ICD-10 Arrives Early – April 1, 2014: CMS Announces New CMS-1500 Healthcare Claim Form

Starting April 1, 2014, Medicare will accept only the revised version of the form. The revised form will give HIPAA Covered Entities who are health care providers the ability to indicate whether they are using ICD-9 or ICD-10 diagnosis codes, which is important as the October 1, 2014, transition approaches. Effectively this means that any healthcare IT system that was scheduled to be compliant as of October 1, 2014 with ICD-10 must actually comply with a component of the ICD-10 requirements early as of April 1, 2014.

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Hospital Readmissions Penalties Interactive Table

Update August 2, 2013 - CMS published a list of 2,225 hospitals in 49 states that will lose up to 2% of their Medicare reimbursement that had too many patient readmission within 30 days of discharge because of three medical conditions: heart attack, heart failure and pneumonia. Under the PPACA, the maximum penalty will increase to 3% by 2015 and expand to include re-admissions for other medical conditions. ICD-10, a standard the describes the condition of the patient, will modify these quality measures when it goes into effect. We have published an interactive, searchable version of the penalties, by city, state, county and hospital for the healthcare industry and consumers to use to easily find the data relevant to their geography or organization.

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Increasing Health Data Interoperability, BigData, Cloud, Exchange, ICD-10 Lay Foundation for Accountable Care

These are important foundations that enable ubiquitous digital health data in a standard interchange, enabling in-depth analysis and increasingly, Cloud and Software as a Service methods to deploy, store and use the information to improve healthcare. These in turn are important foundations to enable Accountable Care. ICD-10 is the new data standard that will express the condition of the patient and how providers get reimbursed.

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Assessing ICD-10 Financial Risk by Service Line

ICD-10 transition and risk assessment best practice by service line: Physician engagement, combined with chart audits and analytics must be used carefully in a balanced method to ensure that the ICD-10 transition works smoothly across service lines, physician groups, and financial management.

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ICD-10 Financial Risk Assessment and Data Quality – Why You Need it and How to Get Started

Summary financial risk information Financial impact data by physician, coder , facility, specialty, to prioritize training and staffing decisions Encounter-level analytics to prioritize clinical documentation improvement process, testing, and compliance activities Payor contract data organized by reimbursement variations Code-level analysis to drive remediation Trending and ICD-10 financial risk benchmarks

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ICD-10 Financial Risk Assessment Should Include Data Quality Assessment

ICD-10 Financial Risk Assessments should include an analysis of historical healthcare claims data for one, two, or ideally three retrospective periods. A data quality assessment is essential, making sure that claims are not duplicates, and that they therefore represent unique events. This is particularly important in view of interim billing on hospital claims. It’s very easy to count hospital admissions multiple times from claims data unless you reconcile claims to a single hospital stay.

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Three EHR Vendors Meet Meaningful Use 2014 Standard, Creates Challenge for EPs Wishing to Achieve Stage 2

By June 13, 2013 only three vendors are ready for inpatient, and three for ambulatory on the CMS website that shows which EHR vendors have their product certified for Meaningful Use under the 2014 Standard. This creates an issue for all Eligible Providers (EPs) who achieved meaningful use Stage 1. Unless their EHR vendor meets the Stage 2 requirements, those EPs no longer qualify for Meaningful Use stimulus dollars.

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CHIME Proposed a One-Year Extension of Meaningful Use Stage 2

The College of Health Information Management Executives (CHIME), proposed a one-year extension of Meaningful Use Stage 2 in response to Senators’ request for feedback on healthcare IT adoption. Note that an actual extension would requre an Act of Congress, according to the Stage 2 Final Rule.

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ICD-10 Cancellation Unlikely – Healthcare Industry Should Still Prepare

"At the same time, physicians should make preparations for the new code set to avoid disastrous results if ICD-10 is rolled out as planned. Those who aren't ready by next year's deadline will not receive payment for their services." We recommend that all HIPAA Covered Entities continue to prepare for ICD-10.

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ICD-10 diagnosis and ICD-10 procedure codes impact provider patient scheduling workflow

ICD-10 will impact scheduling workflow. If your current systems capture ICD-9 codes, your IT team will need to remediate and test scheduling systems. Ultimately, an ICD-10 Financial Risk Assessment, ICD-10 testing, and ICD-10 implementation plan should comprehend ICD-10 provider scheduling.

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