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10/12/2015
As practices enter their second week in ICD-10, some continue to thrive while others struggle, resulting in a mixed bag of experiences with the new code set.
10/12/2015
Don’t let your guard down when you bill some of the most frequently used services — such as electrocardiogram, urinalysis and hemoglobin testing — or your revenue might end up among the tens of millions in denied payments that providers incur annually.
10/12/2015
Question: I have read on a coders’ message board that under ICD-10, you can no longer bill a well visit if a patient presents with a complaint. They say the Z00.0 and the Z01 categories have a note that says, “Excludes 1: encounter for examination of sign or symptom — code to sign or symptom,” which means you cannot code a well visit and a symptomatic complaint on the same encounter. Is that right?
10/12/2015
The Office of Medicare Hearings and Appeals (OMHA) is expanding a pilot project designed to reduce the massive backlog of appeals at the administrative law judge (ALJ) level.
10/12/2015
Pay attention to your frequently billed — and frequently denied — services, especially common testing and injection codes, to see where you can strengthen your claims coding and ensure you get paid for the work your practice conducts.
10/06/2015
CMS has scaled back some objectives in stage 2 of the electronic health records (EHR) meaningful use program but plowed ahead with stage 3, according to a final rule released Oct. 6.
10/05/2015
You’re probably elbows-deep in your ICD-10 transition prep as we speak, but take a moment to review a few points about the transition that experts say may be eluding even the most conscientious practice managers: 
 
Don’t count on the advance payment option. CMS brought up in its recent FAQs the possibility of advance payment on claims held up by ICD-10-related snafus. “If the Part B Medicare administrative contractors (MACs) are unable to process claims within established time limits because of administrative problems, such as contractor system malfunction or implementation problems, an advance payment may be available,” CMS said in FAQ No. 18.  “Physicians would be allowed to submit a single advance payment request for multiple claims for an eligible period of time.”
 
But advance payments will be available only if Medicare’s systems fail, points out Michelle Cavanaugh, an AHIMA-approved ICD-10 trainer and RCM manager for electronic health record (EHR) vendor Kareo in Irvin, Calif. “The prepayment request will not be available for the provider who is not prepared or whose software vendors are not ready to send ICD-10 claims. This is not a safety net.”
Don’t get caught up in wishful thinking. Advance payment remains what it has always been – a remedy for CMS’ screw-ups, not yours (PBN 6/16/08).
 
Click here to read the full story.
10/05/2015
Not every ICD-10 launch day story was happy. The day was “extremely stressful” for Terry Schaefer, office manager for Raymond H. Schaerf M.D., a thoracic and cardiothoracic surgeon in Burbank, Calif.
 
It wasn’t her staff that was the trouble; they were all prepared. But “our billing program and electronic record systems were having trouble accepting the ICD 10 codes,” says Schaefer. “The consults were so complicated, we couldn't code them as we saw the patients,” and they piled up throughout the day.
 
Also, several of Dr. Schaerf’s surgery referrals were coded to ICD-9, which made it necessary to translate them before patients could be seen – “the surgery schedulers were having problems finding the ICD 10 codes necessary for the surgeries,” Schaefer said.
 
“Several people were in tears. Everyone was so far behind,” says Schaefer. “We finally had to resort to ordering food for our staff so we could stay late to catch up.”
 
Schaefer says she’s learned her lesson: “Starting today, no referral will be accepted without proper ICD 10 codes.”
 
10/05/2015
At the clearinghouse Navicure, in Duluth, Ga., the volume of claims arriving from providers remained at its usual high level – about 1 million claims a day – on Oct. 1, reports Ken Bradley, Navicure’s vice president for strategic planning and regulatory compliance.
 
But the volume of claims with ICD-10 codes was relatively low – around one quarter of the total volume, he says.
 
“I am hopeful that we won’t see a significant drop in the number of claims received due to ICD-10,” Bradley adds. “My fear is that some smaller practices have decided to wait a few days before deciding to submit claims with ICD-10 codes.” Decreasing claim volume could be an indication that practices are having trouble with the codes, technical or otherwise, he explains.
 
On the payer side, no payers have rejected claims because of ICD-10 codes, but that too could change once the ICD-10 code volume increases, Bradley says.
 
On day one of ICD-10, Navicure noticed some practices filing claims with ICD-10 codes right out of the gate, shortly after midnight. Bradley figures those were most likely test claims.
 
No one has yet used the Navicure portal to file claims directly – one of the contingencies practices may use if, for example, their electronic health records (EHRs) are unable to transmit ICD-10 coded claims. However, they have been using the portal to recode claims prior to resubmitting them.
 
That was the case for a number of providers who jumped the gun and tried to send ICD-10 claims with a date of service prior to Oct. 1, Bradley reports. That was “the No. 1 reason for Navicare rejections” Oct. 1, he adds. Normally, most clearinghouse-level rejections are related to eligibility.
 
A small percentage of practices – around 1.24% – continued to try to submit claims in an incorrect electronic format, despite an “aggressive” education campaign the clearinghouse has carried out for the last 18 months, Bradley says. Some even tried to include ICD-10 codes on those claims.
 
“We’re still continuing that effort today to reach out to those clients,” he adds.
10/05/2015
Your practice was on top of ICD-10 from day one, you started training well in advance and then the delays began. That’s what happened to Pollux Systems Inc., a health care revenue cycle management company in Evansville, Ind., says Elizabeth Reger, vice president of operations.  
 
Pollux started training two years ago. The company purchased training, which included module training. After the first delay, everyone reviewed the webinars again, Reger explains. Finally, in June, coders started dual-coding.
 
If your organization started early training, you might need a refresher course. Check with your payers and Medicare administrative contractors, look for targeted training from webinars and review information in newsletters such as Part B News’ sibling publications, the specialty coders’ pink sheets.
 
Your vendors also may be able to help. When Canadian Valley Family Care of Yukon, Okla., was preparing for the transition, a trainer from the practice’s electronic medical records vendor came in to help, says Office Manager Teresa Kilpatrick, who adds that another certified trainer also provided training.

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