Saturday, November 29, 2014
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How to Stop Herding Cats and Start Gearing Up for ICD-10

Save the Date!  ICD-10 goes live on October 1st20132014, 2015!  The third time’s the charm!

 

Now that there’s a new compliance date, you may be wondering what’s next.  This is the time to take action and start testing not only your claim files, your whole process.   A large focus has been placed on the changes coders will be facing, but coders are only as good as the information they receive and the knowledge and tools they have at their disposal. 

 

5 Steps to Prepare for ICD-10

    1. Speak with your hospital to see what changes, if any, they have in store for collecting and transmitting newly required pieces of information.
    2. Check with your billing software vendor about testing options and how you will manage the ever-present payer specific requirements you encounter when there is a change.
    3. Verify with all of your vendors their capability to handle the format differences and capture new diagnosis data elements required for accurate coding in ICD-10.
    4. Plan for the increased number of appeals and follow-up items this will cause.
    5.  Test, re-test, and test again. 

 

If you’ve started testing, congratulations!  You are well on your way.  If you haven’t started testing yet, don’t worry – there’s still time, and we’ve outlined some helpful resources to guide you in formulating your plan.

 

While it may seem obvious to some, all practices must verify they are compliant when submitting ANSI 5010 claim files.  Perhaps some eyes are rolling at this obvious statement, but there are some providers’ currently submitting ANSI 4010 files without being aware they are still submitting version 4010.  How could this happen, you may ask?  Most likely their clearinghouse offered the service to up-convert 4010 to 5010 and they never encountered issues with rejections due to an incorrect format, leading to the assumption, they must be compliant.  The implementation of ICD-10 is predicated on the format of the 5010 file structure, so ensuring you are filing a 5010 format is a must. 

 

Once you’ve verified your claims format, finding the next place to start can be a daunting task.  Being overwhelmed and wondering if you are covering all of the areas of impact can seem as manageable as herding cats.  Just typing “ICD-10” into the search engine on a computer will bombard you with pages of information, and much of it is either outdated or not applicable.

 

IMAGINE has a solution to help with the conversion. IMAGINE Conduit, a revolutionary application will assist your practice with the ICD-9/ICD-10 transition. Conduit is designed to help further prepare users for the scheduled October 1, 2015 switch to ICD-10 diagnosis codes by creating a crosswalk for converting electronic 837 claim files that utilize current ICD-9 codes to 837 claim files that utilize new ICD-10 codes. By taking an ICD-9 HCFA and adapting it to an ICD-10 HFCA with minimal human intervention, practices with older technology can better survive the upcoming switch.

 

CMS has released a great deal of information regarding the move to ICD-10, and to help with the transition, they’ve launched “Road to 10”; a practical website, giving users specifics on the whole process including a template for you to build your own transition plan.   The transition is broken down into 5 categories:  “My Specialty”, “My Practice Size”, “My Technology & Staffing Partners”, “Your Trading Partners” and “My ICD-10 Readiness”. 

 

 

How to Build Your Transition Plan Using “Road to 10

Select “Build Your Action Plan” option on the home page of the site,
select your specialty, and choose your options.

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  image002

 

 

Once you’ve made your selections, a timeline will be generated for the different areas
of impact and general information available for each shown below the timeline.

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You can drill down into each section for more detailed information and
ideas/questions for planning your transition.

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The bottom line is the more effort you put into your readiness now, the less likely you or one of your staff members will be labeled with a diagnosis of F48.8 - Occupational Neurosis. 

 

Procrastinate not my friends; the end is near….or at least until the next delay is announced

 

Resources: 
Road to 10; http://www.roadto10.org/

 


 About The Author

Brandy Koskodan photo 

 

 

Brandy has been with the IMAGINE team since 2005 and serves as a Client Success Manager where she enjoys helping clients use medical billing technology to effectively manage their practice.

 

 

 

 

Blog - IMAGINE Team

Breast Cancer Awareness: Exposing the Myths and Uncovering the Facts  

As you may be aware, breast cancer is the 2nd leading cause of cancer death in women and 1 in 8 women will be diagnosed with breast cancer in their lifetime.  

Until the mid to late 1960s there was no specific test for breast cancer.  Although x-rays were discovered in 1895, it was in 1956 that Robert Egan, a radiologist, developed a special film technique.  The first mammogram machine was introduced in 1966.  In the 1960s, simple screen film mammography was state of the art.  New techniques were developed that reduced the amount of radiation required for mammography through continuing efforts from multiple companies in the field. 

Breast Cancer Facts: 

Breast cancer is usually of two main types based on their cell origin.  Lobular carcinoma starts in parts of the breast know as lobules or the area that produces milk.

Ductal carcinoma starts in ductules or the tube that carries milk from lobules to the nipple.  Most cancers originate from the ducts.  

Factors that influence the development of breast cancer include:

    • Age in that a risk of developing breast cancer is found in women over the age of 50.
    • Genetic predisposition for breast cancer, patient’s who have BRCA1 and BRCA2 genes have a significantly increased chance of developing breast cancer.  Some studies have suggested that even an 80% chance of getting breast cancer during their lifetime.
    • Patients with a family history of breast cancer have a high-risk of developing breast cancer as well.

 

Factors that increase your risk include:

    • Alcohol use.  Patients with one or two glasses of alcohol a day might increase the chance of developing breast cancer.
    • Women who have never had children or who had their first child after the age of 30 have an increased risk of breast cancer.
    • Hormone therapy gives you a slight increased risk of breast cancer or increasing your risk of breast cancer.
    • DES (diethyl stilbestronate) in mothers of female children might increase those female children’s risk of breast cancer although most of women, that that applies to, are decreasing in numbers since this drug was given in the 1940s through the 1960s.  
    • Radiation increases you chance of breast cancer just the same as it increases the chance of cancer anywhere especially true if radiation was given as a child during breast development.


Breast Cancer Myths

Myth: Radiation exposure from a mammography will increase my risk of developing breast cancer.    

Truth: The radiation dose in modern mammography is so low that it is unlikely to cause breast cancer.  An interesting fact from eMedicineHelp.com suggests that a passenger on an intercontinental flight is exposed to more radiation that one would receive from having a mammogram & according to the National Cancer Institute, “The benefits of mammography, however, nearly always outweigh the potential harm from the radiation exposure. Mammograms require very small doses of radiation. The risk of harm from this radiation exposure is extremely low.”

Myth: Only women can get breast cancer.  

Fact: It should be noted that males can absolutely have breast cancer and 1% of all breast cancer originates in males.  

Myth: If someone in your family has breast cancer, you are likely to get it as well.  

Fact: Most women who have breast cancer have no family history.  Statistically only about 10% of those diagbosed with breast cancer have a family history of the disease though women with a family history are considered to be in a higher risk group.

 

Breast Cancer Detection & Treatment 

Other means of detection are available for detecting breast cancer.  These include and most importantly self-examination oftentimes women find it easier to examine themselves while in the shower and in the upright position.  It is important for each woman to become familiar with her breast texture in order to discover a lump early and not fully depend on medical personnel to discover a mass.

Ultrasound is an excellent way to characterize masses in the breast.  Largely it can determine whether or not the mass is aggressive and invades adjacent tissue, whether the mass is cystic or solid, or whether the mass has some calcifications that could suggest malignancy.  Ultrasound should be used as an adjunct to mammography and breast examination.  

MRI is an excellent way to evaluate the breast especially in patients who have dense breast tissue.  In fact, an MRI is slightly more diagnostic in patients with dense breast tissue.  Several states have passed laws that mandate that women be informed of the fact that MRIs in patients with dense breasts are more diagnostic than simple mammography. 

 

What can you do to discover breast cancer at the earliest stage because discovering it earlier makes it more manageable and in some cases, curable. 

  1. The first and most important thing any woman or man can do is be familiar with their breasts and once again the best place to do that is in the shower.  Most women feel that with soap and in the upright position that it is easier to examine themselves.  Any suspicious mass or change in the tissue character should be report to the patient’s doctor.
     
  2. Signs and symptoms

    - Breast lump or lymph node lump in the arm pit.
    - Change in size and shape of the breast or the nipple.  Redness, dimpling, puckering, or orange color to the skin.
    - Drainage that may be yellow, pus-looking or may be bloody. 

  3. Be familiar with your genetic background.  Be familiar with close or first generation relatives that have had breast cancer.

  4. Yearly mammograms are still the recommendation for patients over the age of 40.  There have been multiple studies that want to change the interval for screening in patients over the age of 40 and patients over 50.  However, currently the recommendation remains a yearly mammogram in patients over the age of 40.

 

In summary, with today’s technology, state of the art medicine, practiced vigilance by women routinely giving themselves a breast exam, the ability to detect an early lesion, lump, or change in breast tissue could possibly be treated and potentially cured.

 

October  -  Breast Cancer Awareness Month

How can National Breast Cancer Awareness Month make a difference?  We can use this opportunity to spread the word about steps women can take to detect breast cancer early.

Steps women can take to detect breast cancer early & spread the word

  1. Grab your girlfriend, relative, loved one, or neighbor, and plan a day to get your mammograms together.   Finish the day with a plan to do lunch, go to the spa, go workout…..”Just Do It”….Celebrate “Life”
  2. Go on the Breast Cancer Awareness Walk that’s being planned in your community….. BECOME AWARE!!!
  3. Support those who have lived or are living with Breast Cancer and those who have survived Breast Cancer.
  4. Ask doctors and nurses to speak to women in your community, church, office, or any organization you belong to, about the importance of getting screened for breast cancer.
  5. Encourage women ages 40 to 49 to talk with their doctors about when to start getting mammograms.
  6. Organize an event to talk with women ages 50 to 74 in your community about getting mammograms every 2 years.
 

For more information on breast cancer, visit www.breastcancer.org

Sources:
Wendell V. McAbee M.D. 

www.eMedicineHelp.com
http://www.nationalbreastcancer.org/breast-cancer-myths


 About The Author

Delena Supinski

 

 

Delena Supinski coordinates sales activities for IMAGINE Software products and services in the Western United States, while working to provide guidance and build strong relationships with new and existing clients nationwide. 

 

 

 

 

 

Blog - IMAGINE Team

Digital Communications Poses Possible Security Risks & How You Can Protect Your Practice

Microsoft’s Southeast headquarters in Charlotte, N.C., hosted an InfraGard seminar where former Whitehouse CIO, Theresa Payton gave some interesting statistics.  New forms of Malware are found every 90seconds (most re-engineered) and anti-virus programs only catch a third of them.  Two-thirds of breaches are due to human error with ninety percent of them coming from clicking on a bad link.

Although these stats are chilling, the recent increase of hackings has many providers and medical professionals fearing the use of digital communications with patients.  While the benefits of using EMR’s and devices such as apps, and iPads are grand (consistency in care, faster dissemination of information for treatment, etc…), the risks are daunting with infraction penalties ranging from fines up-to 5 million annually (per violation), to imprisonment for up-to 10 years.  The recent Community Health Systems (CHS) breach total cost are estimated to be as high as 50 million.  Experts are anticipating these costs to continue rising.  Jerome B. Meites, Chief Regional counsel for the Office of Civil Rights stated, the crackdown on HIPAA violations over the past year will “pale in comparison” to the next 12 months. 

This rise in fines and the rise of seeking out infractions are causing quite a stir and much like a bad check on the wall of a restaurant, perpetrators can find their dirty laundry aired on a much larger scale-a digitally public wall of shame.

The FBI extended warnings earlier this year to healthcare firms stating they are being targeted by hackers for increased cyber invasions for financial gain.  So how do you steer clear of leaking patient data with savvy hackers who are directly targeting healthcare organizations?

IMAGINE Software’s Systems Specialist and cyber security guru, Jeff Smith offered some tips to help keep your patient data safe:

1. Get Rid of Old Data - Implement Digital shredding strategy for old data (EOB’s, charge reports, patient checks, HCFA’s,  etc…) in your network.  Ensure old data that is not needed is discarded.

2. Analyze Your Network Traffic - Have your IT team create a baseline so you know your normal traffic vs suspect traffic so you can spot anomalies.

3. Have a Crisis/Backup Plan - Practice worst case scenario planning  so that if a beach does occur in your organization, you will have a plan for how each department responds.   Have a plan on how your communication team responds, who gets involved from the legal team ect...

4. Educate Your Staff on Best Practices - Spread awareness of security risks and issues  to your company.  Educate your staff on the importance of not sharing passwords or leaving them on desks, the need for changing passwords frequently, not clicking on links, locking computers when away, and reporting suspicious links or activity.

5. Know Your Laws and What’s New - Stay up to date on laws; specifically HIPAA.  If doing business internationally or across state lines, there are new laws for how data is kept.  It’s key that you understand the HIPAA Security Rule.

6. Conduct a Security Risk Analysis 

a.       This includes Administrative Safeguards (staff training, staff access to data, termination procedures etc…), Physical Safeguards (protection of the equipment, locked doors, surveillance cameras, and protection of the facility where equipment is housed), and Technical Safeguards (protection of the integrity of your office’s computer network, user identification, automatic logoff, data encryption etc…) .   

b.      The application is available for downloading at www.HealthIT.gov/security-risk-assessment and will also produce a report that can be provided to auditors.  According to the U.S. Dept. of Health & Human Services, “By conducting these risk assessments, health care providers can uncover potential weaknesses in their security policies, processes and systems.  Risk assessments also help providers address vulnerabilities, potentially preventing health data breaches or other adverse security events.  A vigorous risk assessment process supports improved security of patient health data.”

 

For more info on HIPAA Violations & Enforcements: Visit American Medical Association: http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/hipaahealth-insurance-portability-accountability-act/hipaa-violations-enforcement.page

Susan D. Hall ( June 16, 2014) OCR attorney predicts spike in HIPAA fines.  Retrieved from http://www.fiercehealthit.com/story/ocr-attorney-whopping-hipaa-fines-you-aint-seen-nothin-yet/2014-06-16

Lynn Sessions, Kimberly M. Wong and Cory J. Fox (June 13, 2014) HHS Attorney: Major HIPAA Fines and Enforcement Coming.  Retrieved from http://www.dataprivacymonitor.com/enforcement/hhs-attorney-major-hipaa-fines-and-enforcement-coming

Marianne Kolbasuk McGee (April 23, 2014) FBI Issues Healthcare Cyber-Alerts.  Retrieved from http://www.healthcareinfosecurity.com/fbi-issues-healthcare-cyber-alerts-a-6779 

U.S. Department of Health & Human Services. Breaches Affecting 500 or More Individuals.  Retrieved from http://www.hhs.gov/ocr/privacy/hipaa/administrative/breachnotificationrule/breachtool.html

U.S. Department of Health & Human Services.  Summary of the HIPAA Security rule.  Retrieved from http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsummary.html

 


 About The Author

IMAGINE'S Joya Sain 

 

 

Joya is on IMAGINE’s Sales & Development team where her ultimate mark of success is growing her clients’ practices using targeted strategies and cutting edge software to increase their patient acquisitions and give doctors maximum medical reimbursement. 

 

 

 

 

Blog - IMAGINE Team

Electronic Health Records: 5 Things You Should Know

Healthcare reforms, government incentives and Meaningful Use are just a subset of the driving factors nudging healthcare providers to adopt electronic health records at astounding rates.

Here are 5 things you should know while researching, vetting and considering a new EHR or a migration to a new EHR platform.

1. Sustainability. The most important factor to consider when selecting an EHR for your practice is the viability of the platform provider. Stage 2 Meaningful Use Certification requirements are far more sophisticated and the documentation required more tedious than that of Stage 1. Confirm that your vendor is in the EHR business for the long-haul and inquire about on-going development plans to meet new government standards.

2. Specialty. The 2013 survey of the EHR market by Black Book Rankings found that of the Physicians planning to change their EHRs, 77% reported that their current EHR was not well suited to their practice. There exists a WIDE array of choice in EHR platforms – do you need one highly specialized to your discipline? At first glance, it may seem appealing to have an EHR specific to your specialty – but will the functionality ever limit your practice as your business continues to grow and potentially transform? A happy medium is to choose an EHR with flexible customization capabilities and open architecture, one with configurable macros or templates and one that will evolve with your practice.

3. Voice Dictation. The biggest fear, apprehension and overall concern heard from providers is a resounding – “An EHR is going to slow me down!” Choose an EHR that will mitigate some of this fear by having the ability to incorporate voice dictation. After a month, a Tennessee practice implemented voice recognition software and the practice manager estimates using the dictation capabilities in conjunction with the EHR reduced the time related to clinical documentation by 75%! It CAN be done!

4. Interoperability. A lack of interoperability among EHR is second only to implementations as providers’ top tech concerns. Confirm that your EHR platform has the ability to interface and exchange information with other software platforms. The Stage 2 Meaningful Use movement focuses on coordinated care – necessitating data exchange – an inability to share information between systems will have negative consequences.

5. Implementations / Training. Practices must establish a POSITIVE Change Management Team and fight anxiety from rising in both staff and providers. Whether migrating from an existing EHR or implementing an EHR for the very first time attitude is everything – with a fabulous, hands-on trainer, of course! The old adage that “you get what you pay for” is certainly applicable in this instance. EHRs are complex platforms that (should) require more training and set up than what is attainable via an on-line self-lead tutorial. Assuming your team already has the right attitude for EHR adoption, confirm that your chosen platform implementations team will be on-site to ensure success together! Navigating EHR setup, configuration and nuances of the platform, based on your specialty, is critical to your success – especially for Meaningful Use attestation.

The Brave New World of healthcare, data sharing, coordinated care and pay for performance are just around the corner. One thing is for certain: healthcare will only continue progression with increased complexities. Invest in your practice. Invest the time and energy now to find the best suited EHR for your practice – not just the “best priced” right now.

EHR Scope, LLC, “Why specialists don’t like their EHRs”
http://www.ehrscope.com/blog/specialists-dont-like-ehrs/, Accessed 19 August 2014

Physicians Practice, “2014 Technology Survey Results”
http://www.physicianspractice.com/technology-survey/2014-technology-survey-results, Accessed 19 August 2014

 


 Courtney Gebben - IMAGINE Software

Courtney is a Sr. Account Executive on the IMAGINE Sales team where she thrives at identifying new opportunities for the IMAGINEehr and IMAGINE Practice Manager solutions.  

 

Blog - IMAGINE Team

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