Monday, March 31, 2014

ICD10 Delayed Until at Least October 1, 2015!

Posted: 31 Mar 2014 08:43 PM PDT

On March 31, 2014, the US Senate voted to approve the bill, H.R. 4302, Protecting Access to Medicare Act of 2014, that will delay the implementation of ICD-10-CM/PCS by at least one year. The bill now moves to President Obama, who is expected to sign it into law. The bill was passed 64-35 at 6:59 pm ET on Monday, March 31.


The bill, H.R. 4302, mainly creates a temporary “fix” to the Medicare sustainable growth rate (SGR). A seven-line section of the bill states that the Department of Health and Human Services (HHS) cannot adopt the ICD–10 code set as the standard until at least October 1, 2015. The healthcare industry had been preparing to switch to the ICD-10 code set onOctober 1, 2014.


This is the second time ICD-10 implementation has been delayed. The original compliance date of October 1, 2013 was officially pushed back a year on September 5, 2012 by CMS. The impending delay of ICD-10 raises a vast slate of questions for coding professionals, provider administrators, education entities, and even the federal government. The focus will likely turn to CMS, who will need to provide the healthcare industry guidance on the exact new implementation deadline and how to move forward.


Impact of Delay Wide Reaching, Next Steps Unclear
The impending delay of ICD-10 raises a vast slate of questions for coding professionals, provider administrators, education entities, and even the federal government. The focus will likely turn to CMS, who will need to provide the healthcare industry guidance on the exact new implementation deadline and how to move forward.
The delay of ICD-10 impacts much more than just coded medical bills, but also quality, population health, and other programs that expected to start using ICD-10 codes in October. The extent of the logistical challenges and costs associated with “dialing back” to ICD-9-CM are not yet fully understood, AHIMA officials said, but are expected to be extensive.
CMS has estimated that another one-year delay of ICD-10 would likely cost the industry an additional $1 billion to $6.6 billion on top of the costs already incurred from the previous one-year delay.  This does not include the lost opportunity costs of failing to move to a more effective code set, AHIMA said.
Many coding education programs had switched to teaching only ICD-10 codes to students, hospitals and physician offices had begun moving into the final stages of costly and comprehensive transitions to the new code set—even the CMS and NCHS committee responsible for officially updating the current code set changed the group’s name to the ICD-10-CM/PCS Coordination and Maintenance Committee.
The delay directly impacts at least 25,000 students who have learned to code exclusively in ICD-10 in health information management (HIM) associate and baccalaureate educational programs, AHIMA said in a statement.
The United States remains one of the only developed countries that has not made the transition to ICD-10 or a clinical modification. ICD-10 proponents have called the new code set a more modern, robust, and precise coding system that is essential to fully realizing the benefits of recent investments in electronic health records and maximizing health information exchange.
While today’s vote delayed ICD-10 implementation, AHIMA officials said they will continue working to ensure that another delay does not occur legislatively. Over the upcoming weeks, updates will be added to AHIMA’s Advocacy Assistant with instructions on how members can continue to advocate their members of Congress on behalf of ICD-10.
“As demands for quality healthcare data continue to increase, this delay will add an additional significant hurdle for the healthcare system to fill these important HIM positions,” Thomas Gordon said. “It is truly unfortunate that Congress chose to embed language about delaying ICD-10 into legislation intended to address the need for an SGR fix in their effort to temporarily address the long outstanding and critically important physician payment issues.”




SGR Fix


Congress was working against a deadline of today, March 31, to reform or “fix” the SGR before it directly impacted physician payment. Without a fix to the SGR formula, Medicare physicians faced a 24 percent reimbursement cut beginning April 1. H.R. 4302, introduced by House Representative Joseph Pitts (R-PA), will replace the reimbursement cut with a 0.5 percent payment update through the end of 2014 and a zero percent payment update from January 1, 2015 to March 31, 2015.

Saturday, March 29, 2014

ICD-10 Proponents Warn of Harmful Implications of Another Delay

AHIMA officials have said that another delay in ICD-10 will cost the industry money and wasted time implementing the new code set. Groups opposing ICD-10 have said that the implementation, with its large increase in codes and need to adapt healthcare systems, causes an unnecessary burden on providers.

CMS estimates that a one year delay could cost between $1 billion to $6.6 billion, according a statement from AHIMA officials. ”This is approximately 10-30 percent of what has already been invested by providers, payers, vendors and academic programs in your district,” AHIMA wrote in a statement, which it encouraged its members to use when contacting Congressional representatives. ”Without ICD-10, the return on investment in EHRs and health data exchange will be greatly diminished…  Let Senate Majority Leader Reid and Chairman [Ron] Wyden know that a delay in ICD-10 will substantially increase total implementation costs in your district.”

In a letter to Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner, members of the Coalition for ICD-10 said that CMS and other government officials should move forward with the current ICD-10 deadline of October 1, 2014. Coalition representatives include the American Hospital Association (AHA), the American Medical Informatics Association (AMIA), BlueCross BlueShield Association, the College of Healthcare Information Management Executives (CHIME), and vendors like 3M Health Information Systems and Siemens Health Services.
“Although many of the signatories to this letter were at odds over the timing of implementation when the National Committee on Vital and Health Statistics (NCVHS) and HHS embraced ICD-10—which has already been adopted outside the U.S. worldwide—we are now in agreement that any further delay or deviation from the October 1, 2014 compliance date would be disruptive and costly for health care delivery innovation, payment reform, public health, and health care spending,” the letter reads. “By allowing for greater coding accuracy and specificity, ICD-10 is key to collecting the information needed to implement health care delivery innovations such as patient-centered medical homes and value-based purchasing,” the letter stated.
“Moreover, any further delays in adoption of ICD-10 in the U.S. will make it difficult to track new and emerging public health threats. The transition to ICD-10 is time sensitive because of the urgent need to keep up with tracking, identifying, and analyzing new medical services and treatments available to patients,” the letter continued. “Continued reliance on the increasingly outdated and insufficient ICD-9 coding system is not an option when considering the risk to public health.”
The impact of another delay in ICD-10 would be far reaching across the healthcare industry, AHIMA officials said. Many healthcare education programs have been teaching ICD-10 exclusively to students in preparation for the October implementation, while healthcare organizations have invested time and money into preparing staff and systems for the switch.
Groups opposing ICD-10 have said that the implementation, with its large increase in codes and need to adapt healthcare systems, causes an unnecessary burden on providers.
The call for a delay likely came as a surprise to CMS. On February 27, Tavenner announced at the Health Information and Management Systems Society Annual Conference that ICD-10 would not be delayed any further, stating “we have already delayed the adoption standard, a standard the rest of the world has adopted many years ago, and we have delayed it several times, most recently last year. There will be no change in the deadline for ICD-10.”
AHIMA Calls on Members to Request Removal of Delay Provision
AHIMA has put out a call to members and other stakeholders to contact their senators and ask them to take the ICD-10 provision out of the Senate’s version of the SGR bill.
When contacting congressional members, AHIMA has instructed callers to state that their senators should:
  • Oppose the specific language in the SGR patch legislation
  • Reach out to the Speaker of the House John Boehner and Senate Majority Leader Harry Reid to remove the ICD-10 language from the bill
CMS estimates that a one year delay could cost between $1 billion to $6.6 billion, according a statement from AHIMA officials. ”This is approximately 10-30 percent of what has already been invested by providers, payers, vendors and academic programs in your district,” AHIMA wrote in a statement, which it encouraged its members to use when contacting Congressional representatives. ”Without ICD-10, the return on investment in EHRs and health data exchange will be greatly diminished…  Let Senate Majority Leader Reid and Chairman [Ron] Wyden know that a delay in ICD-10 will substantially increase total implementation costs in your district.”
Contacting Your Congressional Representatives
For more information on contacting your senators in Congress, visit AHIMA’s Advocacy and Public Policy representative look-up site at http://capwiz.com/ahima/dbq/officials/.

Friday, March 28, 2014

Senate Website Says They Will Approve the "Doc-Fix" Bill on Monday

CLICK HERE TO SEE HOW THE SENATE WILL VOTE ON MONDAY, MARCH 31ST


        
Healthcare Business News
Robert Tennant, MGMA senior policy adviser
Tennant

ICD-10 extension in doc-fix bill divides healthcare industry


By Joseph Conn, Paul Demko and Melanie Evans 
Posted: March 27, 2014 - 2:45 pm ET

While powerful healthcare industry groups are lobbying on both sides of a congressional measure that would force a delay in the launch of the complex and voluminous new sets of diagnostic and procedural codes known as ICD-10, providers are divided on whether the delay will help or hurt them.

Their positions depend on how confident they are they will be ready for the switch to ICD-10 scheduled for Oct. 1, 2014.

The bill, which delays implementation until at least October 2015, passed the House on Thursday and a Senate vote is expected Monday.

“We put a ton of effort into preparing for ICD-10,” said Dr. Brian Patty, chief medical information officer at four-hospital HealthEast Care System, St. Paul, Minn. “We've had our ICD-10 steering committee up and running for two years.”

At immediate risk are contracts the system has for extra coders for case review and to convert ICD-9 codes from an ambulatory electronic health record running on ICD-9 that's being phased out and won't be replaced until next year.

“That's literally about a half a million dollars for various contractors to cover us when we go up on ICD-10,” Patty said.

But what may be worse—if the delay goes into effect—is its impact on relationships with affiliated physicians, who comprise about four-fifths of the medical staff.

“We just began training all of our physicians with online training about a month ago,” Patty said. About 200 havecompleted two to four hours of training, which will have to be repeated next year if the delay goes into effect, he said.

The program began despite skepticism the government might again—as it did in 2012—delay ICD-10 implementation, Patty said.

“Come a year from now, are they going to balk and say, 'That's what you said last time?' ” Patty said.

“I think that the lost good will we've had with our providers will be the biggest hit,” he said.

Prolonging the switch would delay the use of more detailed codes that would more accurately reflect the severity of illnesses and any additional complications or conditions, changes that are needed as providers enter into population health efforts and risk-based payments, said Dr. Frank Byrne, president of St. Mary's Hospital in Madison, Wis.

Byrne called the proposed delay disappointing "notwithstanding the prodigious amount of work yet to be done to get ready for ICD-10." The new codes' improved accuracy is "essential to the transition of healthcare payments from volume to value," he said.

But other healthcare providers, struggling to get ready for a challenge likened to the Y2K of healthcare, welcomed a delay.

Home health clinical manager Diane Glasgow with the Covenant Healthcare Visiting Nurse Association in Saginaw, Mich., called another year to train helpful. Similarly, Terry Gunn, CEO of KershawHealth, said having more time to make the switch to ICD-10 would be a boon for the Camden, S.C.-based hospital. "It's a huge, overwhelming task," Gunn said.

The delay provision is contained in a single sentence of the 123-page bill out of the House Ways and Means Committee, the bulk of which would provide what has become the annual last-minute doc fix to the physician sustainable growth-rate formula.

On Monday, a group of healthcare industry heavyweights called the Coalition for ICD-10 that includes the American Hospital Association and the Blue Cross and Blue Shield Association, opposed the provision.

“The Blues plans are on track to be ready,” said Justine Handelman, vice president of legislative and regulatory policy at the Blue Cross and Blue Shield Association. “We've been working hard. We and our plans will make sure we make our position known that we want to move ahead without further delays.”

The American Medical Association and the Medical Group Management Association have long lobbied for an ICD-10 delay.

“The government has done a woefully inadequate job explaining the return on investment to providers,” said Robert Tennant, MGMA senior policy adviser. “There's no recognition of the tremendous cost and disruption this transition will lead to, including the lost productivity to clinicians and coders.”

A chunk of the federal government's own credibility is at stake in the ICD-10 debate. Throughout 2011, when the ICD-10 conversion date was Oct. 1, 2013, federal officials were adamant that the deadline would hold—until they weren't. In February 2012, HHS Secretary Kathleen Sebelius and then-acting CMS Administrator Marilyn Tavenner threw their own timeline under the bus, granting a one-year extension to the current compliance date.

As recently as last month, Tavenner told an expectant crowd at her keynote speech during the annual Healthcare Information and Management Systems Society convention in Orlando, Fla., that there would be no more budging, ICD-10 would go into effect Oct. 1.

Thursday, March 27, 2014

RN-CODERs PLEASE CONTACT YOUR SENATOR ASAP!

US Senate to Vote on ICD-10 Delay 
CALL NOW
Enter Your Zip Code

Call your US Senators today and voice your opposition to any delay of ICD-10.  

In an early morning voice-vote, Congress PASSED a bill to fix the Sustainable Growth Rate (SGR) for physicians.   This is about physician Medicare PAY -- not about ICD10, but . . .

The language in the bill could delay ICD-10 implementation until October 1, 2015

CMS estimates that another 1 year delay could cost between $1 billion to $6.6 billion. This is approximately 10-30% of what has already been invested by providers, payers, vendors and academic programs.  

Without ICD-10, the return on investment in EHRs and health data exchange will be greatly diminished.  

Tell-A-Friend

Docs Stalling on ICD10 AGAIN -- TELL YOUR SENATOR to VOTE NO TOMORROW!


  
Modern Healthcare Business  
House bill could delay ICD-10 rollout by one year

House 'doc-fix' bill delays ICD-10 by at least a year


By Joseph Conn 
Posted: March 26, 2014 - 2:15 pm ET

(Story updated at 4:15 p.m. Eastern time.)

PLEASE CONTACT YOUR SENATOR BY EMAIL, FAX, PHONE - LOCAL OFFICE & WASHINGTON D.C. OFFICE TO

"STOP THE DOC-FIX -- GO WITH ICD10!" VOTE NO ON FRIDAY!

CLICK HERE to contact your U.S. Senator

The implementation date of the nationwide conversion to theICD-10 family of diagnostic and procedural codes would be delayed by at least a year under a House Ways and Means Committee bill aimed at providing the annual fix to the physician sustainable-growth rate formula.

The ICD-10 switch is scheduled to occur Oct. 1, 2014. But a single sentence in the proposed legislation says, “The Secretary of Health and Human Service may not, prior to Oct. 1, 2015, adopt ICD-10 code sets as the standard for codes sets” and finishes by citing sections in the Social Security Act and the Code of Federal Regulations where the secretary's authority to mandate ICD-10 are located.



The measure was greeted with relief by some who were worried the industry could not be ready for this October and frustration and ire by others upset that those who have invested in meeting this year's deadline may now need to wait another year for others to catch up.

“It's recognition that the industry is simply not ready for the transition,” said Robert Tennant, senior policy adviser for the Medical Group Management Association, which has, along with the American Medical Association, and other professional and industry groups, lobbied HHS for an ICD-10 delay, and for better testing by the CMS of Medicare claims processing for ICD-10 compliance.

“The extension by a minimum of one year—that's' the language, it's not one year—would be a sign to the CMS that they need to be more aggressive with testing and use the year, and not just CMS, to focus on getting end-to-end testing as part of the protocol.”

The delay, Tennant said, also would “really give practices the opportunity to upgrade their software and do internal testing so they'll know exactly what the impact of ICD-10 will mean.”

Tennant said the MGMA and other groups were strongly promoting legislation to do “an overall fix of the SGR,” but as the March 31 deadline loomed before payment cuts under current law would go into effect, “the handwriting was on the wall that a deal may not be possible, so there was some focus on a short-term fixes.” That gave legislators an opportunity to add other proposals, “and one of them was ICD-10,” he said.

THE NATION'S PHYSICIANS HAVE HAD AN ADDITIONAL 12 MONTHS TO "GET READY" -- THIS IS REALLY ABOUT THEIR MEDICARE FEE SCHEDULES, WITH ICD10 TACKED ON FOR THE HECK OF IT -- TO NEGOTIATE WITH PROBABLY.

PLEASE CONTACT YOUR SENATOR BY EMAIL, FAX, PHONE - LOCAL OFFICE & WASHINGTO D.C. OFFICE TO "STOP THE DOC-FIX -- GO WITH ICD10!"

Docs, Upset about Medicare payment, Targer ICD10 AGAIN!!!!

Reform Update: Docs irate over ‘doc fix’ patch; fight shifts to Senate


By Paul Demko 
Posted: March 27, 2014 - 5:30 pm ET

(Story updated with additional comment at 5:40 p.m. ET.)

Doctors are trying to stoke a rebellion against the doc fix.

A one-year extension of the doc-fix patch passed the House by voice vote Thursday, and so efforts to derail the measure now move to the Senate, where Senate Majority Leader Harry Reid (D-Nev.) has reportedly scheduled a vote for Monday.

The American Medical Association issued a statement from President Dr. Ardis Dee Hoven saying the association “is extremely disappointed in today's House action to give up on SGR repeal. There was bipartisan, bicameral support for reform this year, yet too many in Congress lacked the courage and wherewithal to permanently fix Medicare to improve care for patients and provide greater certainty for physician practices. Congressional leadership had to resort to trickery to pass an SGR patch that was opposed by physicians.”

Dr. Charles Mick, an orthopedic surgeon from Northampton, Mass., and a past president of the North American Spine Society, expressed disappointment that congressional leaders once again opted for a patch. “All of us had been very optimistic that this was the best chance in many years for a permanent fix to the SGR problem,” he said.

Now that the House has acted, the chances of heading off the deal appear remote. But Mick is not giving up hope. “We will be putting pressure on the Senate to hopefully come up with a proposal,” he said. “Whether that will occur or not we don't know.”

New Finance Chairman Ron Wyden (D-Ore.) had issued a statement when the doc-fix deal initially surfaced Wednesday, blasting the patch. “My choice is to end the status quo in Medicare by permanently repealing and replacing the SGR,” Wyden said. “There is no reason to wait.”

Tuesday, March 25, 2014

Compliance Question of the Week

Cardiology - For the Week of March 24, 2014

Question:

Will Medicare pay for cardiac catheterizations performed in a non-hospital setting?

Answer:

There is no longer a national coverage determination (NCD) for cardiac catheterizations performed in a non-hospital setting. In January 2006, the Centers for Medicare & Medicaid Services (CMS) issued Transmittal 46 (CR 4280) in which it stated the following. “In the absence of an NCD on cardiac catheterization in other than a hospital setting, coverage is determined by the local Medicare contractor.” This policy went into effect on January 12, 2006. 

(For a copy of this transmittal, search for R46NCD athttp://www.cms.hhs.gov/Transmittals/2006TransN/list.asp#TopOfPage.)

For more great compliance information, go to http://panaceahealthsolutions.com

Friday, March 21, 2014

Getting that first RN-Coder/RN-Auditor Job?!!!

Spring has Sprung!  And we are having a GREAT TURN-OUT for the
March 31- April 4th RN-Coder ICD10 Academy in Las Vegas!

If you're planning to attend, be sure to notify Susan at 909-579-0507  AND make your hotel reservations at the Homewood Suites, Henderson South Las Vegas  702-450-1045  and tell them you're with RN-Coder to get our group discount.

If you've completed at least 1 certification with AACCA and are wondering what to do next, or how to get that first job, etc, be sure you  have a copy of the 27-page report I did last year on all the companies which hire RN-Coders & RN-Auditors!  You can download it from and RN-Coder websites.

Also, at www.RiteCode.com  there's quite a bit of information like "How to Get your first $100,000 coding consulting contract," etc.  RiteCode.com does online continuing education programs for RN-Coders that AACCA will accept to maintain your certification.

AND, don't forget www.Indeed.com   key words like:  "remote coding, ICD10CM, ICD10PCS, RN-Coder, RN Coder, RN coding, nurse coder, CDI, code@home, code from home, chart reviews, RN-Auditor, RN Auditor, RN auditing, nurse auditor, HCC reviews, HEDIS reviews."

Then there's MAXIM health information Services -- click below to get to their website!  TONS of remote coding jobs listed!  Maxim Health Information Services JOBS

This article might be helpful, too:
Getting that first Coding Job

So please don't sit around moping, wondering "Geez, now what?"  Get out there! 

1.  Did you join the RN-Coder Affiliate Network yet?  PLEASE LET ME PAY YOU TO RECRUIT SOME NURSES!

2.  Did you go to www.Blogger.com & set up your "RN-Coder [LOCAL] Blog?"  You can tell potential employers about it, you can post your resume, your RN-Coder training & certifications, AND you can find out who needs what in your area.

3.  Have you checked out www.HFMA.org   and   www.HCCA.org  -- I've mentioned those in classes, so GET ON IT!  Those websites & organizations have TONS of great information AND they have local chapter meetings.  FINANCE and COMPLIANCE  and REVENUE INTEGRITY is who is looking for RN-Coders today.

Thursday, March 20, 2014

The RACs are Dead?! Don't Bet on It!

RN-Auditors, Are You Aware of This?

Ding Dong, the RACs are Dead? Don’t Get Your Hopes Up



The Centers for Medicare & Medicaid Services (CMS) has announced that as it enters the procurement process for the next round of RAC contracts, it is instructing the current RACs to pause their work. The announcement, which appeared on the CMS website at http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Recent_Updates.html, indicates that RACs were to stop sending post-payment audit requests on Feb. 21, 2013 (note that the instruction indicates that this was the last date the request could be sent, not the last day that it could be received). RACs have until June 1 to send files to Medicare Administrative Contractors (MACs) for payment recovery.

The announcement does not indicate what recourse a provider will have if the RAC disregards the instruction. In addition, there have been unconfirmed reports that a large number of requests were sent in the days leading up to Feb. 21. In the event that you receive a request from a RAC that was postmarked on or after Feb. 22, it is worth contacting CMS to notify them that the RAC disregarded the government’s instruction.

Is this the end of RACs? Almost certainly not. CMS is engaged in a re-procurement of RAC contractors; it is not eliminating the RAC program. Is this the end of Medicare audits? Not even close. In fact, this isn’t even a “pause” in Medicare audits; it is only a pause in RAC audits. Medicare audits are conducted by a wide range of “acronymed” entities. MACs, ZPICs (Zone Program Integrity Contractors), and BISCs (Benefit Integrity Support Centers) are just three of the contractors still conducting audits. 

RAC audits have been frustrating in part because they tend to involve a large number of records, and therefore a greatdeal of administrative time. However, the audits conducted by MACs/ZPICs/BISCs typically involve statistical projections and much larger sums of money. Another reason that RAC audits have been frustrating is that the position taken by the RAC often seems to be inconsistent with Medicare law. That problem is also present in audits by the other contractors. 

The pause in RAC audits is a positive development. CMS indicates in its statement that it intends to improve the RAC program. CMS is certainly well-aware of the frustration the medical industry is feeling. Whether there will be any material change in the RAC program remains to be seen, but the pause is preferable to the status quo. It would be foolish, however, to lose sight of the other types of audits. Just last week a physician I work with received a letter indicating that he would be receiving a demand for nearly $1 million based on a ZPIC audit (MACs are the contractors responsible for assessing overpayments, while the other organizations conduct audits and then send the results to the MACs, which perform the recoupment). The ZPIC had reviewed claims from 2006 through 2009 and concluded that payments were improper. The time limits on reopening claims (which will be a topic of a future article) would seem to preclude recoupment in this situation, but the ZPIC insisted that the claims may be properly reopened. 

The bottom line is that the pause in RAC audits is akin to a sun shower during a drought. It is a welcome respite, but it isn’t an end to the problem. 

Wednesday, March 19, 2014

I love Nurse Entrepreneur Network!

RN-CODERS!! Go to www.nurse-entrepreneur-network.com to sign up for LeaRae's FREE e-newsletter.  GREAT TIPS & YES!  She recommends that you set up a BLOG!

Here's this week's Nurse Entrepreneur Network "Tip of the Week" for3/19/2014. If you're a new subscriber, welcome! Please share this email with your nurse friends. They'll thank you.
 
And, check out our Facebook page:

Nurse-Entrepreneur-Network.com - Got a nursing business? Want to start a nursing business? Join the Nurse Entrepreneur Network, the web site for nurses in business.
3 Important Steps to Your Success as a Nurse Entrepreneur

Today's tip may seem very simple but don't be deceived. It is critical to your success as a nurse entrepreneur. Here are the three steps you must take.
 
  1. Dream it - You have probably heard the quote: "If you can dream it you can achieve it" by Walt Disney. Not only is this true, but you MUST first dream it before you can achieve it.  Your dream must be big enough to pull you forward and to keep pulling you forward.
  2. Share it - Tell people about your dream. Let others know about your vision. Steve Jobs was able to motivate people by sharing his dream and his vision with them. 
  3. Pursue it - Walt Disney also said "All your dreams can come true, if we have the courage to pursue them." Keeping your dream in the forefront will help you overcome challenges. There will be challenges along the way and you need to believe in your dream enough to get you through these tough times. 
My vision is to help nurses or other health care professionals who really want to be in control of their income and their destiny, and to live wherever I want while helping these entrepreneurs.
 
I have taken trips to Mexico and still been able to keep up with the Nurse Entrepreneur Network. I am also able to live 6 months of the year in Minnesota and 6 months of the year in Texas while helping nurses to achieve independence.
 
I have worked with several nurses who were considering giving up on being nurse entrepreneurs until I began to work with them and they were able to create the business they wanted.

I have also had challenging times when I wasn't bringing in enough business to support myself. During those times I have contacted nurse case management companies that I would consider to be my competitors and have offered my services as a sub-contractor. I have continued to contact these companies until I have acquired enough work to get me through the lean times. Although this was difficult to do at first, I knew that I needed to do something to stay afloat. My dream was strong enough that I was willing to do whatever I needed to do to keep the dream alive.

I know that if you have a dream, believe in it strongly enough, share it, and pursue it you will find a way to make it happen.
 
That's it for this week! Spread the word by forwarding these tips to your friends and to other nursepreneurs. They'll be glad you did!
LeaRae
 
LeaRae Keyes, Executive Director
Nurse Entrepreneur Network

March 31st deadline for Medicare eligible professionals. . . .

DOCTORS NEED YOUR HELP NOW!  INTRODUCE YOURSELF BY INTRODUCING THEM TO PRACTICE FUSION!  A FREE web-based EHR that will help them comply, get their incentive $$$, and implement ICD10CM!
EHR Incentive Program
The Medicare and Medicaid EHR Incentive Programs provide incentive payments to eligible professionals, eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful use of certified EHR technology. Eligible professionals can receive up to $44,000 through the Medicare EHR Incentive Program and up to $63,750 through the Medicaid EHR Incentive Program.

The Official Web Site for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs

Register Now!  Find out if you're eligible to participate in the EHR Incentive Programs and what you need to do by visiting our Getting Started page.  Registering does not commit you to participating in the program, so register early!
Here are some important 2014 EHR participation dates to keep in mind:
• March 31, 2014 at 11:59 pm ET: Attestation deadline for Medicare eligible professionals for the 2013 program year
• September 30: End of 2014 fiscal year and end of the 2014 reporting period for eligible hospitals
• November 30, 2014 at 11:59 pm ET: Attestation deadline for Medicare eligible hospitals for the 2014 program year
• December 31: End of 2014 calendar year and end of the 2014 reporting period for eligible professionals

Eligible hospitals and critical access hospitals (CAHs) should visit our Eligible Hospital Information page to learn about the EHR Incentive Programs

Monday, March 17, 2014

Happy St. Patricks Day! Watch those GEMS!


Sign up for the RN-Coder COMBO PKG for only $1999!  If you an alumni from 2010 or before, we have a SPECIAL DEAL FOR YOU!   Call Susan at 909-579-0507 for details.


Use Caution When Entering the Crosswalk: A Warning About Relying on GEMs as Your ICD-10 Solution

Pain: Healthcare practitioners and administrators are increasingly aware of the significant time in training and implementation that will be required for the mandatory migration to the new ICD-10 coding environment. Insufficient preparation will result in inaccurate coding, escalating queries, delayed billing and denials of reimbursements.


Many professionals believe that General Equivalence Mapping tools (GEMS), offer an easy “crosswalk” between ICD-9 and ICD-10. Unfortunately, GEMs as “crosswalks” is seriously flawed and not designed for this purpose at all.

Painkiller: Migration to the new system is not a coding problem at all. It is actually a clinical documentation problem. Understanding this and adopting Computer Assisted Physician Documentation (CAPD) solutions that incorporate clinical documentation in their DNA and deal with it at the point-of-care will avoid countless wasted hours and effort.

Point-of-Care Coding by Nurses solves the whole dilemma of CLINICAL DOCUMENTATION!  www.RN-Coder.com 

Thursday, March 13, 2014

RN Coder & RN Auditor Salaries around the country?

Belinda asked me a great question today, "Would like to get some realistic RN coder wages validated so I can recruit."

Here's my reply:

OK, depending on your area, www.INDEED.com has quite a bit of information on Salaries.

Go to www.Indeed.com  and scroll down and you'll see "Salaries".  Put in your zipcode, city or state.  A zip code is the most specific, the state the least specific.  So depending on how wide you cast your net, you will get less or more information.

Key words:  RN Coder   or   RN Auditor

If you want to compare job titles, you'll see there is usually a difference between "RN Coder "  and   "nurse coder".

Over the years, what I've seen is typically the RNs get their going wage for their area + a 15 - 25% "bump" for coding certification.

There is also a difference between employers.  For example, in most areas of the US an insurance company or a government agency usually pays more than a hospital, for example.

REMEMBER:  You can also sign up for "Job Alerts" the same way.  Job title, "RN Coder" and your area with your email.  You will start receiving job postings in your area.

Wednesday, March 12, 2014

Compliance Question of the Week

Cardiology

For the Week of March 10, 2014

Question:

What is the proper way to code a repeat bypass surgery?

Answer:

It is not uncommon for a patient to undergo a repeat bypass surgery. If the physician states “redo” or “repeat procedure,” use 33530 in addition to the appropriate code for the graft, if it is more than one month after the original operation. It is appropriate to use this code in addition to one selected from the 33400–33496, 33510–33536, and 33863 ranges.

Tuesday, March 11, 2014

Getting Physicians INTO ICD10 -- The RN-Coders CAN Help!

3 Best Practices for Getting Physicians on Board With ICD-10 Implementation


As the deadline for ICD-10 conversion approaches, providers face a variety of potential challenges and concerns, from clinical documentation improvement to the transition's impact on productivity.
DoctorAmong those possible trouble spots, however, getting physicians on board with preparation efforts stands out. Last month, brand strategy and marketing execution firm Aloft Group released a study involving nearly 200 healthcare providers, 75 percent of which were community hospitals. Of the providers surveyed, 60 percent cited physician buy-in as a conversion obstacle.
Terrance Govender, MD, director of healthcare at Navigant Consulting, echoes the study's findings. "The main challenge that organizations will see or face is buy-in and being able to present the value of ICD-10 to physicians," he says.
Based on his experience helping providers prepare for the switch to ICD-10 this October, Dr. Govender offered these three tips getting physicians engaged in efforts related to the transition.
1. Send the right message. Many physicians have only learned about ICD-10 through media coverage focusing on the significant increase in codes and the potential drop in productivity, Dr. Govender says. For providers looking to get physicians on board with the new system, he says it's crucial to communicate the value of ICD-10, especially as the healthcare system focuses increasingly on improving quality and cutting costs.
"We're being scrutinized…the types of patients we're seeing, how sick these patients are, how many resources we use," Dr. Govender says. "The way the healthcare encounter is represented by ICD-9 is not granular enough. ICD-10 allows us to be paid more appropriately, it allows us to bill for the use of modern technology and associated procedures, and it also allows us to present a true reflection of the severity of illness of the patients that we're seeing."
It's also crucial to explain to physicians the increase in codes shouldn't worry them, since it's unlikely they will have to deal with the full range of diagnoses, he says. For instance, an orthopedic surgeon won't need to know how to document snake bites. "They don't need to learn how to become coders," Dr. Govender says. "They just need to know how to document their common diagnoses on a day-to-day basis in a manner specific enough to support the ICD-10 code set."
2. Select a physician adviser. The foundation of physician buy-in and education concerning ICD-10 is a carefully selected, well-trained physician adviser who can communicate the value of the new system, according to Dr. Govender. This adviser serves as the voice of the physicians in contexts such as CDI meetings and ICD-10 steering committee meetings. The adviser must also have a good reputation with the medical staff and have a solid understanding of the business side of healthcare.
The physician adviser must also be appropriately trained in ICD-10 and understand his or her part in the preparation process. "An adviser needs to be very clear with his or her role," Dr. Govender says.
3. Never stop spreading the word. Once a healthcare organization has selected and trained its physician adviser, the next step is ensuring continued communication about ICD-10 to physicians. Given the proximity of the transition deadline, many providers have probably already implemented a strategy for raising awareness. However, Dr. Govender says it's important to keep actively promoting awareness all the way up until the transition date, given that people's level of interest and willingness to learn will rise as the deadline draws closer.
"The awareness strategy never stops," he says. "It's a continuous process."
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