The most expensive body parts to get repaired, according to medical billing data

It's expensive being human!

A technical college in Chicago, Coyne College, recently took a diagram of the human body and broke down the most expensive medical procedures for each part. The school’s medical billing program helped formulate the graphic.

These figures don’t factor in medications, lost wages or other expenses that come into play.

Craig Hlavaty, a reporter for chron.com and the Houston Chronicle outlines these common issues and a look into their treatments and costs in his article. The original source for all graphics below is Coyne College and original article can be found here.  

brain
eyes
ears
mouth/teeth
throat
lungs
heart
digestive
liver
skin
arms
legs
feet

The topic of medical necessity has surfaced in the form of National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).

The topic of medical necessity has surfaced in the form of National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).  Some policies which did contain a non-specific code in ICD-9-CM no longer include that code for ICD-10-CM. 

Efforts to fix what has been identified as the first significant issue to emerge under ICD-10 appear to be underway with Medicare Administrative Contractor (MAC).  Local coverage determinations (LCDs) will be updated. 

Checklist for ICD-10 and Audit to Confirm Readiness

October 1st is almost here.  Here is a quick checklist to ensure you are ready:

  1. Have you identified the top ICD-9 diagnoses and trained appropriate staff on the corresponding ICD-10 coding for billing and clinical documentation?
  2. Have you reviewed current clinical documentation and identified gaps for ICD-10 requirements?
  3. Have you contacted all your vendors to ensure they are ICD-10 compliant, such as payers, clearinghouses, and any outside vendors?
  4. Have you tested submitting codes to your payers and clearinghouses?

 

What else do you need to know and consider?

The only other activity that will provide feedback and prepare you for the transition is an ICD-10 audit. An audit of your present ICD-10 coding activities:

- Can focus on your high-risk ICD-10 codes, as well as inform you of your ICD-10 overall readiness from a business and financial risk perspective

- Monitor the readiness of your system vendors

- Ensure everyone in your ICD-10 coding stream is communicating effectively

- Ascertain the readiness of your clinical documentation

- Reveal the true readiness of your coders to handle the ICD-10 transition

- Provide a comprehensive review of your ICD-10 training processes

- Test your readiness to engage payers in the ICD-10 coding transition

A full scale audit of your present processes will give you immediate and accurate feedback on your true readiness for ICD-10. What you don’t know might hurt you!

Read the original post on GeBBS Healthcare RCM Blog.

CMS Releases Proposed 2016 Medicare Physician Fee Schedule and Hospital Outpatient Rules

**UPDATE:  The .5 percent payment increased on July 1, 2015 and will continue to increased by .5 percent each year until 2018.**

 

The centers for Medicare and Medicaid Services (CMS) has released the proposed 2016 Medicare Physician Fee Schedule, which addresses Medicare payment and quality provisions for physicians in 2016.  Under the proposal, physicians will see a 0.5 percent payment increase on July 1, 2015.  Next year will be the first of several years of predictable payments resulting from the legislation that permanently repealed the Sustainable Growth Rate (SGR) this spring.

Read the full article on the American College of Cardiology's website.  

5 Needed Considerations in ICD-10 Enterprise Risk Management

Enterprise risk management – the rather involved process of minimizing financial risk to capital and earnings through effective organization, leadership, and control – is emerging as a central ICD-10 focus.

Despite hearty preparation efforts, healthcare providers face many revenue cycle hiccups that require immediate addressing as the countdown to October 1 continues. To be ICD-10 ready, healthcare institutions need to actively consider 5 areas of risk management focus, according to Fred DiLuzio, PhD, PMP, ICD-10 Program Manager for Hoag Memorial Hospital Presbyterian, and Michael Roach, Director of Program Management Office at Hoag Memorial Hospital Presbyterian.

“It looks near certain ICD-10 is on course for an Oct. 1, 2015 cutover with the recent joint announcement by CMS and the AMA to provide more flexibility and support during post implementation,” say DiLuzio and Roach.

“Your organization’s 'home stretch' enterprise risk management must embrace the same focus we apply to other large-scale, cross-functional, multi-year initiatives where deliberate and proactive preparations are essential requirements to create the conditions for success,” they add.

The significance of honing in on enterprise risk management is imperative as this ICD-10 home stretch comes to an end shortly. As RevCycleIntelligence.com reported, CFOs are generally disconnected from revenue cycle endeavors. Health systems, nonetheless, are not going to receive payments merely because a patient walks in the door. Here are 5 points to consider:

Sustainability

Keeping your head in the ICD-10 game is key for healthcare providers’ engagement sustainability, maintain DiLuzio and Roach. Considering a BSOS (“Bright Shiny Object Syndrome”) can indeed be a problematic approach, they add.

“Consider incentives for key project members that can include project bonuses and/or the opportunity for other prized assignments conditional on successful completion," DiLuzio and Roach state. “Some turnover and natural attrition are common to long projects; however, maintaining ICD-10 expertise and longitudinal knowledge through the post implementation warranty period is one of your critical conditions for success.”

Engagement

Communication is essential. As RevCycleIntelligence.com reported, there are many financially grounded misconceptions about ICD-10 that require clarification.

Project meetings and steering committee reviews are a solid start to preparation but are still only one piece of the ICD-10 engagement puzzle, the authors echo. Promoting keen focus on specific ICD-10 preparation endeavors by recognizing and defining concerns keeps those issues that require addressing from becoming buried come October.

Connection

“Increase the frequency of ongoing payer-provider communications to ensure ICD-10 readiness on both sides. Your risk focus will likely be on mitigating smaller payers and/or clearing houses that may not have yet demonstrated full readiness to receive ICD-10 claims,” DiLuzio and Roach say.

“In these cases, consider as a condition of success a pre-cutover agreement to contractually require a specific percentage payment pending resolution of claims status within a specified date range (i.e. six months),” they add.

Practice

As RevCycleIntelligence.com reported, many denials and rejections are expected following the ICD-10 transition. Knowing what to do in the event such becomes a reality is vital for revenue cycle success.

Nonetheless, implementing a series of mock scenarios, such as what may hypothetically happen following a high claims denial rate, is a suggested strategy to remain properly focused on expected revenue and cash flow aftermath. DiLuzio and Roach recommend business leaders lead these practice sessions to help strengthen revenue cycle come October.

Bonding

As RevCycleIntelligence.com advised, look within your own staffing needs to confirm who your contacts are, such as determining a payer contact and confirming a clearinghouse contact, to help maintain high ICD-10 preparation levels.

Similarly, do not be afraid to reach out and fill up your contact list, the authors say. “Identify contacts and their information (specific names and phone numbers) from all external business partners who may need to be contacted for issues remediation starting Oct. 1,” suggest DiLuzio and Roach. “Include all payers, vendors, clearing houses, etc., whose scope includes ICD-10 payments and data transfers with your organization. Confirm and document each partner’s own ICD-10 support process and escalation path in advance,” they add.

 

Taken from the original article by Jacqueline DiChiara / RevCycIeIntelligence.com

Is it Time to Outsource Your Medical Billing?

For over 25 years, Medical Consultants of America, Inc. has provided medical offices - solo and group practices - with affordable medical billing services with quality secondary to none.  

Most importantly at this crucial time, MCA is ICD-10 compliant.  Our present clients can rest easy knowing there will be no disruption in cash flow beginning 10/1/2015.  

95% if our claims are submitted electronically meaning you get paid faster.  Denied or incorrectly paid claims are followed up by our staff. 

An EMR software system as well as appointment scheduling is available for your use and each practice has access to their account omitting the worry of losing control.

We provide monthly management reports so you can manage your practice.  We also provide consultation services on coding so you are assured of receiving maximum reimbursement. 

We have increased our clients' monthly income by 10-20%.  Our services pay for themselves and your headaches are gone!

Call us today toll-free at (888) 294-5400 or locally at (856) 858-5212.  You can also email questions to cgiblin@mcanj.com

Please visit our website at www.mcanj.com for more detailed information. 

- Cathy Giblin, President, Medical Consultants of America, Inc. 

Text of the Cutting Costly Codes Act of 2015

I

This bill was assigned to a congressional committee on April 30, 2015, which will consider it before possibly sending it on to the House or Senate as a whole. The text of the bill below is as of Apr 30, 2015(Introduced).

 

114th CONGRESS

1st Session

H. R. 2126


IN THE HOUSE OF REPRESENTATIVES

April 30, 2015

Mr. Poe of Texas (for himself, Mr. Farenthold, Mr. Rogers of Alabama, Mr. Brooks of Alabama, Mr. Griffith, Mr. Tom Price of Georgia, and Mr. Roe of Tennessee) introduced the following bill; which was referred to theCommittee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned


A BILL

To prohibit the Secretary of Health and Human Services from replacing ICD–9 with ICD–10 in implementing the HIPAA code set standards.

1.  Short title

This Act may be cited as the Cutting Costly Codes Act of 2015.

2.  Prohibiting replacement of ICD–9 with ICD–10 in implementing HIPAA code set standards

(a)  In general

The Secretary of Health and Human Services may not implement, administer, or enforce the regulations issued on January 16, 2009 (74 Fed. Reg. 3328), the regulation issued on September 5, 2012 (77 Fed. Reg. 54664), or any similar regulation, insofar as any such regulation provides for the replacement of ICD–9 with ICD–10 as a standard for code sets under section 1173(c) of the Social Security Act (42 U.S.C. 1320d–2(c)) and section 162.1002 of title 45, Code of Federal Regulations.

(b)  GAO report on ICD–9 replacement

(1)  Study

The Comptroller General of the United States, in consultation with stakeholders in the medical community, shall conduct a study to identify steps that can be taken to mitigate the disruption on health care providers resulting from a replacement of ICD–9 as such a standard.

(2)  Report

Not later than 6 months after the date of the enactment of this Act, the Comptroller General shall submit to each House of Congress a report on such study. Such report shall include such recommendations respecting such replacement and such legislative and administrative steps as may be appropriate to mitigate the disruption resulting from such replacement as the Comptroller General determines appropriate

Read the original posting on govtrack.us 

Stricter Incident-to Rules Could Mean Less Revenue for Practices

The doctor who initiates a patient's care will have to be in the office when patients are being seen by non-physician practitioners (NPP) if the practice wants to bill incident-to services, according to a CMS proposal in the proposed 2016 Medicare physician fee schedule.  

Currently, the physician supervising the incident-to service does not need to be the same one who originally saw the patient.  CMS seeks to remove a sentence in the regulation that allow that and replace it with the new policy.

That would mean more NPPs would bill directly to Medicare to receive 85% reimbursement as opposed to the 100% reimbursement a practice receives billing incident-to services. 

Read the full article by the DecisionHealth Staff on Part B News.