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The Key to Successful ICD-10 Conversion

Tuesday, December 27th, 2011

The key to successful ICD-10 transition is planning and preparation.

It is an exciting time in Health Care, but will take time and effort to make the transition a success.  The federal government announced that the implementation date had been pushed back to October 2013. This should allow  physicians, medical facilities, and billing services time to ensure that their systems are fully up-to-date with the new codes.

Using a trusted third party billing service can help with a successful conversion.  All reputable billing services will be working hard to make sure that their systems are completely converted to ICD-10. This includes not only making sure that software and systems are updated, but also that their full range of staff has been educated and trained on using this new vast array of diagnosis codes. This includes both physician and procedure codes (ICD-10-CM) as well as hospital based codes (ICD-10-PCS).

It may seem that October 2013 is a long way off, it will be here before we know it.  Now is the time to make to decide about allowing a competent, reliable and efficient medical billing service  handle the details for your practice and provide your office not just with claims processing, but also peace of mind.

The Countdown Is On For ICD-10.

Tuesday, December 20th, 2011

The World Health Organization (WHO) developed ICD-9 in the early 1970’s, now thirty years later, it is time for the US to join the rest of the world and implement  ICD-10,  a diagnostic coding system to replace the current coding system, ICD-9.

There are many reasons the United States is moving to this coding system, one, the current system is out of room.  The system needs more codes to assign to new medical diagnoses. Improved technology will allow ICD-10 to improve analysis of disease patterns and  treatment while streamlining the medical process.

The organization and process of ICD-9 is similar to ICD-10 but the ability and number of codes available increases- ICD-9 has 13,600 codes while the ICD-10 has 69,000 codes.

The Centers for Medicare and Medicaid Services(CMS) announced in January of 2009 that ICD-10 will be implemented into the The Health Insurance Portability and Accountability Act (HIPPA) mandated code set on October 13, 2013.   This is exciting news for the Health Care industry, but the Clock is ticking will you be ready?

Scheduling Services for Medical Offices

Monday, November 28th, 2011

Maintaining efficient use of time in any medical environment can be a difficult task. Doctors, nurses and patients need to be properly coordinated in order to maximize the qualitative and quantitative care given to patients. Creating this efficiency requires comprehensive scheduling solutions that allow for the most effective use of office personnel at all times. Many companies try to sell independent software that can be used in the office to keep track of scheduling, but an Integrated Medical Management solution may be a better choice.

Integrated Medical Management has the ability to manage your office scheduling with services including surgery and anesthesiologist scheduling, timely provider notification of changes, point systems availability and remote access. This integrated medical management solution will allow your office to run smoothly and maximize patient care without having to worry about the maintenance of onsite software or taking up the valuable time of medical office employees.

Scheduling services can be especially helpful to doctors who find that they are working between different offices or clinics. Remote access to scheduling can allow them to coordinate patients and services across multiple offices and clinics, making health care better for the patient and for the doctor. With the help of online scheduling, medical office staff can easily manage doctor’s appointment schedules, patient records and individual appointments. This will ultimately lead to better patient care and a more efficient and successful medical practice.

Medical Records Identify Theft Is Rising

Saturday, November 5th, 2011

The health records and medical billing industries have become increasingly digitized through the past decade. With this increase in technology comes a lot of advantages, but it comes with some disadvantages as well. One of the biggest dangers is the increased and unfortunate phenomenon of medical identity theft. Criminals are always looking to take advantage of information that might be financially advantageous, and they have found medical records to be an attractive target.

The theft of medical identities can take several different forms. Some perpetrators steal the names and social security numbers off patients and then use the information to obtain emergency medical care, which can be very expensive. Stolen insurance information such as member id’s and policy numbers can be used to receive medical care from a variety of medical facilities racking up huge bills. The most frightening form of medical identity theft is when medical billing employees take advantage of their access of records to steal information and then sell it on the black market.

Critics say that the problem stems from a lack of safeguards and proper evaluation of medical billing employees to ensure that theft is not taking place. With the increased digitization of all things medical into the future, the problem is not just going to go away. It is important that medical offices and patients are using secure systems that take very step possible to prevent identity theft. If the system does not properly adapt to securing the information of all patients, there may need to be a complete overhaul in the way records are kept in the future.

Scheduling Services for Medical Offices

Friday, October 7th, 2011

Maintaining efficient use of time in any medical environment can be a difficult task. Doctors, nurses and patients need to be properly coordinated in order to maximize the qualitative and quantitative care given to patients. Creating this efficiency requires comprehensive scheduling solutions that allow for the most effective use of office personnel at all times. Many companies try to sell independent software that can be used in the office to keep track of scheduling, but an Integrated Medical Management solution may be a better choice.

Integrated Medical Management has the ability to manage your office scheduling with services including surgery and anesthesiologist scheduling, timely provider notification of changes, point systems availability and remote access. This integrated medical management solution will allow your office to run smoothly and maximize patient care without having to worry about the maintenance of onsite software or taking up the valuable time of medical office employees.

Scheduling services can be especially helpful to doctors who find that they are working between different offices or clinics. Remote access to scheduling can allow them to coordinate patients and services across multiple offices and clinics, making health care better for the patient and for the doctor. With the help of online scheduling, medical office staff can easily manage doctor’s appointment schedules, patient records and individual appointments. This will ultimately lead to better patient care and a more efficient and successful medical practice.

New Information about Private Medical Insurance

Tuesday, September 20th, 2011

Valuable information about spiraling medical costs throughout the past few decades has been limited. This is partly due to the lack of data available. Statistics for Medicare and Medicaid have been widely available for study while data on private insurers has been anything but transparent. With such a large segment of the health economy in the United States being mostly hidden, it has been difficult to analyze trends and determine the cause of rampantly rising medical costs.

Recently a not-for-profit group in Washington D.C. called The Health Care Cost Institute was launched. The group will be responsible for analyzing large amounts of private insurance data from some of the largest health insurance companies in the United States such as Aetna, Humana, Kaiser Permanente and United Healthcare. The group will release trend reports twice a year that should shed valuable information about rising medical costs.

Research from available data so far has suggested several possible culprits for rising costs. One of them is that the health system is poorly organized and fragmented. Current financial incentives also goad hospitals and doctors to do more medical procedures and tests in order to earn more money. Disclosure of private insurance data will do a lot to disclose how influential these causes actually are to rising medical costs.

Safeguarding Patient Information

Thursday, September 15th, 2011

Keeping patient information confidential is one of the most important issues concerning both patients and their medical providers. The reason for this is clear. Public exposure of private health information can lead to a lot of hardship for patients. These hardships can include identity theft, fraud and embarrassment. Medical providers never intend for private information about their patients get out, but large data leaks of private patient information remains a large problem for medical providers throughout the United States.

There are several different reasons why private patient information is so vulnerable to leaks. Medical offices and companies tend to be behind the times when it comes to computer security and technology. This can leave them open to simple computer attacks. Without integrated systems in medical-organizations there tends to be a lot of duplicate files, which create ripe opportunities for thieves to steal data. Defragmenting data and technology in medical offices and organizations is essential for keeping patient information private.

Eric Johnson from the Wall Street Journal suggests several approaches to solving the problem. Security managers should take close inventory of data throughout an organization in order to determine vulnerabilities and best practices for securing data. Access restrictions should be implemented as not everyone in a health company would need to see all available data about patients. Most of all, data technology should be easy to use for doctors in order to encourage use of information systems that emphasize security.

Manufacturer Rebates Offset Mounting Costs of Medicaid Brand-Name Drugs

Tuesday, August 23rd, 2011

Prices and payment amounts for Medicaid brand-name drugs soared at around three times the inflation rate between 2005 and 2010, reports the Office of the Inspector General. These significant increases, however, were offset by savings created by the Medicaid drug rebate program.

Reports issued by AARP reveal that wholesale acquisition costs (WAC) for the most widely used brand-name prescription drugs have significantly increased since 2002. Addressing Senator Bill Nelson’s concern over AARP’s findings, OIG reviewed drug pricing changes and their impact on Government health care programs like Medicaid. The study examined changes in WACs, average manufacturer prices (AMP) and Medicaid payment amounts for brand-name drugs from 2005-2010. OIG also looked at the effect of rebates paid by drug manufacturers as part of the rebate program.

WACs, AMPs and Medicaid payment amounts increased between 34 and 40 percent at the median over the five-year period, while the inflation rate increased by just 13 percent. Increases in prices and payment amounts for brand-name drugs didn’t just outpace overall inflation though, they outpaced the inflation rate in each of the five years under review. The Office of the Inspector General did find that the per-unit net cost to Medicaid increased at a lower rate than other points of comparison between 2005 and 2009 when the per-unit payment amounts for Medicaid brand-name drugs were adjusted to account for the rebate amounts paid to States by manufacturers. Medicaid’s rebate-adjusted payment amounts for brand-name drugs actually declined at the median in 3 of 4 years.

The results of the study indicate that price increases for brand-name drugs don’t necessarily result in corresponding increases in Medicaid costs. Medicaid’s net costs for brand-name drugs actually increased at a lower rate than other points of comparison, including the inflation rate, due to the savings generated by the rebate program.

New Payor Reporting Tool

Wednesday, August 17th, 2011

The CPR Committee recently introduced its “CPR Reporting Tool,” which was developed as a resource for CPR communications with payers, to HBMA’s website. The tool documents significant quantifiable issues so that CPR and payors can jointly work to solidify reasons for improvement or change on behalf of HBMA membership and was originally designed to address only commercial payor claims issues. It was expanded, however, to include all payors including Medicare and Medicaid and provider enrollment issues.

Using the HBMA Heal The Claims survey conducted in April 2009, CPR developed a Top 10 List of payor issues, from which the reporting tool evolved, as a dynamic real-time survey approach to collecting information from HBMA membership. The tool has been designed using radio buttons and drop down menus—ideal for quick entry—and also features a “Comments” field.

The “Frequency” field is an important part of claims denials. It is meant to capture the amount of times you experience a particular recurring denial program that usually represented a programmatic issues with the payor’s adjudication system.

Improvements for Payers, Billers and Providers: Part 2

Thursday, August 11th, 2011

A myriad of issues affect medical bill management companies. Earlier this week, we discussed challenges facing billing and insurance companies, patients and providers, so here is the rest of the list:

Challenge: Incorrect claims adjudication based on the specialty of a physician.

Solution: Implementation of a mechanism that better enables claims adjudication for physicians with dual specialties.

Challenge: Loading of contract payment terms across multiple systems is inconsistent.

Solution: It is important for payers to make sure contract payment terms are loaded consistently across systems. Also, clearly identify the correct arrangements so provider staff can verify that the claims are paid accordingly.

Challenge: Websites are outdated.

Solution: Payers can help reduce most of the inaccurate claims submissions stemming from inaccurate or outdated information by providing physicians with real time information on their members eligibility and claims history.

Challenge: Authorization systems are outdated.

Solution: Replace the ineffective system—in which PCPs fax authorizations for specialists—with automated information technology so payers can help reduce the amount of paper, facilitate reimbursement and speed things up.

Challenge: Credentialing processes are unregulated.

Solution: Payers could increase the speed and efficiency of the present system (from several months to just 60 days) by applying a consistent process for enrolling or credentialing physicians.

Stay tuned for more from the official Integrated Medical Management Inc. blog!