5010 Update

In April, I blogged that Clinicient was well on its way to addressing new 5010 requirements, If it is Spring it must be 5010 time.  As summer rolls around, I feel like it is appropriate to update our progress.

The latest release of Insight Billing completes our inclusion of 5010 requirements into production.  Our Errata testing is nearly complete and our only issue to date has been with two Medicare part-A intermediaries. This issue was a non-standard implementation of a field known as Admission Type and was easily addressed.

The total number of changes required to move from 4010 to 5010, specific to PT was not significant, and effective July 1, 2011 we will be able to send out all claim data in a native 5010 format.  We continue to monitor submission across the more than 2000 payers with which we interact, but expect a smooth transition between now and January 1, 2012.

If it is Spring it must be 5010 time

With another year comes another standard for healthcare.

On January 1, 2012, the health care industry will be required to conduct the current HIPAA electronic transactions, including claims submission, remittance advice, eligibility, claims status, referral authorizations, and others, using the upgraded 5010 version.  This 5010 version replaces the current 4010 version.  They are called versions because the method for assembling electronic files hasn’t changed, but some of the rules around what data goes where and what is required versus optional have changed.

Clinical Leadership

My tenure at Clinicient has afforded me a unique opportunity to observe the management of hundreds of physical, occupational and speech therapy practices all over the country.  These practices range from very small to very large and represent a wide variety clinical specialties.  I have come to the conclusion that the one thing that separates the super successful practices from the also-rans is one thing: Great Clinical Leadership.

Documentation at the Point of Care

I have used computer based clinical documentation for about 15 years and am often asked to comment on use of EMRs in documentation at the point of care.

My physical therapist colleagues like the idea of getting documentation done efficiently and accurately, but they are concerned that use of the computer during the visit will seem impersonal and get in the way of the relationship between the patient and the clinician.

ANSI 5010 and ICD-10

There are important changes coming in electronic insurance claims and diagnosis coding. The new standard for electronic claims is known as ANSI 5010 and it will be in effect on January 1, 2012. The standard diagnosis codes are changing from version ICD-9 to version ICD-10, effective October 1, 2013. We have been keeping abreast of all of the changes in these standards and working on the technical changes in our systems to prepare for the transition. We will continue to update all of our customers in this space as we get closer to these deadlines.

Meaningful Use of Health Information Technology

On December 30, 2009, CMS  and the Office of the National Coordinator for Health Information Technology released documents clarifying what physicians and hospitals must do to qualify for government incentive payments for the “meaningful use” of electronic health care records.  The standards for Stage 1 of the  meaningful use requirements were finalized on July 13^th, so physicians and hospitals are now eligible to qualify for the first round of incentive payments.  Outpatient rehabilitation organizations will not be eligible for the first round of incentive payments, and it is not clear when they might become eligible. Clinicient is monitoring of all of the developments in this area, and is well positioned to meet the eligibility requirements for outpatient rehabilitation facilities when and if that becomes a reality.

Medicare Plans of Care and Progress Reports

In my experience, Medicare requirements for tracking Progress Reports and Plans of Care are a source of confusion for many Physical and Occupational Therapists. Anyone who treats Medicare patients should review these requirements in detail by reviewing the appropriate Medicare Policy Manual. (Chapter 15, which covers most outpatient clinics, is linked here:  Medicare Benefits Policy Manual.)

This is a very brief summary of those requirements for most settings:  A Plan of Care (POC) is established as part of the evaluation by the therapist. The POC can be as long as 90 days, but may be shorter. The Plan of Care must be reviewed and approved by the referring physician in a reasonable time and you are responsible to keep a written record of the POC Approval.  A new Plan of Care must be done if the there is a substantial change to the plan.
In addition to the POC, there is a separate requirement for a written Progress Report that must be sent to the referring physician at least every 10 visits or 30 calendar days, whichever comes first. The Progress Report does not require physician approval and does not take the place of a POC.

If You Can Measure It …

Every business can be reduced to a handful of numbers that can tell you at a high level how your business is performing. These key performance indicators become the guages on the dashboard of your business that can tell you when you need to pay special attention and potentially think aobut making changes. As the old saying goes, “if you can measure it, you can manage it.”  The first step in the process of business improvement is to identify the key performance indicators of your business and start measuring them regularly. Once you are measuring them, you can establish a baseline – a measure of where your business is today.

Develop Strategies to Reduce Claim Denials

You can lower your accounts receivable days, reduce rework of claims, and increase patient satisfaction by: 1) identifying key problem areas, 2) developing strategies to reduce claim denials, 3) engaging and empowering your staff to employ these strategies. By monitoring your most frequent claim denial reasons, you can identify problem areas. Use your practice management system or denial analysis reports provided by your billing service to track and monitor denial reasons. The key to using this information wisely is to share it with the staff responsible. For example, if there is a trend in denials for member eligibility, implement a policy and procedure for staff who register patients to verify insurance eligibility and benefits. Ensure that your staff have the training and tools to verify insurance eligibility and benefits. On an ongoing basis, provide regular feedback of denial trends to monitor the effectiveness of your strategies.

Providers and their staff who understand how they impact claim denials and cash flow can develop effective strategies to reduce claim denials. The result of employing effective strategies has been shown to lower days AR, reduce the amount of effort in getting claims paid, and increase employee and patient satisfaction.