Why and how must you immediately begin preparations for the ICD-9 to ICD-10 conversion?

Last year, the much debated ICD-9 to ICD-10 conversion deadline was delayed another year and set to October 1, 2015. However, numerous provider groups and stakeholders have been pushing for another delay, which would be the third in total, stating that the conversion will result in unmanageable financial pressure on the already challenged practices.

This article summarizes how ICD-10 differs from ICD-9, what the Congress had to say about the deadline, and in what way must you prepare for the conversion.

CureMD ICD-9 Into ICD-10

The new codes

The first question that most providers have is about the specific changes in the code sets. Here’s a summary:

* 68,000 diagnosis codes as opposed to just 13,000 in ICD-9

* A maximum 7 alphanumeric characters per code as opposed to 3-5 in ICD-9

* Very specific, more complex, and more flexible codes

* Lateral codes as well (different codes for right and left)

* 87,000 procedure codes as opposed to 3,000 in ICD-9

* 7 alphanumeric procedure code characters in contrast to 3-4 numbers in ICD-9

* With detailed methodology descriptions, procedure approach mechanisms, more detail, and flexibility

The Meeting

Last week, the Energy and Commerce Committee’s Subcommittee on Health held a public forum to discuss the ICD-10 deadline. The meeting panel comprised of experts and stakeholders from across the industry, and included doctors and EHR vendors.

The Response

Despite opposition from a few stakeholders who held the view that small practices wouldn’t be able to manage the new codes, the majority voted in support of the October 1 deadline.

The way forward

The response by the congress via the meeting is clearly tilted towards ensuring that the deadline holds. If you were anticipating a delay, and haven’t yet started working on the conversion; you can still manage. Here’s how:

  1. Contact your EMR and Practice Management vendor and enquire your system’s readiness for the conversion. Ensure that their software possesses the necessary updates and ICD-9 to ICD-10 conversion mapping tools to make certain that your system is ready for, and will facilitate the conversion.
  2. In the case that your vendor is not ready, immediately begin looking for a new system. This is because from October 1, your claims will not be processed on ICD-9 codes.
  3. Delegate an ICD-10 expert (from you staff, or hire a professional) to train your staff, and to devise and execute plan for the conversion in line with your practice workflows.
  4. Consider Outsourcing Medical Billing if your ICD-10 expert (and yourself) feel that your current staff will not be able to manage claims processing on the new code set.
  5. Get in touch with payers and clearinghouses to determine their readiness.

The target for completing these steps (apart from staff training which could be ongoing) should ideally be March 15.

  1. Next, you must begin internal testing of the new codes between March and April, to check how well your staff will manage the new codes. Ideally you should be done by this till the end of June at maximum; and make the necessary workflow adjustments to fix errors in which the process proceeds.
  2. After internal testing in June, you need to begin external testing with clearinghouses and payers to determine how well your test claims (with ICD-10 codes) will do once out of your practice.

It is imperative to identify and correct any slow or disruptive processes in every stage of your conversion process. Doing so will enhance the efficiency of your practice, and help make certain that you are ready and equipped for the ICD-9 to ICD-10 conversion by October 1.


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5 Ways Affordable Care Act Affects Reimbursement

The Affordable Care Act (ACA) enters the mature phase of its implementation, which is going to impact physician revenue in different ways – some favorable, others not much. Therefore, it is time for physicians to prepare for challenges ahead.  Here are 5 ways that the ACA will impact your income in the years to come.

Extra services covered in insurance

According to the ACA, more services will be covered by insurances that were not covered previously. This step has gained immense support because “patients who have insurance and access to primary care have better health outcomes,” said Jeffrey Cain, MD, President of the American Academy of Family Physicians (AAFP).

Now patients won’t have to pay from their pockets for medical services like blood pressure checkup, mammography, childhood and autism screenings, and contraception.

CureMD- Affordable Care Act

Increase in patient volume

More and more Americans will be insured in the years ahead and looking for primary and eventually specialty care. This means primary care practitioners can now enroll new patients bringing more money. However, most of these patients will come from low-income families, who will be insured on subsidized rates and pay out of pocket.

Increase in out-of-pocket payment patients

Practitioners will be forced to rethink their patient payment policies because of changes in the ACA that will increase the trend of out-of-pocket charges. Kaiser Family Foundation found out in a survey that 72% of employees had a deductible for single coverage, which was 20% more from 2006. It further reported that annual deductible for 72% of employees was $1,097 in 2012, which was 88% higher since 2006.

Rise in penalties will impact reimbursements

CMS incentive programs, Meaningful Use and Physician Quality Reporting System (PQRS), will reduce or stop payments from 2015. Meanwhile, physicians who haven’t complied with the programs will bear financial penalties.

From fee-for-service to pay-for-performance model

Accountable Care Organizations (ACOs) are a breath of fresh air for the physicians trying to decrease cost without compromising quality. This new payment model, pay-for-performance, was introduced to maximize the benefits for patients to improve quality of care while reducing costs. However, as the Model matures, physicians will be required to report their performance to CMS in order to participate in the shared savings.

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Telemedicine: Paving Way for Cost Effective Medical Services for Primary Care

According to an article published in the Herald Journal, the history of telemedicine can be traced back to the 1920s, when patients on ships at sea would connect with physicians on shore through radios. With innovation in technology, telemedicine services were provided through interactive television in the 1970s and via video conferencing in the age of digital technology.

Telemedicine: Paving Way for Cost Effective Medical Services for Primary Care

However, the evolution of telemedicine has been curtailed in every period of time – lack of technology in the early 20th century to government regulations in the 21st century – which has added to the skepticism of physicians.

Barriers to adopt Telemedicine healthcare

Under the government’s Affordable Care Act, focus has shifted to cost-effective, quality patient care that has given rise to different approaches of healthcare delivery such as Accountable Care Organizations and telemedicine. However, there are certain barriers to adopting telemedicine at a practice:

1.      Barrier to establish patient-physician relationship

This is the major concern for primary care and specialist physicians, who haven’t introduced telemedicine at their practices. Initially, they hesitate that the use of telemedicine will hinder them from developing effective patient-physician relationship, which will affect outcomes.

2.      Barrier to prevalent practice workflow

Another barrier that most physicians face is disruption to prevailing workflows. Physicians have adapted to changes in the health IT industry by implementing EHRs technology at their practices and designing new workflows accordingly.

However, they are hesitant to adopt telehealth, fearing that it will not be possible to incorporate this approach with the current workflow that is suitable for the new technology they have spent heavily on.

3.      Barrier to medical practice beyond state borders

State and federal laws regarding physicians’ license and reimbursement procedures create a barrier to telemedicine adoption. According to the law, physicians should be licensed to provide medical services in the state they have physical presence in and where they provide telehealth services.

Moreover, changes to reimbursements – shift from value to volume – make it harder for practices to collect from patients via telemedicine.

Benefits of Telehealth services

Despite an air of skepticism among providers, telemedicine is growing by leaps and bounds. Medical Economics, quoting statistics from an IMS research, said over 300,000 patients were monitored via telehealth services for various health problems including cardiac, mental health and diabetes in 2012. The report further said that the number is expected to increase to 1.8 million by 2017.

Assisting home care patients

Telemedicine has made a difference in lives of home care patients by providing telehealth services. Its effectiveness can be measured from the success of a healthcare program introduced by the Veterans Health Administration (VHA) Department that aimed to provide telehealth services to home care patients with chronic diseases.

The services were provided via vital sign monitors, videophones, digital cameras – specifically for wounded patients and those having skin-related issues. Within four years of starting the program, 30,000 patients enrolled to receive telehealth services bringing down hospital visits by 19% which helped in saving costs.

Assisting patients in rural areas

Telemedicine has been particularly helpful in providing efficient and quality health service to patients living in rural and remote areas. Rural primary care physicians have used telehealth approach to facilitate their practice and patients by:

  • Providing quality healthcare within the community
  • Saving cost and time on travelling to city
  • Making medical care available round the clock
  • Providing emergency care to patient prior to transporting them to hospital
  • Making initial diagnosis prior to specialist consultation
  • Consulting with specialist

Assisting primary care physicians

Primary care practices have faced setback because of increase in specialist practices and changes in the health IT sector. According to a study, Primary Care: Current Problems and Proposed Solutions, a shortage of over 40,000 primary care physicians is expected by 2025.

Telemedicine has played a role in primary care health as it has proven to be a successful approach to provide cost and time effective healthcare to patients, resulting in patient retention.

  • Primary physicians can team up with specialists to provide healthcare
  • Facilitate hospitals in providing post-surgery general medical care according to specialist instructions
  • Providing cost effective care in nursing homes
  • Giving privacy to patients suffering from diseases that are still stigmatized in closed communities, like HIV and mental health issues

 Solutions to Barriers for Telehealth

Dr. Adam Darkins, chief consultant for telehealth services at the U.S. Department of Veteran Affairs (VA) has emphasized on the importance of relationship between patients and their physicians for telemedicine system to function effectively.

Dr. Jason Mitchell, director of AAFP’s Center for Health IT clarified that telemedicine is not different from regular medicine practice. He explained that only difference is the mode of interaction between the doctor and the patient.

However, the government needs to make certain provisions in order to remove barriers that hinder success of telemedicine.

  • Flexibility in practice license for telehealth physicians: Telemedicine providers should be given relaxation to practice medicine in states other than their own. This way government can cover the shortage of primary care physicians and facilitate them to recruit patients to meet their costs.
  • Modify reimbursement policies: With changes in insurance policies, patient payments have become a major part of collections. This will create further problems for practices to collect payments from patients who have received consultation via telemedicine.

Changes under the Affordable Care Act are all about providing cost effective, quality healthcare services to patients that can be achieved through telemedicine system. This system is particularly beneficial for small to medium practices that can provide services to more patients, while saving time and money.

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Why EHR customer satisfaction is the highest among big groups?

The health IT market is flooded with government certified EHRs to meet the Meaningful Use program. The task is to find out the right medical vendor that fulfills practice requirements. This is particularly difficult for small to medium practices, as it appears vendors pay more attention to providing flawless services to large practices. According to Black Book Rankings 2014 Survey, practices having 25 or more physicians are more satisfied with vendor customer support than practices catering to small/medium groups.(2-5, 6-25). Among the respondents, 90.2% of physicians from large practices reported satisfaction with their vendors as compared to 72.5% of physicians from small or medium sized practices.

One of the major reasons is the vendor resources that do not allow them to give proper attention to small practices. Health IT is a competitive market where large practices and hospitals are major buyers of technology. They drive the health IT market by creating technology demand for huge infrastructures. With sufficient financial backup to implement an EHR system, they partner with vendors for a long period. Similarly, vendors prefer to utilize their limited resources on big projects that promise maximum revenue. By doing so, they usually miss the opportunity to create loyal customers among small practices and provide most of their customer support to physicians in large practices, as highlighted by the Black Book Rankings 2014

Another reason for dissatisfaction among small practices is related to their efforts in vendor search and implementation of EHR. It’s fair to suggest that part of the blame is on the physicians with small practices. Instead of conducting a thorough research of the market, they rush into buying the first EHR they come across [EHR buyer tips]. On the contrary, large practices take their time in understanding the market, the products they offer, strengths and reputation of vendors and demands of their practice before selecting the right vendor. For them, it’s a business partnership that can only work when the vendor fulfills its side of bargain with impeccable technology and customer support.

However, one cannot blame small practices entirely for lack of customer support on the vendor’s part. Ideally, it’s the vendor’s responsibility to provide customer support during the implementation and post implementation phase of EHR. Before signing a contract with a new practice, vendors should make analysis of their available resources and capabilities, so that the customer does not have to suffer in the long run.


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Narrowing down your EHR options

Adopting an Electronic Health Record (EHR) system is no longer an option, but an obligation. If your practice does not do so, you’ll be subject to penalties that will increase as time progresses.

Additionally, you will be deprived of the incentive payments that many of your competitors are benefiting from. However, with several hundred EHR vendors to select from, you require an EHR pricing and vendor comparison to make the right decision.

While the most important component of most decisions is price and costing, you still must develop an initial plan to determine which EHR vendor is appropriate including the how-much-will-it-cost-me component.

First you need to limit the number of vendors on your option base. For doing so, you will first need to identify several vendors based on your personal knowledge, market research and on recommendations of other physicians.

Look at the software and hardware their systems require. For example, a server-based system will require more hardware. Additionally, many of the leading vendors have EHR solutions that do not require installable software and can be accessed via internet. So first, you need to be sure of the solution you require.

Once this comparison is done, you should narrow down your options by a more specific EHR software assessment. In this, you’ll analyze specific features that you require in your EHR. Which vendor is ready for ICD-10 and Meaningful Use Stage 2 certified, for example. Also do some research on other services offered by these vendors; common techniques for this are via rating and review websites, asking other healthcare professionals and by visiting the vendors’ websites. For example how efficient their customer service is and if they have integrated systems (if you require practice management solutions as well).

Now with your options even more limited, conduct an EHR pricing comparison to determine which vendor has solutions that meet your budget. During this stage, include all costs such as those needed for the implementation, average staff training costs and any potential cost that you can think of.

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