Tuesday, April 23, 2013

Will The Leaders of Today, Be The Leaders of Tomorrow?

Will The Leaders of Today, Be The Leaders of Tomorrow?

If history repeats itself, they will not. Today’s leaders and their corporations will be replaced by new companies that no one has heard of with young innovative leaders at the helm. The uptown offices will be exchanged for Wellness Centers in neighborhoods because patients will demand greater shared decision making and value-based care with increased fiscal responsibility.

Why will the industry’s strongest and most powerful corporations loose the innovation race? Because their “Innovation Department” will never be able to convince the most senior executives that innovation is more than just a new product or a marketing angle. It is a mindset, a corporate culture that originates from the top and is woven into the foundation of a corporation.

The most brilliantly written legislation supported by the best and brightest auditors with access to the entire collection of big data will NEVER change the current trend in healthcare spending if patients are not involved. This involvement, or patient engagement must be center stage over the entire continuum of care; not a follow up call after a hospital admission by a Case Manager. We must look outside the box to address the needs of patients and not insurers. Then, we must create flexible solutions that meet those specific needs.

The ability to adapt quickly will be necessary and this conflicts with current corporate ethos. Accountability has been diluted by board meetings and conference calls. While emails are shuffled around from person to person, no one wanting to take action. Instead of teaching physicians and clinical staff how to document to a higher level of specificity we are hiring companies to re-code medical records. Is that really a solution?


Be proactive. Start making changes today. The next wave of innovation is on the horizon.

Empirical Risk Management www.ermconsultinginc.com 877-938-9232

Whose Patient Engagement Goals Are We Talking About? | Center for Advancing Health

Whose Patient Engagement Goals Are We Talking About? | Center for Advancing Health

ICD-10 Transition Basics

The ICD-9 code sets used to report medical diagnoses and inpatient procedures will be replaced by ICD-10 code sets. 

1. What does ICD-10 compliance mean?
ICD-10 compliance means that everyone covered by HIPAA is able to successfully conduct health care transactions using ICD-10 codes.

2. Will ICD-10 replace Current Procedural Terminology (CPT) procedure coding? 
No. The switch to ICD-10 does not affect CPT coding for outpatient procedures. Like ICD-9 procedure codes, ICD-10-PCS codes are for hospital inpatient procedures only.

3. Who is affected by the transition to ICD-10? If I don’t deal with Medicare claims, will I have to transition?
Everyone covered by HIPAA must transition to ICD-10. This includes providers and payers who do not accept Medicare. 

4. Do state Medicaid programs need to transition to ICD-10?
Yes. Like everyone else covered by HIPAA, state Medicaid programs must comply with ICD-10. 

5. What happens if I don’t switch to ICD-10?
Claims for all services and hospital inpatient procedures performed on or after the compliance deadline must use ICD-10 diagnosis and inpatient procedure codes. (This does not apply to CPT coding for outpatient procedures.) Claims that do not use ICD-10 diagnosis and inpatient procedure codes cannot be processed. It is important to note, however, that claims for services and inpatient procedures provided before the compliance date must use ICD-9 codes.

6. If I transition early to ICD-10, will CMS be able to process my claims?
No. CMS and other payers will not be able to process claims using ICD-10 until the compliance date. However, providers should expect ICD-10 testing to take up to 19 months. 

7. Codes change every year, so why is the transition to ICD-10 any different from the annual code changes?
ICD-10 codes are different from ICD-9 codes and have a completely different structure. Currently, ICD-9 codes are mostly numeric and have 3 to 5 digits. ICD-10 codes are alphanumeric and contain 3 to 7 characters. ICD-10 is more robust and descriptive with “one-to-many” matches in some instances.

Like ICD-9 codes, ICD-10 codes will be updated every year.

What strategies have you developed to successfully transition your company to ICD-10? 
Have you completed Documentation Improvement Initiatives? Have you mapped your 50 most commonly billed codes to ICD-10? Are you tracking and monitoring your progress through internal compliance reviews?  How will you protect your revenue while managing the costs of transition?

If not, you must start now. The deadline is fast approaching!
Call ERM today for a free consultation 877-938-9232