Meeting the deadline for ICD-10


The switch to ICD-10 is still due for the United States, since the rest of the developed countries like UK, France and Australia have made the changeover from ICD-9 to ICD-10 back in the 1990s.
ICD-10 was introduced to physicians and provides them with a more precise way of coding the patient data. This is important as the diagnosis and their relevant treatments have changed significantly in the last decade since the beginning of ICD-9. However some physicians have their apprehensions about the enhancement in specificity that can lead them to more claim denials.But there is no need to be worried about. Using the ICD-10 will help remove uncertainty and will eventually reduces the amount of documentation needed to validate the claims. Thus there will be fewer denials as it will be easy to assign the codes correctly.

Challenges faced in transformation 

The ICD-9 is in the use for very long time that it has become an important part of our health system. From technical schools to the professional ICD-9 coders and insurance companies. All of them have a system built on use of ICD-9.
Small practices are going to hit the hardest by this change. In a study carried out by the American Medical Association (AMA) in collaboration with other medical groups, the transformation cost can be as much $84000 for small practices and $300,000 for practices consisting of 10 physicians. Most of these costs are associated with training of the staff, revision of super bills and modifications in work and cash flows. The study further revealed that payer contracts and enlarged documentation costs are additional costs to overcome.

Overcoming the challenges  

As the deadline draws closer, physicians are trying their best to make sure their revenues are not affected by the ICD-10.
Maybe the most important part of transformation for the practices is to synchronize themselves with their vendors in order to make smooth transition from ICD-9 to ICD-10. However there will be a significant fee the clients have to pay in order to upgrade to the new coding set.
Much more will be required than just a quality health IT vendor for a smooth transition to ICD-10. Physicians have to study on the new regulations and prepare themselves for ICD-10. Also a fair amount of training will be needed. Attending webinars about ICD-10 and utilizing any kind of material to get staff ready for the change.
It is important that you prepare your practice for the ICD-10 before October 2014 and make the appropriate decisions that will help you avert paying high price for the transformation. Although the early stages of ICD-10 will not be simple, but preparing and planning ahead of time will help you save lots of effort and make it less painful.

Labels: ,

Over 4 million people register for Obamacare



With just five weeks to go before Obamacare enrollment period comes to an end, federal officials revealed that about 4 million people have signed up for health insurance plans that are being sold under the Affordable Care Act (ACA).The new target for Obamacare comes with various warnings that could affect the peoples view about success or failure of the program. The target includes how many people actually pay for their coverage and how far the registrations are lagging in terms of initial estimates.
The Obama administration has detached itself from its own reporting of Obamacare registration statistics as it looks to see how the healthcare reforms could be improved.
Obamacare’s number of registrants was revealed by Marilyn Tavenner’s blog post, the administrator of Centers for Medicare and Medicaid Services (CMS).
According to her, the new Affordable Care Act (ACA) is benefiting the Americans. She said that around 4 million people have signed up for private health insurance plans through the state-run marketplace. However, she didn’t disclose the number of people who have paid premium for the first month as a requirement for registration. According to insurance experts, about 20% of those who have registered did not pay for their plans.
The Congressional Budget Office (CBO) had earlier predicted that in February 2014, about 1.27 million people will register for Obamacare. In a February 2014 interview, President of Health Policy and Strategy Associates in Washington, Robert Laszewski said that Obamacare registration is falling off significantly.
CBO made its predictions before the launch of HealthCare.gov which famously crashed for a good period of 2 months after its launch due to various unidentified problems, which directly affected the registration process. Affordable Care Act exchange websites in Maryland and Oregon also suffered similar issues with their portals which contributed to the overall program collapse.
CBO had originally predicted that around 7 million people would register for Obamacare by the end of March 2014.
Recently, the US vice president Joe Biden said, "We may not get to 7 million, but if we get to 5 or 6 million, that's a hell of a start."
On Tuesday, February 25, Secretary of Health and Human Services (HHS) Kathleen Sebelius said that the Obama administration never considered CBO’s estimated figures as realistic. According to her, it was just a forecast and the research methodology behind it was unclear.
March 31 is the deadline by which the Americans must have a health insurance or they will face a tax penalty that totals to 1% of their adjusted gross income or $95, whichever is higher.
It may be a good initiative by the Obama administration, however, it still remains to be seen whether they are able to achieve their targets come end of March.

Labels: , , , , ,

How ACOs get paid?


In traditional Medicare payment system hospitals and doctors are generally paid for each procedure and test. According to experts it increases the costs. But ACO’s create saving incentives by providing the bonuses when the providers keep the costs down. Hospitals and doctors are required to meet some specific standards, mainly focusing on prevention. What it means in simple words is that the providers are paid for keeping the patients healthy and out of the hospitals. If for some reason ACO isn’t able to save any money than they could be trapped with investments costs mainly consisting of improvement costs like adding a new nurse manager, they also have to pay a penalty if they doesn’t meet benchmarks of savings and performances. Those ACOs being sponsored by any rural providers or physicians can however apply to receive their payments in advance, in order to help them build infrastructure for a harmonized care.

Read more about ACOs at the link below:
http://alextate07.wordpress.com/2014/02/18/what-is-an-aco-accountable-care-organization/