Final Stretch to ICD-10 Implementation: 13 Days and Counting

Final Stretch to ICD-10 Implementation: 13 Days and Counting

Doctors, hospitals and health systems are worried the new medical coding system, with more than 100,000 new codes for medical procedures and conditions, will be too much trouble and not worth the improvements officials promise to the quality of care. The switch happens Oct. 1.

The required Oct. 1 conversion to the ICD-10 coding system will be worth the costs and headaches, supporters say. With up to seven alphanumeric characters in ICD-10 compared with a maximum of four numeric digits in ICD-9, there will be lots more room for the codes to accommodate new medical conditions and procedures. With ICD-9, “we've just run out of space.

Ready or not, the U.S. healthcare industry is poised to flip the switch from the ICD-9 to the ICD-10 diagnostic and procedural coding system on Oct. 1, significantly changing how billions of dollars in medical claims are calculated and billed every day. Experts predict most large hospitals and health systems and most large physician groups will weather the federally required conversion just fine, though they could experience temporary cash-flow squeezes because of ICD-10-related payment delays. The organizations most likely to have trouble, however, are smaller providers, particularly smaller physician practices.

Built on earlier successes during the final end-to-end testing week in July, according to the Centers for Medicare and Medicaid Services. With 1,200 providers and billing companies participating, and testers submitting more than 29,000 claims, the third successful test week shows that "CMS systems are ready to accept and process ICD-10 claims," according to the agency.

Participants in the testing week successfully submitted ICD-10 test claims and that were processed through Medicare billing systems. The acceptance rate for July was similar to the rates for weeks in January and April, but with an increase in the number of testers and test claims submitted, CMS officials say:

·         29,286 test claims were received

·         25,646 test claims were accepted, for an 87 percent acceptance rate

·         1.8 percent of test claims were rejected due to invalid submission of ICD-10 diagnosis or procedure code

·         2.6 percent of test claims were rejected due to invalid submission of ICD-9 diagnosis or procedure code  

For October 1 your office should have:

·         Reviewed the ICD-10 that applies to your practice

·         Mapping of ICD-9 to ICD-10,

·         Training of Staff

·         Physicians and Other Applicable Staff trained and prepared for CLINICAL DOCUMENTATION

·         Superbills changed to reflect ICD-10

·         Verified readiness with your current vender

·         Created your new TEMPLATES to reflect ICD-10

·         HEDIS / PQRS ICD-10 Ready

·         Taken FINANCIAL steps in case  of delays in Reimbursement

 

Available Tools for Implementation:

 

MONTHLY PCP MANAGEMENT SUPPORT

·         Review and negotiation of agreements with Insurance carriers

·         Support during the transition period from the current reimbursement of Fee-for-Service to the new to  Pay-for-Performance (P4P) compensation

·         HEDIS/PQRS, Quality Indicators and MRA

o   Staff members are educated to be alert to the particular set of conditions impacting all annual HEDIS/PQRS Measures for year

o   Develop a HEDIS/PQRS and MRA tracking patterns

o   Do regular and periodic internal audits

o   Supervision of HEDIS and PQRS reporting and review of MRA ratings with Medicare panels

o   Include in as part of the job description tracking compliance with HEDIS/PQRS as well as positioning the practice to receive awards for excellent performance based on the bonus formulas of the different insurance carriers

·         Performance Reports

o   Value Base Modifier (VBM): The reimbursement systems are changing from reimbursing on a Fee-for-Service (FFS) basis to include incentives for quality, outcomes, improved patient experience, and reduced costs. The shift can be summarized as: Paying for value, not volume.

o   Contracts of Value for performance are based on maintaining existing FFS or capitation payment methods but linking efforts to payment increases or other incentives to providers’ performance on specific measures of quality, efficiency and outcome. The purpose of VBP models is to provide incentives of payments based on quality measures with the objective and assumption that improved quality improves health outcomes and reduces costs to the insurer.

o   HPP / ACK enables you to track performance so you can stay ahead of the Value-Based Modifier Program, and improve the quality of care for your patients.

·         Assisting with Compliance Issues related to Insurance Carriers, CMS or AHCA needs

·         Ongoing telephone support and periodic online visits and presentations of information

·         OPTIONAL: Monthly analysis of accounts receivable and practice financial information

·         RECOVER amounts detected from overcharges by the Insurance carrier shall be paid to HPP at a rate of 15% of the total amount recovered.

 

 

 

FOR MORE INFORMATION

HPP Management Group, Corp.

5201 Blue Lagoon, Suite 800 Miami, FL 33126

Phone: (305) 227-2383

Email: pesilverio@hppcorp.com  Website: http://www.accuchecker.com