Types of Mapping Between ICD-9 and ICD-10

Types of Mapping Between ICD-9 and ICD-10

A General Equivalence Mapping (GEM) system offers the best industry-wide standard currently available for the forward and backward mapping of ICD – 10 Codes. GEMs can be practically applied as long as clinicians remain aware of their limitations, use them as a starting point, and receive ICD-10 training and education.

A GEM contains an alphabetical index to entries, classification system for procedures, and the appropriate code numbers. The major difference is that GEMs provide clinicians with the ability to forward map from ICD-9 to ICD-10 codes, and backward map from ICD-10 to ICD-9 coding.

An alphabetical list provides the starting point to begin a search for the appropriate code. Just as the words in a language translation guide can contain multiple meanings, the same is true of a GEM. When the index is accessed, it will return as many related items as possible. It’s up to the clinician to narrow the parameters and choose the appropriate code meaning.

A GEM will return a source code for ICD-10 and ICD-9, along with “flags” that are divided into different categories. Flag identify if the system has identified an approximate, combination or no mapping equivalent. A scenario and choice list are also available to provide more information for combination possibilities and the choice list provides alternatives for a combination entry.

Many terms, procedures and concepts have been changed or included in other categories. Adjunct codes are included to provide additional information about a specific procedure and clinicians may be faced with a combination of codes that must be used to identify a specific procedure.

The GEM results will vary depending upon the entity that created it. Additional options are available to help clinicians narrow the data for further specificity, along with instructional notes to help clarify a patient’s particular situation.  GEM mapping between ICD – 10 sets isn’t a mirror copy and there will be discrepancies.

Numerous GEMs exist from multiple sources and clinicians would do well to examine the GEM from their preferred source to ascertain which would be more beneficial and the most applicable within their practice. GEMs return a variety of potentially applicable results for each situation and some are more helpful than others in a particular practice environment.

The number of new codes, greater specificity and multiple options makes the documentation process much more involved, time-consuming and frustrating for clinicians. Searches will result in multiple options that must be examined in-depth to create a match that accurately represents the illness or injury, the type of encounter and the specifics related to an individual patient.

Coders and billers will be using coding books and software systems to make their conversions and many have argued that it may be easier, quicker and more convenient for clinicians to do the same. A GEM can literally return thousands of results for a single conversion query. GEMS are meant to be a short-term solution until clinicians become fluent with the ICD – 10 coding system or design their own crosswalk system.

Utilizing a GEM system will help clinicians ease into the ICD-10 transition, but they should be aware that it isn’t a magic wand or a one-size-fits-all solution. It offers possibilities, potential and helps bridge the gap in coding, but isn’t a definitive solution.

The ability to backward and forward code is the primary attribute and advantage of a GEM system. They’re essentially reference guides that can help clinicians during the ICD-10 transitional period, but should be combined with the clinician’s expert judgment.

 

The GEM for ICD-10 and Limitations

The GEM for ICD-10 and Limitations

A General Equivalency Mapping (GEM) system is available to assist clinicians determine the correct coding options in the ICD-10 system. It’s a necessary and useful tool, but one that has distinct limitations. It provides no substitute for real training. A GEM is a general purpose tool and wasn’t originally developed for coding. It was a means of analyzing data and conducting research and studies.

GEM is a tool that can be used by clinicians to conduct searches and reverse searches to identify the correct ICD-10 codes in their practice. Translations and conversions can be done between either coding system to the other. Translating ICD-9 to ICD-10 is known as forward mapping, while ICD-10 to ICD-9 is called backward mapping. Searches will turn up approximate matches, possible combinations, and potential scenarios from which to choose and search for more data.

There are multiple versions available that have been created by vendors and professional organizations. Versions are available from the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS), along with many vendors of EMR software systems. The ease of use will be determined by multiple variables that include the developer, logic and programming used.

The results that the GEM returns are dependent upon the creating entity. Clinicians will receive entirely different coding options depending upon which GEM they’re using. The sheer volume of codes in ICD-10, combined with those that didn’t exist in the old system, means that a given GEM won’t always return the best matches or choices.

The chance of a one-to-one match is very slim, and in certain circumstances the GEM may offer none at all. All search features aren’t created equal and clinicians may find they have to try multiple search terms before the GEM returns any results at all.

It’s imperative that practitioners remember that GEMs aren’t designed to be an exact converter within a clinical setting and even an “exact match” may only be an approximation. Other coding difficulties may arise when differentiating between an initial encounter and a subsequent encounter. Some ICD-10 codes may not offer lateral solutions, which means practitioners will have to create the data themselves.

The imperfections of GEMs can have a significant impact on revenues for practices, making it imperative that clinicians bill and code at the highest possible level whenever practical and prudent. GEM results may not provide an accurate reflection of the clinician’s intent or care episodes.

Any unmapped codes that are encountered will present additional challenges for overworked practitioners struggling to adapt to a new code set and maintain revenues. Examples that reflect no translation between codes are surgical instruments, cardiovascular devices and autopsy. While the latter two are unlikely to arise in the average practice, it still points out the limitations of a typical GEM.

A GEM is a tool that provides a starting point for clinicians and is no substitute for ICD-10 training and education. The GEM can’t think or factor in the many aspects that practitioners must consider when diagnosing and treating a patient. For that, clinicians must rely on their training and unique experience.

Physical Therapy Marketing to Patients — Before, During and After Visits

Physical Therapy Marketing to Patients — Before, During and After Visits

Effective physical therapy marketing begins even before the patients starts his / her treatment. Nitin Chhoda shares some important strategies about effective marketing to patients before, during and even after their treatment.

physical therapy marketingOwners of a physical therapy practice will soon learn that marketing takes up a significant portion of their clinic time. The business of physical therapy marketing never stops.

Clinicians must market their business to attract patients, find ways to promote themselves to clients in the office, and develop follow up methods to keep the clinic in the forefront of clients’ minds.

Patients can pick and choose the therapist they see and practice owners must market to ensure those clients are selecting them. Physical therapy marketing can be viewed as a dating game where therapists court new patients, woo them from other sources and keep the romance alive with ongoing strategies.

Good Physical Therapy Marketing

Building a good patient-therapist relationship takes time and effort, but if clinicians are giving clients what they want, or perceive they want, it can be the beginning of a long and profitable relationship.

Successful physical therapy marketing strategies begin with a clinic standing out from its competitors. Practice owners can utilize a variety of techniques that take advantage of referrals, word-of-mouth advertising and free information.

Social media, search engine marketing, patient newsletters and discounts for patients that pay cash can all be utilized to build a reputation as the preferred go-to therapist. Physical therapy patients want to feel better or mitigate their pain and practice owners need to demonstrate to prospective clients how they can accomplish those goals.

Clients want to feel cared for and clinicians that make each patient feel as if they’re the clinic’s only priority are guaranteed return business, an effective physical therapy marketing technique. Clinicians who achieve that are building a team of cheerleaders for the practice that will have far-reaching effects.

Promoting a physical therapy practice doesn’t have to be expensive. Some of the best strategies utilize simple but low-cost methods. The most effective physical therapy marketing strategies use a combination of techniques and can include any of the following.

  • Patient newsletter (a very effective physical therapy marketing strategy);
  • Hold a customer appreciation day;
  • Establish a VIP club with discounts for those who pay cash or pay their balance by a specific time and give away free trial memberships;
  • Write a column for the local newspaper, do regular radio spots and make the clinic’s expertise available to TV stations;
  • Submit press releases online to announce new products, methods, techniques and services;
  • Network with other healthcare professionals for referrals;
  • Send patients a note, email, voice mail or text message thanking them for their visit, inquire about their health or offer an incentive for discharged patients to return;
  • Give a community presentation on injury prevention or the benefits of exercise;

  • Create and distribute an audio CD or short DVD about the practice, its services or the benefits of physical therapy;
  • Develop a product or treatment method specific to the clinic;
  • Provide free information on the business website;
  • Utilize social media to connect with clients;
  • Offer a core service and two or three specialized services such as massage or acupuncture;
  • Create a blog;physical therapy marketing to patients
  • Write a book;
  • Seek staff input.

The best therapists,with the help of above physical therapy marketing techniques, are with the most patients. They are clinicians that are warm, sincere and provide a superior patient experience.

They are not afraid to display a sense of humor if appropriate. A good bedside manner is essential and humanizes therapists to their clients.

In the office, even little niceties like free coffee and juice creates a friendly ambiance that makes patients feel welcome, cared for and promotes a practice they eagerly return to for all their physical therapy marketing needs.

How to Minimize Your Accounts Receivable

How to Minimize Your Accounts Receivable

Accounts receivable is one of the biggest problems for private practices. Across the nation, there’s millions of dollars that practices are still waiting to collect from insurance companies. The problem is twofold. Practices aren’t using integrated software that performs automatic functions and many billers are being forced to enter each bit of data manually. That leaves them less time to concentrate on collecting from payers.

To remain financially secure, clinicians must do everything they can to shorten the revenue cycle for each patient and get paid faster. That means streamlining the biller’s job with software that contains automation and one-touch functionalities, along with scrubbing and editing abilities. Next to the clinician, a biller is the most important person in a practice. They’re highly trained professionals that keep revenue flowing into the practice.

Accelerated Submissions

In Touch EMR™ and In Touch Biller PRO are the two most advanced software systems available. The integrated systems work together to provide billers with tools that facilitate the entire billing process from start to finish. Efficiency is extremely important in today’s economic climate and In Touch EMR™ allows practitioners to create a claim and submit it to the biller by the time the patient leaves the office.

The system contains essential time-saving features that notify billers of potential problems that could delay the claim, such as incompatible CPT codes. If an inconsistency exists, billers can edit the claim as needed. The claim is automatically optimized, batched and sent the same day. The biller doesn’t have to manually load and send.

Where’s The Claim?

A critical part of the biller’s job is to track, monitor and follow up on submitted claims. In Touch Biller PRO enables billers to track each claim at every stage of the process. The software tells billers exactly where the claim is and its status, an ability that’s missing in most systems, but one that allows billers to track and process claims seamlessly.

The system automatically posts ERAs to patient accounts without the need for billers to do the task manually. That one ability alone provides an enormous time savings that can add up to $1,200 or more per month and thousands each year.

Next t to the clinician, the biller is the most important person in a practice. Any opportunity to streamline his/her job with automation should be implemented. In Touch EMR™ and In Touch Biller PRO makes the biller’s job easier, shortens the revenue cycle and allows practitioners to get paid faster.

What to Look for in Billing Reports

What to Look for in Billing Reports

Billing is the cash flow engine of the private practice. It should be simple, streamlined and efficient. Billing software can be used to check patient eligibility and post ERAs, along with sophisticated functions that include scrubbing claims, posting payments and billing secondary insurance with the click of a button.

Perhaps one of the most important functions is the ability to generate detailed yet simple reports. Such reports offer clinicians the means to determine if billers are being as efficient as possible and provide them with an accurate overview of the practice’s financial health.

Utilizing Metrics

An aging report provides a wealth of information. It shows therapists how much money that’s owed but hasn’t been collected. Practitioners can look up accounts receivable by payer and break it down utilizing a variety of different metrics ranging from location to procedure.

Practice owners can ascertain which payers reimburse slowly and providers that aren’t billing as much as others. Reports can be created by ICD and CPT codes to discover which procedures earn the most for the practice and which patients generate the most revenue. In Touch EMR™ has the ability to generate reports with sophisticated measures and customization options.

Data And Proofs

In Touch EMR™ provides clinicians with the ability to know exactly where their money is. They can do it themselves without waiting for the biller. Reports can be created for a week, month or even the last six months. The reports can be taken to the biller or the payer if needed. In Touch EMR™ enables practice owners to view their practice from a higher level and gives the clinician ammunition to address payment issues.

The reports provide therapists with the data needed to address biller problems and expedite the billing process. In Touch EMR™ reports show practitioners where potential problems exist and the point of origin. Therapists may find that they need to stop doing business with specific payers and providers.

It can take an average of a month to collect from insurance companies, but clinicians should be aware that it can take longer when working with Workers’ Compensation, out-of-state clients and auto accident claims. Clinics that experience a lot of these types of claims should be aware that the revenue stream may be delayed through no fault of the biller or provider.

The power and potential of In Touch EMR™ provides clinicians with valuable metrics and tools to diagnose the health of their practice and if the billing department is doing a good job. The integrated system gives practitioners the ability to create their own reports independently of the billing department. In Touch EMR™ gives practice owners the tools to run their lifestyle, not a system that runs them.

 

How to Automate Patient Follow Up

How to Automate Patient Follow Up

One of the most important things a clinician can do is to keep his/her name in front of patients. That can be done with automated patient follow up. When patients provide their information, the practice should obtain the client’s mail, email, home phone and cellphone number, along with their permission to communicate with them in those ways.

An automated system should be able to contact patients by all four of those mechanisms. The In Touch EMR™ has the ability to accommodate those who utilize mobile devices and older patients who may not be comfortable with modern technology. Patient follow up encompasses more than appointment reminders.

Traditional Mail

In Touch EMR™ has the ability to generate personalized greeting cards with a variety of user defined messages. The feature is an effective means of connecting with new and established patients. Cards are computer generated, but have the look and feel of a personal note.

Cards are effective in welcoming new patients after their first visit or thank established patients for their continuing patronage. Cards can be sent on client birthday or on their anniversary with the practice. Cards tend to make a more lasting impression and are perceived as requiring more effort on the part of the practitioner.

Email

An email message can be generated for the same purposes as a card and many individuals prefer being contacted by email rather than other means of communication. Messages can be used to notify clients about special deals, coupons and referral programs. When applicable and appropriate, congratulatory messages can be sent for an upcoming marriage, birth of a baby or workplace promotion.

Every practice should produce a newsletter and email is a convenient means of delivering it. In Touch EMR™ has the ability to generate newsletters with new, educational and engaging content that requires little effort on the part of the clinician.

Cellphones

In Touch EMR™ can send personalized voice messages to a variety of mobile devices. Studies have shown that individuals typically respond to a text or voice mail within five minutes of its receipt, making it ideal for patient communication. Clinicians can connect with a variety of messages, from appointment reminders to extending holiday greetings.

Home Phones

There are still some individuals who resist the use of smartphones and computers. These are typically older patients. They may not have a computer or mobile device, but they will most likely have an answering machine. In Touch EMR™ can generate any type of message desired to keep in touch with patients that may be resistant to newer types of technology.

Automated patient follow up is an essential part of operating a successful clinic. Automation simplifies the process for staff, while building goodwill with patients who are then more likely to refer the practice to others. It’s customer service at its best, facilitated through the automatic abilities of the In Touch EMR™.