PIVOT Points
The transition strategy, tools and resources
you need to be ready for ICD-10
Agencies should audit 100% of their claims for coding accuracy in order to identify and resolve issues in processes so that they will get paid properly and avoid billing delays related to ICD-10.
During an audit, agencies should examine the codes that have been assigned.
Look, for instance, for anomalies such as missing seventh characters, a nine in the fourth or fifth position, and manifestation codes assigned without their etiology as examples, says Trish Twombly, senior director for DecisionHealth in Gaithersburg, Md.
Focus on whether the patient is still receiving active treatment for the condition described by the code title when you choose a seventh character that corresponds to either an “initial” or “subsequent” encounter, according to the Coding Clinic. It doesn’t matter if your agency isn’t the first provider to see the patient for the condition, as long as your agency is providing active treatment for it, the seventh character “A” is what you should assign, said Anita Rapier, Coding Clinic senior coding consultant, during a Dec. 2, 2015, webinar on the 7th character issue.
Coding experts were largely satisfied with the guidance update, feeling that it provided much-needed clarity for the times when home health will have to assign initial encounter codes. Specifically, antibiotic therapy for infected post-operative wounds as well as wound vac treatment for trauma wounds or dehisced wounds are both examples of active treatment that should be coded with an “A,” said Rapier.
To prepare for ICD-10, agencies must take their auditing to next level right away – Use these three tips to make sure your audit is working correctly.
Read More »
Give your doctors documentation tip cards or checklists for common home health diagnoses. Doing so will save home health coders and nurses time.
Having your marketers offer such educational material to office managers and discharge planners will help limit productivity delays your agency’s nurses and coders will face in ICD-10, starting Oct. 1, says consultant Arlene Maxim of A.D. Maxim Consulting in Troy, Mich.
Read More »
You won’t lose case-mix points for ICD-10 diagnoses codes that fall under the definition of “initial encounter,” even if you’ve already submitted claims with these codes, according to the FY2016 PPS final rule, released Oct. 29.
In the rule, CMS affirmed the validity of the use of seventh characters for initial encounters in home health, and will reissue the PPS payment logic (grouper) to award points for “certain” initial encounter codes, effective Jan. 1, 2016, but retroactive to all claims with a M0090
(assessment completed) date on or after Oct. 1, 2015.
In determining which diagnosis codes would be appropriate for home health to indicate that care is for an initial encounter, CMS and the cooperating parties developed a revised translation list that will be posted to CMS’ website. However, the federal agency did not specify when the list will be published nor did it offer any further detail on which codes it will include.
At the very least, the list should include codes for various complications such as infected and dehisced surgical wounds, which would align with the Chapter 19 guidelines on which this decision is based, says Trish Twombly, HCS-D, senior director for DecisionHealth in Gaithersburg, Md.
To view the FY2016 PPS Final Rule, click Here.
Use this ICD-10 chart to gain insight on how long clinicians’ productivity decreases due to ICD-10 will last.
Read More »
Agencies will continue to go without extra reimbursement for common psych diagnoses like depression in ICD-10. But don’t let that stop you from coding an important part of a patient’s care, as it will only confirm CMS’ suspicion that these conditions don’t impact resource use.
Read More »
During a brief press call Sept. 24, CMS provided some last-minute encouragement that it is ready for the ICD-10 transition scheduled for Oct. 1 and would not be deterred even by the government shutdown being discussed in Congress.
Patrick Conway, CMS’ principal deputy administrator, reminded reporters that provider claim filing and contractor review are not immediate and it would take at least “a full billing cycle” to know how the transition is going.
He suggested providers who had issues should appeal for help first to their electronic health record and billing system vendors and clearinghouses, then to their Medicare Administrative Contractors and finally to CMS’ ICD-10 ombudsman, William Rogers, M.D., who was also on the call.
Asked about the anticipated shutdown, Rogers admitted that “we don’t have a lot of experience with this … people who aren’t in this room are deciding what we can and can’t do.” But Conway insisted that “we will continue to process claims and to implement the ICD-10 transition” regardless of Congressional action.
Use this ICD-10 readiness checklist to guide you with the new code set.
Read More »
Agencies preparing for ICD-10 should reexamine their data security policies — and make sure to address those policies with staff. Doing so could help agencies prevent a significant and costly data breach, or at least lessen chances that one will occur.
Read More »
CMS has granted approval for state Medicaid fee-for-service programs in California, Louisiana, Maryland and Montana to delay the full implementation of ICD-10.
The state programs instead may take ICD-10 claims and convert them into ICD-9 codes and use the older system to calculate payments to providers, according to a report from Modern Healthcare. Apparently, the claims processing systems in those four states are unable to perform payment calculations using the new ICD-10 codes. The “crosswalks” in these states are not a long-term solution, according to CMS spokesman Jibril Boykin, who was quoted in the Modern Healthcare report, though time limits were not provided and will vary on a state-by-state basis.
Meanwhile, IT experts remain concerned about the late hour of some states' lack of readiness for ICD-10, while others worry providers in these states may suffer from delayed payments with this piecemeal approach.
Use this scenario to strengthen your understanding of the new code set.
Read More »
Just one combination code, E11.311 (Type 2 diabetes mellitus with unspecified diabetic retinopathy with macular edema), will sufficiently capture diabetic macular edema in ICD-10, whereas, in ICD-9, the condition requires three separate codes: 250.50 for the diabetes, 362.01 for background diabetic retinopathy and 362.07 for the diabetic macular edema. Read More »
At this point, agencies should feel that ICD-10’s implementation date is set in stone, says consultant Arlene Maxim of A.D. Maxim Consulting in Troy, Mich. The one-year grace period that CMS and the American Medical Association announced last month for physician practices does not include home health agencies.
Meanwhile, bills floating in Congress to prevent ICD-10’s Oct. 1 implementation have not gained traction. Yet many in the industry remain unconvinced that ICD-10 is truly coming. At a recent conference Maxim attended, where about 70 home health agency managers were present, only two managers felt ICD-10 would actually begin Oct. 1.
Test your ICD knowledge in preparation for the new code set. Read More »
The results are in: home health agencies nationwide believe the scheduled implementation of ICD-10 — more than payment cuts, Medicare audits or face-to-face changes — will have the biggest impact on home health operations and financials in 2015.
The implementation of ICD-10 on Oct. 1, 2015, will have the greatest regulatory impact for the home health industry, according to 32% of 274 respondents to a question within DecisionHealth’s 2015 Trends Survey. Read More »
CMS has released the latest home health grouper, which will be used to determine payments effective Oct. 1, 2015. Table 2A remains the same as what was published in the 2015 PPS final rule. The 201 ICD-9 case-mix codes that lost their case-mix value on Jan. 1 have also been left off the case-mix list in the ICD-10 code list. The codes that also won’t carry case-mix points in ICD-10 are those from the pulmonary, psych 1, psych 2, and blindness/low vision diagnosis categories. View the new grouper at http://go.cms.gov/IK8OWX.
Test your ICD knowledge in preparation for the new code set. Read More »
You should be gradually increasing the number of real-life claims you’re dual coding in ICD-9 and ICD-10 to minimize the impact of the transition on your productivity and ultimately revenue.
Aim to be dual coding a minimum of 10% of your claims with the goal of increasing this by an additional 5% each month until ICD-10 arrives, says Brandi Whitemyer, HCS-D, director of education and training for DecisionHealth in Gaithersburg, Md. Read More »
Only 14% of the 248 agencies surveyed in September had begun dual-coding. Most respondents expected to begin dual-coding testing in Q1 2015 and Q2 2015. Read More »
Test your ICD knowledge in preparation for the new code set. Read More »
Start dual coding charts now and track the extra time it takes to assign ICD-10 codes to help determine what additional resources you’ll need to lessen the impact on your productivity.
Maurice Frear, HCS-D, currently dual codes two charts per week, but plans to increase that number as the implementation date draws closer, says the coder for Bon Secours Home Health and Hospice Services in Virginia Beach, Va. Read More »
While 31% of HHAs say they will invest in training and education to stem coding productivity losses, 22% say they don’t know what they will do, according to Diagnosis Coding Pro’s 2015 Home Health Coders’ Productivity Survey of 230 coders. Read More »
Test your ICD knowledge in preparation for the new code set. Read More »
Days after some members of a key House subcommittee broached the idea of allowing extended use of both ICD-9 and ICD-10, CMS said that simply wouldn’t work.
Agencies and other care providers are preparing for the Oct. 1 implementation of ICD-10. But during a Feb. 11 Energy and Commerce Health Subcommittee hearing on ICD-10 progress, some representatives asked about the feasibility of dual implementation. Rep. Morgan Griffith (R-Va.), for instance, mentioned that ICD-10 might lead to an even larger physician shortage, particularly in rural communities. Read More »
About 81% of the claims received during CMS’ first-ever ICD-10 end-to-end testing week were found acceptable by Medicare contractors, CMS announced Feb. 25. More than 660 businesses including providers, clearinghouses and billing agencies submitted ICD-10 claims Jan. 26 through Feb. 3 and had them processed through billing systems. Of the 14,929 test claims received, 12,149 of them were accepted, CMS says. Most claims errors were unrelated to ICD-9 or ICD-10.
Test your ICD knowledge in preparation for the new code set. Read More »
Now is the time to go back to your ICD-10 transition team and do a post-mortem of all your preparation efforts to assess what your agency was able to accomplish, what it has yet to achieve, where your training was effective and what areas you may have neglected. Read More »
The seven health care stakeholders testifying before Congress Feb. 11 about ICD-10 preparedness spoke largely in favor of the new, more specific code set — and said providers will be ready. Read More »
Information from CMS that will help you distinguish between ICD-10 myths and facts. Read More »
Agencies that don’t have six months’ worth of operating cash on hand should secure a line of credit to prepare for reduced productivity, claims delays and denials on and after Oct. 1, 2015. But many agencies don’t expect to have that much money available in time for the ICD-10 roll out and may lack a backup plan to deal with cash flow disruptions, according to a recent Home Health Line ICD-10 survey. Read More »
Interested in what concerns your peers most about the ICD-10 transition? Check out this data based on Home Health Line survey data! Read More »
Use these scenarios to guide your coding of CAD, angina, hypertension in ICD-10. Read More »
House Energy and Commerce Committee Chairman Fred Upton (R-MI) and House Rules Committee Chairman Pete Sessions (R-TX) issued a joint statement on Dec. 10, in which they expressed a commitment to ensure ICD-10 implementation is achieved on Oct. 1, 2015, and are prepared to have a hearing on the issue in 2015. Read More »
CMS’ latest ICD-10 testing week drew far less response — and a lower acceptance rate — than a similar testing week held in March.
The federal Medicare agency accepted 73% of the roughly 7,800 claims submitted during the Nov. 17-21 testing week, according to preliminary results announced Nov. 25 by Diane Kovach, CMS Provider Billing Group Director. Read More »
Survey results show that agencies are falling behind on ICD-10 preparations, starting with a gap analysis. With ICD-10 set to start in about one year, only 21% of the 240 respondents to HHL’s recent Home Health ICD-10 Readiness Survey say they already have performed a gap analysis. Read More »
Ensure your agency is on track for ICD-10. Read More »
Jacksonville, FL | Feb. 8-11
New Orleans, LA | Feb. 22-25
D.C. Metro | Mar. 7-10
Dallas, TX | Mar. 21-24
Chicago, IL | Apr. 18-21
Philadelphia, PA | May 23-26
Copyright © 2015 DecisionHealth. All Rights Reserved.
Two Washingtonian Center
9737 Washingtonian Blvd., Ste. 200
Gaithersburg, MD 20878
Toll-free: 1-855-CALL-DH1 (1-855-225-5341)