Happy Holidays!

Wishing you a very

from all of us at 
Practice Alternatives, Inc! 
(Check out our newly re-vamped website: now easy to find anything you need.)

Modifiers

Have you ever been entering charges, only to see this warning pop up?

If you are entering charges and enter a modifier that is not on the Standard Modifier List, Rexpert will give you a warning popup in case you mistyped or were mistaken. But then when you click OK, the warning will disappear and the charge will save as normal, rather than making you change the modifier before saving. Why?

Rexpert has built-in features to catch typos, errors, and omissions before they ever get saved, but in the case of modifiers the situation is a little more complex. There is a Standard Modifier List, but sometimes the correct modifier for a charge is one that's not on the list. This is because while CMS keeps a list of modifiers acceptable for Medicare, other insurance companies may have their own additional modifiers or different regulations for how to use a modifier. If you take into account all the insurance companies there are and the vast opportunity for situations requiring a modifier (anesthesia, mental health, dental, etc.), it's easy to see how the modifier list could soon have thousands of entries.

The long and short of it is that the best way to ensure accuracy is not for Rexpert to bar you from entering modifiers that are not on the standard list, but to simply prompt you to reexamine your modifier to make sure that YOU know it's right.

Written by Laura Rowe

Meaningful Use Updates

Meaningful Use for 2015 is being streamlined. Rather than some providers reporting on Stage 1 and some providers reporting on Stage 2, and complicated rules regarding who can report on what, everyone will now be required to report the same measures. CMS has put together a Modified Stage 2, with requirements that are accessible to everybody, even those new to Meaningful Use.

The reporting period is being cut from a year to 90 days -- Eligible Providers may choose any consecutive 90 day period starting on or after January 1st, 2015, and ending on or before December 31st, 2015. 

In addition, the number of measures required to report on is being cut to 10 objectives: 

• Protect Patient Health Information
• Clinical Decision Support (one rule for Stage 1, five interventions for Stage 2)
• Electronic Prescribing
• Public Health Reporting
• Computerized Provider Order Entry (medications)
• Computerized Provider Order Entry (laboratory and radiology)
• Health Information Exchange
• Patient Specific Education
• Medication Reconciliation
• Patient Electronic Access (VDT)
• Secure Messaging

These are all either previously required or a combination of previously required measures. Providers who had been planning to attest to Stage 1 may be excluded from any measures that were not required for Stage 1, namely the measures listed in green above.

Providers who had been planning to attest to Stage 2 will find the requirements to be a simplified version of what they were already preparing to meet. The new objectives focus on advanced use of EHR technology, cutting out redundant and outdated measures and simplifying requirements.  

Reporting under the new guidelines will be very simple for AuroraEHR users -- the Meaningful Use Reports screen will feature the measures required for everybody and only those measures, making running the report a snap.

Written by Laura Rowe

Survive the Phishers

What would you do if you got a e-mail confirming the purchase of a $22,000 flight to Australia on your credit card, with a link allowing you to cancel? If you would furiously click through to complain and cancel, you are in good company -- so would many others. But your natural reaction could have far-reaching consequences. That e-mail was dangled in front of you as bait in a phishing scam. "Phishing", a play on the word "fishing", is becoming more common and sophisticated.

The concept is simple: scammers send an e-mail that sounds like a legitimate reason to click onto a website and type in your credit card info, password, or other personal financial details. The e-mails are terrifyingly easy to fall for: Scammers imitate well-known companies down to the logo and convincing website address. Mac McMillan, head of a security company, is quoted ominously in an article from Health Informatics, “Probably about 42 percent of e-mails are opened when we do the exercise of phishing attack testing. And an additional 60 percent of those who open the e-mails, provide the information asked in those messages.” That is 25% of recipients of these fake phishing e-mails going on to provide their credit card information: one-fourth of these employees could have had their identity stolen!

This identity theft could have terrible consequences for the employee, but even worse ramifications for the company. Once phishing scammers know personal details for a few employees, they often use that information to fake their way into higher and higher levels of data access within the company. As members of the medical community, you can immediately see the danger to patients' personal and medical information. Just one doctor, nurse, or front desk staff member clicking on a convincing e-mail can eventually lead to a security breach affecting hundreds of patients. The mistake is simple; the consequences are high.

How can you prevent such a disaster? Be aware. Know the ways to spot a phishing e-mail and make a habit of some simple safeguards.

Top priority in phishing protection is to beware all links and attachments. Links lead to websites ready to collect your financial details. Attachments may contain viruses or key-loggers which will record every keystroke on your computer and decipher your passwords as you type. Ultimately your goal is to never even open a phishing e-mail. If you don't identify it in time, at least refrain from clicking on the link or opening an attachment. Are you are in any doubt? Don't click. If you know the sender, contact them by other means instead.

Legitimate e-mails may have links and attachments too, of course, so read on for things that should arouse your suspicion, and things you can check to confirm your fears.

Suspicious Elements

• Non-personalized greeting such as "Dear Member"Scammers send out e-mails by the dozen, but your real bank or company that you have done business with will have a name to attach to your e-mail address and will use it.
• Urgent action: "Only three days to cancel!"
  Scammers try to lure you to give out information first and think later.
• Unsolicited call for personal/financial information
  Legitimate banks, credit card companies, and the IRS do not request your account information by e-mail. Period.

Things to Check

• Deceptive e-mail address
  Anyone could have signed up for an e-mail like 'sales.practice-alt@gmail.com'. Compare it to the legitimate 'sales@practice-alt.com'. Not anyone can sign up for this one, since the section of an e-mail after the @ symbol indicates the organization it is linked with, and is not chosen by the individual. If an e-mail claims to be from a particular company, expect that company's name to be after the @ symbol.
• Links in disguise
  Hover your mouse over any links in the e-mail. Does the link that appears at the bottom of your browser window match what is typed? Look also for misspellings (i.e. "Payapl" instead of Paypal) or for numbers substituted for letters. (Paypa1) They're hoping you won't look closely. Does the link start with 'https' or only 'http'? Any legitimate website asking for financial details will begin with 'https' -- 's' for 'secure'. Check every link, as an e-mail may include a legitimate link to throw you off guard, followed by a phishing link.
• Pop-up windows
  If a seemingly-innocent link opens a site with an immediate pop-up window asking for your name and password, don't enter them. You may have been linked to a legitimate site, but the phishers have inserted a pop-up that is going straight to them.
• Attachments with executable filesWhat type of file is the attachment? Watch out for these: .exe, .bat, .com, .vbs, .reg, .msi, .pif, .pl, .php. Any one of these files could be hiding a virus or other malware. A .zip file could be concealing one of these executable files too. 

Again, when in doubt, just don't click. If you get an e-mail with a suspiciously urgent call to action that you can't face ignoring, then contact the company it claims to be from, using a DIFFERENT means than provided in the e-mail. Rather than clicking on the e-mail's link, use the number on your bank statement or the website printed on their business card. Don't google for the website, since that could turn up a phishing site that uses a deceptive web address.

Now that you know the warning signs of phishing, you can check your ability to detect a scam by taking this test from Sonic Wall. How'd you do? Phishers are gunning for your personal information and access to your practice's records, but you can still outwit them. Just be on your guard and think before you click!

Written by Laura Rowe

CPTs Unchanged

Just 22 days till ICD-10 is implemented! It's about to get real. We've spent a lot of time discussing the significant differences between ICD-9 and 10, the need to prepare for the switch, and the difficulties of translating from one to the other. Today we can relax, though -- there are some areas where the switch really will be simple.

As CMS explains in their Myths and Facts info sheet, even though ICD-10 covers more than ICD-9 did, it will not replace other systems of coding, notably CPT codes for procedures. Consequently, where you used ICD-9 with a CPT code with a modifier, you will now use ICD-10 with the same CPT code with the same modifier.

For example, if you see a new patient with a bruise on her right ankle, you would code it correctly as follows:

• ICD10 code S90.01XA (contusion of the right ankle, initial encounter)
• CPT code 99203 (Office Visit, New Patient Level 3)
• Modifier RT (right).

Even though the old ICD-9 code would not have specified the right ankle and the new ICD-10 code does, you still need to use the CPT modifier RT, specifying the right ankle, just like with ICD-9. You'll need to choose the ICD-10 code that specifies the correct laterality, but after that the CPT coding will be just as normal - no modifications to fit ICD-10: no change at all.

Of course, the wrong ICD-10 code can still be a big problem -- if you used S90.2XA (contusion of the left ankle, initial encounter) with the same CPT code and the modifier RT, your claim would be rejected, because the ICD-10 and the CPT modifier contradict each other.

Whether or not you are scurrying to catch up your ICD-10 knowledge in time for the changeover on October 1st, you can rest assured that your CPT coding skills will carry over.

Contributors: Christine Parker, Laura Rowe.

The Worst...

In the medical world, we focus on giving patients the best healthcare possible and keeping them well and healthy, but for every patient, sooner or later, there does come a day when they pass away. Typically they have no chance to settle up their accounts before they do, either.

The repercussions of this sad situation are well illustrated in this question from one of our clients:

"As far as I know, there isn't an option box to check in a patient's account for the patient being deceased. If there isn't I think it would be a very helpful thing to know. I am a biller, and when I am making calls, I feel horrible to find out I'm calling someone that has died."

What an awkward and uncomfortable situation. We quite agree that she needed a way to find out discreetly that the patient was deceased. Fortunately, it is pretty easy to prevent this situation when using Rexpert. Below are the steps for recording on a patient's account that the patient is deceased:

Go to Account Registration in the Clinical tab:

Under the Dates section, you'll see a box to enter the date the patient passed away: 

After you've filled this out and saved it, whenever you open the patient's account afterwards, there will be clear warning messages notifying you that the patient is deceased: 

Now, if you are the first to hear the bad news, you are equipped to enter it into Rexpert for the benefit of everyone else who needs to know. No biller need ever again have to find out while in the middle of asking for the deceased's money!

Written by Laura Rowe

Windows 10

You may have noticed an addition to your Windows 7 or Windows 8/8.1 tool bar that looks like this:

This is your invitation from Microsoft to upgrade to Windows 10. This is a free upgrade and not a subscription. It will be available on July 29th.

For Windows 7 users there are major changes in Windows 10 that you should consider when deciding whether to upgrade. 

You will be asked whether you want to log in with a Microsoft account. You can either create one or choose the link that lets you sign in without a Microsoft account.

The start menu will look very different from Windows 7. The "tiles" found on Windows 8 are there but you can right-click and remove them as you wish. Happily the Start menu will have the features you have come to expect: a list of installed applications and power options.

Universal Apps and the Windows Store

Many of the apps that come with Windows 10 are "universal apps," which are the successor to Windows 8's "Metro apps" or Store apps." Unlike on Windows 8, these apps actually run in windows on the desktop, so you may actually be interested in using them.

To get more of these apps, you'll need to download them from the Windows Store. There's no way to "sideload" these types of apps by downloading them from the Internet, although you're free to avoid them entirely and install traditional Windows desktop applications from the web. You can also mix and match traditional Windows desktop applications and new apps from the Store. They'll all run in windows on your desktop.

Settings App or Control Panel

The Settings option in the Start menu takes you straight to the new Settings app, which is evolved from the PC Settings app on Windows 8. This is designed to be a more user-friendly way to configure your computer.

However, it still doesn't contain every setting. The old Windows Control Panel is still included. Some older settings may only be available in the Control panel, while some newer settings may only be available in the Settings app. To quickly access the Control Panel and other advanced options, you can right-click the Start button or press Windows Key + X.

The Refresh and Reset options also make the leap from Windows 8 to 10. These allow you to quickly get your computer back to a like-new state without having to actually re-install Windows.

You won't be able to disable automatic Windows updates on Windows 10 Home systems. You'll need Windows 10 Professional to defer updates.

Edge Replaces Internet Explorer

In possibly the most earth-shattering feature of the update, Internet Explorer is no longer the default browser, although it's still available for businesses that need access to its older rendering engine. In its place is a modern browser named Edge. Microsoft's Edge browser should be more standards-compliant and perform better. It also no longer supports ActiveX controls, so all those old Internet Explorer tool bars and browser plug-ins will no longer function. If you've been using Internet Explorer, this is the browser you'll be using instead. If you're using Chrome or Firefox, you can install that and continue browsing normally.

Desktop and Security Improvements

Windows Explorer was renamed File Explorer and now has a ribbon -- even if you don't like the ribbon, File Explorer offers many useful features. For example, the file-copying-and-moving dialog window is much improved and Windows can mount ISO disc image files without third-party software.

There are also many security improvements. Windows 10 includes Windows Defender by default -- Windows Defender is just a renamed version of Microsoft Security Essentials, so all Windows systems have a baseline level of antivirus protection. SmartScreen is a reputation system that tries to block harmful and unknown file downloads from harming your computer.

Windows 10 is much easier to navigate than Windows 8, but you may want to wait to upgrade until you have a chance to play with Windows 10 a bit.

Written by Janice Crawford

CMS Is Here to Help!

There are 79 more days till the ICD-10 switchover! Does it feel real yet? October 1, 2015, is rushing right up. Fortunately you are not the only one hoping for a smooth transition without painful claim denials and confusion. CMS is looking ahead and making preparations to help out. Recently CMS announced four key ways it intends to help:

1. Designating an Ombudsman

CMS anticipates questions and issues from many providers, so they are designating an official whose entire time will be devoted to investigating and resolving your problems as you adjust to ICD-10. Stay tuned for more information about how to submit issues to this ombudsman.

2. Leeway on Specificity

It can take a while to reach proficiency with any new system, so CMS is going to grant some leeway for the first twelve months: Your Medicare claims (under the Part B physician fee schedule) will NOT be denied because you used the wrong ICD-10 code - as long as you were close. Note that you could still be denied for something else, you still need to use a valid ICD-10 code, and you still need to use an ICD-10 code from the right family. However, this promise reassures you that as long as you are trying hard you will be given some grace for small mistakes.

3. Penalty Suspension

Similarly, for quality reporting for the year 2015 (i.e. Physician Quality Reporting System, Value Based Modifier, or Meaningful Use Stage 2), you will not receive penalties based on using an ICD-10 code that wasn't specific enough. The same caveats apply here: you do need to use a valid ICD-10 code from the correct family.

4.Advance Payments

If your claim is held up in processing because Medicare contractors are delayed by adjustment problems, you will be able to apply for an advance payment based on your claim. Again, stay tuned for more detail on how to do this when the time comes.

Thinking about all the areas this change to ICD-10 will affect can be a little daunting. However, whenever this gets you down, remember that CMS has options to make this easier for you.

Written by Laura Rowe

Release 10.80

Did you notice some changes this morning? We have another new release, just put out last night, with some exciting improvements.

Here are some of the biggest changes:

Charge Entry

We added three new diagnosis code fields to the Charge Entry main tab, opening up the possibilities for more diagnoses on one charge. This is in order to help you prepare for ICD-10. Since ICD-10 is more specific and designed to cover more than ICD-9, the days are coming when you will need to enter more and more diagnoses on one charge. We've got you covered!

Did you have a patient who jumped from a burning building after being pecked by a turkey and accidentally bitten by another person, all during a volcanic eruption, while pushing a babystroller colliding with a scooter (nonmotorized) ....? Again, we have you covered for the more complex ICD-10 coding coming up!

Managing Medication Lists

In the past, after you downloaded medications from Rcopia, in order for the patient's AuroraEHR medications list to accurately reflect them, you would have to tediously enter them in by hand. No more! Now with this one handy little button on the Medications screen, you can reconcile those two lists painlessly.

Reconcile with Rcopia takes you to the Clinical Reconciliation screen, where you can choose which medications from Rcopia and the patient's AuroraEHR medications list deserve to make the final cut, eliminate duplicates, and combine them into one accurate and concise list -- all with point and click!  We are waiting for a certification from Rcopia, but when it comes through, all this will work for allergies, too.

Ordering Labs and Pathology

We've reworked the method for ordering labs and added the ability to order pathology tests. Where you used to use Clinical Labs to order labs, you'll now use Outside Orders. Your old task for Clinical Labs should now go to Outside Orders, or you can find the Outside Orders button on the AuroraEHR-Patient View, on the bottom left. Once in the screen, you can review previously ordered tests and select one of the circled buttons below to order new ones. 

Clinical Reminders

One more important change is a new field in Account Registration. 

This is to record patient preference for what method you will use to deliver their clinical reminders. This is important for a Meaningful Use measure called Patient Reminders or Preventative Care. Don't stress about having all staff start using this field immediately, since you may need to update your patient registration forms, but by the end of the week it should be routine to check that this is filled out for every patient who comes in. Collecting this information is essential for Meaningful Use stage II calculations!

Hopefully all these improvements will do what they're designed to do: make your life easier, especially when it comes to complying with Meaningful Use! If you have any questions or comments, don't be shy to use the feedback button on the Rexpert main screen to contact us. We are happy to help!

Written by Laura Rowe

Urgent: ICD-10

Are you hoping that the transition from ICD-9 to ICD-10, currently scheduled for October 1, 2014 October 1, 2015, will be delayed for the third time? Well, it is looking more and more like this dream will not become a reality. It is time to get your encounter forms/charge tickets/superbills updated to the new ICD-10 codes. As you know from our previous blog post on ICD-10, the number of diagnosis codes is going to increase from 14,000 to almost 70,000.

So what do you need to do to get ready for this earth-shaking change? As you can imagine, with the addition of 56,000 diagnosis codes and the added complexity for all codes, your current single-page encounter forms/charge tickets will be a thing of the past; there is no font small enough to fit them all on one page. You will likely have an increase of 2-4 pages for every charge ticket you have, even with expert formatting. You will need to reconsider which diagnoses your practice uses the most, and choose appropriate ICD-10 codes to use in updating your encounter forms. The AAPC has a great website resource that helps with finding ICD-10 codes.

As you choose ICD-10 codes for your new encounter forms, be very aware that there is no such thing as a crosswalk from ICD-9 to ICD-10. Even the General Equivalence Mappings (GEMs) from CMS are not a true crosswalk. Not only is ICD-10 incredibly more complex than ICD-9, it also uses a completely different organizational system in some areas.

Making a change on your encounter form like the one from ICD-9 code 649.51 (spotting complicating pregnancy) to the three equivalent ICD-10 codes O26.851/O26.852/O26.853 (depending on which trimester) is easy, although it will clearly require more room on the form. Not one-to-one but we can deal with this, right?

Wait till you get into wounds, though! ICD-9 uses the term "complicated open wound," which can indicate complications of a foreign body, infection, delayed healing or delayed treatment. But in ICD-10, a wound is either a puncture or a laceration, with a foreign body in it or not.  Delayed healing and treatment don't come into it at all, and infections require you to add a separate code! This will involve reorganizing your encounter form.

This combination of greater specificity and total reorganization can lead to staggering statistics when attempting to map one system to the other. There is one ICD-9 code (733.82) that corresponds to 2530 ICD-10 codes. Let me say that again. 2530! This is not a one-to-one match. Understand that the GEMs do not help you to find the ICD-10 code corresponding to previous ICD-9 code. Rather, they help you find the best re-diagnosis under the new system. Consequently, if your new encounter form looks exactly like the old one, but with new codes, it will almost certainly lead to errors in coding and misdiagnosis. Using the pregnancy example above, 649.51 does indeed translate to O26.852, but if that is the only option available on the encounter form, without considering O26.851 and O26.853, you will have serious coding mistakes, with every patient coded in her second trimester of pregnancy. A good ICD-10 encounter form, because of the fundamental difference between the systems, will have new descriptions and more selection, but still cover the diagnoses your practice will use most frequently.

Don't fear: Though this transition should not be underestimated, it can be made! If your encounter forms are generated through the Rexpert System, we will create your new one. Once you've selected your new organization and ICD-10 codes, just send those in to us, requesting them on a new encounter form. As a bonus for the practices that want to be ahead of the game, we will create the new document for free as long as we receive your edited form(s) by May 1, 2014 June 30, 2015. After that deadline, we will create a new document for you for $100 a form. This price may increase as the ICD-10 changeover looms closer, and there will be a final cut-off date after which we can no longer accept requests. Contact Client Services for more information on this promotion and for details on how to get started.


Contributors: Christine Parker, Mel Johnson, and Laura Rowe.

ICD-10 Testing

UPDATE: As ICD-10, after delay after delay, is finally looming in the near future, we're updating some previous posts with vital information about this new system and what you need to do before the deadline for ICD-10 compliance.

In our last blog post, we discussed the urgency around getting all encounter forms ready for the ICD-10 changeover in October. This week, we would like to tell you about some of the testing that we've done on our end to ensure that we will be ready for the change as well.

In August 2013, GVT did several ICD-10 test-claims to Emdeon. All of these tests came back successful; we received the normal processing reports back that the claims were accepted and approved. However, the test results had very limited feedback other than the test success. We did not receive the payor response and we are working with Emdeon to send more ICD-10 tests when the payor feedback will be available. 

Additionally, in the first week of March 2014, GVT sent several ICD-10 tests to Medicare and all results were successful as well. It was a similar scenario to Emdeon testing where we received back the normal reporting that the claims were accepted and approved. Per Medicare EDI, that feedback is all that is offered at this time.

In July 2014, Medicare testing will continue and data will be exchanged at both ends more extensively. GVT will send the ICD-10 test claims and Medicare will send back actual EOBS/remittance advice for those test claims to Rexpert. If practices would like to volunteer for testing, they will need to fill out this form here: https://www.surveymonkey.com/s/TWL6WRT by March 24, 2014. Medicare will be selecting practices based on their own testing needs, so it is possible that none of our practices will be chosen. If Medicare chooses your practice for ICD-10 testing in July 2014, please contact GVT client services.


Contributors: Christine Parker and Mel Johnson

ICD-10 Updates

UPDATE: As ICD-10, after delay after delay, is finally looming in the near future, we're updating some previous posts with vital information about this new system and what you need to do before the deadline for ICD-10 compliance.

Are you ready for more ICD-10?! Don’t worry; we’ve passed the boring, basic, background information. It’s time to move on to the practical side of the ICD-10 implementation in Rexpert. If you have been following along with our ICD-10 blog series, then you will remember that Rexpert will follow a sequence of phases during the ICD-10 implementation. There will be two testing phases (to be done prior to 10/1/14 10/1/15) and the live phase on October 1, 2014 October 1, 2015. You will be expected to participate in the testing phases and provide feedback to Client Services on any errors or issues that occur during testing.

Now, so as not to bombard you with too much information all at once, we will save details on the testing procedures for a later blog post. To prepare you for the upcoming testing, it’s best to first become familiar with the testing parameters. So, today I will be guiding you through some of the updates that will be were made to Rexpert during the September 2014 release.

There are three important areas to be aware of while transitioning from ICD-9 to ICD-10. These fields will be used during both the testing phases as well as the actual live phase on October 1, 2014 October 1, 2015. Warning: These pictures are for reference ONLY. Do NOT change the settings of the fields in these pictures without first coordinating with Client Services.

System Options

The ICD-10 Starts On field has been added in R10. This date is set by Client Services and dictates the day on which a practice will transition to ICD-10. Access this field through Settings > System Options, Main Tab.

Charge Entry

Within the database, each charge will be internally and automatically marked to indicate whether it uses ICD-9 or ICD-10 diagnosis coding. All charges entered after the ICD-10 start date (mentioned above) will be coded as ICD-10. However, all charges entered prior to the ICD-10 start date will still be set to ICD-9. To create a smooth transition, Charge Entry has been updated to automatically adjust the diagnosis browse to display the correct code set. If a charge is set to ICD-10, the diagnosis browse links to the ICD-10 code list and [vice versa].

Payor Options 2 Tab

Individual payors can be set to accept ICD-10, ICD-9, or both by editing the new ICD version(s) accepted by this payor option that will be added to Rexpert in September. Access this options through Settings > People and Places > Payor, Payor Options 2 Tab. If a charge has been created using ICD-10 but the payor is not yet ready to receive ICD-10 claims, the GEMS ICD crosswalk will be used to translate the ICD-10 codes to ICD-9. The ICD translation takes place during the billing extract and the charge maintains the diagnosis codes entered by the user.

Keep these updates in mind when you check out our upcoming posts on Testing for Emdeon. And don't forget: September 30, 2013 is was Rexpert Release 10 and October 1, 2014 October 1, 2015 is the compliance date to implement ICD-10. If you have any questions about these new options, contact Client Services via the Feedback button or leave a comment below.

ICD-10 vs. ICD-9

UPDATE: As ICD-10, after delay after delay, is finally looming in the near future, we're updating some previous posts with vital information about this new system and what you need to do before the deadline for ICD-10 compliance.

Last week's post, Introducing ICD-10, was a very short introduction to the new ICD-10 code system that will be required in 2014 2015. Since the transition from ICD-9 to ICD-10 is major and requires multiple steps, it will be hard to put such a massive amount of information into one post. So, for the next few weeks, we are going to be dedicating posts solely to informing you of all aspects of ICD-10.

In our entry last week, we outlined tips for designing an ICD-10 implementation plan. Please know that this is something only you can set up with your practice. We cannot create a plan for you! However, Client Services will be happy to serve as a reference if and when you have a question. This and future posts are also meant as references to help with the process of designing and executing your plan.

Now that you have been introduced to ICD-10, this week we will cover:

• The history of ICD-10
• The benefits of ICD-10
• The major differences between ICD-9 and ICD-10 coding

According to the ICD-10 Official Guidelines for Coding and Reporting, "the ICD-10-CM is a morbidity classification published by the United States for classifying diagnoses and reason for visits in all health care settings." Originally adopted in 1990 by the World Health Assembly (WHO), the official compliance date for transferring to ICD-10 diagnosis codes will be on October 1, 2014 October 1, 2015. The compliance date was initially set for October 1, 2013, but has been delayed to next year and then delayed yet again! With 2014 fall 2015 fast approaching, it is time to start preparing for the transition.

A good start is to know how the ICD codes have changed from version 9 to 10. ICD-10 diagnosis codes have been designed to enhance the world of medical coding in several ways. According to ICD-10 trainer DeLinda Ross's presentation, ICD-10-CM At A Glance, ICD-10 codes "provide more clinical detail and specificity", promote a better quality of coding and documentation, and "provide better data for research quality measurements, and setting health policy". Already, ICD-10 sounds like a vast improvement to ICD-9, right? With more specificity and less margin of error, doctors will be able to better communicate between each other for the benefit of the patient.

These benefits manifest themselves in the changes to ICD-10 coding. These changes include:

• The addition of two characters: Whereas ICD-9 codes contain 3 to 5 character per code, ICD-10 codes contain 3 to 7 characters.
• Example: XXX.XXXX = 7 character code
• Note: all codes must be at least 3 digits and a decimal separates the 3rd and 4th characters.
• The placeholder x : for codes using the 7th character, but not the 5th or 6th characters, x can be used to mark the character's place in the code without giving it a value. 
• Example: T75.4xxA = electrocution, shock from electric current, shock from electroshock gun (taser), initial encounter
• 7th character defines encounter: 
• Initial encounter
• Subsequent encounter
• Sequela
• Combination codes: include conditions, symptoms, and/or manifestations. These are defined by parenteses or brackets.
• Example: T360x1D = poisoning by penicillins, accidental (unintentional), subsequent encounter
• Laterality: pinpoint which side of the body has the condition
• Example: left hand, right shoulder, left ear, right lung, etc.
• Timeframes: removing the 5th digit in a code indicates episode of care/trimester for OB codes
• Example: O99.013 = anemia complicating pregnancy, third trimester

The ICD Codebook has experienced some changes as well. Whereas the ICD-9 codebook had 17 chapters, the codebook for ICD-10 diganosis codes now has 21 chapters. Many of those chapters have been reorganized. For instance, eyes and ears now have their own chapters rather than being grouped with the nervous system. In addition, "chapters are organised by body or organ system or by etiology or nature of the disease process" (Ross). From there, each chapter is then divided into subchapters. 

Note: The list of changes to ICD-10 diagnosis codes goes on, but cannot be covered in a short blog post. The ICD-10 Official Guidelines for Coding and Reporting contains the complete list of changes.

More information about ICD-10 is sure to follow, so keep an eye out for next week's post on Testing.

Questions? Concerns? We'd love to help! Just let Client Services know via the Feedback button. Also, if you know of any resources to help others, please leave a comment below.

Researched and compiled by: Kylie McKenzie Soder

Introducing ICD-10

UPDATE: As ICD-10, after delay after delay, is finally looming in the near future, we're updating some previous posts with vital information about this new system and what you need to do before the deadline for ICD-10 compliance.

Please take note of the following dates. They are very important. Write them on a sticky note, enter them on your calender, tattoo them on your arm... just don't forget!

September 30, 2013 - Rexpert Release 10.0

October 1, 2014 October 1, 2015 - Compliance date to implement ICD-10

The reason these two dates are important and so intimately connected is a simple one: we will all be required to switch our diagnosis codes from ICD-9 to ICD-10 on the second date. Rexpert's next release, on September 30, 2014, will provide is providing support for testing and compliance.

This change is going to be tough, but Rexpert will be going through a series of phases over this next year to create a smooth transition for everyone. Each practice should develop a plan for this period.

Some things to consider while designing a ICD-10 implementation plan are:

1. Training: What training must your providers and internal staff go through so that your practice is ready to code services using ICD-10? If you need resources for such training, use the Feedback button to request assistance, so that we can point you to sites and programs suitable for your specialty.
2. Interfaces: Does your practice use other software that interfaces with Rexpert? Please double-check that this software is set to transition to ICD-10 on the same date as Rexpert. For example, if it is a hospital system, this may determine the date that Rexpert is switched for your practice.
3. Electronic Health Record (EHR): If an Electronic Health Record is available, will the EHR do the coding? What is the ICD-10 update schedule? There will be similar issues with coordinating dates.
4. Internal Documentation: What updates need to made to your patient documentation, encounter forms, and/or charge tickets? Plan on your encounter forms to at least double in length and significantly change in character. Some estimates place an ICD-10 encounter form at 4-5 pages. These changes, especially, need to be worked out well in advance, since it will be impossible to convert everyone's forms starting on September 15, 2014 September 15, 2015! We can develop your new forms and place them "to the side" in your system where they will be ready for the transition date. Rates for this service will increase as the final deadline approaches, so make sure to plan ahead.
5. Test Billing Processes: This is so complex that it is best left for a later week's post!

Here's a chance for you to help your fellow users. Please leave a comment about what you've done so far to get ready for this transition. What challenges are you facing? Have you found any good resources? What is a good first step for a practice which has so far done nothing? Thank you!


Written by: Kylie McKenzie Soder

Error Enlightenment

Frustrated with getting the same faxing errors over and over again without knowing what they mean? Here are a few common errors, what they mean, and what to do about them.


"No carrier detected" 
The connection was unsuccessful due to an interruption or because the line was busy. Try again a little later.

"reject"
Reject is a more general error, caused by the fax encountering the same error from the receiver for three consecutive retries. For example, if the destination number hangs up during the fax three times in a row, you will see this error.

"No response to MPS" 
This is a communication error, indicating that the receiver has disconnected partway through the transmission. Try again a little later, and if the problem persists, notify the party you were trying to fax.

"No response to PPS; Giving up after three attempts"
This is a communication error, indicating that the receiver has disconnected before the end of the transmission. This may be caused by the receiver's inability to keep up with the transmission rate. Try contacting your fax provider and asking them to turn off Super G3, lowering the transmission rate. Client Services can contact the fax provider for you, but be sure to contact us as soon as possible, as the detailed error logs needed for these adjustments are only kept for 48 hours.

"Failure to transmit clean ECM image data"
This is a communication error, indicating that the receiver has disconnected partway through the transmission. Try again a little later, and if the problem persists, notify the party you were trying to fax.

"Failed to properly open control V.34 channel." 
This error means that your fax machine is claiming to accept the highest speed of fax transmission, but is unable to carry through on the boast. It then fails to receive the fax because it can't cope with the speed. Contact Client Services for help fixing this situation. Again, do this well under 48 hours from the time of the error for best results.

"DIS/DTC received 3 times; DCS not recognized; too many attempts to dial."
This error indicates that no connection could be established with the destination. Try again a little later to make sure that the error is consistent, and if necessary contact Client Services or your fax provider directly. Try to do this less than 48 hours from the time of the error so that detailed error logs will still be available for troubleshooting.

No receiver protocol (T.30 T1 timeout); too many attempts to dial.
This error means that there was no response to the carrier signal. Your fax provider can adjust the signal class and this may help. Contact Client Services less than 48 hours from the time of the error so that detailed error logs will still be available.

"Failure to train remote modem at 2400 bps or minimum speed; Giving up after 3 attempts to send same page."
This error indicates either a problem with the quality of the receiving line, or timing issues during the sending. Your fax provider can make an adjustment that may help, so contact Client Services less than 48 hours from the time of the error, while detailed error logs are still available.

"RSPREC error/got DCN; too many attempts to dial"
This error indicates that the receiver hung up in mid-call. This can be caused by poor quality of the receiving line or by malfunction of the receiving equipment. Adjustment of the speed of the fax may resolve this. Contact Client Services less than 48 hours from the time of the error, so that we can contact your fax provider while detailed error logs are still available.

"Calls to the Caribbean Islands are not permitted" 
This error just calls to your attention the inhumanity of sending a fax which will only draw people away from their true Caribbean focus, the beach. Contacting Client Services to fix this error is not necessary, as really the only fair solution here is to hand-deliver the information. This will force you to spend a few days in the sun and sand yourself, but we must all make such sacrifices to deliver quality service!

Hopefully this information will help you work around any errors. And if the reason you're not getting any faxing errors is that you are not faxing anything, you are missing out!

Rexpert offers 3 free faxes a month, so there is no downside to giving it a try. There are plenty of upsides too: Faxing a document straight from Rexpert saves time and sanity compared to the clunkier method of printing out the entire document, walking to the fax machine, and faxing it that way. Any patient document can be a fax, but virtually any report prepared in Rexpert, from charge verification to scheduling, can also be faxed.

So go forth and start faxing!

Compiled by Laura Rowe

PQRS 2015

     In May of 2013, we published an introduction to the Physician Quality Reporting System (PQRS).  The reporting requirements for PQRS change every year: Here is the latest for 2015:

     Why report PQRS at all? All eligible professionals (EPs) who report PQRS in 2015 will avoid negative Medicare payment adjustments in 2017. In 2017, EPs who did not participate in PQRS and successfully report during the 2015 reporting period will have all their Medicare fee-for-service payments reduced by 2%. This applies to Medicare Part B covered professional services furnished by the EP during 2017 or any subsequent year. This 2% reduction is an increase over the previous years' negative payment adjustments. Even worse, the Value-Based Payment Modifier stacks on top of that to a reduction of up to 4% for solo practitioners or 6% for EPs in a group of 10+ EPs. In other words, you are facing a 4- 6% reduction in your Medicare payments in 2017. But you can escape all these reductions with PQRS reporting.

     How do you preserve your Medicare payments and report PQRS?

     • Report on at least 9 measures covering 3 NQS domains for at least 50% of the EP’s Medicare Part B FFS patients. EPs that see 1 Medicare patient in a face-to-face encounter must also report on 1 crosscutting measure. 

     • EPs that submit quality data for only 1 to 8 PQRS measures for at least 50% of their
patients or encounters eligible for each measure, OR that submit data for 9 or more
PQRS measures covering less than 3 domains for at least 50% of their patients or
encounters eligible for each measure will be subject to Measure-Applicability Validation (MAV).

     • EPs that see 1 Medicare patient (face-to-face encounter), but do not report on 1
cross-cutting measure will be subject to MAV. (See the Analysis and Payment
webpage)

     • Measures with a 0% performance rate will not be counted.

    Note that the cross-cutting measure reporting requirement is in addition to the requirement for other measures, so that you would be reporting 9 measures + 1 cross-cutting measure. Click here for a list of cross-cutting measures provided by CMS.

     MAV is a process that evaluates PQRS requirements for EPs in special circumstances. All EPs that do not meet the basic reporting requirements are subject to this process. MAV will either determine that the EP has reported unsatisfactorily and has not avoided the penalty, or that the EP, due to the limited scope of his or her practice, was not required to report as many measures as normal and has reported satisfactorily. 

    Now that you understand the guidelines, how do you actually report? There are several methods by which to report PQRS in 2015, but we strongly recommend that you use the PQRS Registry because of the increased requirements and the ease of tracking that this program offers. All of our clients, no matter which state they are in, can use NJ HiTec for PQRS reporting. Registration for NJ HiTec runs about $400 and it makes it easy for individual EPs to track their own status for incentive or penalty. To register, please visit http://www.njhitec.org/pqrs/ and choose the “click here to register” option. Once you register, please let us know so that we can call you about PQRS with instructions on your next steps.

Compiled by Laura Rowe