The Centers for Medicare and Medicaid Services (CMS) says they are completely prepared for new ICD-10 claims within the current system. Recent testing has claimed to be successful and resulting in no rejections other than those caused by human error.
But what constitutes this system as “ready”? There is still a measurable amount of error in implementing both ICD-9 and ICD-10 codes into the system as it is currently programmed.
Negative testing was employed as part of the testing process, explaining some of these statistics. Over 1,000 billing companies and healthcare providers took part in the testing process. No new ICD-10-related flaws were detected during this test period. The overall pass-through rate of claims did not change significantly in the new trial compared to previous ones.
Preparations for implementing the system have included an official ombudsman for the ICD-10 program. CMS technical advisor Stacey Shagena declared the testing successful, adding that problems reported by contractors were fixed and did not re-emerge.
The transition to ICD-10 is coming. Are you prepared for it? As of October, 1 2015, health care providers must switch the ICD-10 code set. If you fail to do so, claims that are filed using ICD-9 codes will likely be denied.
The transition to ICD-10 is complicated and potential costly, causing it to be delayed multiple times. But, with no further delays expected, the time has come to commit to the transition. In fact it’s imperative to do so, as the industry is getting a proverbial “shove” in the back by the Centers for Medicare and Medicaid Services (CMS).
The good news is that CMS has put together a list of steps that health care providers can take to make the ICD-10 transition a little less frightening.
Video screenshot from WILX
Last week, Anesthesiology Business Consultants, a physician billing and practice management company, was raided by 20 federal agents at their Jackson, Michigan offices. The agents with the Department of Health and Human Services were brought in from Detroit, Philadelphia and New York to perform the investigation.
The investigation also included 10 computer forensic examiners who copied data from company computers and seized physical documents as well. After their arrival, some account managers were asked to stay for questioning, while other workers with the company were instructed to go home.
It has been alleged that Anesthesia Business Consultants is involved in health care fraud in Brooklyn, New York where the company has clients.
The state of Oregon recently reported that the 380,000 of its citizens who are newly enrolled in Medicaid are younger and healthier than previously expected. For this reason, the coordinated-care system did not adversely impact the ability to meet the targeted savings of $11 billion over 10 years.
There was a 21 percent decline in emergency department visits for patients served by the coordinated-care organizations in Oregon since 2011. In addition, the state reported there was a 48 percent decrease in hospital admissions related to chronic obstructive pulmonary disease and a decrease of 9.3 percent in hospital admissions that were linked to short-term diabetes problems. Furthermore, reports show that Oregon Health Plan members had lower utilization rates than existing members in the plan and inpatient costs have fallen since 2011.
In 2012, there was an Oregon Medicaid reform initiative that started after the CMS provided a $1.9 billion grant. There are now 990,000 enrollees on the Oregon Health Plan managed by 16 CCOs. These CCOs can earn incentive payments if they meet or exceed 17 performance-measure targets. This has, in turn, helped improve patient care while giving CCOs the ability to be proactive in how they care for people’s overall health.
Throughout 2010 MBA Medical Business Associates has directed a significant amount of their focus and capital on an effort to improve the billing efficiency and availability of information to anesthesiologists and other providers practicing in a hospital setting. MBA’s goal has been to use technology to improve the exchange of information between hospital-based providers and their business office. Isolation from the billing and business operations of their practice has historically been a source of inefficiency, financial strain, and additional risk for physicians who spend most of their time in the hospital.
According to MBA President Michele Andersen, “Because they spend the majority of their workday in the hospital, with limited access to the billing and business operations of their practice, anesthesiologists and other hospital-based providers typically have to invest more time and effort to assure their services are being billed properly and that they are getting paid for every service they provide. In addition, there is often a redundancy in paperwork and data entry, which not only reduces efficiency, but also increases the risk of billing errors.”