iATROS Blog

Best Practices for HIPAA 5010 Implementation, Preparation & Compliance

SGR update - Senate approves a 31-day patch; House to act next

This evening the Senate approved by unanimous consent a bill that will provide a 31-day payment patch to the Medicare sustainable growth rate (SGR) formula. The bill will freeze current rates for services provided through Dec. 31, and temporarily avert a 23 percent cut to physician payments that was slated to take effect on Dec. 1.

The House of Representatives has adjourned for the week. The representatives are anticipated to vote on the bill upon their return.

While the 31-day fix, if approved, is a step in the right direction, it is only a temporary patch. Physicians still face a 25 percent cut on January 1, 2011. MGMA continues to call for an additional 12-month fix to give lawmakers time to find a permanent solution. Additional member grassroots advocacy during December is necessary to halt the 25 percent cut on Jan.1. We will continue to keep you apprised as we receive further updates.

Source: Washington Connexion

From Multiplication to Calculus: ICD-9 has 16,000 codes, ICD-10 has 155,000 codes

Imagine finishing up and turning in a multiplication quiz at the age of 8 while your teacher hands you a calculus exam simultaneously?  Now realize that if you can't handle that test, then you don't make your allowance.  Physicians livelihoods are about the get that much harder.  Reimbursement cuts may be looming, but figuring out how to even get reimbursed may even be more painful.  By Oct. 1, 2013, U.S. physicians are required to adopt an updated version of the International Classification of Diseases.  The current code-set used is called ICD-9, which consists of 16,000 codes, while the new code-set, ICD-10 has 155,000 codes.

As a prerequisite to the adoption of ICD-10, entities must adopt updated electronic transition standards, known as HIPAA 5010 by Jan 1, 2012, less than one year away.  HIPAA 5010 (HIPAA - Health Insurance Portability and Accountability Act) was initially scheduled to occur much sooner - April 1, 2010, but were pushed back near the term of the Bush Administration.

ICD-10 is commonly used across the globe in other countries, but what makes the U.S. that much different, is that those countries do not pay physicians according to diagnosis and procedural codes.  As a result, in the U.S., the preparation on behalf of all parties involved in the

The iATROS Billing and Collections Team Raises the Bar

Earlier this year one of our new clients had only been collecting 80 % of their total AR within 120 days, as of month end July 2010, six months after joining iATROS, our billing and collections team is capturing 98.47 % of revenue within 120 days. iATROS Healthcare Solutions strives to collect the maximum amount of revenue for each of our clients and we feel that the efforts of our billing and collections team reflects our company’s goals. iATROS is continually raising the bar to provide a more effective billing and collections effort for our clients.

For more information about iATROS Healthcare Solutions, please contact us at squinn@iatroshealth.com or via phone at (904) 296-1600.

Medicare & Other Health Plan Changes Coming in 2012

Florida medical billing professionals, listen up! Changes to Medicare policies and other health insurance policies are on the way for 2012, making patient verification benefits all the more crucial in Florida. Many plans have new limitations, exclusions or waiting periods that your medical billing staff will need to be aware of. Among the changes:

• Medicare Part B premiums are increasing, but deductibles are decreasing;

• Medicare Part C plans are expected to drop in price;

• For State of Florida employees, HMO options are changing and many won't be available next year;

• Capital Health Plan next year will consider chiropractic treatment a specialty service requiring specialist co-pay;

• Some plans that offered benefits covering both eye glasses and contacts will now cover only eye glasses or contacts.

The myriad of different benefits, restrictions, exclusions, waiting periods, etc. can be overwhelming to say the least. Verification of patient benefits is time consuming and can be confusing, taking time, energy and expertise away from helping other patients. But it's a crucial element of your business. Failing to accurately and thoroughly verify patient benefits can leave you holding the bag for uncovered treatments that your patients can't afford to self-pay.

To help keep your medical practice running efficiently and profitably, iATROS Healthcare Solutions offers pre-verification of benefits conducted prior to your patients' appointment. This allows your staff to more accurately collect patient co-payments and deductibles at the time of the appointment, reducing the number of patient collections days in your A/R to zero. Consider that after the customary 180-day collections window, each dollar gone uncollected is worth an average 45 cents. In today's shaky economy, collecting as much of your earned payments as early as possible is all the more important to your practice's bottom line.

To find out more, contact iATROS Healthcare Solutions, based in Florida but serving clients nationwide, at (877) 900-6763.

Contingency Plan Needed for HIPAA 5010 Compliance, Florida Health Experts and Others Say

Who's ready for the January 1 HIPAA 5010 compliance deadline? Not many, according to results of a new study by the Medical Group Management Association (MGMA). Those results have prompted industry officials to ask the Department of Health and Human Services (HHS) to immediately issue a comprehensive contingency plan.

The MGMA wants the HHS to develop a plan that will allow health insurance plans to adjudicate claims even if they lack a portion of the required data content. This will allow practices that are unable to fully meet the New Year's Day deadline to continue practicing without a cash flow disruption. According to the MGMA's study:

• Nearly a fourth of study respondents say they have yet to even hear from their practice management system software vendors regarding the HIPAA 5010 transition;

• Only 35 percent say they've begun internal testing of their new systems;

• Almost a quarter of respondents (21.7percent) have yet to schedule internal testing;

• Just 5.7 percent say they've been contacted by all of their major health plans'

• 35 percent report that a few of their major health plans have contacted them;

• Only 15 percent have begun external testing with all of their major health plans;

• A full 27 percent say external testing has not yet been scheduled;

• Just 4.5 percent say their 5010 implementation is complete;

• 40 percent say their implementation is less than one quarter complete.

"It is clear that a significant number of medical groups will not have the ability to transmit claims and other electronic transactions using the Version 5010 format by the January 1 deadline," said Susan Turney, MD, MS, FACP, FACMPE, MGMA president and CEO.

Turney noted study results that show physician practices are developing contingency plans of their own to help dodge financial hardship caused by the expected interruption in cash flow. More than a third (33.3 percent) plan to establish a line of credit at a local financial institution; 35.6 percent will set aside cash reserves to help sustain operations; and more than half (50.6 percent) say they'll go back to paper claims.

"It is unacceptable to expect physician practices to take such drastic action, such as reverting to paper claims, to avoid serious cash flow issues resulting from this mandate," Turney said. "The shift in the industry to electronic transactions in recent years could amplify the problem. Many health plans have transitioned staff away from handling paper claims, and we are concerned that a sudden, large increase in volume could also result in delayed payments."

Are you ready for the Jan. 1 HIPAA 5010 deadline? If you're still having issues, contact iATROS Healthcare Solutions at 877-900-6763. Our expert EMR and healthcare compliance consultants can help walk you through all portions of your transition to make sure you're up and running with little or no disruption in your cash flow or business operations.

A Code for What Ails You - Florida Medical Codes From Lightning Strikes to Turtle Bites

Have you ever looked at exactly what ICD-10 entails, Florida? Medical codes for diagnoses and procedures together number 155,000, up from 24,000 just a few years ago. And some of what you'll find in those codes may seem strange.

Get injured in a chicken coop as opposed to on a squash courts? There's a code for that. Was it an accident in the driveway of a mobile home or a house? There's a code for that, too. Struck by lightning, pecked by a macaw or injured while playing a tuba - it's all in there. And many of these codes have people scratching their heads and wondering if medical coding has gone a bit overboard.

We're unsure why it matters whether you slipped and hit your head on the floor of an art gallery or the opera house. But we assure you there's a medical code that differentiates the two. And it's up to Florida's medical coders to get every detail correct when submitting claims to insurance companies for a physician's reimbursement.

For many physicians in Florida, medical coding, along with multiple other ever-changing functions, has become a strain on their human, time and financial resources. That's why iATROS Healthcare Services offers services including medical coding and billing, patient scheduling and pre-verification of insurance coverage, EMR conversion and consulting and more. If the business of healthcare is limiting your ability to actually deliver quality healthcare to your patient, call iATROS at 877-900-6763.

Five Ways to Better Florida Medical Coding Compliance for Your Surgery Center

Here at iATROS Healthcare Solutions, we're constantly asked for advice on improving medical coding compliance in Florida. Medical coding has undergone massive changes in the past few years. ICD-10 alone increased the number of diagnosis codes from 13,000 to 68,000 and the number of procedure codes from 11,000 to 87,000, making an already tough job even tougher. Here are five top ways to improve your surgery center's medical coding compliance.

1. Keep detailed operative notes. Include descriptive keywords, measurements and counts. For instance, many surgeons miss out on compensation earned because they'll list, for instance, removal of two colon polyps, failing to note that the second polyp was removed via a different method from a different location. Removal of that second polyp can be billed as a second procedure.

1. Hire or outsource to experienced coders. Those who have been doing medical coding for a significant amount of time have a better understanding of the subtle difference between certain codes and modifiers. Although schools are churning out new coders in record numbers willing to work for less money, an experienced coder, whether in-house, freelance or via a medical coding provider like iAtros, will be well worth the investment and could help save you from being charged tens of thousands of dollars for coding compliance mistakes.

1. Insist upon open communication between physicians and coders. Operative notes often lack certain needed details or can simply be confusing. Many centers coders schedule weekly appointments to review operative notes together, making doubly sure that no mistakes, omissions or opportunities for compensation are missed.

1. Keep your staff up-to-date on medical coding and compliance changes. Join medical societies and associations, subscribe to coding newsletters and read medical publications that include information on coding compliance issues.

1. Hire an outside medical coding compliance consultant. In Florida, medical coding and compliance is particularly critical, considering the higher-than-average number of Medicaid enrollees statewide. iAtros Healthcare Solutions boasts a team of highly experienced medical coding and compliance specialists. We keep up-to-the-minute on all industry changes and trends. Let us handle the headache of medical coding and /or coding compliance issues while you and your staff concentrate on treating patients.

Call iAtrost Healthcare Solutions at 1-877-900-6763 to discuss your Florida medical coding compliance needs today.

Newly Uninsured Often Skip Needed Healthcare

NEW YORK CITY – Nearly 75 percent of people who lost their employer-sponsored health insurance when they lost their jobs over the last two years said that they skipped needed healthcare or did not fill prescriptions because of cost, according to a new Commonwealth Fund brief.

“Nearly three quarters of people reported they had a problem paying medical bills or were carrying medical debt,” said Sara R. Collins, PhD, coauthor of the brief and vice president of the Commonwealth Fund, a private, New York City-based foundation. “People didn’t access care that they needed because of the cost.”

According to the Commonwealth Fund brief, an estimated 15 million working-age adults lost their jobs and health benefits from 2008 to 2010. A majority of these individuals (57 percent) became uninsured. One-quarter of adults were able to go on their spouse’s insurance policy or find another source of coverage, while 14 percent continued their coverage through COBRA (Consolidated Omnibus Budget Reconciliation Act).

“This shows how vulnerable people are when they lose their jobs to also losing their health insurance. There are not affordable options outside of jobs,” said Collins.

The Commonwealth Fund advocates for more intervention from the federal government. “To the extent that the jobless situation continues, hiring isn’t at levels required to reduce unemployment. Reinstating COBRA subsidies to cover 65 percent of premiums would provide protection for those who have lost benefits,” said Collins.

Other key findings:

• Over the period 2008 to 2010, an estimated 9 million adults ages 19 to 64 lost a job with health benefits and became uninsured.

• Eight percent of lower-income workers continued their coverage through COBRA after they were laid off, as opposed to 21 percent of workers with higher incomes.

• About one-half of surveyed adults who became uninsured after losing a job with benefits skipped a recommended medical treatment or follow-up test (52 percent), did not get specialist or other physician care when needed (50 percent), or did not fill a prescription (47 percent) in the past year, citing cost as the reason.

Source: Healthcarefinancenews.com

Modernizing Medicaid Pharmacy Could Save States $33 Billion

DALLAS – A new study by the National Center for Policy Analysis shows that states and the federal government could save $33 billion in prescription medication costs by switching to models used by Medicare and other private payers.

“Drug therapies often substitute for more expensive and less effective surgical treatment and can reduce the need for hospitalization. Americans see their doctors more than 890 million times each year, and two-thirds of office visits to physicians result in prescription drug therapy,” said Devon M. Herrick, senior fellow with NCPA and an author of the report. “Even though they appear to provide better value for money than other forms of therapy, drug expenditures are one of the fastest growing components of the Medicaid program.”

“Increasing the Cost-Effectiveness of Medicaid Drug Programs” identified a number of areas in which states could save money, including increased use of generic drugs, negotiating competitive rates for drug dispensing, coordinating and tracking drug therapies, establishing reimbursement rates similar to what private plans pay, and empowering consumers with some control of the money they spend on medications.

Many states pay for Medicaid prescription drugs on a fee-for-service model and are lobbied on the local level to negotiate higher dispensing fees paid to pharmacies. The average state dispensing fee is $4.82 per prescription, with Alabama ($10.64) and Texas ($7.50) having the two highest rates in the country. By comparison, Medicare Part D pays an average dispensing rate of $2.

In Texas, Gov. Rick Perry is proposing the state's prescription drug benefits be managed like those in the private sector, a move the state has estimated will save $84 million in the first year alone.

“This latest research confirms that Governor Perry and Texas policymakers are on the right track. Medicaid shouldn't pay more for drug benefits than private insurers and Medicare," said Mark Merritt, president and CEO of the Pharmaceutical Care Management Association, a national organization representing pharmacy benefit managers. “Currently, the program uses fewer generic drugs and pays drugstores more than triple the fees that Medicare or private insurers pay. By modernizing Medicaid drug benefits, Texas will save $3.8 billion over the next decade without cutting benefits to those in need.”

According to a February 2011 report from the Lewin Group, a healthcare policy research and management consulting firm, states could save more than $25 billion over 10 years by focusing on lowering dispensing fees ($10 billion) and increasing generic use ($15.3 billion).

While generic drugs make up more than two-thirds of all medications spent for Medicaid, they account for less than one-quarter of total spending, providing an opportunity for additional saving through wider use of generics. Further, the average price for a generic drug prescription in the Medicaid program is $20.61, compared to the $195.54 average for brand name medications (including drugs for which there are no generic equivalents).

The NCPA report also noted that efforts to lower dispensing fees to resemble Medicare and private plan benefits face a stumbling block based on federal law. Most private plans “carve in” prescription medication benefits and then negotiate dispense rates on a broad basis, either by the health plan itself or through a third-party pharmacy benefits manager. Most state Medicaid programs “carve out” the prescription benefits based on federal requirements for drug companies to provide rebates of up to 23.1 percent of the average manufacturer’s wholesale price for brand drugs and 13 percent for generic drugs. Since these rebates were not available to private plans administering pharmacy benefits, most states run their prescription programs at the state level.

“State Medicaid programs that carve out drug benefits often do not pay sufficient attention to coordination and management of drug therapies. This responsibility is essentially taken away from health plans and taken over by the state,” the NCPA report noted.

By allowing states to operate more like Medicare Part D or private plans without jeopardizing rebates from pharmaceutical companies, lowering dispensing fees from the average of $4.81 to near the Medicare average of $2 would save significant money.

“Many pharmacies can survive on $2 dispensing fees from the PBMs that manage private drug plans. Some chain drug store and big box retail pharmacies succeed on $4 generic prescriptions they fill for consumers without a drug plan,” the report stated. “This suggests Medicaid fee-for-service dispensing fees are arbitrarily set too high in many jurisdictions.”

Source: Healthcarefinancenews.com