The Clinicient Collective

5010 Update

keddrickstuart — Tue, 28 Jun 2011 17:22:59 +0000

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

keddrickstuart — Wed, 06 Apr 2011 20:07:22 +0000

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.

For those who haven’t seen the CMS literature, Version 5010 has two main goals.

It makes possible the adoption of ICD-10 in Q4 2013
Improve the specificity of what data needs collecting around items like diagnosis codes, condition codes and other codes.

CMS and its partners have done an excellent job of sounding the alarm that it is time to be ready for this change and Clinicient is ready.

As has consistently been the case with standards updates, the most confusing aspect has been the timing and steps required to avoid missing critical deadlines. At first glance, it seems simple:

January 1, 2011: Begin testing new 5010 versions
January 1, 2012: Cut-off date for 4010 versions

But the reality is little more complicated.

Compliance has been broken into two steps

Level 1 compliance aimed at testing of data structures and formats, such that an organization is 100% confident of the file structure.
Level 2 compliance aimed at submission of specific claim data to specific intermediaries and payers such that an organization is 95% successful submitting. This is sometimes referred to as Errata Testing.

Your Clinicient EDI team expects to be finished with Level 1 compliance by mid-April and our efforts toward Level 2 compliance are beginning this week. In fact, until April 1, 2011 it was impossible to even begin errata testing with anyone. Since that date, it has been possible to test with nearly all CMS intermediaries and that will be our first Level 2 work.

From here the deadlines and requirements become a little more varied. For instance, Highmark Medicare began errata testing on April 1, and expects all “new to Highmark after April 15th” providers to use the 5010 version in production. A non-Medicare payer like Harvard Pilgrim has set up their own schedule of testing July 1, 2011 and production August 1, 2011.

As an existing provider, your only requirement is to make sure your EDI vendor is capable of submitting to any and all payers by January 1, 2012. Your Clinicient EDI team is confident of this and are aggressively testing the 5010 version so this transistion is behind us in the next several weeks.

For more info try:

http://www.cms.gov/Versions5010andD0/Downloads/w5010BasicsFctSht.pdf

or follow this blog:

http://www.icd10watch.com/

Keddrick Stuart

VP Product, Clinicient

Clinical Leadership

jerryhenderson — Sat, 19 Feb 2011 21:56:53 +0000

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.

So what defines a Great Clinical Leader? Why is Great Clinical Leadership the vital ingredient in successful practices? Let me try to explain:

Notice that I said “Great Clinical Leadership”. I did not say “Great Leadership”, ”Great Business Leadership”, or “Great Management”. No one would argue that having leadership and specifically great business leadership and a great management team are important, even vital; but I don’t believe any practice can be successful without Great Clinical Leaders.

Great Clinical Leaders must be clinicians. Period.

The most brilliant business strategist or accomplished business manager cannot successfully manage a group of clinicians without having clinical experience and background.

I don’t believe this is because clinicians are by their nature uncooperative or unwilling to be managed. But, without a clinical background, it is very difficult for the best of leaders to have credibility with the clinical staff and the process of communicating with clinical staff becomes much more challenging.

It is difficult the the non-clinician to challenge the assertions and opinions of the clinical staff. Put a little more simply, it is harder to call ”Bull Puckey” with credibility. For example, even though it is often left unsaid, the recalcitrant clinical staff member can always think “What does he/she know?” after being challenged about their perceptions about productivity or what constitutes an acceptable level of care for a patient.

Great Clinical Leaders Have Extensive Industry Knowledge

Besides having a clinical background, great clinical leaders must have an extensive knowledge of “the industry”: including insurance industry trends, government regulations, and clinical treatment trends and controversies. In other words the ”the big picture”.

Great Clinical Leaders Have a Clinical Opinion

The Great Clinical Leader has an opinion or philosophy about what constitutes effective patient treatment and on the latest treatment trends or fads. That opinion is grounded in experience and at least some scientific rationale. The leader should be able to act as a mentor to the staff on treatment decisions.

Great Clinical Leaders are Great Communicators

The Great Clinical Leader has the communication skills necessary to convey the “big picture” to the clinical staff. It is nearly impossible to translate the big picture to clinical staff without being a clinician yourself.

Great Clinical Leaders are also transparent in their communication. They do not try to shield the clinical staff from all of the “dirty details” about factors that have gone into making a decision.

Great Clinical Leaders Know What They Don’t Know

Great Clinical Leaders will seek out the advice of other business and management professionals. They will hire a knowledgeable consultant when needed. They will make sure they hire the best people for their billing office and front desk. They know it is worth it to pay a little more to get the best administrative staff.

Great Business Leaders are Collaborative

A great business leader will work with the clinical staff and with the other leaders in the organization.

Great Clinical Leaders Demand Great Patient Care

The overriding goal of the Clinical Leader is to foster an environment for to encourage the clinical staff to provide the best possible care to your patient population given the reality of resources you have available.

Great Clinical Leaders Expect Fair Reimbursement

Sustaining and growing a practice that provides great patient care relies on getting fairly compensated for providing the care as soon as possible.

Documentation at the Point of Care

jerryhenderson — Fri, 11 Feb 2011 00:11:40 +0000

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.

My experience has been to the contrary and I have a few pointers on how you can document with an EMR at the point of care without letting it “get in the way”.

It may seem obvious, but explain what you are doing … “During our visit together I am going to enter all of my findings. I will report my impressions and my treatment plan to Dr. Kildare. I will also use this information as we continue to work together to assess your progress….“ You get the idea. The patient needs to understand what you are doing and why it is important.

Also, seemingly obvious but a mistake I see made all of the time: Do not position the computer so that it is directly between you and your patient. Imagine yourself sitting on the other side of a computer screen from someone and how it makes you feel.

Show your patient the information as it is being entered and use that as a teaching opportunity. “See, your shoulder movement in this direction is limited to 55 degrees, and normal is closer to 180 degrees.”

Take the time to make eye contact with your patient instead of worrying how to enter information in the system. If needed, take a “time out”, by saying “OK, let me get that information into the computer, it will just take a second, then I have some more questions I want to ask you.”

One last thing: Offer to give the patient a copy of your evaluation for their records. Invite them to ask questions about it after they have had a chance to review the information. This will help your patient understand why your documentation is an important part of their care.

ANSI 5010 and ICD-10

jerryhenderson — Wed, 20 Oct 2010 19:59:41 +0000

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

jerryhenderson — Wed, 01 Sep 2010 15:42:29 +0000

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.

In a nutshell, electronic health care records must meet a battery of requirements to demonstrate meaningful use, which include:

Order entry for referrals to other providers
Real time drug-drug and drug-allergy contraindications
A Problem List of current and active diagnoses
E-prescribing
Maintain active medication/allergy list
Incorporating clinical lab test results as structured data
Check insurance eligibility electronically
Exchange key electronic information among providers of care and “patient authorized entities”

The Certification Commission for Health Information Technology (CCHIT) is an independent organization that is developing specific requirements for electronic medical records. CCHIT is working in conjunction with the federal government to ensure that standards are in place that match federal requirements. CCHIT certification of systems will normally be necessary to meet the meaningful use requirements for the incentive payments. CCHIT has not developed standards specific to outpatient rehabilitation. When outpatient rehabilitation is folded into the mix, CCHIT will develop certification standards, and Clinicient products will become certified with CCHIT at that time.

Medicare Plans of Care and Progress Reports

jerryhenderson — Wed, 01 Sep 2010 15:41:14 +0000

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 …

jimplymale — Mon, 30 Aug 2010 23:51:31 +0000

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.

Once you have numbers, you’ll want to establish some benchmarks for where you think those numbers should be. In doing this, what’s more important than the absolute numbers are ratios because they allow for comparisons to other companies regardless of the size of those companies.

I would like to suggest three simple ratios you can and should start measuring that will help you to monitor . This list is by no means exclusive, but it provides a set of key indicators that if improved can help you to increase your revenues, profitability and free cash flow.

Measure 1 – Days A/R. This key peformance indicator asks the question “how many days on average does it take me to collect for the work I do”. This number is a ratio of your total receivables to your revenue. A good benchmark for Days A/R is 40 – 45 days – in other words it takes you 40 to 45 days on average to collect for the work you are doing today. Of course this will vary by your payer mix and other factors outside of your immediate control, but it provides a good target. It’s important to calculate this number monthly based on a stable A/R number that is matched to a stable revenue number. This usually requires a “hard close” which any modern practice management system should easily provide.

Measure 2 - Payment per visit hour by therapist and by payer. This ratio asks the question ”for an hour worth of appointment time, how much am I collecting for this therapists work or from this payer?” It’s a little different than payment per visit because visits may have varying length. It’s also different from units per visit because you can’t pay your therapists with units. You must be very careful when calculating this number: you can only calculate it based on visits that are fully paid against the actual payments received for those visits. Just taking this month’s payments divided by this month’s visits is like comparing apples with oranges. Getting a sense for your true payment per visit hour will tell you which insurance contracts (and which therapists) are most profitable on a per visit hour basis. The benchmarks for payment per visit hour vary by region, but if you think about what you’re paying your therapists by the hour and what you want your gross profit margin to be, it should give you a good benchmark for this number.

Measure 3 – Average Payment per visit hour by Referral Source. This key performance indicator asks the question “which referral sources send me the most profitable patients?” Not all referrals are equal and not all referral sources are equal. In developing your marketing plan, it’s important to know not only the largest referral sources, but also to understand which referral sources if developed further could be the source of more profitable business. The best way to use this number is for ranking your marketing efforts – perhaps investing a little more in marketing to smaller referrers whose referrals are more profitable.

In a future article, we can look at where to look or “drill down” if any of these numbers is heading in the wrong direction.

Develop Strategies to Reduce Claim Denials

Clinicient — Mon, 30 Aug 2010 20:05:32 +0000

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.