Tag: medisoft

Revenue Cycle Management

Reporting Cardiac Stress Tests

Interpretation only, or supervision, too? The answer affects your coding.

If coding for cardiac stress tests makes you want to pull your hair out, you are not alone. Understanding the nuances of the appropriate stress test codes can be tricky. Here’s how to avoid the confusion so you can seamlessly report stress tests.

Notice What Happens During Stress Tests

Cardiologists use stress tests, also known as treadmill or exercise tests, to see how well a patient’s heart deals with work.

When a patient takes a stress test, the cardiologist (or tech) hooks up the patient to heart monitoring equipment, and the patient walks slowly on a treadmill. Next, the treadmill’s speed increases and tilts to simulate the patient going up a small hill. During the test, the cardiologist monitors the patient’s heart rate, breathing, blood pressure, and level of tiredness.

Stress tests allow the cardiologist to diagnose coronary artery disease, determine a safe level of exercise for the patient, and diagnose a possible heart-related cause of symptoms such as chest pain, shortness of breath, or light-headedness.

stress test

Grasp 93015 — Several Codes in One

When it comes to reporting stress tests, the CPT® manual gives you the following options:

  • 93015, Cardiovascular stress test using maximal or submaximal treadmill or bicycle exercise, continuous electrocardiographic monitoring, and/or pharma­cological stress; with supervision, interpretation and report
  • 93016, … supervision only, without interpretation and report
  • 93017, … tracing only, without interpretation and report
  • 93018, … interpretation and report only.

Problem: The way that the CPT® manual lists the above codes could suggest that they work together. This interpretation isn’t correct, but the manual does not offer any extra explanation beyond the descriptor language for the codes’ appropriate usage.

Solution: You can look to an article in the January 2010 CPT® Assistant to see the close connection between the stress test codes.

According to CPT® Assistant, 93015 represents a complete cardiac stress test procedure, which includes the technical and professional components of the service — 93016, 93017, and 93018. To correctly report 93015, one cardiologist must perform all three components in a nonfacility setting like an office, clinic, or diagnostic testing center.

If the cardiologist does not perform a complete 93015, he should report just the code or codes that best represent the service he did perform (93016-93018).

Reporting stress tests in the hospital: If the cardiologist reports stress tests in a facility setting like the hospital, the facility would report the technical component (93017), and the cardiologist would report the service he performed (93016, 93018, or both).

Bonus tip: The PC/TC indicators for these codes in the Medicare Physician Fee Schedule also can help you use these codes correctly:

  • Code 93015 has indicator 4, meaning it’s a global test code that describes selected diagnostic tests where there are associated codes that indicate (a) the professional component only and (b) the technical component only.
  • Codes 93016 and 93018 have indicator 2, meaning they are professional components only. Codes 93016 and 93018 describe the physician work portion of selected diagnostic tests where there is an associated code that describes the global test.
  • Code 93017 has indicator 3, meaning it is the technical component only. Code 93017 indicates the staff and equipment costs of selected diagnostic tests where there is an associated code that describes the professional component of the diagnostic test only.

Understand the Individual Component Codes of 93015

Let’s dig deeper into each component of 93015 — 93016, 93017, and 93018 — to see what it means when a cardiologist reports these codes.

1. Code 93016 is a professional component you report for the physician’s supervision only, without the interpretation and report. Medicare’s diagnostic test supervision guidelines require this component.

Expert tip: Report 93016 only if the physician provides direct supervision of the stress test. Physicians should document they supervised in order to use this code.

2. Code 93017 represents the service’s technical component such as technicians, providing the equipment, paying for rental space, utilities, supplies, etc. You use 93017 for tracing only, without the interpretation and report.

Expert tip: For tests performed in a facility setting, only the facility reports 93017.

3. Code 93018 is a professional component.

Expert tip: Report 93018 if the provider provides an interpretation and a written report.

Learn more-

Cardiac Stress Test 

Cardiac Health

~Excerpt taken from the 2018 Cardiovascular Survival Guide

Revenue Cycle Management

Clear up EOB Confusion

Remember: An EOB is not a bill.

Working in the healthcare field, you know that acronyms are a part of your daily life. From the Health Insurance Portability and Accountability Act (HIPAA); to local coverage determinations (LCDs); to relative value units (RVUs) — as a coder, you are constantly bombarded by acronyms.

It’s common for one such acronym, explanation of benefits (EOB), to cause confusion among patients. Read on to learn more about EOBs, as well as remittance advice (RA).

Delve Into How EOBs Work

Insurance companies send EOBs to patients two to three weeks after their initial appointment.

“EOBs are insurers way of explaining their reimbursement, based on the CPT® codes and ICD-10 codes submitted,” says Catherine Brink, BS, CMM, CPC, president of Healthcare Resource Management in Spring Lake, New Jersey. “EOBs usually list the service provided was approved or not approved, the amount a provider charged, the amount approved by the insurer, the amount paid by the insurer, the amount you may be billed, then a code that indicates how the claim was paid, denied, or partially paid based on the patient’s policy. This is explained in detail on the EOB.”

Don’t miss: Although patients often mistake an EOB for a bill, an EOB is not a bill.

“Most patients do not understand EOBs or the definition of the acronym ‘explanation of benefits,’ which means what the insurer will pay based on your particular policy,” Brink says.

Check out this example from Brink: A participating provider charges $200 for a service. Medicare’s approved amount for this service is $160. Medicare pays 80 percent of $160-$128. The 20 percent difference, $32, is the patient’s responsibility to pay. If the patient has a Medigap insurance plan, then that $32 is usually paid by insurer depending on the insurance plan. The $40 difference from what the par provider charged and the Medicare approved amount must be written off by the par provider since it is part of the par contract with Medicare. Biller and coders must understand this and adjudicate the remittance advise, which is sent to the provider, correctly.

Note: An EOB is sent to the patient and an RA is sent to the provider. The patient needs to understand the EOB since he is responsible for the 20 percent.

Helpful tip: When asked how practices can help ease the confusion patients often have about EOBs, Brink says practices should explain to patients what the EOB will tell them and try to help them interpret it.

Practices could let their patients bring in EOBs and explain them. Practices could post this on their websites as a helpful service they provide, Brink adds.

Some practices offer education classes for patients to teach them about EOBs, and the patients like these classes, Brink says. “I see this in bigger practices who have the personnel to do this, for instance, education sessions, such as breakfast seminars.”

Practices Should Utilize RAs to Ensure Maximum Reimbursement

While an EOB is sent to the patient, a RA is sent to the provider who billed the service, according to Melanie Witt, RN, MA, an independent coding expert based in Guadalupita, New Mexico.

“Both types of statements provide an explanation of benefits, however,” Witt says. “The content of the RA and the EOB is nearly identical with the exception of a few minor items.”

Both RAs and EOBs contain the following information, according to Witt:

  • Information regarding the patient
  • The service provider
  • Any adjustments made to the claim
  • The type of procedure performed
  • The date the procedure was performed
  • The cost of the procedure
  • An explanation if the payment was denied

“Additional information regarding the patient’s benefits is often included as well, including the particulars of the plan, such as co-payments and deductibles,” Witt adds.

The major difference between RAs and EOBs is that an EOB contains a disclaimer stating the EOB is not a bill, according to Witt.

Example: For example, at the top of an EOB for Cigna, you will find the statement: “THIS IS NOT A BILL. Your health care professional may bill you directly for any amount you owe.”

Practices should utilize their RAs to streamline their processes.

“All billing staff should spend time studying the reasons cited for adjustments or denials from the RA they received,” Witt says. “Each RA message should be tracked to ensure that any patterns of inappropriate adjustments (incorrect use of a modifier, bundling issue, reduction for secondary procedure, etc.) or denials (code not covered, code bundled, demographics incorrect, not medically necessary, etc.) are addressed to ensure maximum reimbursement.”

Billers should also use RAs to compare what was paid to the published fee schedule from the insurer, Witt adds.

-originally posted from TCI Supercoder June 26, 2018

Revenue Cycle Management

4 Common Myths on Reporting Heart Failure Dx Codes

ICD-10 can be tricky to master with the sheer number of diagnoses to choose from, sequencing rules, and special notes. However, you don’t have to sacrifice precious dollars in your cardiology practice.

Bust these four myths to streamline your heart failure claims.

Male anatomy of human organs in x-ray view

Myth 1: Acute and Chronic Heart Failure Develop at Same Rate

Truth: Acute heart failure develops suddenly, and the symptoms are initially severe. On the other hand, chronic heart failure usually develops slowly, over time.

“Patients with chronic heart failure have a previous history of heart failure and are on long-term management such as medications to control the heart failure,” says Carol Hodge, CPC, CDEO, CCC, CEMCcertified medical coder of St. Joseph’s Cardiology in Savannah, Georgia explains. “Chronic heart failure is an established form of heart failure that can be controlled, but not cured.”

Coding solution: If the physician documents acute diastolic congestive heart failure, you would report I50.31 (Acute diastolic (congestive) heart failure). However, if the physician documents chronic diastolic (congestive) heart failure, you would report I50.32 (Chronic diastolic (congestive) heart failure).

Myth 2: ADHF Doesn’t Involve Worsening of Heart Failure Symptoms

Truth: Acute on chronic heart failure (ADHF) is the sudden symptomatic worsening of heart failure (established known heart failure), says Julie-Leah J. Harding, CPC, CPMA, CEMC, CCC, CRC, CPEDC, RMC, PCA, CCP, SCP-ED, CDIS, AHIMA-approved ICD-10 trainer and ambassador and director of revenue operations-cardiovascular surgery at Boston Children’s Hospital in Boston, Massachusetts.

ADHF typically includes dyspnea with physical activity and or lying flat, the patient may have gasping for breath while walking, lower extremity swelling, fatigue, pulmonary edema (chest congestion), palpitations, loss of appetite, weight loss, low urine output, confusion and memory issues, according to Harding.

When chronic heart failure becomes uncontrolled, it is referred to as acute on chronic, and symptoms such as increased shortness of breath and pedal edema, may occur, according to Hodge.

“The worsening of these symptoms on top of the chronic condition is referred to as ‘acute on chronic,’” Hodge explains. “Once the acute phase isresolved, it is returned to being referred to as ‘chronic.’”

Coding solution: The physician documents acute on chronic right heart failure. You should report I50.813.

Myth 3: Specificity Not Important in Heart Failure Documentation

Truth: When it comes to heart failure documentation, specificity is vital. As Harding emphasizes, “You can offer any magnitude of ICD-10 codes, but if it is not documented, you cannot report them.”

“The most common mistake I see in reporting heart failure is that documentation only supports heart failure, unspecified,” Hodge says. “Providers need to be educated to document whether the heart failure is systolic, diastolic or combined. And, is it right or left heart failure? “

Harding talks about her experience from the congenital heart disease perspective.

“In the congenital heart disease world, most of our patients have a form or element of heart failure, according to Harding. “Our struggle, and it is common in the acquired world as well, is the lack of specificity in provider/clinician documentation.”

We seldom receive “acute,” “chronic,” or “acute on chronic” written in the patient record, Harding adds. We often query the providers for clarification.

Myth 4: You Can Ignore “Code First” Notes

Truth: You should also pay close attention to “code first” notes in ICD-10.

For example, a “code first” note under category I50- (Heart failure) tells you to sequence heart failure due to hypertensive heart and chronic kidney disease.

A common error she sees is coders not using the combination codes or the hypertensive with heart disease codes, according to Hodge.

“These codes should be used to indicate hypertensive heart disease followed by the code for the type of heart failure,” Hodge adds. “Kidney disease very often occurs with hypertension and congestive heart failure, and those guidelines should be followed to correctly sequence those codes.”

Coding solution: The physician documents that the patient has hypertensive heart and chronic kidney disease with acute systolic (congestive) heart failure and with stage 5 chronic kidney disease. You would report the codes in the following order: I13.2 (Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease); I50.21 (Acute systolic (congestive) heart failure); N18.5 (Chronic kidney disease, stage 5).

-originally posted on TCI supercoder, June 26, 2018

Integrated Cloud Based Solutions

ICD-10 Walking Through the Workflow

With less than a year to go until the ICD-10 code set implementation deadline, physician practices should be pursuing a comprehensive plan designed to ensure a smooth coding transition with minimal cash flow disruption.

A key step in any ICD-10-CM transition strategy is to conduct a detailed assessment of existing workflows and processes to determine which elements will require modification, according to Bess Ann Bredemeyer, a consulting director with McKesson Business Performance Services (BPS).

By identifying each point in the claims lifecycle that ICD-10- CM will touch, appropriate adjustments can be made and simulations conducted to test the new processes against real-world conditions.

“The best way to proceed with an assessment is to begin at the patient encounter and then move through to the claim drop and denial management,” Bredemeyer said. “That way you won’t miss anything.”

Clinical Documentation  Whether the clinical documentation is sent directly to a coder or to data entry personnel, it is also important to ensure that any changes in National Coverage Determinations (NCDs) and payer’s Local Carrier Determinations (LCDs) are incorporated and reflected in the claim. A good approach includes:

  • Identifying the top 50 most utilized diagnoses codes
  • Evaluating where additional documentation will be required
  • Mapping out modifications to support appropriate reimbursement
  • Updating charge tickets, super-bills and other revenue cycle tools

This is a Test  With all the elements theoretically in place, it is critical to begin testing your new workflow to determine if it can handle ICD-10-CM. Code audits can assess both clinical documentation and coding to determine whether the claims should come through clean or not. A real-world testing process may also reveal previously unknown problems that would otherwise remain hidden until the ICD-10 go-live.

Don’t Be Denied  Because of the complexity of ICD-10-CM and the sheer magnitude of the change, it’s reasonable to assume that even the best-laid plans may encounter some unexpected problems. For that reason, it makes sense to be prepared for a rise in denials. For physician practices, that means ensuring that staffing is adequate to manage an increase in volume, and that problems will be quickly identified and remediated.

“There is no denying that the transition to the new code set will require planning and resources to mitigate the burden of change,” Bredemeyer said. “That’s why you should get started now on developing a workflow analysis impact assessment that will help you develop a detailed ICD-10 timeline and budget.”

Article Resource:

ReveNEWS, Industry Spotlight, “Walking Through the Workflow- An Important First Step,” November 2013 edition located on the McKesson ReveNEWS website

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PQRS..more than just letters in the alphabet!

In all the whorl wind of Meaningful Use Stages one and two, e-RX incentives (or penalties), ICD-10 implementation, there’s another “oldie but goodie” program for providers to participate in.  The program has been around for a few years, but did you know come 2015, you may be subject to another penalty (on top of everything else) for not participating in this program?

According to CMS- The Physician Quality Reporting System (PQRS) is a reporting program that uses a combination of incentive payments and payment adjustments to promote reporting of quality information by eligible professionals. Beginning in 2015, the program also applies a payment adjustment to eligible professionals who do not satisfactorily report data on quality measures for covered professional services.

Planning to participate in 2013?  Here are some things you should know:

  • To earn the 2013 PQRS incentive payment and avoid the 2015 PQRS payment adjustment you need to collect your data from January 1 through December 31 of this year.
  • Decide if you are going to report through your EHR (you may have to discuss with your vendor if you can report through your EHR), or if you are going to report your measure on claims.
  • Become very familiar with the CMS website- http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS
  • Report on each eligible claim
  • Avoid including multiple dates of service and/or multiple rendering providers on the same claim – this will help eliminate diagnosis codes associated with other services being attributed to another provider’s services
  • For measures that require more than one code, ensure that all codes are captured on the claim
  • If your claim with the reporting codes on it was denied for payment the PQRS codes will not be included in the program analysis.
  • Check you remittance advice for remark code N365, which reads “This procedure code is not payable. It is for reporting/information purposes only.”
  • Review all diagnoses (if applicable) and CPT Service (encounter) codes for denominator inclusion in PQRS/eRx (i.e., claims that are denominator-eligible).

Participation this year in the program could earn you incentives of up to 1%.  Failure to report could land you a whopping 1.5% pay cut (in addition to all those other penalties from CMS).

Need to learn more?  Visit us on the web at www.sunrize.com.  CMS also has a new eHealth Website that has some useful information as well- http://www.cms.gov/ehealth.

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Seven Value Propositions for Practice Choice

7 Value Propositions of McKesson Practice Choice

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1.      Lowers Cost of traditional EHR/PM Technology ·
         Avoid costly servers and IT staffing using a Web-based solution
         Learn, setup, & maintain one integrated solution
         Practice Management
         Health Records
         Patient Portal
         e-Prescribing
         Claims Engine including ERA, Electronic Eligibility Checking & Relay Health EDI.
         Low-hassle rolling upgrades always keeps your practice current and compliant
         Automatic backups & security
2.    Is Intuitive, Designed for the Small Independent Medical Office
         Be at ease with McKesson – a leading healthcare company that’s been in the EHR space for over 20 years
         Be confident in an built-from-the-ground up investment using Microsoft’s latest technology stack designed specifically for the independent practice
         Be efficient with our multiple role layout. We studied this space specifically, and laid out the software considerate of the many hats you wear during the day
         Learn easily and train new staff with integrated training videos, guides, and online help.
        Share best practices online chatting with other Choice practices like your own
3.       Protects Cash Flow
         Check patient eligibility real-time to guarantee reimbursement
         Ensure recommended procedures are performed to benefit patient health and encourage visit volume
         Improve collections by taking visit and account payments at check-in
         Embedded Claim/ERA services with auto-posting keeps cash moving
4.    Helps you Go Electronic without compromising Patient Care
         Avoid excessive clicking with single screen documentation that mimics paper
         Smart Notes design enables clinicians to pull and push data from the chart while you build the note
         Gain efficiency using natural terminology to search codes
         Care for patients with a powerful cross sectional chart summary
5.       Creates New Efficiencies with Technology
         Make patient care simpler via electronic prescriptions with clever interaction checking
         Maximize reimbursement with insurance-preferred labs automating when creating an order
         Save time eliminating paper lab results via an electronic connection
6.    Enhances Patient Touch
         Supplement patient-provider interaction with electronic messaging
         Give patients and their providers a consolidated health summary in-hand or electronically
         Quickly manage refill requests online
         Keep patients informed via patient education material summaries
7.       Gains Visibility to the Health of your Patient and Practice
         Speedily generate patient lists and reminders to communicate with the right audience
         Benchmark yourself against Meaningful Use performance and clinical quality measures
         Interrogate your financial health with comprehensive report generation

For additional information please visit our website at www.sunrize.com or call 502-538-4665.

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Mandated Sequestration Payment Reductions Beginning for Medicare EHR Incentive Program

Incentive payments made through the Medicare Electronic Health Record (EHR) Incentive Program are subject to the mandatory reductions in federal spending known as sequestration, required by the Budget Control Act of 2011.

Incentive Payment Reduction

The American Taxpayer Relief Act of 2012 postponed sequestration for two

months. As required by law, President Obama issued a sequestration order on March 1, 2013. Under these mandatory reductions, Medicare EHR incentive

payments made to eligible professionals and eligible hospitals will be reduced by 2%.

Reduction Timing

This 2% reduction will be applied to any Medicare EHR incentive payment for a reporting period that ends on or after April 1, 2013. If the final day of the reporting period occurs before April 1, 2013, those incentive payments will not be subject to the reduction.

Please note: This reduction does not apply to Medicaid EHR incentive payments, which are exempt from the mandatory reductions.

Want more information about the EHR Incentive Programs?
Make sure to visit the EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

http://www.sunrize.com

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Tips for successful EHR Implementation

Successful EHR Implementation

By Chris Torregosa, Project coordinator

With all the government stimulus money made available to hospitals and clinics these days, many groups are purchasing and implementing an EHR system. Some implementations go smoothly and achieve their goals while others they struggle or stall due to inexperience and frustration with the selected system. Some tend to fall short due to limited resources or IT issues. In certain instances, many groups experience little or no success at all. These groups then begin to contemplate whether it is a problem with their staff learning the system, the workflow processes within the group, or simply the EHR system’s abilities to meet their requirements. Regardless of your group’s size, many implementation issues are common throughout. Like any new journey in life that requires a certain amount of knowledge, there is much to learn and many things that can go wrong without proper direction. Here are a few tips to help ensure a successful EHR implementation:

1) There is no “I” in the word “Team”.

Any football fan knows that any given play can’t be run on the field unless everyone is completing their assigned role. The quarterback can’t throw or handoff the ball unless his offensive line is providing the proper protection from the opposing defense. I can go on and on, but the point is that the sane team concept can and should be applied to an EHR implementation. Navigating through an EHR implementation is not solo task. Everyone from the receptionist to the biller, to the medical assistant, to the physician will play a role in the success of the implementation. Involvement from the stakeholders is essential to create buy in into the project and to identify any ways the EHR could fail.

Like any normal team, there needs to be leadership. In an implementation, a Physician champion should be elected. The role of the Physician champion is to provide good input and communication, and to be an energetic supporter and positive motivator throughout the project. He or she is responsible to keep driving the project forward despite any road blocks that lie ahead.

Lastly, like any good team, practice makes perfect. It is incumbent of the staff to learn and practice. The more and more you practice with the system, the more familiar and comfortable you will be. This will ease any anxiety and in turn provide confidence within the group.

2) Setting realistic goals and expectations.

Implementing an EHR is by no means an easy task. A successful implementation involves a great deal of planning long before you go live. One of the first tasks during the process is to create a realistic implementation timeline that everyone is comfortable with. It is important to be flexible and open to modifying the schedule if necessary. Also, remember that you don’t have to do everything at once. A phased-in, incremental approach is suggested so that users are not learning everything at once and become overwhelmed. Another important aspect of the implementation is staying focused throughout the project. Staying on schedule in the timeline is more about making the EHR implementation a priority.

3) Positivity despite challenges.

Many challenges and frustrations will present themselves during an implementation. It will create uncertainty and doubts as to whether these challenges can be overcome. It is important to stay positive and realize that there is no reason why these challenges can’t be overcome.

4) Consult with experts with EHR experience .

It is a tall order to successfully implement an EHR without prior experience. There are many aspects of an implementation that can be overlooked that may result in failure. Assistance from someone with experience in implementing EHR systems can make a difference towards the outcome of the implementation ….. Visit www.sunrize.com  or call 888-880-0384 to speak with one of our experts on implementation of an EHR.

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What is ANSI 5010?

 

What is ANSI 5010? ANSI 5010 is the new version of HIPAA transaction standards that regulates the electronic transmission of healthcare transactions. The 5010 standards will replace the existing 4010/4010A1 version of HIPAA transactions and address many of the shortcomings in the current version, including the fact that 4010 does not support forthcoming ICD-10 coding.  
When must the transition to ANSI 5010 be completed?
 By January 1, 2012, practices will need to complete electronic transactions in an ANSI 5010-compliant format. These electronic transactions include claims, eligibility inquiries and remittance advices. Failure to comply may result in denied claims, slower payments and increased customer service issues.
What is the urgency to upgrade my practice management system? Significant changes have been made to Mc Kesson’s Medisoft® practice management systems to comply with the new ANSI 5010 standards. These changes affect the amount of data and the way data is stored in the systems as well as your practice workflow. If you are on an older version of the software, the implementation of the compliant versions will be more complex and time-consuming than previous upgrades. In addition, testing of the new ANSI 5010 standards has already begun. By upgrading now, you can take advantage of the testing period and ensure that your claims are compliant in advance of the deadline. 

  How can Sunrise help? 

Visit our websites, at www.sunrize.com and www.ppemr.com , to find out more about our limited-time offers.

Medisoft v17 and Practice Partner are our ANSI 5010-compliant releases. Medisoft v17 is currently available Don’t wait to start preparing.

 

Call us today at 888.880.0384 
 
or visit our website at www.sunrize.com

 

At Sunrise, we are here to help your practice transition to ANSI 5010.
 Medisoft v17 and Practice Partner are our ANSI 5010-compliant releases. Medisoft v17 is currently available Don’t wait to start preparing.