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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.

ICD10CM Updates for 2017

Effective October 1, 2016:

Deleted 2017 ICD-10-CM Codes

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

• Page 1/2: ICD-10-CM D49.5 to T85.83XA
• Page 2/2: ICD-10-CM T85.83XD to Z98.89

New 2017 ICD-10-CM Codes

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

• Page 1/8: ICD-10-CM A92.5 to E13.3419
• Page 2/8: ICD-10-CM E13.3491 to I69.910
• Page 3/8: ICD-10-CM I69.911 to M97.21XA
• Page 4/8: ICD-10-CM M97.21XD to R82.79
• Page 5/8: ICD-10-CM R93.41 to S02.80XD
• Page 6/8: ICD-10-CM S02.80XG to S99.131A
• Page 7/8: ICD-10-CM S99.131B to T83.512D
• Page 8/8: ICD-10-CM T83.512S to Z98.891

Revised 2017 ICD-10-CM Codes

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

• Page 1/2: ICD-10-CM C7A.094 to S49.039D
• Page 2/2: ICD-10-CM S49.039G to T85.690S

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.

2. “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.

3. “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.

Why clinical documentation is the missing link

to value-based reimbursement

Written by Emily Rappleye (Twitter | Google+)  | August 10, 2016

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The key to successfully making the jump from the old era of healthcare — one where fee-for-service is king — to the new era of healthcare — one where transparency, consumerism and value dominate — may actually be as simple as improving clinical documentation, according to Anthony Oliva, DO, vice president and CMO of Nuance Healthcare.

"For those who thought, 'Maybe we can just hold out and [value-based care] will all go away,' it's never going to go away; it's only going to get worse," Dr. Oliva said at the Becker's 2nd annual CIO/HIT + Revenue Cycle Conference in Chicago.

Healthcare is a classic example of a model explained in Ian Morrison's book The Second Curve, according to Dr. Oliva. This two-curve model posits that any market undergoing transformation has two curves: the old and the new. Companies must ride the first curve and learn how and when to jump to the second, Mr. Morrison explains in the book.

In healthcare, the first curve was designed around the provider, according to Dr. Oliva. This is because the provider had control over the entire healthcare economy and was able to dictate supply and demand. On the first curve is a carefully controlled entry of physicians into the market, according to Dr. Oliva. On this curve, physicians are able to exert absolute control over demand, too. The attitude was, "Cut my fees by 5 percent and I'll just see 5 percent more people," Dr. Oliva said.

Now this fee-for-service world is being challenged by cost controls, informed consumers and transparency, and it is flipping the power dynamic to a second curve. The trouble is that physicians need to understand how to make the leap to the second curve — value-based care — and remain financially stable.

One of the big changes in the second curve is newly found transparency, according to Dr. Oliva. Patients can go online and not only find information about diseases and medical treatments, but also find information about the quality of care their hospitals or even their individual physicians provide.

"In the past, quality was really determined for the most part by the relationship you had with your physician," Dr. Oliva said. "We never knew whether a physician was good or bad. How would you know that a physician is practicing in a standard of care that's acceptable for his or her specialty? We did a lot of assuming."

Now not only are quality outcomes tied to reimbursement by CMS, but the transparency of information magnifies this change because patients can go online and compare physician performance. These physician transparency tools — Dr. Oliva named ProPublica's Surgeon Scorecard as an example — use Medicare billing information to compare physician performance.

"We see that the connection is vital between what the physician writes in the record to what's billed to insurance companies and Medicare," he said. This means a physician won't be properly reimbursed — or accurately scored on public scoring systems — if he or she is not properly documenting the severity of his or her patients.

This makes clinical documentation improvement essential to landing the jump from the first curve to the second curve in healthcare. Dr. Oliva advised attendees not to take their clinical documentation improvement programs for granted. "If you look at it as a severity capture program first, the revenue will take care of itself," he said.

DEVELOPING: CMS Releases 2017 ICD-10-PCS Codes

Written by Laurie M. Johnson, MS, RHIA, CPC-H, FAHIMA | Friday, 03 June 2016 00:00

The Centers for Medicare and Medicaid Services (CMS) released the 2017 ICD-10-PCS codes as well as other supporting documentation on Thursday.

Before you get excited, the 2017 ICD-10-CM codes have not been released yet. The additional supporting documentation includes the 2017 ICD-10-PCS Official Coding and Reporting Guidelines, the addenda for the ICD-10-PCS Index and Tables, a text listing of the 2017 procedure codes with the file layout description, the order file which includes the long and short descriptions of the 2017 procedure codes, and a conversion table for the 2016 to 2017 codes.

The update also states that the following documents will not be updated beyond 2016: The ICD-10-PCS Reference Manual, the document describing the development of the ICD-10 Procedure Coding System (ICD-10-PCS), and the ICD-10 Procedure Coding System Power Point slides.

The long-awaited 2017 ICD-10-PCS codes are 75,789 in number. The new codes are found in the Medical and Surgical, Administration, Measurement and Monitoring, Extracorporeal Therapies, and New Technology sections. The highest number of changes is in the Medical and Surgical section, which now totals 65,676 codes. The Administration section has 39 changes, which increases the number of codes to 1,427. Extracorporeal Therapies section adds four new codes to increase the total to 46. The New Technology section has added 27 new codes which give us a glimpse into the procedures, devices, and substances that will be approved for New Technology add-on payments to MS-DRG v34.

The biggest changes include the revision of the definitions of root operations Control and Crea
tion, new root operation “Perfusion,” which was added to the Extracorporeal Therapies section, and changing the body part terminology in the Heart and Great Vessels Body System. The coronary arteries will now be identified by the number of arteries treated and not sites. This change is supported in the 2017 ICD-10-PCS Coding and Reporting Guidelines. The new definition of Control is stopping, or attempting to stop, post-procedural or other acute bleeding. This revision now includes “other acute bleeding,” which may be based on the clinical documentation. The new definition of Creation is putting in or on biological or synthetic material to form a new body part that to the extent possible replicates the anatomic structure or function of an absent body part which has changed the focus of this root operation from only sex-change operations to operations in other body systems. The new root operation of Perfusion is defined as extracorporeal treatment by diffusion of therapeutic fluid.

The 2017 ICD-10-PCS Official Coding and Reporting Guidelines were developed based on the internal review of the 2016 version and public input. The areas that have been revised include B2.1a, B3.2, B3.4a, B3.6b, B3.6c, B3.7, B3.9, B4.2, and B4.4. Guideline B2.1a revision provides an alternative when clinical documentation is not present and the coder may use the general anatomic region as an unspecified code. The expectation is that this option will be used rarely. B3.2 (Multiple procedures) has been altered in the examples of this guideline. B3.4a adjusted the spacing for the provided examples. B3.6b and B3.6c adjusted the guideline to match the changes from coronary sites to coronary arteries in the Tables. B3.7 added “other acute bleeding” to reflect the change in the definition of root operation Control. B3.9 addresses the excision of an autograft. This guideline change provides more information to other body part value. This change includes “different procedure site” rather than other body part value. This revision will assist the coders to determine if a separate code should be reported. B4.2 adds information regarding cardiovascular structures that could have branches and how to assign a code when the specific artery or vein is not available in the correct table, but a general body part is available. The provided example of this guideline is the occlusion of the bronchial artery being coded to the body part value Upper Artery in the body system Upper Arteries, and not to the body part value Thoracic Aorta, Descending in the body system Heart and Great Vessels. Guideline B4.4 addresses coronary arteries as a body part value. As discussed earlier, coronary arteries as body parts are a big change for the 2017 version. The change involves a switch from the number of sites treated to the number of coronary arteries treated.

The first update to the ICD-10-PCS codes is finally here! The link to the new files for ICD-10-PCS is provided below. The industry continues to look for the 2017 ICD-10-CM codes and most importantly, MS-DRG v34.
Resources: https://www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-PCS-and-GEMs.html