Glitches with ICD-10 Implementation

Until this point most billing is done with ICD-9 codes. These billing codes would be sent from a hospital, clinic, physician's office etc. to a private insurance company or to Medicare and Medicaid offices to let them know what procedure was performed. However now the billing codes need to be changed to ICD-10. ICD-10 is updated and more specific based on the diseases, ailments and surgeries we have in 2015 versus many years ago when ICD-9 were first coded. This means all the procedures, old and new, need to be assigned to this new form of ICD-10 coding. 

Believe it or not, not everything has going completely according to plan with the recent ICD-10 implementation, and there have been “glitches” so to speak.

An article published by Healthcare IT News has noted some of these glitches and some of the response.

1. Private payers want your coding to be right. Although it’s true that CMS is allowing a year grace period to allow coders to get the hang of it, many private payers are not necessarily committed to the same standard. Some practitioners are even giving themselves an extra hour just for coding. 

2. “Clearinghouses.” Some clearinghouses cannot go through until they have been cleared, and not all new codes are currently being recognized. This may take some time.

3. “Referrals.” For some physicians this is the lifeblood of their practice. They rely on referrals for much of their patient clientele. Somehow ICD-10 was not allowing one physician to give, or receive referrals.

4. “Eligibility checks. Some insurance websites were unavailable for the first 2 days. We were not able to check eligibility on some patients. We may or may not be paid for these visits and according to our insurance contracts; we are not allowed to bill the patient. Any patients I saw on the first 2 days of October who we were unable to verify their insurance was treated for free and there's nothing I can do about it. I know some people will say not to see them without this verification but they were sick. What good is a doctor who doesn't treat sick patients?”

5. “Wait times.” Billers always have a difficult time contacting payers, it’s probably their biggest complaint. There was a story of one biller who had to be on hold for three hours with their payer.

In time, the glitches will decrease. Some of them are obviously very short term while other will take longer to sort out, but one thing is certain, everyone will be a lot happier when they are resolved.  

Share your Thoughts:

Did you know about this change from ICD-9 to ICD-10 codes? Do you think this was a necessary update for healthcare policy? How do you think this healthcare policy change will impact billing to private and public insurance? 

Thank you to Baylor University MBA in Healthcare for keeping their students up to date on the changes and future in healthcare policy. 

Sources:

http://www.healthcareitnews.com/news/6-glaring-disruptive-icd-10-glitches

http://image.slidesharecdn.com/ppt2013icd-10preparationwrafbfinal11012013-131108070936-phpapp02/95/icd10-presentation-takes-coding-to-new-heights-11-638.jpg?cb=1383894713

New Solutions to Healthcare Delivery

A fascinating blog was recently written in a Harvard Business Review blog explaining why our efforts to change the way we delivery healthcare might not work. 

For a while now the discussion has focused around how our healthcare providers are compensated – fee for service vs. paying for patient outcomes. It’s no secret that many providers are motivated and incentivized by their payment structure, however this blog argues, rather convincingly, that we need to change much more than the payment structure if we want to change how healthcare is delivered today. This blog offers 4 ways that we might be able to achieve the kind of change we are looking for.

1. “Let doctors be doctors, not managers.” It’s true that physicians now days have so much more to do than just provide care for their patients. Perhaps if we allow physicians to just concentrate on the healthcare delivery, then we could see more efficient outcomes.

2. “Develop standard protocols for care.” Relativity is the enemy of efficiency. If we can help hospitals and providers to offer care using standardization, we will see more efficient outcomes.

3. “Hold people accountable for the little things. An endemic problem in many healthcare institutions is the unfinished task. Who is accountable for stocking the amoxicillin? For making sure the bathrooms are clean? For fixing patient beds? For paying vendors? These small tasks make a big difference to the experiences—and survival—of patients. We use simple tools like pareto analysis of drug use and reports of patient-centered outcomes to hold providers and their managers accountable to the care they deliver.”

4. “Invest in technologies that promote efficiency and transparency” Change is difficult for most of us, but it’s even more difficult for healthcare providers that have been doing things the same for decades. The average healthcare provider today is not a spring chicken, and they are not used to the technology changes that many of us are. However, this is an important step to moving healthcare into a more efficient industry.

I believe that these four suggestions are spot on. It’s amazing to know that healthcare challenges are global, and we can learn a lot about ourselves by looking abroad.

Share your Thoughts:

What do you think about the suggestions to change/solve the healthcare challenges? Do you think health policy should be involved in implementing some of these ideas?

Thank you to Baylor MBA Healthcare Program for encouraging creative solutions to complex health care and policy difficulties.

Sources:

https://hbr.org/2015/04/fixing-health-care-will-require-more-than-a-new-payment-system

https://rmsbunkerblog.files.wordpress.com/2013/03/what-is-an-aco.jpg

Big Data Results: Healthcare

‘Big Data’ is a buzz phrase that you hear a lot these days, but not necessarily something that you hear being associated with healthcare. Other industries like the airlines or just about any manufacturing company has used big data to analyze the hundreds of thousands and millions of flights, or used when producing a ‘widget’ that millions of Americans use. Big data has been effective for these industries for over a decade for the simple fact that these industries can use information to predict demand of their services.

Recently the Robert Wood Johnson Foundation has supported an initiative that is examining whether the ACA’s health policy coverage expansion has been as effective for patients and healthcare providers. The foundation used data from 14,300 providers caring for about 5.8 million patients. Some of the results of this initiative were fascinating.

“There was no evidence that patients with previously untreated illnesses were taxing primary care capacity during the first nine months of 2014 (though new patients may require more time to schedule and attend appointments). New patient visits to primary care doctors represented 21.8% of all visits this year through September, compared with 21.6% for the same months in 2013. And minimal changes in national rates of three major chronic diseases—diabetes, high-blood pressure and elevated cholesterol— provided no support for the concern that new patients were sicker than they have been in the past.”

This kind of data analysis can help everyone involved in healthcare from patients, physicians, hospital facilities and even health policy makers. Using this data analysis is easier said than done however. Let’s not forget that healthcare information is highly protected by HIPPA laws, and is worth millions of dollars by those trying to hack into systems and steal this information.

Be that as it may, the value for healthcare managers by leveraging this information is there, and should be used effectively in the future.

Share your Thoughts:

Do you think using healthcare data can help health policy more focused and effective? Do you think these types of analyses are important for tax payers and politicians to use in shaping American health policy? Do you think the results discussed are of interest?

Thank you to Baylor University MBA in Healthcare program for helping their students focus on real world health care practice and policy. 

Sources:

https://hbr.org/2014/12/public-health-data-should-rely-on-software-not-surveys

http://mhealthwatch.com/wp-content/uploads/2013/11/Big-Data-Health-Initiative-Unveiled-at-White-House-Event-300x189.png