Thursday, March 31, 2016

The Seventh Character’s Relevance – A, D & S in ICD-10


Start listing the major differences in the codes of ICD-9 and ICD-10 and this will probably the first on your list – the addition of seventh character extender.  This seventh character, in a way, is what ICD-10 is all about.  The tabular list of codes primarily listed in chapter 15 and 19, give you a detailed idea about why the number 7 is not so lucky in this case.  Let’s see how the 7th character plays it’s role.  If you need additional assistance, subscribing to MedConverge’s CodeAssist Service will provide you access to our ICD-10 ResourceHub as well!
A – Initial Encounter
‘A’ signifies that the patient is receiving treatment for the particular diagnosis for the first time. The confusion is faced when the patient visits the clinic for the continued treatment of the same diagnosis.  No matter how many visits the patient makes for the initial treatments of the same diagnosis, it will be coded with the extension ‘A’.
For example, if a surgery is to be conducted on the 3rd day after the diagnosis, the surgeon will still need to code it with the extender ‘A’, since the surgery is a part of initial treatment itself.
D – Subsequent Encounter
Once the initial treatment of the diagnosis is over, the patient may need to visit the clinic for a routine follow up.  In that case, the following treatment will be coded ‘D’.
S – Sequela
Sequela, characterized with letter, ‘S’ is used when a complication is faced due to a past injury, for example; a scar as a result of a burn or chronic pain as a result of a healed back injury.
X – The Placeholder
Though not a part of seventh character extenders, the character ‘X’ plays a vital role in coding where the seventh code is required.  When the code is less than 6 characters long and still requires a seventh code extender, that is where the character ‘X’ come into play.
For example, code – T79. 6XXA is for Traumatic ischemia of muscle, initial encounter.
Here the code for Volkmann’s contracture consists of only 4 characters; whereas it needs the seventh character ‘A’ to mention that it is an initial evaluation of contracture, constituting active treatment.  The character ‘X’ is used as a place holder for 5th and 6th position.
The seventh character codes can be complicated – one needs to use them carefully.  Specific and accurate coding is very essential for the seventh character since it can be easily mixed up with and can hamper your claim.

Friday, March 25, 2016

Ways To Prevent Medical Billing Fraud

Have you ever been a victim of medical billing fraud?  Medical billing fraud, especially those related to insurance billing are far more common in practices than you would think.  There are cases of willful fraud committed as well as those that are committed without even knowing it.  In either case, the onus of the fraud and its legal consequences rests on the practice.  How can you prevent these from taking place at your practice? Well, here are certain things you can do…
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Same Procedure – Same ChargeThis is one of the most common mistakes – charging different amounts for the same procedure based on insurance allowed.  In order to avoid having to post insurance write-offs on a patients account, healthcare facilities often charge different patients dissimilar amounts for a similar procedure or treatment.  Make sure that this practice is avoided at your facility.  If you wish to offer a discount to a patient due to their financial hardship, do so by asking the patient to complete a financial hardship form.  Remember, every patient needs to be treated the same and must be charged the same amount for the same procedure.
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Patient Co-payments
Your heart wants to reduce the amount due from a patient undergoing financial hardship and you waive off the patients copayments – don’t!  Your waiving off a patient copayment amounts to medical billing fraud, as it violates your insurance contract.  This is also seen as taking unfair advantage over other practices and an attempt to woo patients to your practice.  Ask the patient to fill the required form to avail a hardship discount.
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Federal Laws
You may not be a lawyer, but it is important to know the laws that apply to your practice and follow them to the letter.  For example, under the False Claims Act, it is illegal to submit claims for payment to Medicare or Medicaid, which you know, or should know, to be false or fraudulent.  Any infringement of this law could lead to hefty fines, repayment of up to three times the amount and also criminal penalties.  Another example is the Anti-Kickbacks Act, under which rewarding another physician monetarily for referred patients or receiving gifts or money in return for prescribing certain medicines is punishable under both civil and criminal statute.  It makes good sense to be aware of these and other laws – and stay clear of infringing them.
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Entering the wrong code will likely cause your bill to be rejected.  However, depending on the error, it could also be seen as ‘up-coding’ that is billing for a more costly procedure or service than the one provided.  It may be a genuine mistake, but the onus will finally fall on you and you will need to prove that this was a mistake and not an intended medical billing fraud.  With the implementation of ICD-10, the number of codes has gone up, thus creating more chances of such errors.  Double check all bills before they are submitted and ensure that your staff does that too.

Wednesday, March 23, 2016

Do EHR Design Flaws Lead to Errors In The Emergency Room?

Information Technology and computers are supposed to make our work easier, faster and accurate.  However, the transition to digitized record systems seems to be causing a whole new category of patient safety errors.  From ordering medication dosages larger than required to making entries in the wrong patient’s records – are these user errors in the making or are they due to a poor system design?
The financial incentives offered to hospitals to adopt EHRs by the federal government under the 2009 stimulus package and the 2010 health reform law, was supposed to make the system efficient while at the same time reduce errors by linking patient records.  The system would also help coordinate and track healthcare delivery across the health system, with penalties for healthcare facilities that did not meet the standards.
Unfortunately, the ER is a place, where things take place, very often at a rapid pace.  An emergency leaves little room for recording data on the electronic system – care for the patient is the prime concern.  With doctors and nurses juggling between multiple patients, verbal communication is more effective.  The ER is a different type of healthcare situation and has evolved a distinct workflow over the years.  A large number of ERs thus evolved electronic record programs distinct and independent of the hospitals systems.  However, these ER record systems find themselves incompatible with the systems that the hospitals are buying and are thus phased out.  The new EHR models may be efficient, but to work in an ER situation, they require adjustments.  The current models often create a technology mismatch in the ER, something that may not be so for the rest of the hospital.
According to a report published in 2013, by Jesse Pines and other members of the American College of Emergency Physicians, mistakes made in the ER like entering data in the wrong patient’s file or ordering the wrong medications, became more common after the switch to digital systems. “The way the systems are set up, it can actually predispose to higher error rates,” said Jesse Pines.  The report further states that, “a growing body of evidence suggests that many errors may be the result of poor design rather than user errors. That “can have a profound influence” on patients.
Electronic record systems have resolved a large number of safety concerns.  However, since it is the administrators or the technology experts who decide which system to invest in, rather than the doctors who will be using them, EHR providers design the system based on the wants of the administrators and technology experts.  In order to understand how the system would work in an ER, designers need to talk and sit with the ER staff or better, spend time in an ER to understand the nuances of using the EHR system there.
Manufacturers of EHR systems admit that doctor’s feedback and suggestions are important and they give it high priority in their designs.  However, there is a lot of improvement required to make the system ER friendly.  Some manufacturers have designed supplements to help fix communication gaps with emergency medicine.  However, hospitals are reluctant to buy add-ons after having paid millions for the EHR system in the first place.
Even with these challenges, the future does look bright.  With technological advancements, we are sure to see a transformation in the electronic health record space.

Saturday, March 19, 2016

Tips on Improving Patient Engagement through Health Information Technology


Since the beginning of time, communication has been the most important factor in human relationships. In time, the way we communicate has evolved and today, technology plays a huge role in our communication with each other. Communication between patients and providers is gaining importance in the healthcare industry. Good communication with your patients will result in them following your advice, while making it easier for you to follow up post their visit to your clinic. However, creating and maintaining a genuine connection with your patients and ensuring that they follow your advice in taking necessary care of themselves outside your clinic can be a challenge.
Most people today engage with technology to track and find out about their own health issues – the wide array of nutrition, diet, exercise websites and software applications are testimony to that. So, what are the various technology methods that can be utilized to increase patient-provider interaction? Given below are some of the methods that are already available and user-friendly for both patients and providers.

Patient portals

One of the most common ways to increase engagement with patients is through the use of the patient portals on the EHR systems. The patients immediately become party to their healthcare once they have access to their personal health information. However, healthcare providers should remember to seek out the most effective features of an EHR patient portal, as information that is too prescriptive or similar to box checking could put off a patient. It is also important that healthcare providers take the time to explain what they are documenting as this will go a long way in keeping the patient involved in the process. Using the EHR, providers can offer their patients complete and accurate information about their medical evaluations, along with manage appointments and follow ups electronically. Quick communication between them can help providers identify symptoms earlier and inform patients what to do till they arrive at the clinic.

Promote connected PHR

The PHR (personal health record) is an electronic application that a patient uses to maintain and manage their own health information. Providers should promote the use of connected or tethered PHRs that is linked to the EHR system in the healthcare centre. Patients can access information regarding their health care through a secure portal. While allowing patients to check on their healthcare history, it will also allow providers to follow up with the patients and remind them of upcoming check-ups.
Secure direct messaging
Using secure direct messages or secure emails is a great way to engage with patients. Following up with the patients after their visit, checking on them periodically, keeping track and reminding them of future tests or visits, an email or message will help influence the quality of care the patient receives. Engage with the patient even before they physically visit your premises – this can be done by offering online check-in. Allow them to check lab/test reports without having to come to the clinic. All these help develop relationships and encourages interaction between the patient and the provider.

Maximize mobile and wearable technology use

Smartphones have changed the way in which we interact with the rest of the world. Using this technology to its fullest, providers should bring in mobile applications for patient-provider interaction. Providers using the mobile space are finding themselves more in demand that those who are still stuck with computer based portals. Another technology which can close the gap in patient-provider engagement is wearable technology – the fitness band for example. Providers having access to data collected on a wearable device can be better informed about the patient’s overall health. The wearable device actually becomes an assistant to the healthcare provider by delivering accurate data about the patient. One important factor that these wearable devices could make a difference to – it will help the providers predict health issues and arrive at a better diagnosis.

Wednesday, March 16, 2016

Inferior Healthcare Mobile Apps could cost hospitals upto $100 million every year


One of the most frustrating aspects of mobile health applications offered by hospitals is the lack of required services that consumers want.  Although, out of 100 of the largest US hospitals, 66 offer consumer mobile health apps; only 2% of patients are found to be using them.  This coupled with the non availability of services that consumers want from their health apps, may cost each hospital more than $100 million annually in lost revenues, according to a report by Accenture, titled “Losing Patience: Why Healthcare Providers Need to Up Their Mobile Game”.
The findings of this report should be an eye opener for hospitals.  Out of the three most desired functions by patients – access to medical records, booking, changing or cancelling appointments and requests for prescription refills; only 11% of hospital apps offer at least one of them.  The rest of the hospitals do not seem to have aligned their mobile app functions and user experience with what the patients expect.  This is the reason why around 7% of patients have switched their healthcare providers citing poor experience with the online customer service, including mobile apps.
Currently, most hospitals only offer a subset of features in their mobile apps, such as the ability to view labs or look up basic forms.  However, today’s tech savvy patients are not impressed with static services that are focused around core medical records; instead they want more personalized features such as appointment scheduling.  Hospitals need to adopt a patient-centric approach when developing or revamping existing mobile apps.
According to Accenture, as consumers come into healthcare with their expectations of services experienced from other industries, healthcare providers will witness switching rates on par with the other industries, which range from 9% for the mobile phone industry to as high as 30% for the retail industry.
The report states that 38 out of the 66 hospitals that offer consumer mobile health apps, have developed their apps in-house rather than through a mobile app vendor.  According to their suggestion, hospitals should engage prominent digital and mobile health companies to understand what the consumer wants and how they fit into the healthcare ecosystem.  The question is not of buy versus build – with mobile health it has to be both.
Mobile engagement is becoming increasingly important to the success of every hospital in today’s digital age.  It is imperative for hospitals to keep up, as the pace and scale of mobile health technology continues to grow faster and larger.

Monday, March 14, 2016

Outsourcing your Medical Billing Services

Do you remember why you started your medical facility?  The desire to help and treat others of their ailments – wasn’t that the reason?  And yet here you are, dabbling with billing, insurance companies, revenue cycles and bad debts – all of which impinge on the time that you could be spending looking after your patients.  A lot of us feel that it is prudent to look after our affairs on our own.  Imagine your patient feeling the same way and treating himself on his own.  However, the reason why your patient comes to you for treatment and does not do so on his own, is because you are trained and specialized in the treatment of their ailments.  Given that line of thought, would it not be better to outsource your medical billing services to a specialist?  While there are pros and cons to both methods of dealing with your medical billing – in-house and outsourced, but, with the complexities and constantly changing regulatory scenario, it makes a lot of sense to outsource your medical billing to an entity which specializes in this field.  Let us take a look at some of the benefits of outsourcing your medical billing services.
Reduced CostsThere are overhead expenses involved with running your medical facility; a fraction of which you bill to each patient at your facility.  In a similar manner, a billing service provider spreads their expenses across their entire client base, which provides an economy of scale, allowing them to operate at a lower cost.  This translates to you spending less than what you would, if you were doing your own medical billing.
Dedicated ServicesA medical billing service provider will make money, only if you are making money – thus, the primary goal for a medical billing service provider is to ensure the profitability of your practice.  Your service provider will review and post all payments, ensure that you are paid the correct amount due to you and chase up on all outstanding claims, till they are processed and paid.
Expert AdviceJust as physicians are experts in their field of work and are able to identify and treat an ailment with relative ease, medical billing service providers are also experts in their field and can identify and rectify problem areas in your medical billing and payments.  Using their skills to chart data to create and analyze weekly, monthly and annual reports, medical billingservice providers ensure that all problems are nipped in the bud and do not spiral out of control.
Changing LandscapeKeeping pace with the changing landscape in healthcare and its related regulations is difficult to say the least.  New CPT codes, changing carrier rules and increasing regulatory requirements need constant upgrading and vigilance to ensure that you do not default.  Your current practice may not give you enough time to dedicate yourself to this task.  This is where service providers make the difference.
Focus on your WorkYour primary work is treating patients and anything that takes your time away from it, is eventually counter-productive to your expertise.  You may not be the one actually calling up a carrier to follow up on a claim, but you still deal with the overall management and all the issues that come with it.  Outsourcing your billing to MedConverge, a provider of comprehensive medical billing services in Atlanta, will enable you to increase the number of patients you treat, as well as give you time to spend with your loved ones; time which otherwise you would be spending on your  revenue cycle issues.

Monday, March 7, 2016

Medical Billing And and Coding Specialization



All medical billing and coding professionals use standardized classification systems to code the patient’s medical and care history.  However, there are medical billing and coding professionals who specialize in specific areas of medicine and work as specialist coders and billers.  To become a specialist medical billing and coding professional, you would require a certificate or degree in health information technology along with relevant qualification in the specialized field.  Though the certification requirements do vary with the type of specialization, you will need a mix of academic and work experience to qualify as a specialist medical billing and coding professional.
Why would you choose to seek specialist certification in medical billing and coding?  There are several good reasons with some of them listed below:
  • Specialist doctors prefer to hire specialist medical billing and coding professionals.
  • Specialization opens up new career opportunities for you.
  • With a limited code to work with, your job gets more defined.
  • Specialization makes you more valuable as an employee.
Cardiology Billing :


Cardiology billing is one of those specialized areas that require highly specialized skills, as cardiovascular billing is far more complex that general billing.  A complex treatment with overlapping procedures, cardiology treatment has always been difficult to translate into foolproof insurance claims.  Patient collections for cardiologists are more complicated, due to larger co-pays owed.  Specialists in cardiology billing need to have a combined knowledge of cardiology procedures with specific cardiology coding and billing.
Dermatology Billing :


Medical billing and coding professionals who wish to specialize in dermatology billing are required to possess knowledge of dermatology procedures such as debridement, lesion excisions, Mohs micrographic surgery, flaps etc.  Dermatology billing with its many terms and unique aspects such as sizing lesions and wounds makes it a specialized subject.  Specialist coders need to be familiar with these aspects and the specific codes for dermatology procedures.

With over two decades of experience in the healthcare revenue management domain, MedConverge offers specialized and customized medical billing and coding services to enhance your collectibles.  MedConverge offers specialized billing and coding professionals in areas such as Cardiology, Gastroenterology, Otolaryngology, Rheumatology and Dermatology and more.  Our team works with you to ensure that you receive the reimbursements that you deserve.  Contact us at 800-898-0709 or e-mail us at info@medconverge.com for more information.