Industry Updates

Industry trends and legislative changes that affect seniors and the medical professionals providing their care.

How Will ICD-10 Affect Your Practice?

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To best prepare for the October 2014 ICD-10 conversion, think through where you use your ICD codes now and how you can make the process more efficient.

To best prepare for the October 2014 ICD-10 conversion, think through where you use your ICD codes now and how you can make the process more efficient.

From the Centers for Medicare and Medicaid Services:

In order to be fully prepared for the October 1, 2014, ICD-10 transition, you need to know exactly how ICD-10 will affect your practice. Although many people associate coding with submitting claims, in reality, ICD codes are used in a variety of processes within clinical practices, from registration and referrals to billing and payment. The following is a list of important questions to help you think through where you use ICD codes and how ICD-10 will affect your practice. By making a plan to address these areas now, you can make sure your practice is ready for the ICD-10 transition.

  • Where do you use ICD-9 codes? Keep a log of everywhere you see and use an ICD-9 code. If the code is on paper, you will need new forms (e.g., patient encounter form, superbill). If the code is entered or displayed in your computer, check with your Electronic Health Record (EHR) and/or practice management system vendor to see when your system will be ready for ICD-10 codes.
  • Will you be able to submit claims? If you use an electronic system for any or all payers, you need to know if it will be able to accommodate the ICD-10 version of diagnoses and hospital inpatient procedures codes. If your billing system has not been upgraded for the current version of HIPAA claims standards—Version 5010—you will not be able to submit claims. Check with your practice management system or software vendor to make sure your claims are in the HIPAA Version 5010 format and that your system or software can include the ICD-10 version of diagnoses and hospital inpatient procedures codes.
  • Will you be able to complete medical records? If you use any type of EHR system in your office, you need to know if it will capture ICD-10 codes. Look at how you enter ICD-9 codes (e.g., do you type them in or select from a drop down menu) and talk to your EHR vendor about your system’s capabilities for ICD-10. If your EHR system does not capture ICD-10 codes and you use another terminology (SNOMED), you will still need ICD-10 codes to submit claims.
  • How will you code your claims under ICD-10? If you currently code by look up in ICD-9 books, purchase the ICD-10 code books in early 2014. Take a look at the codes most commonly used in your office and begin developing a list of comparable ICD-10 codes. Alternatively, check your software for an ICD-10 look up functionality.
  • Are there ways to make coding more efficient? For example, develop a list of your most commonly used ICD-9 codes and become familiar with the ICD-10 codes you will use in the future; and invest in a software program that helps small practices with coding.

Want more information about ICD-10?


Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, deadline. Sign up for CMS ICD-10 Industry Email Updates and follow on Twitter.

 

Source: The Centers for Medicaid and Medicare Services


FDA Acts to Reduce Use of Opioid Drugs

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The move to reduce overprescribing of painkilling drugs covers pills containing hydrocodone, which is more widely dispensed in the U.S. than cholesterol and blood pressure medications.

The move to reduce overprescribing of painkilling drugs covers pills containing hydrocodone, which is more widely dispensed in the U.S. than cholesterol and blood pressure medications.

In an effort to reduce the widespread abuse of narcotic painkilling drugs in the U.S., the Food and Drug Administration has recommended imposing far more severe restrictions, including an education program that zeros-in on reducing the misuse and misprescribing of opioids.

The decision by the federal agency follows a recommendation given to it by an advisory committee, which voted 19-10 to limit the amount of such medicines that can be prescribed without a new prescription. The move covers pills containing hydrocodone.

Hydrocodone is more widely dispensed in the U.S. than even cholesterol and blood pressure medications. But since it is commonly sold as a generic drug, hydrocodone makes up just a fraction of the fast-growing $7.3 billion pain market.

Key elements of the plan—called Epidemic: Responding to America’s Prescription Drug Abuse Crisis—include:

  • Expansion of state-based prescription drug monitoring programs
  • Recommending convenient and environmentally responsible ways to remove unused medications from homes
  • Supporting education for patients and health care providers
  • Reducing the number of “pill mills” and doctor-shopping through law enforcement

 

Read full report.


Online Health Care Insurance Exchanges Debut Oct. 1

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Question: I’m 68 years old. Should I be shopping for health insurance on the online exchanges?
Answer: No. Seniors 65 and older, and disabled individuals, already meet their insurance requirements through Medicare. In fact, selling marketplace coverage to people who have Medicare is illegal.

Beginning October 1, 2013, uninsured Americans can sign up for health care insurance online through an exchange. The exchanges will allow individuals and consumers to comparison shop for health insurance, if they are eligible.

 

Online Health Care Insurance Exchanges

The new exchanges are online marketplaces where individuals and small employers will be able to shop for insurance coverage.

Seniors and disabled individuals enrolled in Medicare Part A — which covers hospitalization and limited nursing home care and is free for most beneficiaries – do not need to buy a marketplace plan, because they are already meeting the insurance requirements. Indeed, selling marketplace coverage to people who have Medicare is illegal.

The Marketplace does not offer Medicare supplement (Medigap) insurance or Part D drug plans. For information on these programs, visit Medicare.gov. Medicare beneficiaries can enroll in the program’s traditional drug coverage on Medicare.gov during the Medicare open season, which begins Oct. 15.

Here are some answers to common questions about the exchanges:

What is an exchange?

It’s an online marketplace where individuals and small employers will be able to shop for insurance coverage. Enrollment begins Oct. 1 for policies that will go into effect on Jan. 1. The exchanges will also help people find out if they are eligible for federal subsidies to help cover the cost of coverage or if they are eligible for Medicaid, the federal-state health insurance program for the poor. Read more