Healthcare Practice Management

Identifying the Right ICD-10 Codes

by Nitin Chhoda PT, DPT | Aug 14, 2015 | ICD 10, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation, Physical Therapy Management, Physical Therapy Software

Crosswalks and mapping are terms that clinicians will be hearing a lot about when trying to ascertain the correct translation of an ICD-9 code into the new ICD-10 code system. Mapping and crosswalk tools are included with the ICD-10 codes to help clinicians covert the old codes with which they’re familiar to the new code set. The crosswalks will be maintained for three years past the official ICD-10 implementation date of Oct. 1, 2014.

The mapping ability is a valuable tool, but practitioners shouldn’t be tempted to use it as a substitute for the appropriate training. There will be many look up entries that return multiple results and practitioners must rely on their training, experience and common sense to identify the correct ICD-10 code to use. The crosswalks are searchable and will return multiple choices. Mapping will lead to an alphabetic list, then to tabular listings for further data.

Approximate Matches
Due to the greater specificity in ICD-10 codes, there will be extremely few exact matches between the two coding systems when they perform a search, but practitioners will find a wealth of approximate matches. The mapping tools included in the new codes provides medical professionals with a dictionary for translation and a starting point from which to work.

Searches
When no match is located, clinicians can perform searches that will lead to a multitude of potential coding options. A single translation can lead to any number of matches with additional possibilities to explore to create an accurate description of the condition. ICD-10 codes come with expanded possibilities for each condition. Consequently, there will be few exact matches and a single crosswalk for every situation just isn’t possible.

Combinations
There will be multiple translation choices and clinicians must go further into the system to determine which code best reflects the immediate situation. The increased specificity of the coding set will often return multiple options. Depending upon the situation, clinicians can utilize up to 12 codes if needed to accurately describe a patient’s illness, disease or injury.

Reverse Matches
It’s possible to obtain the appropriate ICD-10 codes through reverse matching, but it’s important to remember that even when only one match is located, it won’t be a complete equivalent to the previous ICD-9 code. Clinicians will need to delve deeper to establish an exact match. Converting codes from ICD-10 to ICD-9 is backward mapping and one way to ascertain the correct code conversion.

Scenarios
There will be times when no match can be found and the mapping tool will provide a clinician with multiple scenarios, each with its own set of variations and parameters. Choice lists provide professionals with additional determination tools.

Exact Matches
Clinicians will find very few exact matches when converting ICD-9 to ICD-10 codes. If a search turns up only one alternative, it’s considered a one-to-one match. However, practitioners should exercise caution, as the return of a single match doesn’t automatically mean the two codes are identical.

A much more common occurrence will be a return of no matches due to the new concepts expressed in the ICD-10 codes. The new codes may express multiple results for a single ICD-9 code and vice versa. The crosswalk search tool isn’t perfect or infallible. In some instances, clinicians will need to try different search terms to navigate the system and find the desired information.

Crosswalks and mapping tools provide clinicians with a bi-directional dictionary of coding options, but much like a foreign language, there will be times when a particular concept, illness, disease or injury won’t have an exact translation. Alternately, a search may return multiple possibilities. In these instances, the experience, expertise and training of the clinician will be the determining factors.

The New Challenges with the ICD-10 Rules

by Nitin Chhoda PT, DPT | Aug 11, 2015 | Healthcare Practice Management, ICD 10, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

(What’s Going to be Toughest to Learn – External Causes)

Remembering some of the changes that will take place as a result of the transition to ICD-10 will come quickly, but documentation requirements are a major issue for clinicians. The greater specificity of the ICD-10 codes allows for greater accuracy, but it increases clinician documentation requirements by 15 percent.

Some of the differences include codes that include place holders on documentation forms for future needs. In the current healthcare climate, payers will want to know if another entity may be responsible for paying the costs. They’re going to examine each claim closer, making it essential that clinicians are as specific as possible. It’s estimated that 65 percent of a practitioner’s notes won’t be specific enough.

One of the most difficult facets of the new codes is the way documentation is divided. There are four parts and external injury will cause the most frustration and be the hardest to remember. The external causes portion of the documentation should be a primary focus for practitioners. New documentation requirements want very exact information about the external causes of where and how an injury took place.

General Equivalency Mapping (GEM) was created by the National Center for Health Statistics to make the documentation task easier, but the system isn’t perfect. GEM is linked to all the various code alternatives for a given instance, and a single search can return as many as 2,500 responses. Other times, a compound word search will turn up nothing, while a single word will result in what the clinician wants.

GEM displays approximate matches and combinations through an alphabetic list first and then to a tabular listing from there. Practitioners will always want to wind up at the tabular section. There is always the “Not Elsewhere Classifiable” or “Not Otherwise Specified” category, but many clinicians anticipate problems with payers if either designation is used, considering the push for greater specificity.

Many payers are under the assumption that the implementation of ICD-10 codes automatically means that there’s a specific and corresponding code for every patient issue. This isn’t the case and there will be times when those two designations will be the only available options to use.

Disease classifications and categories have received some restructuring and classification of some conditions is different from what clinicians have become accustomed. Injury groups are now classified by specific locations on the body. Practitioners will find that some diseases that were lumped together now have their own separate chapters.

Clinicians should always endeavor to code at the highest level of specificity and detail, but avoid coding for a probable or suspected diagnosis. Coding should only be completed for all the symptoms that can be documented. Acute conditions should be listed before chronic issues if both exist. In some instances, a bilateral code doesn’t exist in which case clinicians will be required to do this separately.

Coding requirements with ICD-10 are more stringent and will require considerably more effort on the part of clinicians during the documentation process. The learning curve will lead to an inevitable loss of productivity at first. Practitioners should be prepared for this and book patient appointments accordingly. Productivity and efficiency will return to normal levels as all concerned become more familiar with the new ICD-10 coding requirements.

HIPAA Electronic Transaction Standards with ICD-10

by Nitin Chhoda PT, DPT | Aug 10, 2015 | Healthcare Practice Management, ICD 10, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

(Do You Need to Maintain Both Code Sets in Your Practice – Yes)

Even though everyone will be using ICD-10 codes after Oct. 1, 2014 if they want to get paid, clinicians won’t quite be finished with ICD-9. Patient records prior to ICD-10 implementation must be transitioned to the new coding system. There will be coding, form and procedural changes and there are sure to be glitches along the way. With forethought, planning and understanding, the changeover can proceed easier than many might anticipate.

Clinicians and billers will have new codes to use and new standards they must implement to adhere to HIPAA regulations. Multiple changes will take place over a very short time that will be stressful. There are strategies that can be used to accomplish all the target goals that don’t require an inordinate amount of effort, excessive overtime, and maintains HIPAA compliance.

For the smoothest transition, clinicians will need patient demographic information and the means to access it at will as they make the change from their old methods to the new EMR systems capable of handling all the new codes. To maintain HIPAA compliance, sensitive data can be stored on-site or in the cloud, providing that necessary security measures are in place.

All new patient information will be coded using ICD-10. Importing ICD-9 into the data into the new coding format for existing patients will take some time, but clinicians will find that as information is transferred and existing patients continue their care, overlaps will become apparent. Practice owners will need to maintain both coding systems for a time to ensure the complete transfer of patient data.

To facilitate the initiation of ICD-10, some EMRs have automatic crosswalks that will convert the coding. To ensure compliance, it’s essential that clinicians contact the clearinghouses and payers they work with and run sufficient testing to make sure all systems can communicate with each other. Each practice should make an effort to practice with converting ICD-9 to ICD-10 to familiarize themselves with its nuances before the official implementation date.

HIPAA version 5010 is the new standard for conducting electronic transactions to ensure patient privacy is maintained. It provides a platform for the use of ICD-10 coding. Practices and billers must implement the new HIPAA 5010 standards before ICD-10 codes can be utilized.

The upgrade to version 5010 was essential, as the old systems couldn’t use or accommodate the greatly expanded code set. HIPPA 5010 applies to “covered entities” that includes payers, providers, clearinghouses and health plan carriers. They all must upgrade to the new standards if they submit claims for reimbursement, transmit patient information, track claim status and verify coverage eligibility.

Clinicians should be aware that there are a couple of potential exceptions when the use of ICD-9 codes may still apply. Those are Workers Compensation and personal injury claims. The Affordable Health Care Act regulations continue to evolve and future legislation may change to encompass those two entities under ICD-10 coding.

The use of both coding systems allows practices to test and troubleshoot any intercommunication problems with payers and providers within its network. The testing process can identify areas where clinicians may need more training in appropriate documentation and provides valuable coding practice for clinicians and billers.

Practitioners aren’t alone – there are numerous sources of online assistance. Free training and resources are available on websites that include Medicare, the American Health Information Management Association (AHIMA), and the American Academy of Professional Coders (AAPC). The Find-A-Code application is also available that offers crosswalks, lookups and tools to simplify coding.

Five Ways to Minimize Financial Havoc with ICD-10 Transition

by Nitin Chhoda PT, DPT | Jul 16, 2015 | Electronic Medical Records, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

The implementation of ICD-10 codes will have a financial impact on all practices. Practitioners will need to prepare for situations ranging from software errors that prevent reimbursements to the cost of staff training.

This requires a strategic plan that addresses the potential for multiple problems that will directly affect a clinic’s financially security and well-being.

Maintain Cash Reserves – Plan Ahead

A practice’s cash flow depends on coders/billers obtaining the best turnaround times on claims and that may not happen in the early months of ICD-10 implementation.

The reimbursement process will undoubtedly experience slow-downs and clinicians would do well to have sufficient cash reserves on hand to pay the bills and staff during the growing pains the new system is sure to suffer.

It’s best to acquire a business line of credit or a business credit card with a 0% APR for six to nine months to help tide over the first few months after ICD-10 is enforced.

Training And Education Essentials – Invest in Resources

Some practice owners will be fortunate to have staff training provided by vendors. Those who aren’t will be required to locate competent contractors who can provide the specialized training and education required for the implementation.

Everyone within the practice will require training. This includes the billers/coders as well as clinicians, who will need to modify clinical documentation to justify the increased specificity with the ICD-10 coding system.

Without enough training, bills will keep coming back to practitioners to fix, which will delay the entire payment process.

In-House Or Outsourced Billing – Examine Pros and Cons

Practitioners who are considering outsourcing will want to weigh the costs of training for in-house services against hiring an outside firm to handle those duties.

Coders/billers will need substantial training to minimize the disruption of reimbursements.

Experienced billers/coders are already in short supply and it may be better for the practice financially to hire a specialist who has already undergone training.

The Impact Of Security Vulnerabilities – Protect Data

Maintaining security is a very real concern, especially with the array of potential problems surrounding the transition.

Ensuring the security of patient information may include the purchase and installation of security software, while others may incur additional costs from vendors who are responsible for the system’s integrity.

Mistakes, oversights or compliance issues can cost a practice dearly.

Prepare for the Threat Of RAC Audits – Maintain Compliant Documentation

No one wants to hear that they’re the target of a Recovery Audit Contractor (RAC). ICD-10 implementation errors could appear as an attempt at fraud or abuse, causing a stain on a clinician’s reputation and disruption of the practice’s operation.

The best way for a clinic to be prepared is for the clinician to improve their documentation standards with the increased specificity that is necessary to justify the use of the new ICD-10 codes.

A RAC intervention is a lengthy and costly process for a private practice owner. In fact, it has the potential to drive a practice out of business.

The implementation of ICD-10 coding will take a financial toll on practices of all sizes. Preparing for the transition requires that clinicians use all their deductive skills to identify areas where the coding change will have a financial effect and plan for every contingency.

The ICD 10 Countdown for Your Private Practice

by Nitin Chhoda PT, DPT | Jul 9, 2015 | Electronic Medical Records, Medical Billing, Physical Therapy Billing, Physical Therapy Documentation

The transition to ICD-10 codes is the most significant change in 30 years and many clinicians still don’t realize that without the new codes, all their claims will be rejected after Oct. 1, 2014.

The deadline for implementation won’t be pushed back again.

Practitioners need to prepare now and establish a timeline to give themselves adequate time for staff training, to update/upgrade systems and conduct testing.

Conduct an Impact Analysis

The code transition will impact systems and people in multiple ways.

Clinicians will need to conduct an impact analysis to determine how extensively implementation will affect both manual and electronic systems.

The American Medical Association has indicated that the process of updating clinician and vendor systems will take up to six months.

Finding a Vendor

Practitioners will need to contact vendors to ascertain costs and how quickly implementation of new software and hardware can be completed.

It’s essential to find a vendor that supports staff training and maintains responsibility for updates/upgrades, while minimizing costs.

Clinicians may find they need to locate a new vendor to meet their needs.

Communication Is Key

No practice stands alone and clinicians will need to communicate with one another, their biller or billing service, vendor, clearinghouses and insurance companies to ensure systems are compatible.

Extensive system testing will be required between all the entities involved and will take two to three months to complete.

Custom Templates and Modifications

Clinicians should begin now to familiarize themselves and staff with the new codes. Documentation may need modification to reflect coding changes, create claims and accommodate data collection methods.

Don’t use cookie cutter templates – create customized templates that are relevant to the practice.

An EMR and billing software that provide crosswalks between ICD-9 and ICD-10 codes are critical.

Training for Success

Staff training will take two to three months.

A training schedule will need to be created that provides every staff member with a working knowledge of the codes and how they will affect their duties, but one that minimizes the effects on daily operations.

Training exercises using the new codes is good practice for the implementation deadline.

The transition to ICD-10 codes can’t happen overnight. It takes extensive planning and communication between all the parties involved. ICD-10 isn’t a catastrophe, but getting caught unprepared will be catastrophic for the survival of practices. One break in the chain anywhere along the line and clinicians won’t be paid.

Medical Management — How to Streamline with EMR

by Nitin Chhoda PT, DPT | Jun 9, 2015 | Electronic Medical Records, Physical Therapy Documentation, Physical Therapy Management

One of the many and major benefits of using electronic medical records system is the ability to streamline the entire documentation and billing process.

This can significantly improve productivity and boost cash flow. Nitin Chhoda explains how to streamline your practice with a simple, efficient and integrated EMR system.

Correct medical management is the key ingredient to a healthy, growing practice. The way therapists manage their clinics will determine whether they succeed or fail.

Practice owners must think like business owners instead of medical providers, a task that many find difficult to reconcile with the everyday treatment of patients.

Assistance With the Help of EMR

Electronic medical records system offers valuable assistance and significantly lightens the load of medical management. Effective medical management of a physical therapy practice involves more than just getting more patients in the door.

It means identifying problems and issues within the clinic, tracking trends, and streamlining the entire range of office procedures. Along with improving client care, superior management means being reimbursed in the timeliest manner possible.

Reducing administrative costs and efforts, while planning for the future, are all earmarks of an efficiently run clinic that will experience exponential growth.

The Benefits of EMR

The most obvious benefit of an EMR in medical management is the ability to identify where unknown problems have crept into office procedures. Time is money in the business world and a physical therapy practice is a business with all the attending problems, issues, wasting of resources and marketing requirements.

Therapists who embrace the features of an EMR will see increased revenue, cost reductions, more effective marketing efforts and better utilization of resources.

Therapists will first notice an increase in cash flow through faster payments via electronic reimbursement submissions. The entire medical management claim and payment system is accelerated and funds can be deposited directly into the clinic’s account.

EMRs eliminate the days of waiting for claims to reach their destination and the return of paper checks that must then be physically transferred to the bank. EMRs provide clinics with the means to capture one-time and recurring payments online via credit or debit cards.

Determine Best Payers

Clinicians can easily determine the best payers through the metrics available in an EMR.

Therapists can ascertain each client’s insurance coverage and eligibility for services, and have the data entered long before the patient’s appointment, allowing for quicker medical management billing and coding that attains a new level of accuracy.

Information is power and EMRs place a wide range of data at a therapist’s fingertips to evaluate medical management staffing needs and deploy clinicians where they’re most effective. It may be possible to eliminate employees or practice owners may discover they can add staff to expand services into spas, corporate and home health programs, and senior facilities.

EMRs provide data that equips therapists with medical management information on local and national demographics, along with treatment trends, that can be used to formulate streamlined and more effective marketing campaigns that target groups by age, gender, location, services or insurance providers.

High Tech Communication

The ability to communicate with clients via multiple methods, including voice and text messaging, offers clinics 21^st century technological tools with which to work. The term paperwork is destined to become obsolete with EMRs that record and store documents digitally.

As therapists fine tune their EMR documentation software to reflect their individual practices, medical management in all its many facets will become more streamlined and efficient than ever before, allowing clinicians to market their clinics more effectively, increase cash flow and manage practices for greater efficiency and profitability.