Get Your "Sepsy" On!

Please send this excellent training music video to all your nurse & physician friends far & wide.  It is an EXCELLENT way to get everyone watching for
the signs & symptoms of Sepis!

https://www.facebook.com/EMTsParamedics/videos/10153681909773624/

Thank you!
- Joyce

AACCA RN-Coder Test-Prep Dates Announced for 2016

PLEASE COMPLETE THE ONLINE VERSION OF THIS PROGRAM BEFORE ATTENDING THE TEST-PREP.  This is NOT a class, it is a REVIEW. You do NOT have to attend a Test-Prep in order to complete a program -- ALL programs are available online 24/7 and may be completed at home, including the AACCA testing.  For questions, please contact Patricia  AACCAMembers@gmail.com.

AACCA RN-Coder ICD10 Certification Exam 

IS GIVEN ON FRIDAY OF THIS WEEK. There are 2 online sections, about 4 hours total. We are usually finished by 1pm on Fridays.

FREE HOT BREAKFAST & DINNER for those nurses staying at Homewood Suites daily. FREE WIFI & FREE SHUTTLE to/from airport, local restaurants & stores. There is no Daily Resort Fee -- so staying with us at Homewood Suites will save you about $500 for the week!

** THIS IS A NO SMOKING FACILITY **

We start promptly at 8:00am daily. We will be going over the power point presentations, homework assignments and grading the Mid-Term Exam. On Thursday please have the Final Exam ready to turn in. Each day we will review ICD10CM and ICD10PCS. There will be assignments daily. Dress is casual and comfortable.

Go to RN-Coder Continuing Education Programs for course descriptions & information about the Homewood Suites property.

You must call Homewood Suites 702-450-1045 to make reservations so we know you are attending THIS test-prep. If we do not have 10 nurses staying at the hotel by two weeks prior, the test-prep may be cancelled.

THIS SCHEDULE IS SUBJECT TO CHANGE WITHOUT NOTICE.  

Please check with the hotel prior to making non-refundable travel arrangements.

THERE IS NO COST FOR THE TEST-PREP & YOUR TESTING FEES ARE WAIVED IF YOU REGISTERED FOR THE RN-CODER COMBO PKG.  If you registered for a SINGLE PROGRAM, the cost of the Test-Prep is $499 for all 5-days and the Exam fee is $399.  You must be an AACCA member to be able to sit for the Certification Exam.  Go to www.AACCA.net for membership details.

CLICK ON THE BIG BLUE BUTTON ON THE RIGHT SIDE OF
www.RN-Coder.com  or click a link below:

AACCA RN-Coder ICD10 Test-Prep - February 15 - 19, 2016
https://tockify.com/rncoder/detail/29/1455552000000

AACCA RN-Coder ICD10 Test-Prep - May 16-20, 2016
https://tockify.com/rncoder/detail/30/1463410800000

AACCA RN-Coder ICD10 Test-Prep - September 12-16, 2016
https://tockify.com/rncoder/detail/31/1473692400000

AACCA RN-Coder ICD10 Test-Prep - December 5 - 9, 2016
https://tockify.com/rncoder/detail/32/1480953600000

Licensed RN - Health Risk Educator Consultant

28813BR

This is an in office position in New York City.  There is 50-75% of travel to medical practices within metro New York, and occasionally boroughs and some rural areas.

An RN license is required. Experience with clinical claim review and coding is required.

POSITION SUMMARY
Works with internal business partner (specifically the CRMO clinical coding team), to develop relationships with local network and health care management teams to educate, train, and provide face to face support to physician practice groups who serve our commercial exchange membership (both on and off exchanges, individual and small group clients) in support of risk adjustment.

Uses clinical skills to assess, plan, monitor, and evaluate healthcare services in the provider office setting 
participating in direct patient care and assessment.
Responsible for educating providers on how to properly document medical services and interventions received during
face to face member encounters, including proper coding and claim submission for services rendered.
Works on-site in physician offices to assist with scheduling appointments for health risk assessments and other
related medical services in support of our commercial exchange members who may have a gap in care.
Serves as a liaison to peers to provide in-depth clinical knowledge and expertise to support the education of providers.
Performs audits of medical records to ensure all assigned ICD-9 codes are accurate and supported by written clinical
documentation.
Identifies barriers utilizing critical thinking skills to identify improvement opportunities, communicate them to the
national team, and help facilitate gains in efficiency and appropriate risk score capture.
Leads work groups to develop learning strategies to improve health care delivery performance.
Serves as the training resource and subject matter expert to regionally aligned network practices.
Identifies and recommends opportunities for process improvements at the practice level to improve overall risk
adjustment scores and gaps.
Identifies opportunities to promote quality.
Shares best practices in risk adjustment across all sites/regions.
Simultaneously manages multiple, complex projects.

BACKGROUND/EXPERIENCE 
-RN with current unrestricted state licensure required. 
-CPC certification or CRC certification required. Nurses that currently hold the CPC certification will be required to obtain the CRC certification within 6 months post hire. Nurses that currently hold no coding certification will be required to obtain the CRC certification within 6 months post hire. 
-3-5 years clinical experience required.

EDUCATION
The highest level of education desired for candidates in this position is a Bachelor's degree or equivalent experience.

LICENSES AND CERTIFICATIONS
Nursing/Registered Nurse (RN) is required

ADDITIONAL JOB INFORMATION
You want to work where you can learn, grow and test yourself. And, of course, you want decent, competitive pay and benefits. You've come to the right place. Our salaries and benefits are market-competitive, with bonuses for high achievers. And our benefits come with lots of choices. All are aimed at helping you achieve health and financial well-being. Our employees health and financial well-being are important to us. As of April 2015, we increased our U.S. minimum base wage to $16 per hour, for both hourly and salaried employees. And effective in 2016, eligible Aetna employees can qualify for an enhanced medical benefits program that could save some families thousands of dollars.

Aetna is about more than just doing a job. This is our opportunity to re-shape healthcare for America and across the globe. We are developing solutions to improve the quality and affordability of healthcare. What we do will benefit generations to come.

We care about each other, our customers and our communities. We are inspired to make a difference, and we are committed to integrity and excellence.

Together we will empower people to live healthier lives.

Aetna is an equal opportunity & affirmative action employer. All qualified applicants will receive consideration for employment regardless of personal characteristics or status. We take affirmative action to recruit, select and develop women, people of color, veterans and individuals with disabilities.

We are a company built on excellence. We have a culture that values growth, achievement and diversity and a workplace where your voice can be heard.

We conduct pre-employment drug and background testing. Benefit eligibility may vary by position. Click here to review the benefits associated with this position.

70,000 Ways to Classify Ailments

Hi Joyce,

Saw this article in the Wall Street Journal today.  Wanted to get it to you.

Thanks for my CEU certificate and my RN-Coder Certification credential!!!!

Hope all is well!

Margie

70,000 Ways to Classify Ailments

Enormous expansion of codes doctors use will change paperwork, insurance, monitoring

ENLARGE

‘We’re hoping [the switch to the new codes] will be like Y2K,’ when computer systems managed the date switch to 2000, says Dr. Robert Wergin, president of the American Academy of Family Physicians, shown with a patient in 2014. Photo: Dan Little/Lincoln Journal Star/Associated Press

By

Melinda Beck

Sept. 27, 2015 7:46 p.m. ET

70,000 Ways to Classify Ailments - WSJ Doctors, hospitals and insurers are bracing for possible disruptions on Oct. 1 when the U.S. health-care system switches to a massive new set of codes for describing illnesses and injuries. Read more...

Doctors, hospitals and insurers are bracing for possible disruptions on Oct. 1 when the U.S. health-care system switches to a massive new set of codes for describing illnesses and injuries.

Under the new system, cardiologists will have not one but 845 codes for angioplasty. Dermatologists will need to specify which of eight kinds of acne a patient has. Gastroenterologists who don’t know what’s causing a patient’s stomachache will be asked to specify where the pain is and what other symptoms are present—gas? eructation (belching)?—since there is a separate code for each.

In all, the number of diagnostic codes doctors must use to get paid is expanding from 14,000 to 70,000 in the latest version of the International Classification of Diseases, or ICD-10. A separate set of ICD-10 procedure codes for hospitals is also expanding, from 4,000 to 72,000.

Hospitals and physician practices have spent billions of dollars on training programs, boot camps, apps, flashcards and practice drills to prepare for the conversion, which has been postponed three times since the original date in 2011.

Some coding experts warn that claims denials could double as providers and payers get used to the new, more specific codes.

Others are more sanguine. “We’re hoping it will be like Y2K,” when the switch to 2000 dates was expected to crash computers world-wide, says Robert Wergin, president of the American Academy of Family Physicians. “Everybody will worry, and the claims will go through fine.”

The real upshot won’t be apparent immediately. “Any problems that crop up will be far more evident on Oct. 15 than Oct. 1, because it takes that long to process claims,” says William Rogers, an emergency physician who is the Center for Medicare and Medicaid Service’s ombudsman for ICD-10 conversion.

ICD codes are an international system for recording diseases, injuries and other conditions set by the World Health Organization; federal agencies developed the far more elaborate version for the U.S. To get paid, doctors submit such diagnosis codes along with separate procedure codes that describe the service performed. Private and government insurers scrutinize the ICD codes to judge whether the service was medically necessary.

The new coding system is needed, many health-care experts say, because modern medicine has outgrown the old one, adopted in the U.S. in 1979. The ICD-9 doesn’t differentiate between Type 1 and Type 2 diabetes, for example, or distinguish Ebola from “other diseases spread by viruses.”

ICD-10 will help researchers better identify public-health problems, manage diseases and evaluate outcomes, proponents say. Over time, it will create a much more detailed body of data about patients’ health—conveying a wealth of information in a single seven-digit code—and pave the way for changes in reimbursement as the nation moves toward value-based payment plans.

“A clinician whose practice is filled with diabetic patients with multiple complications ought to get paid more for keeping them healthy than a clinician treating mostly cheerleaders,” says Dr. Rogers. “ICD-10 will give us the precision to do that.”

A Code For What Ails You

Search through the database of 70,000 medical diagnoses codes.

ENLARGE

The multitude of codes for external causes of injuries have gotten most of the attention to date. Hurt in a prison swimming pool? That’s Y92.146. Crushed by a human stampede while resting or sleeping? That’s W52.04. But insurers and Medicare officials say that, in most cases, they won’t require doctors to include such external-cause information for billing, although it is useful for research purposes.

Clinicians will need to document enough detail about patients’ conditions to support the new codes, including what side of the body is affected, how severe the problem is and whether it has occurred before.

ICD-10 also offers different codes for ailments depending on myriad circumstances, such as whether respiratory diseases are due to tobacco use and whether obesity is due to consuming excess calories or some other reason. In many cases, doctors readily know such information; in other cases, it could require more discussion and longer visits.

Medicare officials say they won’t deny claims solely for lack of specificity for the first 12 months, as long as providers supply the correct general category of illness. But that doesn’t apply to hospital procedure codes, and most commercial insurers aren’t offering such a grace period.

To what extent insurers will require doctors to use the most specific codes, or use them to adjust reimbursement rates, isn’t clear. “In the first few months, the goal is simply to get the ICD-10 codes into the system and make sure providers are using them,” says Clare Krusing, a spokeswoman for the America’s Health Insurance Plans.

Cost estimates for the ICD-conversion vary widely. Dueling studies have estimated the cost from less than $10,000 to more than $225,000 for small practices. Some large hospitals systems say they have spent millions on training and other preparations.

“This affects literally every single system in a hospital, except maybe the cafeteria,” says Ed Hock, managing director of revenue cycle solutions for the Advisory Board Co., a consulting firm that has warned its hospital clients to expect their accounts-receivable days to increase by three to five, on average. “That can mean millions of dollars in cash flow.”

ICD-10 codes will affect Medicare payments for some conditions because the added specificity moves them to a different severity tier, which changes how they are reimbursed. For example, in ICD-9, there is only one code for hepatic encephalopathy, a severe brain disorder that can occur with liver failure, which is considered a major complication. ICD-10 asks whether the patient is in a coma and if not, the condition is downgraded to a regular complication and the hospital is paid, on average, $2,800 less, according to an analysis by the Advisory Board.

But ICD-10 does give providers and health plans a chance to increase payments by recording patients’ conditions in more detail. In Medicare Advantage and other plans that receive per-member, per-month fees to provide care, payments are adjusted to reflect the severity of patient illnesses, so the more secondary diagnoses providers record, the more they may be paid.

“Hospitals leave millions of dollars on the table today through incomplete documentation or coding errors,” says Mr. Hock. “There’s a revenue opportunity in doing this right.”

Some patients will be affected, too. Those getting regular tests or infusions at outpatient centers will need to bring new orders bearing ICD-10 codes starting Oct. 1, says Kevin Lenahan, chief financial officer at Atlantic Health Systems, which owns five hospitals in New Jersey.

Atlantic plans to have personnel armed with ICD-10 code books stationed at every registration desk that day. “We won’t turn patients away. We’ll either call their doctor, covert the code for them or, in the worst case, we’ll put the bills on hold until we get the right information,” says Mr. Lenahan.

Insurers will have to work with both ICD-9 and ICD-10 codes for months or years until all the claims for tests, treatments and doctor visits before Oct. 1 are cleared. “If someone had a service in August that doesn’t get billed until December, that will still have an ICD-9 code,” says Debra Cotter, director of ICD-10 implementation for Pittsburgh-based Highmark Inc. Insurers generally give patients two years to submit out-of-network claims. “If someone has stashed a bill in a shoebox, it might be a year or more before they realize they’re owed some money,” Ms. Cotter says.

Write to Melinda Beck at HealthJournal@wsj.com

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)