Archive for the ‘ICD-10’ Category

Coders and their providers can bone up on coding, regulation, compliance, and billing while earning continuing education units (CEUs) and continuing medical education (CMEs) at AAPC’s 2010 National Conference in Nashville, Tenn. on June 6–9.  This annual event draws thousands of attendees including doctors, medical coders, and office/practice managers to connect on the business side of health care.  This is the first conference to be approved for 15.75 CME (AMA PRA Category 1™) credits.

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What’s new on the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics (NCHS) website is the 2010 update of ICD-10-CM. This latest update replaces the 2009 release. Read more »

By Angela “Annie” Boynton RHIT, CPC, CCS, CPC-H, CCS-P, CPC-P, CPC-I

Recently, it seems that the health care industry has focused almost entirely on the challenges that we’re all facing with regard to 5010 implementation. To make things worse, many do not fully understand the specific changes or the benefits that will come from the 5010 migration. All HIPAA-covered entities are required to be compliant by January 1, 2012.

The most widely recognized change in the 5010 Electronic Data Interchange (EDI) architecture is the version indicator that allows EDI transactions to differentiate between ICD-9 and ICD-10. This is only a small part of the reason that implementing 5010 is crucial to any organization’s overall ICD-10 plan.

There are over 850 specific changes in 5010; many of these changes correct deficiencies that are found within the current 4010A EDI standard. Additionally, 5010 will be able to aid covered entities by reducing transaction costs, minimizing manual processing, and reduce staffing needs, as well as seeing the introduction of additional features and new functionality. As a result, Gartner Group did a cost benefit analysis stating the industry could see between $11.6 billion and $33.8 billion in increased revenue from the 5010 migration alone. Here are some tangible benefits that migrating to 5010 will offer:

• Improved clarity in provider loops (or fields)
• ICD-10 support
• Clarified National Provider Identifier (NPI) instructions
• Requirements for guarantor/dependent information on eligibility responses
• Improved Coordination of Benefit (COB) transactions by telling payers which transactions is primary vs. secondary, enabling correct provider payment on initial submission
• Reductions in “syntax error”-related denials
• Improved tracking
• Multiple identifiers will be allowed
• Responses will be limited to the claims where an inquiry is made
• 45 new service type codes will be introduced
• Greater ease of use for eligibility transactions (specifically the 270 and 271 eligibility responses)

Ease the transition to 5010 by creating a well-designed and high-level supported project plan to guide the implementation team. It is imperative that the project plan allow for the unexpected. Changes of such magnitude typically require more work than we expect. 5010 is largely an IT infrastructure change, and we all know that the unexpected can occur in life, and especially with computer/system changes. Make sure the 5010 project plan has enough room built in for unexpected delays and setbacks that will surely crop up.

5010 is not simply a software update. The effort needed to properly implement 5010 will be considerable; do not make the mistake of thinking that 5010 is only a vendor/software issue. Business processes, business intelligence, budgeting and even staffing changes are only a few areas where additional focus may be required. Organizations that leave their 5010 implementation plans solely in the hands of their vendors will be in trouble in 2012.

Do not expect a regulatory pushback. If you are one of the many organizations waiting with bated breath that the Department of Health and Human Services is going to push back the 5010 implementation deadline, you are going to have a long wait. The biggest evidence of this is that the Centers for Medicare and Medicaid Services (CMS) is about to commence testing in April, 2010 of its 5010 systems. Non-compliance of this HIPAA-mandated change is punishable by fines, minimum $100 per transaction up to $50,000 a year annually, per transaction.

Engage vendors now. Early identification of all vendor systems and a thorough review of all applicable vendor contracts are paramount to the success of 5010 implementation. If vendors are going to charge more for this regulatory update, or if there are any additional fees, organizations need to know sooner rather than later. In addition, if vendors are still saying that they do not have a plan in place, or seem to be stalling, a vendor change may be necessary. The earlier vendors are contacted, the better for the overall success of an organization’s 5010 implementation plan.

5010 is an HIPAA-mandated standard change, and it is vital to the overall success of ICD-10-CM/PCS implementation. Equally important, but less recognized, is the fact that 5010 has the potential to save the health care industry billions of dollars. There are significant challenges, and it will not be easy. But in its own right 5010 will help our country usher in a new era in health care documentation, data exchange and delivery. These will benefits us all.

By Rhonda Buckholtz, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC

Even though at this point it is hard to see down the road, there are many anticipated benefits of ICD-10-CM. One of the major benefits in moving to ICD-10-CM is that providers will have the ability to better describe new diseases and new understanding of diseases such as diabetes, HIV, injuries and external causes, drugs and neoplasms. ICD-10 will allow expertise in clinical classification and terminology that will assist in the use of clinical terminologies in electronic health records as well as provide international compatibility. ICD-9-CM is over thirty years old;  it is outdated and there is no room for future expansion. Read more »

Jillian Harrington,
ICD-10 Curriculum Team
American Academy of Professional Coders

One of the questions I receive most often when out and speaking with people in the compliance community about ICD-10 is “What can we do to get started?”.  Compliance professionals are in an interesting situation, as they are not typically the main starting point for operational issues such as these.  However, an early start to becoming compliant with the ICD-10 code sets, either as a provider or a payer is obviously of great importance to all compliance staff. Read more »

Deborah Grider, CPC, CPC-H, CPC-I, CPC-P, CPMA, CEMC, COBGC, CPCD, CCS-P
Vice President, Strategic Development
American Academy of Professional Coders

Recently, I traveled to Washington and was given the privilege to attend and participate representing the AAPC in listening session with various industry leaders in December in the country including AHIP, AHA, AMA, Blue Cross Blue Shield, CMS, and many other organizations regarding the problems and challenges the industry faces when implementing ICD-10. Every organization present during the session was asked to identify key challenges when facing the enormous task of ICD-10 implementation.  The most concerning area is that most organizations including health plans, hospitals, physicians and medical practices and many others assume that HHS will push back the implementation date and most have not begun to start the process of discovery and understanding of ICD-10 with their organization.  In fact the consensus from the industry that most were ignoring the ICD-10 mandate for now. One of the most significant areas of concern was business process changes which will impact every organization and ICD-10 training.  Getting ready for ICD-10 is the most significant change that our industry will experience in decades. Read more »

Two industry-leading sources in medical coding join forces to offer ICD-10 implementation training to providers, outpatient clinics and health plans in preparation for the 2013 compliance deadline

SALT LAKE CITY—Dec. 17, 2009— The American Academy of Professional Coders and Ingenix today announced a collaborative training effort that will ensure physician practices, outpatient clinics and health plans are properly prepared to implement ICD-10 medical coding systems by the Oct. 1, 2013 compliance deadline set by the Centers for Medicare & Medicaid Services. The programs, which include on-site, Web-based and group training sessions, will be available beginning January 2010. They were developed by a team of experts led by nationally renowned ICD-10 authority Deborah Grider, CPC, CPC-I, CPC-H, CPC-P. Read more »

By Rhonda Buckholtz, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC

Have you begun your planning for ICD-10 implementation? By now all organizations should be in the planning stages and doing an impact analysis to ensure implementation success.

One hidden danger zone that could derail your best laid plans and your budget are contracts. Take a good hard look at both the vendor contracts that you have and any health plans you are contracted with. Read more »