Health Insurance Exchange in Idaho and Rhode Island Move Closer to Reality

The Idaho Department of Insurance and the Department of Health and Welfare drafted legislation to establish a health insurance exchange. In Rhode Island, Governor Lincoln Chafee issued an executive order establishing an Exchange. Financing of the Idaho exchange is not included in the draft. Carriers are not required to participate in the exchange, nor does it dicate whether carriers must offer insurance inside or outside the exchange.

Continue ReadingHealth Insurance Exchange in Idaho and Rhode Island Move Closer to Reality

ICD-10 Readiness Compromised by ICD-10 Revenue Cycle, Analytics Vendors

We find that most analytics and revenue cycle companies are ignoring the future role coordinated medical coding will have, the transition to ICD-10, and the clinical documentation and processes on the revenue cycle. The ICD-10 transition will re-write the book on revenue cycle management (RCM). RAC audits and Electronic Medical Records (EMRs) will be subject to a new paradigm with ICD-10.

Continue ReadingICD-10 Readiness Compromised by ICD-10 Revenue Cycle, Analytics Vendors

HIPAA 5010 and ICD-10 Implementation Timeline Widgets

HIPAA 5010 and ICD-10 implementation timelines were published as widgets for payers, large providers, small providers and vendors by Health and Human Services Centers for Mediare and Medicaid (CMS). There are helpful items such as actions to take immediately, for HIPAA 5010 and more regarding ICD-10.

Continue ReadingHIPAA 5010 and ICD-10 Implementation Timeline Widgets

ICD-10 Global Lessons, More on Parallels with Canada and Australia

ICD-10 under the U.S. health system is new, so many are looking for parallels and lessons learned from other countries. In a recent blog, we noted that there are many reasons that the U.S. implementation of ICD-10 will be different. In particular ICD-10 CM is larger than the WHO version of ICD-10, and in the U.S., ICD-10 will serve as a new reimbursement paradigm, unlike Canada. However, as we noted there is one big similarity - more planning is always better.

Continue ReadingICD-10 Global Lessons, More on Parallels with Canada and Australia

Skilled Nursing Resource Utilization Group Classifications

The Resource Utilization Group Skilled Nursing Standard (RUG, or currently RUG-IV) classification system has eight major classification categories: Rehabilitation Plus Extensive Services, Rehabilitation, Extensive Services, Special Care High, Special Care…

Continue ReadingSkilled Nursing Resource Utilization Group Classifications

ICD-10 Transition Training and Consulting – Speaking from Experience

ICD-10 assessments should start with a thorough understanding of how to communicate, educate, train at all levels. Here are some topics our team can speak to for your organization including “ICD-10 Organization Strategy” and “ICD-10 and Business Continuity Planning” We have given many presentations throughout the US in the past year.

Continue ReadingICD-10 Transition Training and Consulting – Speaking from Experience

ICD-10 Implementation and Risk Planning

ICD-10 implementations, ICD-10 implementation consulting and ICD-10 risk management have been more popular topics on our blog so I am sharing an excerpt of slides I prepared for a recent industry conference near Washington DC the Workgroup for Electronic Data Interchange (WEDI).

Continue ReadingICD-10 Implementation and Risk Planning

Global Lessons: Planning and Preparation are Keys to ICD-10 Success

Here is a summary of lessons learned from the Canadian experience with ICD-10 implementations and also importantly where the two implementations differ.

Continue ReadingGlobal Lessons: Planning and Preparation are Keys to ICD-10 Success

Headline News in Healthcare is About Cost, Paperwork Reduction Rules Expected

This is a first step toward implementation of an Affordable Care Act provision that cuts red tape in the health care system. HHS estimates this will save $12 billion over ten years. Whether a patient is eligible for coverage The status of a health care claim submitted to a health insurer

Continue ReadingHeadline News in Healthcare is About Cost, Paperwork Reduction Rules Expected

EHR Interoperability Standards

Electronic Health Records (EHR) or Electronic Medical Records (EMR) integration approaches depend on the strategy and priority in exchanging patient information between various healthcare applications, and the standards available:

Continue ReadingEHR Interoperability Standards