Compliance Question of the Week . . .

Laboratory

For the Week of September 21, 2015

When does the coverage for the new colorectal cancer screening test take effect?

The effective date for the national coverage determination (NCD) for screening for colorectal cancer using Cologuard™—a multitarget stool DNA test—is  effective for claims with dates of service on or after October 9, 2014. The implementation date for non-shared Medicare administrative contract (MAC) edits is September 8, 2015 and for non-shared MAC edits is January 4, 2016, according to transmittal R183NCD
(available at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/2015-Transmittals-Items/R183NCD.html).

Patient Accounts Nurse Auditor - RN

Job Title: Patient Accounts Nurse Auditor - RN

Department: Patient Business Services

Job Number: 34571

Location: Memphis, TN

St. Jude Children’s Research Hospital is a world-renowned institution that is recognized as one of the best places to work in the nation. As a premier center for research and treatment of childhood catastrophic diseases, we employ a diverse team of scientific and healthcare professionals dedicated to the promise of hope. Children from all 50 states and from around the world have come through the doors of St. Jude for treatment, and thousands more have benefited from our research.

The Patient Accounts Nurse Auditor, under the supervision of the Patient Accounts Manager, concurrently reviews medical records to determine appropriate documentation and substantiates the medical necessity and coding of insurance claims. (KF)

WORK SCHEDULE:

Monday – Friday; 8:00 AM - 4:30 PM  

Job Qualifications:

EDUCATION REQUIREMENTS: 
Graduation from a school of nursing required.
 
EXPERIENCE REQUIREMENTS:
Two (2) years in a hospital business office setting performing healthcare claim audit functions and responsibilities required.
Experience using and familiarity with medical and billing claim forms preferred.
 
LICENSURE REQUIREMENTS:
Must possess a current Tennessee State Board of Nursing license if primary residence is Tennessee or a Nurse Licensure non-Compact state.
Must possess a current State Board of Nursing license in the state of primary residence if the state is a Nurse Licensure Compact state.
 
OTHER CREDENTIAL REQUIREMENTS:
Certification with the American Association of Clinical Coders and Auditors preferred.

To apply online, visit: https://jobs.stjude.org/css_external/CSSPage_Referred.ASP?Req=34571&s_cid=3-1-1853-36-25632

St. Jude Children’s Research Hospital is an Equal Opportunity Employer. St. Jude does not discriminate on the basis of race, national origin, sex, genetic information, age, religion, disability, sexual orientation, gender identity, transgender status, veteran’s status or disabled veteran’s status with respect to employment opportunities.  All qualified applicants will be considered for employment.  St. Jude engages in affirmative action to increase employment opportunities for minorities, women, veterans and individuals with disabilities.

ICD10-PCS codes for Inpatient | CPT codes for Outpatient !!!!!

Why hospitals would want procedures coded in CPT and ICD-10-PCS coding

by CARL NATALEAUG 3, 2015 - 09:15 PM

With less than two months to go, it shouldn't need repeating that ICD-10-PCS will only be used by hospitals for inpatient procedures. That means hospitals will use CPT codes for outpatient procedures. Remember that's for billing.

But in the ulcer example from ICD-10 Trainer below, they used ICD-10-PCS codes for an outpatient procedure. Yes, CPT was used for reimbursement. But this example imagined a hospital that wanted to have the same data to compare inpatient data and outpatient data.

It also allows hospitals more scheduling flexibility if medical coders are skilled in CPT and ICD-10-PCS coding.

• Let that ulcer bleed: How to code the treatment of a bleeding peptic ulcer. (ICD-10 Trainer)

• ICD-10-CM/PCS – Part 56: Amputating the little finger. (Codebusters)

Welcome to ICD10Data.com

ICD10Data.com is a free reference website that contains all of the official American ICD-10-CM (diagnosis) and ICD-10-PCS (procedure) medical billing codes. Use this site to search for any code, and to discover how the structure of the new coding set works.

ICD-10-CM/PCS will replace ICD-9-CM on Thursday October 1, 2015. Beginning then, all health care providers, health plans, and health care clearinghouses will be required to use the new ICD-10-CM/PCS coding system.

We've made ICD10Data.com more smartphone and tablet friendly - please do not hesitate to use this website in a mobile environment.

Codes

• 2015 ICD-10-CM Diagnosis Codes
• 2015 ICD-10-PCS Procedure Codes

Coding Rules

• Newborn/Neonate Diagnoses (0 years)
• Pediatric Diagnoses (0-17 years)
• Maternity Diagnoses (12-55 years)
• Adult Diagnoses (15-124 years)
• Female Only Diagnoses
• Male Only Diagnoses
• Manifestation Codes
• Present On Admission Exempt Codes
• Codes Questionable As Admission Diagnosis
• Codes Unacceptable As Principal Diagnosis
• Duplicate Codes

Indexes

• 2015 ICD-10-CM Diagnosis Codes Index
• 2015 ICD-10-CM External Cause Index
• 2015 ICD-10-CM Table of Neoplasms
• 2015 ICD-10-CM Table of Drugs

DRG

• Medicare Diagnosis Related Groups

Be sure to keep www.ICD10DATA.com handy -- it's a great FREE resource for RN-Coders and RN-Auditors!

OK! This CMS Agreement with AMA Helps Us "GO TO 10!"

Grace period agreement likely the death knell for another ICD-10 delay

July 8, 2015 | By Dan Bowman

In announcing a joint effort with the American Medical Association to ease the transition to ICD-10 for providers, the Centers for Medicare & Medicaid Services on Monday essentially sounded the death knell for the possibility of a fourth delay.

CMS said that, for the first year after the transition, it will not deny or audit Medicare claims from providers based solely on the specificity of diagnosis codes, as long as the codes on such claims are from the correct family in the new code set. What's more, if Medicare contractors cannot process claims due to problems with ICD-10, CMS will authorize advance payments to physicians.

Additionally, an ICD-10 ombudsman employed by CMS will work to sort through issues as they arise via a "Coordination Center," according to the agency.

While AMA wasn't the only organization opposed to the transition, it certainly was the most vocal. In May, it backed Rep. Ted Poe's proposal to eliminate ICD-10. And last November, then-AMA President Robert Wah joked that the association wanted to freeze ICD-10 in carbonite.

Now, AMA and CMS are seemingly locking arms and singing Kumbaya.

The plan offers a solution similar to legislation floated by Reps. Diane Black (R-Tenn.) and Gary Palmer (R-Ala.), who proposed grace periods of 18 months and two years, respectively. However, the key differentiator, according to American Health Information Management Association Senior Director of Coding Policy and Compliance Sue Bowman, is the requirement that codes stay within certain familial parameters. AHIMA opposed both Congress members' solutions, but offered support for the CMS-AMA collaborative effort, as did both Black and Palmer.

"The other proposals were too open ended," Bowman told FierceHealthIT. "We were concerned about the potential for wildly erroneous data and even fraud and abuse. The other proposals opened the door to say you could put any code on a claim and somehow expect to be paid with no questions asked."

Bowman said the new solution offers some flexibility for providers to learn the system and not have to worry about some of the specificity early on, while still requiring a basic level of accuracy.

"This got to the heart of what the physician community really wanted, which was not too much rigidity during the learning curve period," she said.

While pressure from the AMA and other groups no doubt loomed large, Bowman said the desire to ensure a smooth and successful transition likely was the biggest factor in CMS' decision to move forward with the grace period.

Whatever the case, she hopes that now people will have less anxiety, and will focus more on getting ready for the compliance state.

With AMA, CMS and AHIMA all on the same page, that's probably a safe bet. - Dan (@Dan_Bowman and @FierceHealthIT)

A Physician Roadmap to ICD-10 - 55 Days & Counting!

Written by  Donald Bialek, MD, MPH and Tom Ormondroyd

• http://www.roadto10.org/

  With the sustainable growth rate (SGR) bill now signed into law, it is time for physicians to really focus on their preparations for the upcoming ICD-10 implementation. ICD-10 will affect every aspect of a physician’s practice, including patient encounters, clinical and financial workflow, as well as compensation and reimbursement. It requires more accurate documentation and gives physicians more diagnostic choices to capture new data in order to ensure they are paid for the complex work being performed.

An ICD-10 roadmap can help physicians minimize productivity loss, avoid financial pitfalls, and ensure they receive proper financial and quality credit for the care they provide. Physicians will require a focused education and training plan, tailored to the “need-to-know” aspects of ICD-10. Just as it was unnecessary to use all of the codes in ICD-9, this will certainly be true of ICD-10.

Physicians first should focus on the clinical conditions that they see most frequently, then concentrate on specialty and common co-morbidities of their patients. Attention to clinical documentation is critical. ICD-10 is meant to capture more detail, and it is mandatory that the documentation supports this granularity to ensure accurate reimbursement and the capturing of the true severity of each patient’s illness. Also, getting it right the first time helps avoid time-consuming questions from coders and clinical documentation improvement specialists later in the process. Education is a personal experience, not a one-size-fits-all approach. Educating oneself in ICD-10 strategies varies from person to person, but usually the process takes 3-12 hours. Planning for that time and choosing an approach that fits are both crucial to ICD-10 success.

When beginning ICD-10 education, a physician should have four training goals:

• Focus on large topic areas – ICD-10 has 8-10 core documentation concepts that can be applied to any disease, such as site, specificity, laterality, timing, manifestations, stage, and status.
• Target risk-heavy and high-volume areas – only address gaps in current practice.
• Concentrate on specificity and underlying conditions – document more than the first diagnosis to establish severity of illness and medical necessity.  
• Incorporate electronic medical record (EMR) training to be optimized for ICD-10 with the use of templates, prompts, and automatically incorporated data already in the EMR in the clinical note. Using documentation templates improves physician efficiency and helps the physician be more timely and complete in documenting each visit. 

It is important for physicians to spend time preparing for ICD-10 now in order to avoid repeatedly correcting denied claims or enduring bad outcomes from an audit due to incomplete or inaccurate documentation. A good initial design generally is preferable to trying to repair things after the fact. ICD-10 presents significant changes to the medical coding vocabularies. It is focused on clinical needs so that essential clinical information about each patient can be captured. It is important to ensure that EMRs capture the necessary information to do this.

The ICD-10 transition deadline is just months away, and it is time to address these areas of concern.


About the Authors
Donald Bialek, MD, MPH, is a member of the Precyse Advisory Council. A seasoned expert in the healthcare field, he has been instrumental in bringing clinical and operational perspective to his work in quality, physician engagement, clinical operations, and informatics. 

Tom Ormondroyd is the vice president and general manager of Precyse Learning Solutions and is the creator of Precyse University and Precyse University DNA. He also oversees several business lines, including ICD-10 Consulting and Educational Services. 

ONLY NURSES CAN CODE ICD10 . . . READ THIS!

ICD-10 transition is not just about Oct. 1

by CARL NATALEJUN 24, 2015 - 06:00 AM

  

Many healthcare organizations are focusing on being ready for the ICD-10 changeover on Oct. 1. Just as important is what will come after that.

Productivity losses

This is legend. The fear is that ICD-10 code set is so large and complex that medical coders aren't going to be able to keep up with their current coding output.

ICD-10 opponents like to point to Canada's 40 percent drop in coding productivity after their ICD-10-CA implementation. But they also switched from a paper-based system to PC-based system at the same time. Canadian coders had a lot to learn and get used to.

Whether American coders will face comparable challenges is something we won't know until after Oct. 1. But those challenges could be mitigated by strong ICD-10 training and clinical documentation improvement (CDI) programs. These investments could help preserve medical claim productivity.

After Oct. 1, medical practices could look for other ways to streamline medical coding workflow. Remove inefficiencies. Add automation.

Denials

This is another legend. The American Medical Association (AMA) is predicting denial and rejection rates as high as 20 percent. Which is the basis of their call for an ICD-10 grace period.

Before medical practices panic over that possibility, they need to know their denial statistics now so they can compare what happens to claims after Oct. 1. They need to track:

• Days in accounts receivable by healthcare payer
• Denial rates
• Amount of reimbursements denied
• If reimbursements match the contracted rates

If tracking waits for Oct. 1, medical practices won't know if the numbers reveal problems or business as usual. Weekly tracking could help keep small problems from becoming big ones at the end of the month.

And if tracking spots problems, there needs to be a process to contact healthcare payers for find out what is the status of claims.

ICD-10 denial management starts now. Medical practices need to understand what triggers denials now and what could cause problems with ICD-10 claims. This will help prevent crippling reimbursement delays.

Queries

If physicians aren't documenting at a level that supports ICD-10 specificity, the number of queries from medical coding staff will increase. And that's going to affect productivity for coders and clinicians. To keep the documentation process moving smoothly, medical coders can improve their queries to make them as efficient and useful as possible:

1. Write in clear, concise and precise language
2. Use evidence specific to the case
3. Avoid asking leading questions
4. Include query in the clinical documentation
5. Start using ICD-10 language
6. Avoid writing queries

 Unfortunately these issues will require resources after Oct. 1. That date is not the finish line. Medical practices need to keep running long after the ICD-10 deadline.