.
Dr. Y: It’s key. For thirty years, since ICD-9, we physicians have been battling the insurance companies about how to get paid and only in the last few years have things settled down a bit. Now you want to start the battle all over again. Continue reading
Posted in ICD-10
This February, I participated in the first of four 3M Data Integrity webinars, where a polling question was asked of the audience: Are your physicians actively engaged in documentation improvement?” Here’s how the participants answered:
- 59 percent said that their physicians were actively engaged in documentation improvement
- 36 percent responded that their physicians were NOT actively engaged in documentation improvement
- 5 percent were not sure or did not know Continue reading
Donna: Hey Sue, did you see the results of that recent ICD-10 survey?
Sue: No, I didn’t! What did it say?
Donna: Well, it looks like the biggest concern the participants had regarding I-10 preparedness was physician education.
Sue: I can understand that! Physicians need to know about ICD-10 documentation requirements in order for everything else to fall into place.
Donna: That’s right. What do you think organizations should be doing now to get their physicians prepared? Continue reading
Posted in ICD-10
When I first started thinking about this topic, a million things came to mind. Should the oldest compliance challenge—what is most expensive—be number one on the list, or should the top issue be the one that could cause the most problems? Having to narrow it down to ten became more of a challenge than I anticipated. Here goes—my opinion of the Big Ten compliance challenges facing physicians in 2013.
- Documentation (or the lack thereof) –Those of you who read my blogs know my position on this, but let me say it again: As the old adage goes, “if it wasn’t documented, it didn’t happen.” This is true in paper as well as electronic records. And even if you are using an EMR that literally will not let you enter another digit until you complete a document step, it’s still a problem. I have seen cloned EMR documentation that says the patient had the same flu at every visit since 2009. And the OIG has noticed too. Beware the cloned EMR. Remember, coders populate your claims with your documentation and the RAC and other auditors are watching intently. Continue reading