Health Policy

Payment is Keyed to Coding — Practice makes perfect

Published on June 20, 2012 by Seth Flam DO in Health Policy. 0 Comments
Meaningful-Use-Cash-Check

Back in 2001 a prominent healthcare attorney, Alice G. Gosfield, stated, “Physicians need to listen up about the importance of proper coding… I understand that our coding system is not the easiest thing to learn. But look, [physicians] got A’s in organic chemistry, they can handle this.” And, as they learned in medical school, physicians need more than good grades to succeed. Understanding medical coding rules is now about to get more complex, as two new important coding systems will be impacting physicians in the next couple of years. It is the responsibility of your EMR/EHR vendor to assist you in becoming more familiar with the new coding systems, and at MediTouch® we take that responsibility seriously. We have just released innovative updates to our Web-based, cloud computing software that give providers new ways to practice coding with these new vocabularies and the ability to begin to convert problem list codes to the newer coding nomenclatures. Continue reading…

5010 Update — How the Government and Blues have botched the 5010 claims transition (Where is my check, and how do I make payroll?)

Published on February 6, 2012 by Seth Flam DO in Health Policy. 0 Comments

History: Per The Centers for Medicare & Medicaid Services (CMS) website, on January 16, 2009, Health and Human Services (HHS) published two final rules to adopt updated HIPAA standards; in one rule, they officially adopted the X12 Version 5010 for claim submission and related transactions. They mandated compliance by January 1, 2012. CMS still states on their website that this 3 year timeframe, “gives the industry enough time to test the standards internally, to ensure that systems have been appropriately updated, and then to test between trading partners before the compliance date.” This statement is anything but the truth as it relates to many health plans, and especially the Government and Blue plans.

HIPPA 5010 Transition

In another rule, HHS modified the standard medical data code sets for coding diagnoses by adopting the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10). They mandated the start date for the cut-over to ICD-10 as October 2013.

On November 17, 2011, the CMS Office of E-Health Standards and Services (OESS) reported that they would not enforce compliance with the HIPAA 5010 transaction set until after March 31, 2012 (big mistake). They also announced that the 90-day delay would not affect the implementation date for the ICD-10 coding system change, which as of that date remains October 1, 2013 (another big mistake). Continue reading…

EHR Vendors Can Lead the Way on Quality — Can we really wait for the government to innovate?

Published on July 20, 2011 by Seth Flam DO in Health Policy. 0 Comments
Doctor-Innoculation

Many of the ways that EMRs relate to public health issues have been closely linked to government mandate, especially with the advent of Meaningful Use. Even before Meaningful Use, providers and EHR vendors were mostly in reaction mode, responding to the PQRS (formally PQRI) and the eRx (electronic prescribing) incentive programs. When I read the blogs of the large EHR vendors, I have noticed a persistent push-back on new regulations or requirements. Some of the resistance to follow the government’s lead is well deserved. There are at least 5 Meaningful Use Measures that were legislated as part of the HITECH Act that are confusing or “not ready for prime time”. I have also observed that, with Meaningful Use part 2 – due in 2013, many vendors are pushing for less change not more; we will blog on Meaningful Use 2 soon.

The real question is, why can’t EHR vendors innovate without government intervention or incentive? At MediTouch® our medical team believes we can. We recently demonstrated the way we lead innovation during a topical public health challenge, the Whooping Cough outbreak (in some states). Continue reading…