HIPAA Electronic Transaction Standards with ICD-10

HIPAA Electronic Transaction Standards with ICD-10

(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

Five Ways to Minimize Financial Havoc with ICD-10 Transition

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.

ICD 10 codesThis 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

ICD 10 codesMaintaining 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

The ICD 10 Countdown for Your Private Practice

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.

ICD 10 codesThe 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 SuccessICD 10 codes

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

Medical Management — How to Streamline with EMR

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.

medical managementCorrect 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

medical management streamlineClinicians 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 21st 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.

Physical Therapy Billing: Simplifying Enrollment with Insurance Companies

Physical Therapy Billing: Simplifying Enrollment with Insurance Companies

There are times when new practices are unable to enroll with major insurance companies. In this article, Nitin Chhoda provides some valuable tips on how to simplify the complicated process of enrollment and get your practice in-network with the payers you wish to work with.

physical therapy billing enrollmentAlthough physical therapy billing is complicated by the various billing requirements of insurance companies and government programs, some private practices are finding ways to simplify the process.

In fact, physical therapy billing is being redefined by physical therapy documentation software and EMRs.

The changes that are being make streamline the process, improve claims acceptance from insurance companies, and improve the patient experience.

Applications to Insurance Companies

For each insurance company that a physical therapy practice would like to bill, an application process must be completed and even certification may be required. Insurance companies have a lot of power in this regard and the process can be time consuming and costly.

These physical therapy billing applications cannot be taken lightly, and the terms of the final contract with each insurance company should be carefully reviewed.

The contract terms will determine just what you can bill for and what the limits are for each insurance company. Not only will this inform what the physical therapy billing staff does, but it should also be used to instruct physical therapists on how to work with patients to get the most benefit from the limits imposed by the insurance companies.

The Most Efficient Way to Enroll

There are now services that offer to apply on behalf of your practice for a fee. In many cases, this can be worthwhile, as the time and energy it takes to complete this kind of application takes physical therapy billing or management staff away from other duties.

Hiring a specialist to do this temporary work may be the most efficient way to enroll with a number of insurance companies as well as government programs like Medicare and Medicaid.

But this still involves a great deal of attention, at least from physical therapy billing and management. You may want to start by determining exactly which companies you want to enroll with.

Not every insurance company will be worth working with, especially if the limits are particularly low or they have a particularly high rate of rejection and denial of claims. Once you have drafted a list of potential companies and programs, you can work with an application company to get enrolled more quickly and efficiently.

Integrating Insurance Requirements into an EMR

physical therapy billing companies

A fully integrated and flexible physical therapy EMR can provide clinicians with the correct weighted procedures and treatment options so that when the information is transferred to the physical therapy billing staff, the billing process can be seamless and smooth.

A physical therapy billing and documentation software solution can help make enrollment smoother for physical therapy billing staff as well as for management. Once the terms are set, the specific can be entered into your EMR.

Without wasting time looking up the details of each insurance contract, the physical therapy billing staff can fill out the necessary claims and submit them more quickly and accurately than ever before. If the requirements are integrated into the EMR, everyone benefits including the practice as a whole.
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.