Back to School: Identify How ICD-10 Will Affect Your Practice

In order to be fully prepared for the October 1, 2014, ICD-10 transition, you need to know exactly how ICD-10 will affect your practice. Although many people associate coding with submitting claims, in reality, ICD codes are used in a variety of processes within clinical practices, from registration and referrals to billing and payment.
The following is a list of important questions to help you think through where you use ICD codes and how ICD-10 will affect your practice. By making a plan to address these areas now, you can make sure your practice is ready for the ICD-10 transition.

• Where do you use ICD-9 codes? Keep a log of everywhere you see and use an ICD-9 code. If the code is on paper, you will need new forms (e.g., patient encounter form, superbill). If the code is entered or displayed in your computer, check with your EHR and/or practice management system vendor to see when your system will be ready for ICD-10 codes.
• Will you be able to submit claims? If you use an electronic system for any or all payers, you need to know if it will be able to accommodate the ICD-10 version of diagnoses and hospital inpatient procedures codes. If your billing system has not been upgraded for the current version of HIPAA claims standards—Version 5010—you will not be able to submit claims. Check with your practice management system or software vendor to make sure your claims are in the HIPAA Version 5010 format and that your system or software can include the ICD-10 version of diagnoses and hospital inpatient procedures codes.
• Will you be able to complete medical records? If you use any type of electronic health record (EHR) system in your office, you need to know if it will capture ICD-10 codes. Look at how you enter ICD-9 codes (e.g., do you type them in or select from a drop down menu) and talk to your EHR vendor about your system’s capabilities for ICD-10. If your EHR system does not capture ICD-10 codes and you use another terminology (SNOMED), you will still need ICD-10 codes to submit claims.
• How will you code your claims under ICD-10? If you currently code by look up in ICD-9 books, purchase the ICD-10 code books in early 2014. Take a look at the codes most commonly used in your office and begin developing a list of comparable ICD-10 codes. Alternatively, check your software for an ICD-10 look up functionality.
• Are there ways to make coding more efficient? For example, develop a list of your most commonly used ICD-9 codes and become familiar with the ICD-10 codes you will use in the future; and invest in a software program that helps small practices with coding.

Want more information about ICD-10?
Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, deadline. Sign up for CMS ICD-10 Industry Email Updates from CMS.

Courtesy of: Centers for Medicare & Medicaid Services (CMS) Weekly Digest Bulletin

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How Late Payments, Patients can Throw off a Medical Biller's Day

By Marsha Sosebee from Physicians Practice

Dear Diary, even though it’s Monday, today started out with much promise of being a good day. The end of month collection percentage totals for last month looked great. The percentage of money in the over-120-day-and-aging bucket was down to 0.2 percent and the overall amount due on the accounts receivable report was down by $32,000. I had high hopes that the day would end as well as it began.

My first task of the day was to review the schedule to see which of today’s patients had a past due balance. Finding four such patients, I began to review their history and send necessary alerts to the receptionist. The first two patients had balances from surgeries and were making regular monthly payments as promised. So far so good. The third patient had owed a balance for almost two months and had not yet set up a payment plan, even though he had been back for a recheck appointment just last week. That’s where my hopes for the day began to sag a bit.

The fourth patient had been the victim of a car accident and one of our doctors had been called from the emergency room to do surgery. The hospital had not given us any insurance information on this patient, so I looked to see what information the patient had given at his first recheck appointment in our office. Nothing was written in the section for insurance. Great. As I read through the note history, I found a note from the receptionist that said, "At checkout, asked patient to pay on surgery balance. Patient responded that the accident was the other guy’s fault and that’s who would have to pay the bill." Further notes revealed his adamancy that he was not going to pay this surgery balance. We were at an impasse because our doctor was on main ER call that day and we were required to continue seeing him until treatment was complete. At this point, my hopes for the day were swinging mighty low.

I called the car insurance claims adjustor only to be told that the hospital bills had exhausted the MedPay limits on the patient’s automobile policy and the at-fault driver did not have car insurance. The patient’s attorney had already been in contact with them about a settlement but in all reality, it would probably end up going to court. The adjustor said that if a settlement was reached, it would be paid to the patient who would be responsible for using it to pay the remainder of his medical bills.

I added my note to the history and inserted a pop-up note that I needed to speak with the patient when he arrived. Judging by the previous encounter our staff had with him, I was not looking forward to his arrival at 10:30.

The next order of business on the “to do list” was to check status of pre-certs that had been requested last week. I called ABC insurance company first because three of the precertifications were theirs. I don’t know how so much changes in one week at insurance company, but apparently it can. I dialed the same number I had called the week prior to begin the precert process. After going through the maze of prompts, a person answered who informed me that I had reached the wrong department. I assured her I had chosen all prompts carefully. She asked for the number I had dialed originally. I told her 800-000-0000. She said that was the problem; that number was not for precerts at all. She agreed to transfer me to the correct department. The person in that department would have loved to help me, but they don’t handle precerts for that employer group. Again, I was transferred to the correct department. Four transfers later, I finally connected with a representative who said that if I had just dialed 800-000-0000 I would have reached her directly and avoided all of this unnecessary frustration. I’m glad she couldn’t see my expression through the phone.

Confident that I had at last reached the right person, I gave her the patients' information for whom I had requested precertifications. Two were in process she said, but the third request was not on file.

"Why not?" I demanded to know. I had sent all three sets of clinical information and photographs in the same envelope. If two were there, what happened to the third one, I wanted to know. The rep suggested that maybe I had forgotten to include the third one. I knew I had put all three in there. After 20 minutes of back and forth and being put on hold so she could check with other departments, she finally came back to the line to let me know it was found in the mail room. She informed me that I would have to send the photographs again because she was not able to locate them.

At this point, I gave up all hope for the day ending on a good note and I was pretty sure this was a good indication of how my week was going to be. It was also at this point that I wondered if other billers really faced the same frustrations as me. I also contemplated whether or not billers should automatically have a prescription of Prozac. Like some people have a jar of peppermints on their desk, maybe billers need a little jar of happy pills.

Signed,

A frustrated biller

Article courtesy of Physicians Practice http://www.physicianspractice.com/blog/How-Late-Payments-Patients-Throw-off-Medical-Billers-Day?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=07112013

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Improve Patient Education to Improve Medical Practice Collections

Often patients misinterpret how, and how much, they will be billed for their visits.

Take for example, the copay. When patients pay a copay at time of service, they sometimes believe this is all they will owe. So when they receive a bill in the mail a few weeks later, they complain.  They call and say something like, "I was told I only had a $10 copay, and that's ALL I am paying!”
Addressing a patient concern like this one takes up staff time and hinders the collection process. Staff may feel so bad when speaking with a patient that they may even adjust off the patient's balance.

Problems due to payment misinterpretations, however, are avoidable if your front-office staff spends a few minutes prior to a patient's appointment explaining how the billing process works. 
A front-office person should come out to the lobby, sit with the patient, and explain each policy the patient will need to sign, including your practice's privacy policy, payment policy, and cancellation policy. This will indicate to the patient that he is valued and cared for.

Explaining the payment policy and how benefits work in a calm and professional manner will provide the patient with a much greater understanding of how his policy works. Over the years I have seen firsthand how many patients have a poor understanding of these important elements.   Although this one-on-one patient explanation might seem like a concierge-type service, it's a sound investment to make in your practice. 
Patients will no longer misunderstand how payment works, and they will have a greater understanding of insurance. That of course, will translate to more streamlined patient collections.

Patients will also have a better understanding of their benefits, which means they will  understand when billing questions and complaints should be directed to insurers, rather than to your practice. With all of the insurance exchanges marketing to patients; and the print, electronic, and television ads touting “affordable plans” to your patient population, it is more imperative than ever to spend the time explaining patient benefits clearly.
Consider the time spent explaining payment and benefits to your patients as part of your customer service package. Train your front-office staff to step out from behind the desk, sit with the patient, answer any question, and build rapport. You won't be sorry.

Article  By P.j. Cloud-moulds of Physicians Practice
http://www.physicianspractice.com/blog/improve-patient-education-improve-medical-practice-collections?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=01112013

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Part A and Part B Endeavor Contact Information (Medicare/Noridian)

Medicare Updates

• Part A and Part B Endeavor Contact Information
User Security may assist providers with locked accounts, password resets, etc.:
o JE: 855-609-9960
o JF: 877-908-8431
For assistanct with specific claim or eligibility issues, contact Customer Service:
o JE: 855-609-9960
o JF: 877-908-8431

JE states include California, Hawaii, Nevada, American Samoa, Guam and the Northern Mariana Islands.
JF states include Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington and Wyoming.
Additional Endeavor Information
Information regarding Endeavor is available on the Noridian website:
o Part A:
 JE: med.noridianmedicare.com/web/jea
 JF: www.noridianmedicare.com/parta/
o Part B:
 JE: med.noridianmedicare.com/web/jeb
 JF: www.noridianmedicare.com/partb/

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New Measures in Pay-for-Performance Programs

Pay for performance, or P4P as it is more commonly known, is not a new concept and some plans have been using this type of initiative with providers for a decade or more. Those providers that participate in Medicare's Physician Quality Reporting System (PQRS) — which uses a combination of incentive payments and payment adjustments to promote reporting of quality information — as well as those participating in large Blues plans, will be most familiar with this model.

The shift What is new is the shift away from P4P as a "bonus" structure and a shift toward an "earning" structure. That is, the extent to which payers are incorporating P4P into their payment strategies means that a portion (or percentage) of providers' revenue is "earned" through meeting P4P targets or measures.  These new models are referred to as "value-based," shifting away from straight fee-for-service payments to some combination of performance- and fee-based compensation, which puts some of the financial risk on providers. The hope is this type of compensation model will improve the quality of care, reduce medical costs over time, and improve patient outcomes. So you can think of the newer P4P models as Pay for outcomes, or P4O.  Under Medicare  The Affordable Care Act expands P4P efforts in hospitals through the establishment of a Hospital Value-Based Purchasing Program begun last year, where hospitals are rewarded for how well they perform on a set of quality measures, as well as on how much they improve in performance relative to a baseline.  The healthcare law also extends the Medicare PQRS program through 2014. However, beginning in 2015 the incentive payments go away, and physicians who do not satisfactorily report quality data will see their payments from Medicare reduced. This marks the real beginning of P4O, in my view, due to the setting of a "quality care" baseline against which the ability to earn will then be tied.

By commercial payers For commercial payers, value-based contracts are springing up around Patient-Centered Medical Homes (PCMHs) and accountable care organizations (ACOs). However, new and negotiated contracts for generalized services — that is, practices that are not technically a PCMH or ACO — are now typically being crafted with P4P/P4O components that allow practices to "earn" additional dollars or year-to-year increases in multi-year contracts through meeting specific measures and targets.  Theses measure are typically HEDIS-based (Healthcare Effectiveness Data and Information Set) which is a widely used set of performance measures developed and maintained by the National Committee for Quality Assurance (NCQA). Many of these measures are focused on high-cost conditions such as heart disease, diabetes, high blood pressure, as well as preventive measures like immunizations and medication management. New and changed measures for 2014 include breast- and cervical-cancer screenings.

 Commercial payers utilizing P4P measures typically have a combination of HEDIS-type "quality" measures as well as "self-reported" measures, where practices can report on items such as EHR implementation and use, and status in achieving NCQA programs such as Patient-Centered Medical Home (PCMH), diabetes, heart/stroke, and back pain recognition programs. In addition to NCQA measures, there is substantial investment underway by the Agency for Healthcare Research and Quality (AHRQ) and other public policy organizations to identify further evidence-based medicine practices that could be used for measurement. And the National Quality Forum (NQF) is leading focused efforts to collect and normalize data, and endorse additional performance measures.

Article By Susanne Madden of physicians Practice http://www.physicianspractice.com/physician-compensation/new-measures-pay-performance-programs?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=31102013

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Ten No-cost Ways to Improve Patient Satisfaction

Patient satisfaction is a big deal. It boosts patient attraction and retention, and it reduces the likelihood a patient will file a malpractice lawsuit. It also saves a practice time: Happy patients do not take up physician and staff time complaining. Finally, it is beginning to affect reimbursement. Already for hospitals, and soon for all physicians accepting Medicare, patient satisfaction scores will determine bonuses and penalties.

Unfortunately, physicians do not always understand what satisfies, or even delights, patients. They tend to believe that the biggest component of patient satisfaction is quality of care.  What they miss is that patients have no way to effectively evaluate the quality of care. Instead, patients rely on proxies, and those proxies have everything to do with how the physician and staff make the patient feel — emotionally.
Here are 10 ways physicians and staff can significantly increase patient satisfaction:

 1. Use the patient's name. People love to hear their own name.

2. Use an honorific (Mr., Ms., etc.) to address a patient, particularly if you want to be addressed as "Dr. Jones."

3. Wear easy to read nametags just below your right shoulder. First name only is fine for staff. The objective is to give the patient something better to say than "Hey, you," if she needs something.

4. Make eye contact with the patient as often as is practical. This indicates you are paying attention and engaged with the patient.

5. Tell the patient what to expect. This applies to medical assistants bringing a patient back to an examining room, physicians making referrals to specialists, and check-out staff recapping the billing for visits.

6. Let the patient know what you expect of him. If you need to enter data during the visit, for instance, say, "I am entering your information, but I am listening," to indicate he should keep talking. Say, "I have to enter this information. I'll be done in just a minute," to indicate that you need silence.

7. Give written visit summaries, patient education materials, and instructions. Patients forget an incredible amount of what is said during the visit by the time they get to their car. The ability to reference a written record reassures them.

8. At the conclusion of the appointment, make eye contact with the patient and say, "Take care." This phrase resonates with patients more than, "Thank you," "Have a nice day," or "See you soon."

9. Run on time, or close to it. This may be the primary way patients evaluate the regard the practice has for them.

10. Return phone calls and fulfill requests according to your posted protocol. It is only reasonable for a patient to assume that a practice out of control in some areas is out of control in others.

Please note that I did not mention coffee and Wi-Fi in the waiting room or birthday cards for patients.  Some patients may appreciate amenities and remembrances, but none will identify them as indicating caring and concern.  Behavior, sincere and consistent, is what convinces patients that they are respected and well cared for.

Article  By Carol Stryker of Physicians Practice http://www.physicianspractice.com/blog/ten-no-cost-ways-to-improve-patient-satisfaction?GUID=2E8F906E-CDE7-43B7-AC93-7066F83372C7&rememberme=1&ts=29102013

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Improve Medical Practice Efficiency by Offering Group Visits

As reimbursement declines and overhead increases, many practices are struggling to keep up. But rather than attempting to squeeze more patient visits into each day, has your practice considered seeing more patients per visit?

Perhaps it should. The number of practices offering group visits has increased from about two percent to three percent just two years ago to about 10 percent this year, practice management consultant Owen Dahl recently told Physicians Practice.

Here's more on how a group visit works, what it entails, and why your practice may want to consider it.

How a group visit works. During a group visit, multiple patients with similar chronic conditions (such as diabetes, osteoporosis, congestive heart failure, or COPD) meet at the same time with their physician and other appropriate staff.  The visit is held in a private area in the practice, such as a conference room.
The visits may include the following components:

• The taking of vital signs;
• An educational piece, such as a 30-minute discussion with a nutritional counselor, dietician, exercise physiologist, podiatrist, or an ophthalmologist;
• A group discussion, during which patients talk with each other about their particular needs, struggles, challenges, lessons learned, and so on;
• And an individual assessment, during which the physician pulls patients out of the group individually for private exams.

"You see these 15 patients in an hour and half, so you're very efficient there," said Dahl. "The other thing that happens is you free up time slots on your schedule to see other patients."
How a group visit is reimbursed.  After the group visit, the practice bills the appropriate visit (99213 or 99214) for each patient that attends. "You don’t bill based on time, you bill based on the criteria for the level of visit they had," said Dahl, noting that documentation must support the level of code.

How a group visit benefits patients. Group visits provide patients with a support group facing similar issues, and they give patients an opportunity to receive more in-depth education about their condition. That often translates to better outcomes, said Dahl.

"You're actually improving patient care, and I say that with some conviction," he said. "The research that’s been done indicates clearly that there’s a positive outcome with patients being more compliant with their treatment plans ... seeking care, getting involved. There are all of these spinoff benefits that come together.

"How a practice can get involved. Assess your patient population to determine if you have enough patients with similar chronic conditions for which a group visit would be beneficial. Then, determine if enough of your patients would participate, said Dahl.

If you determine that a group visit is something you can and should offer, promote it to patients through one-on-one discussions, handouts, and if applicable, on your practice's website or patient portal.

Before the visit, require all participants to sign group-visit specific HIPAA forms noting that they understand that they will be talking about personal health information with other patients, and stating that they will keep the information shared during the group visit confidential.

Article By Aubrey Westgate of Physicians Practice

Do you offer group visits at your practice? What tips would you share with other physicians?

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