Confucius

He who learns but does not think, is lost! He who thinks but does not learn is in great danger.

Ralph Waldo Emerson

What you do speaks so loudly that I cannot hear what you say.

Ralph Waldo Emerson

US President

BARACK OBAMA,

President T. Roosevelt

“It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood, who strives valiantly; who errs and comes short again and again; because there is not effort without error and shortcomings; but who does actually strive to do the deed; who knows the great enthusiasm, the great devotion, who spends himself in a worthy cause, who at the best knows in the end the triumph of high achievement and who at the worst, if he fails, at least he fails while daring greatly. So that his place shall never be with those cold and timid souls who know neither victory nor defeat.”
– Theodore Roosevelt

Dr. Phil

“If you want more, you have to require more from yourself.”
– Dr Phil

The current classification coding system used in the U.S., ICD-9-CM, is a 30-year old system and can no longer accurately describe today’s practice of medicine. Continuing to use this system jeopardizes the ability to effectively collect and use accurate, detailed healthcare data and information for the betterment of domestic and global healthcare. By failing to upgrade, we could find ourselves building an infrastructure that does not provide the information necessary to meet the healthcare demands of the 21st century.

Despite annual updates, ICD-9-CM does not meet our healthcare needs. Terminology and classification of numerous conditions and procedures are outdated and inconsistent with current medical knowledge and application. ICD-9-CM also cannot address the increasing pressure for more specific codes, especially codes that represent new technology. Outdated codes provide inaccurate or limited data and insufficient detail related to health diagnoses, procedures and technologies.

Medical care has changed drastically since ICD-9-CM was implemented. Many new healthcare diagnoses and services can no longer be described accurately using ICD-9-CM. For example, the terminology used to classify asthma in ICD-9-CM is outdated, resulting in an inability to assess the efficacy of treatment protocols that are based on the current clinical classification of asthma types.

Specific Gains

Upgrading ICD-9-CM to ICD-10-CM, a U.S. version of ICD-10 developed by the World Health Organization, and ICD-10-PCS, a procedural coding system designed by the Centers for Medicare and Medicaid to replace the current inpatient procedural coding system included in ICD-9-CM, will provide superior information for measuring healthcare service quality, safety and the efficacy of care. This data impacts quality reports and report cards, outcomes and performance measurement, clinical research, case management and pay-for-performance programs.

So why is the U.S. healthcare system the only developed country that has not adopted ICD-10? Perceived cost is a huge factor. However, delaying its implementation will actually increase future implementation costs as implementing a new coding system will require systems and application upgrades. This can be avoided if implementation is planned with other system changes to maximize impact and reduce complexity.

Not only does ICD-10 leverage our investment in EHR and modern technologies, but it also will give the U.S. healthcare system:

* Better data for patient safety, quality of care analysis and reimbursement;

* Increased capacity to identify and respond to public health or biological threats;

* The ability to achieve full benefit from the use of SNOMED-CT as the clinical language of medicine.

Although reimbursement considerations should not drive code set revisions, accurate and specific coded data should be used to support appropriate reimbursement. The level of specificity in ICD-10-PCS will provide payers, policy makers and providers with more detailed information for establishing appropriate reimbursement rates, evaluating and improving the quality of patient care, improving efficiencies in healthcare delivery, reducing healthcare costs, and effectively monitoring resource and service utilization.

For example, reduced healthcare costs will result if a more specific coding system is employed, facilitating prevention and identification of fraud and abuse or the specificity needed to conduct good quality improvement and error reduction programs. The exchange of additional data beyond the basic claim, and the time it takes to gather and process such detail, will significantly be reduced due to the more specific detail contained in the ICD-10-CM and ICD-10-PCS codes.

An Investment That Pays

By being the only country with a modern healthcare system that has not adopted ICD-10 (more than 100 countries already have), we are also making it more difficult to share disease and mortality data at a time when such global sharing is critical for public health. With recent public health and bioterrorism events, our ability to track and respond to international threats in real time is limited by our reliance on ICD-9-CM.

For example, ICD-10-CM would have better documented the West Nile Virus and SARS complexes for earlier detection and better tracking. Our national data systems are being rendered useless. The U.S. must be part of the world health data community. Many countries rely on U.S. analytical tools based on codes and groupers. This market edge is being lost by the inexplicable delay in coming inline with contemporary code sets.

The adoption of SNOMED-CT as the Consolidated Health Informatics initiative and license agreement between the National Library of Medicine and SNOMED International position it as the clinical language of medicine in the U.S. Eventual use of SNOMED-CT will not eliminate the need for classification systems. Even with fully deployed terminology systems, most health informatics professionals point to the ongoing need for classifications to permit aggregation of clinical data for administrative purposes including reimbursement, statistical and epidemiological analyses, and health policy decisions.

Continued use of the outdated version of ICD diminishes the U.S. investment in SNOMED-CT. The anticipated benefits of an EHR will not be fully achieved if the reference terminology employed, such as SNOMED-CT, is aggregated into a 30-year old classification system for administrative use and indexing. Valid maps are urgently needed to link from a highly specific terminology to a classification system so that information captured in the reference terminology can utilize the power of summary required for healthcare reporting and indexing offered by the classification systems. The ICD-10 medical coding system facilitates more robust mapping from SNOMED-CT in the EHR due to its granularity and use of current clinical terminology.

In 2003, the National Committee for Vital and Health Statistics (NCVHS) recommended that the Department of Health and Human Services initiate the rulemaking process for adoption of ICD-10-CM and ICD-10-PCS. NCVHS spent two years carefully listening to arguments and weighing the evidence before proceeding with their positive recommendation to the full committee.

ICD-10-CM and ICD-10-PCS needs to be implemented by October 2008. That means immediate adoption through the HIPAA rule making process in 2005 is critical to permit the healthcare industry to manage this transition and ensure continuity in its healthcare data reporting.

Linda Kloss, R.H.I.A., C.A.E., is the CEO of the American Health Information Management Association, headquartered in Chicago.

An electronic medical billing clearinghouse acts as a middleman that takes electronic medical claims information and then submits it electronically to insurance companies the medical billing clearinghouse contracts with.

Why Should a Medical Billing Business Consider Using a Clearinghouse?

Look at it this way: If you don’t use a medical billing clearinghouse, your client sends you a medical claim in superbill format, you input that information into your medical billing software, you print out that information on to a CMS1500 form, you mail that form out to the appropriate insurance carrier. The insurance company checks the claim for any errors, if everything is correct (called a “clean claim”) the insurer submits payment to the physician for the services rendered and then you bill/invoice the physician for the services that you provided them. Now, how long do you think that process will take and what would be your expense? Well if you were to do this for each and every claim, for each and every client that you have, then I can assure you that it would only take about a month and a few weeks before you’d be out of business.

A medical billing clearinghouse cuts down on the amount of time it takes for medical claims to be accepted and processed by insurance companies. Today, the electronic medical billing clearinghouse also saves the environment because less paper is being used to complete the reimbursement process.

Why Is An Electronic Medical Billing Clearinghouse A Must?

There are several reasons but these impact both your business and your profits:

• Medical billing clearinghouse software catches errors that you may have made during the data entry process.
• Once a clearinghouse catches those errors they let you know in real time where the mistakes were made for each and every medical claim so you can correct them, thus reducing the chances of receiving rejected claims.
• You submit your claims to a clearinghouse electronically so the clearinghouse that you pick should also transmit your claims to the insurance carriers electronically, which will dramatically reduce your reimbursement time to less than ten days. I guarantee you that your clients will love you to death and pay on time each and every month.
• Using an electronic medical billing clearinghouse eliminates the need for you to re-key data over and over for each payer, which saves you hundreds of hours in data entry. Plus, because they already have the insurance carriers’ information in their system, you can worry less about human errors being made when transmitting claim information.
• A medical billing clearinghouse allows you to submit all your claims at the same time, rather than submitting them separately for each individual insurer. Again, the faster and more cleanly your claims are submitted to the carriers, the faster payments are received by your medical billing client.
• A medical billing clearinghouse gives you a secondary location from which to manage all your electronic claims — in addition to the back ups that you create of your work on a daily basis, such as those on your computer, on CD/DVD, tape drives, etc.
• A medical billing clearinghouse saves you from spending valuable hours of your time waiting on hold following up on claim errors or rejections with several different insurance carriers.
• Electronic medical billing clearinghouses drastically reduce or eliminate the need for you to print paper forms, envelopes and spend money on postage.

Simply put, when you use a good medical billing clearinghouse, your clients get paid faster so you can continue to service your clients needs, which, in turn, will make your clients refer more business to you without your having to ask. As a result, your ROI (return on investment) and profits will skyrocket. In short, a medical billing clearinghouse, especially today’s electronic medical billing clearinghouse, can give your medical billing business a competitive advantage over your competitors who do not use them.

The Medical Billing Clearinghouse You Choose Should:

• Provide you with a huge payer list from which you can choose.
• Be nationwide, NOT regional.
• Provide sync support for the type of medical billing software you are using to create, batch and submit claims.
• Have an easy-to-get-out-of contract.
• Provide excellent customer service and support.
• Give you online access to update, track and manage the claims you have submitted.
• Not charge excessive monthly fees that are beyond the industry norm.

The medical billing clearinghouse you select should also provide you with the ability to process the following (Note: Some of these services can be offered to your clients at an additional charge thus increasing your profits per client):

• Eligibility verification
• Sent file status
• Claim status reports

Rejection analysis Drop and mail paper claims if needed Secondary claims processing

• Electronic Remittance Advice (ERA)
• Patient statement services
• Payment processing reporting
• Transaction summaries and reports of all your clearinghouse activity

A home-based medical billing and coding business is one that provides physicians with several levels of services and a medical billing clearinghouse does the same for the medical billing business owner. Be absolutely certain that you shop around for medical billing clearinghouses that best fit your needs and budget — but DO NOT choose one strictly based on cost.

Electronic medical billing clearinghouses must provide at least the services I’ve mentioned earlier. If you have to wait due to customer service issues at your clearinghouse you will lose money, your personal and business credibility, and finally your valuable clients.

Last, pay special attention to the medical billing clearinghouse’s startup and enrollment fees that you may have to pay for each practitioner or practice you will be submitting claims for. Those charges can eat into your profits. There are medical billing clearinghouses in the marketplace that charge flat fees regardless of how many physicians you bill for now or in the future, so proper research is the best way to keep your clearinghouse expenses to a bare minimum.

Written BY: P.G. Hackett

MIssed Opportunity

Even when opportunity knocks, a man still has to get up off his seat and open the door.

The problems associated with nurse and pharmacist shortages are becoming an old and sad story. Now you can add a new chapter: The lack of medical coders has risen to critical levels in some areas, and those who do nothing about it stand to lose millions of dollars in unbilled charges.