Sunday, September 25, 2016

What Happens on October 1st this year?!?!


Do NOT use unspecific ICD10 codes!

Your diagnosis codes will start affecting payment January 1st!

Going forward, CMS & the third-party payers are "matching" your CPT codes with ICD10 codes
to build payment policies for the future.

The codes you submit now will affect current reimbursement & FUTURE reimbursement.

Check out this video -- very interesting!

Tuesday, September 20, 2016

RN-Coder Compliance Question of the Week

Can you provide some examples of chest manipulations and the documentation required to report the applicable codes?
Chest manipulations are described in CPT with examples such as cupping, percussing and vibration to facilitate lung function by mobilization of sputum. These services must be documented as reasonable and necessary to be covered, and there must be evidence of the following:
  • Consistent with the nature and severity of the individual’s symptoms and diagnosis
  • Reasonable in terms of modality, amount, frequency and duration of treatment
  • Generally accepted by the professional community as being safe and effective treatment for the purpose used.

Tuesday, September 13, 2016

RN-Auditor COMPLIANCE Question of the Week

I have heard that the Medicare “ICD-10 flexibilities” will expire on October 1, 2016. What does this mean exactly?

According to the Centers for Medicare & Medicaid Services (CMS), ICD-10 flexibilities were solely for the purpose of contractors performing medical review so that they would not deny claims solely for the specificity of the ICD-10 code as long as there is no evidence of fraud. 

As you say, these ICD-10 medical review flexibilities will end on October 1, 2016, and providers will be required to code to accurately reflect the clinical documentation in as much specificity as possible, as per the required coding guidelines. 

Note, however, that providers should already be coding to the highest level of specificity as this is not a new requirement.

Monday, September 5, 2016

RN-CDS Compliance Question of the Week

For the Week of September 5, 2016

What is the difference between “history of” and “follow-up” in physician documentation?

Using “history of” and “follow-up” as if they are the same is a common documentation mistake.

“History of” is often used to indicate the current clinical indication. However, in ICD-10-CM, “history of” means that the patient has a past medical condition that no longer exists and is not receiving any treatment, but has the potential for recurrence.

“Follow-up” goes along with “history of” because follow-up codes indicate continued surveillance following a completed treatment of a condition, not follow-up during treatment.

Thursday, August 25, 2016

5 Reasons Nurses Want to Leave Your Hospital

5 Reasons Nurses Want to Leave Your Hospital

Rebecca Hendren, August 9, 2011
Your nurses have one eye on the door if you do any of the following.
Although economic woes abound, nurses are planning their exit strategies and will make a move when things improve. A recent survey from healthcare recruiters AMN Healthcare found that one-quarter of the 1,002 registered nurses surveyed say they will look for a new place to work as the economy recovers.
Are your nurses engaged, committed employees? Or are they biding their time until they can go somewhere better? To predict whether you face an exodus, take a look at the following five reasons why your nurses want out.
1. Mandatory overtime
Nurses work 12-hour shifts that always end up longer than 12 hours due to paperwork and proper handoffs. At the end, they are physically, mentally, and emotionally exhausted. Forcing them to stay longer is as bad for morale as it is for patient safety.
Some overtime is acceptable. People get sick, take vacations, or have unexpected car trouble and holes in the shift must be filled to ensure safe staffing. Nurses are used to picking up the slack, taking overtime, and pitching in. In fact, overtime is an expected and appreciated part of being a nurse. Many use it to help make ends meet. Mandatory overtime, however, is a different matter. Routinely understaffed units that rely on mandatory overtime as the only way to provide safe patient care destroy motivation and morale.
Take a look at the last couple of years' news stories about RN picket lines. Most include complaints about mandatory overtime.

Sunday, August 14, 2016

ICD10CM Updates for 2017

Effective October 1, 2016:

The following 311 ICD-10-CM codes will be deleted in the 2017 ICD-10-CM code set, effective October 1, 2016.
The following 1,974 ICD-10-CM codes will be added to the 2017 ICD-10-CM code set, effective October 1, 2016.

The following 425 ICD-10-CM codes have desciption changes in the 2017 ICD-10-CM code set, effective October 1, 2016.

ICD-10 Denials Increase for Practices

ICD-10 – a diagnostic coding system developed by the World Health Organization, is in its early implementation stages, and it has already caused the health care organizations to cope with a number of challenges arising due to poor education and preparation regarding ICD-10. Poor education regarding this new coding system has led to a number of consequences, including compliance issues, claim rejections, coding backlogs, delays, and denials.
In this article, we will be discussing how implementation of ICD-10 has led to increased number of denials and what an organization can do to limit the impact of this new coding system on its denial rates.

ICD-10 Denial Rate Forecast

The health IT industry, has published white papers predicting that the implementation of ICD-10 will lead to a 100 to 200 percent increase in claim rejection and/or denial rates.
Explaining that during the post-implementation phase of ICD-10, healthcare organizations may experience significant impact on the length of time and amount of rework required for claim rejects and their productivity. Practices may suffer a negative impact of ICD-10 on their cash flow and revenue due to lost productivity and increasing number of coding errors.
The companies recommended that organizations should measure their denial rates and types of rejects or denials during the transition phase in order to plan and act accordingly.
  • Of 4.6million claims submitted every day, only 2 percent were rejected because of invalid or incomplete data.
  • About 0.09 percent claims were rejected due to invalid ICD-10 codes.
  • About 0.11 percent claims were rejected due to invalid ICD-9 codes.

3 Most Common ICD-10 Denials

The implementation of ICD-10 can prove to be a bumpy ride for your practice if you haven’t done enough preparation. In order to gain maximum benefit from this transition and to minimize denial rates, it is important that you act proactively.
To help you do so, we are listing 3 most common ICD-10 denials and ways to avoid them.
  1. “Diagnosis Code: Invalid; Diagnosis code must be most specific.”
The new ICD-10 coding system provides specific codes for specific condition. In order to avoid denials due to unspecific codes, select the most specific code for each condition and claim.
  1. “Diagnosis Code: Invalid; Must be a valid ICD-10-CM diagnosis code.”
Denials that specify the above reason can be caused by a number of issues. In order to avoid these denials, choose the most specific and valid ICD-10 code that rightly represents the patient’s documented condition.
  1. “Diagnosis Code: Invalid; Claim cannot contain a mixture of ICD-9 and ICD-10 codes.”
In order to avoid claim denials due to this reason, make sure that the outpatient claim contains either ICD-10 or ICD-9 codes.
The best way to handle ICD-10 rejections and denials is to stay proactive. Educate your staff on how documentation and procedures may affect denial and rejection rates. Learn from the denials and establish best practices on how to prepare proper medical claims.