Archive for June, 2012

June 28, 2012

ICD-10 driving Kaiser crazy, but also saving a lot of money

Thanks to FierceHealth Finance for this report:

George Halvorson, whose Kaiser Permanente hospital system and medical group spent more than $4 billion to adopt a fully integrated system of electronic health records, said the upcoming deployment of ICD-10 is anathema to his organization.

“I hate ICD-10. It drives me crazy,” Kaisers CEO remarked during a question and answer session after delivering a keynote speech at the Healthcare Financial Management Association’s Annual National Institute on Monday. “It adds so little value, and I can’t find any therapeutic upside.”

ICD-10, the massive expansion of procedure coding, will roll out to providers in 2013. During Halvorson’s presentation, he noted that Kaiser’s rollout of an EHR system is saving about $3 billion in annual costs by making it more efficient to treat chronic conditions and combat sepsis, which kills tens of thousands of hospital patients a year.

Halvorson said the use of ICD-10 is a response to running out of current diagnosis-related group (DRG) codes rather the a logical expansion based on clinical data. “They’re putting the current codes into certain buckets to expand them, and they’ve run out of room,” he said, adding that it is more suited to work with a paper-based medical record system.

A Kaiser spokesperson said the system still plans to deploy ICD-10. “I think we’re required to,” said communications officer Ravi Poorsina.

However, Halvorson said he already is looking toward the ICD-11 iteration, in the hopes it might be better integrated with electronic health records. The American Medical Association has recently advocated a quicker move toward ICD-11.

For more:
Here’s info on Halvorson’s HFMA ANI address

June 26, 2012

Coding education in Texas!

We’re teaching in Texas in July! Come join SHA for coding education in McAllen July 9-10 and Dallas July 30-31.

Beginners: The coding book is friendly if you know how to use it!

  • PLUS: 3.75 nursing contact hours and 3 CEs toward HCS-D maintenance

Intermediate: Go over basic skills, move to PPS, case-mix, RAC targets, and complicated scenarios.

  • PLUS: 9.75 nursing contact hours and 9.75 clock hours for administrators and 10 CEs toward HCS-D maintenance
June 25, 2012

5010 grace period is approaching

CMS has offered a reminder, and some tips, regarding the 5010 upgrade.

The enforcement discretion period for the 5010 for all HIPAA-covered entities to complete their upgrade to the Version 5010 electronic standards ends June 30, 2012. There are a few things to keep in mind for processing your Version 5010 claims, which should help avoid unnecessary rejections:

  1. ZIP Code: You need to include a complete 9-digit ZIP code for the billing provider and service facility location. You should work with your vendor to make sure that your system captures the full 9-digit ZIP.
  2. Billing Provider Address: You need to use a physical address for your Billing Provider Address. Version 5010 does not allow for use of a PO Box address for either professional or institutional claim formats. You can still use a PO Box, however, as your address for payments and correspondence from payers as long as you report this location as a pay-to address.
  3. National Provider Identifier (NPI): You were previously allowed to report an Employer’s Identification Number (Tax ID) or Social Security Number (SSN) as a primary identifier for the billing provider. For Version 5010 claims, however, you are only allowed to report an NPI as a primary identifier.
June 20, 2012

CMS webinar on Version 5010 is today

The Centers for Medicare & Medicaid Services (CMS) regional offices are hosting an informative webinar on Version 5010 for health care providers, clearinghouses, and vendors on June 20, 2012. The webinar will be available at three times in the Eastern, Central, and Mountain-Pacific time zones. Register today by visiting

WHAT: CMS Webinar – Version 5010: Are You Ready?
DATE: June 20, 2012 
TIME: 10:00 a.m. – 11:00 a.m. ET
12:00 p.m. – 1:00 p.m. CT
1:00 p.m. – 2:00 p.m. PT

At this event you will learn more about:

  1. Current Conversion Statistics
  2. Final Preparations for 5010/D.0
  3. Operational Concerns
  4. Future of EDI Communications
  5. Resources and Contact Information

Version 5010 refers to the standards that HIPAA-covered entities must use when electronically conducting certain health care administrative transactions, such as claims, remittance, eligibility, and claims status requests and responses.

To be compliant, organizations must use Version 5010 to send and receive claims and all other HIPAA-adopted electronic transactions starting January 1, 2012; however, CMS has implemented an enforcement discretion period, which is in effect until June 30, 2012.

June 19, 2012

CMS is watching for visits after late reassessments

The Centers for Medicare and Medicaid has clarified in a new set of therapy Q&As that you shouldn’t schedule additional therapy visits to make up for non-billable ones.

CMS states that HHAs “should not change the number of therapy visits a patient receives based on whether prior visits were Medicare-covered or not; and … patients should only receive the number of therapy visits called for in the patient’s plan of care.”  Other clarifications from CMS include:

  1. Count the day after each assessment as day 1 of the 30-day count. CMS had previously said that each reassessment resets the 30-day clock, but these Q&As clarify that the day after the reassessment is counted as day 1.
  2. CMS will not prescribe specific standardized assessment tools. The agency encourages therapists to look at their associations for appropriate tools.
  3. The 30-day requirement doesn’t negate the 13/19 requirement. If a therapist performs a reassessment just before the 13th visit to comply with the 30-day rule, the 13th visit reassessment still must be performed, CMS notes.

See all the Q&As