PYA Consulting Principal Denise Hall, along with co-presenter Julie Chicoine, recently updated health lawyers about ICD-10 transition readiness at the American Health Lawyers Association Institute on Medicare and Medicaid Payment Issues, held March 26-27, 2014.
ICD-10 Transition: What Health Lawyers Need to KnowPYA, P.C.
PYA Principal Denise Hall, along with Senior Corporate Counsel Julie Chicoine of Ohio State University Wexner Medical Center, presented “ICD-10 Transition: What Health Lawyers Need to Know” at the AHLA 2015 Institute on Medicare and Medicaid Payment Issues.
Evaluation and Management Coding Risk RevisitedPYA, P.C.
PYA Consulting Manager Valerie Rock's presentation covers the factors that impact E/M documentation and coding risk; current issues and concerns surrounding physician documentation; and perspectives and interpretations that can impact coding, education, and auditing.
ICD-10 Is Really Here: What Does That Mean To Compliance Officers?PYA, P.C.
PYA Principal Denise Hall presented “ICD-10 Is REALLY Here: What Does that Mean to Compliance Officers?” at the THA 2015 Fall Compliance Conference. The presentation helps providers get “in tune” with the latest in ICD-10 compliance:
* A brief discussion of ICD-10 and its impact on healthcare.
* Compliance risks with the transition to the ICD-10 system.
* Mitigation of compliance risk and denial activities during and post-implementation.
* ICD-10’s impact on value-based purchasing and quality-based payment models.
Speaking before the Georgia Pediatric Practice Managers Association, PYA Consultant and ICD-10-CM Trainer Kim-Marie Walker addressed recent ICD-10 developments along with basic guidance for the transition, including:
• Comparison of ICD-9 and ICD-10
• ICD-10 organizational and structural differences
• Vendor recommendations and available resources
• Transition planning and roles
The Evolving Role of the Compliance Officer in the Age of Accountable CarePYA, P.C.
Much has been written about new competencies physicians must develop in the face of payment and delivery system reform. But providers are not the only ones seeing their roles change. Compliance officers, who serve as organizations’ internal police officers, will have many new challenges. PYA Principal Martie Ross presented a national Health Care Compliance Association (HCCA) webinar entitled “The Evolving Role of the Compliance Officer In the Age of Accountable Care.”
Providing and Billing Medicare for Transitional and Chronic Care ManagementPYA, P.C.
PYA Principal Martie Ross co-presented “Providing and Billing Medicare for Transitional and Chronic Care Management,” along with Robert Jarrin, Government Affairs Director of Qualcomm Life at the AHLA 2015 Institute on Medicare and Medicaid Payment Issues program. Together they:
Briefly summarized research regarding advantages of care management services.
Explained the history of Medicare policy regarding care management services.
Provided detailed explanation of billing rules for transitional care management and level of reimbursement.
Provided detailed explanation of billing rules for chronic care management and level of reimbursement.
Highlighted unique arrangements for providing centralized care management services.
ICD-10 Transition: What Health Lawyers Need to KnowPYA, P.C.
PYA Principal Denise Hall, along with Senior Corporate Counsel Julie Chicoine of Ohio State University Wexner Medical Center, presented “ICD-10 Transition: What Health Lawyers Need to Know” at the AHLA 2015 Institute on Medicare and Medicaid Payment Issues.
Evaluation and Management Coding Risk RevisitedPYA, P.C.
PYA Consulting Manager Valerie Rock's presentation covers the factors that impact E/M documentation and coding risk; current issues and concerns surrounding physician documentation; and perspectives and interpretations that can impact coding, education, and auditing.
ICD-10 Is Really Here: What Does That Mean To Compliance Officers?PYA, P.C.
PYA Principal Denise Hall presented “ICD-10 Is REALLY Here: What Does that Mean to Compliance Officers?” at the THA 2015 Fall Compliance Conference. The presentation helps providers get “in tune” with the latest in ICD-10 compliance:
* A brief discussion of ICD-10 and its impact on healthcare.
* Compliance risks with the transition to the ICD-10 system.
* Mitigation of compliance risk and denial activities during and post-implementation.
* ICD-10’s impact on value-based purchasing and quality-based payment models.
Speaking before the Georgia Pediatric Practice Managers Association, PYA Consultant and ICD-10-CM Trainer Kim-Marie Walker addressed recent ICD-10 developments along with basic guidance for the transition, including:
• Comparison of ICD-9 and ICD-10
• ICD-10 organizational and structural differences
• Vendor recommendations and available resources
• Transition planning and roles
The Evolving Role of the Compliance Officer in the Age of Accountable CarePYA, P.C.
Much has been written about new competencies physicians must develop in the face of payment and delivery system reform. But providers are not the only ones seeing their roles change. Compliance officers, who serve as organizations’ internal police officers, will have many new challenges. PYA Principal Martie Ross presented a national Health Care Compliance Association (HCCA) webinar entitled “The Evolving Role of the Compliance Officer In the Age of Accountable Care.”
Providing and Billing Medicare for Transitional and Chronic Care ManagementPYA, P.C.
PYA Principal Martie Ross co-presented “Providing and Billing Medicare for Transitional and Chronic Care Management,” along with Robert Jarrin, Government Affairs Director of Qualcomm Life at the AHLA 2015 Institute on Medicare and Medicaid Payment Issues program. Together they:
Briefly summarized research regarding advantages of care management services.
Explained the history of Medicare policy regarding care management services.
Provided detailed explanation of billing rules for transitional care management and level of reimbursement.
Provided detailed explanation of billing rules for chronic care management and level of reimbursement.
Highlighted unique arrangements for providing centralized care management services.
What do big data and advanced analytics mean for healthcare? This question was answered during the Georgia Society of CPAs (GSCPA) 2015 Healthcare Conference, February 6, at the Cobb Galleria Centre in Atlanta, GA. PYA Principal Marty Brown and PYA Analytics President & CEO Brian Worley presented “Big Data Applications in Healthcare.”
Real World Issues with Implementing Compliant Financial Assistance and Billin...PYA, P.C.
PYA co-presented “Real World Issues with Implementing Compliant Financial Assistance and Billing and Collection Policies” at the 2014 AHLA Tax Issues for Health Care Organizations program.
MIPS APM for ACOs: A Hybrid Reimbursement ModelCitiusTech
CMS announced the Quality Payment Program (QPP) final rule in October 2017, stating how it plans to implement the clinician payment changes to QPP, mandated under the Medicare Access and CHIP Reauthorization (MACRA) act. The implementation of the MACRA act impacts different type of organizations, one such being the Accountable Care Organizations (ACOs). ACOs are evaluated for payments on the basis of quality care and the cost factors associated in achieving their quality goals. Post MACRA implementation, all clinicians will receive payments as per the MIPS (Merit based incentive payments) and Advanced APMs (Advanced alternative payment models). ACO’s can register as APM entities and are eligible to receive payments under Advanced APMs. There is a third category of APM entities which participate in Advanced APMs models but do not meet the threshold of payments and patients set by CMS. Such entities fall into a category that is straddling the line between APM and the MIPS track, called MIPS APM (partially qualifying APM participants). This document discusses about the reporting, scoring and payments for the MIPS APM entities
Chronic Care Management Coding Guidelines Effective January 1, 2017Manny Oliverez
The Centers for Medicare and Medicaid Services (CMS) recently released new billing requirements for chronic care management services. CMS initiated these latest billing changes in order to improve payment accuracy for CCM services as well as reduce the administrative burden for providers.
Visit Our Website: http://www.CaptureBilling.com/
Quality and Outcome Framework (QOF) is a voluntary annual incentive programme for GPs in England, detailing practice achievement results. The primary objective of QOF is to drive the quality of primary care and reduce variations in the quality of care amongst GPs
Big Data: Implications of Data Mining for Employed Physician Compliance Manag...PYA, P.C.
PYA Principal Denise Hall, along with King & Spalding’s Michael Paulhus, co-presented “Big Data: Implications of Data Mining for Employed Physician Compliance Management” at the Health Care Compliance Association’s (HCCA) 19th Annual Compliance Institute.
This presentation covers the basics of Healthcare domain and the testing challenges faced there off.Good content for people having interest or working in Health Care domain.
Mercy Hospital Freedom Program“Hospital Based Preventive Care Program coupled with Patient Financial Incentives”
William D. Kirsh, DO, MPH
Medical Director,Department of Preventive Medicine
Exclusive Contracting and Incentivizing Quality in Your Hospitalist ProgramPYA, P.C.
PYA Principal Carol Carden co-presented a session along with Mark Easterly, Vice President of Legal Services for Houston Methodist, on “Exclusive Contracting and Incentivizing Quality in Your Hospitalist Program" at the AHLA Physicians and Hospitals Law Institute.
Healthcare Consumerism and Cost: Dispelling the Myth of Price TransparencyHealth Catalyst
The world of healthcare costs is confusing and messy for both patients and providers. Many providers don’t fully understand their costs and therefore struggle to meet the increasing pressure for greater price transparency for consumers. With price transparency rules finalized and implementation looming, many providers are racing against the clock to adapt business practices to meet regulations and communicate the implications to consumers. And each organization’s financial health depends on transparency, as uncertainty about costs keeps many patients from seeking care.
Deb Gordon, seasoned healthcare executive and author of the book, “The Health Care Consumer’s Manifesto: How to Get the Most for Your Money,” and Pat Rocap, Director of Cost Management Services at Health Catalyst, examine the relationship between cost and pricing as the path to transparency for consumers. Deb and Pat provide expert analysis and practical advice to help you become a savvier provider and consumer when it comes to healthcare pricing and spending.
- The implications of federal price transparency regulations.
- The connection between healthcare costing and pricing.
- How to start your organization’s journey to understand costs and why it matters.
- Why price transparency is important to both patients and providers.
Chronic Care Management in Post-Acute/LTC SettingPYA, P.C.
PYA Principal Denise Hall and PYA Manager Lori Baker presented an educational session, “Chronic Care Management in Post-Acute/LTC Setting” to members of The Vision Group during The Society for Post-Acute and Long-Term Care Medicine’s (AMDA) Annual Conference.
EMR ICD Coding and training for staff of medical recordsSrishti Bhardwaj
Computerization of medical Record;
Electronic medical record (EMR),
advantages of EMR,
ICD coding system :
application of ICD,
Minimum recording standards – training for staff and caregivers
Ben Quirk spoke to the South Florida medical group community about the impact of ICD-10 on the healthcare industry. It was a very informative talk that covered a lot of need-to-know details, including how ICD-10 relates to Meaningful Use and SNOMED.
PYA Consulting Manager Linda ClenDening primed attendees of the Tennessee Orthopaedic Society 2014 Annual Meeting with a presentation, “Preparing Now for ICD-10-CM,” which:
Covered the transition, impact, and operational aspects of ICD-10.
Provided a high-level review of what’s new in ICD-10 coding conventions and guidelines.
Reviewed common diagnoses/documentation requirements in ICD-10.
ICD-10 is an unknown terrain that the country is going toward. No one knows what to expect. Some expect productivity to decrease by as much as 50% due to its implementation. Some predict this new system will result in a shortage of coders. Is any of this true? This presentation will investigate the impacts – both foreseen and unforeseen – that ICD-10 implementation will have on radiology billing companies and radiology groups.
ICD-10 Presentation to Bays Medical Society January 2014Florida Blue
Collaboration between physicians, payers and others across the health care industry is critical to a successful ICD10 implementation. Florida Blue is here with resources and expertise as you begin your ICD-10 journey, but the time to act is now! Visit our site to get started: http://ow.ly/sGVfF
What do big data and advanced analytics mean for healthcare? This question was answered during the Georgia Society of CPAs (GSCPA) 2015 Healthcare Conference, February 6, at the Cobb Galleria Centre in Atlanta, GA. PYA Principal Marty Brown and PYA Analytics President & CEO Brian Worley presented “Big Data Applications in Healthcare.”
Real World Issues with Implementing Compliant Financial Assistance and Billin...PYA, P.C.
PYA co-presented “Real World Issues with Implementing Compliant Financial Assistance and Billing and Collection Policies” at the 2014 AHLA Tax Issues for Health Care Organizations program.
MIPS APM for ACOs: A Hybrid Reimbursement ModelCitiusTech
CMS announced the Quality Payment Program (QPP) final rule in October 2017, stating how it plans to implement the clinician payment changes to QPP, mandated under the Medicare Access and CHIP Reauthorization (MACRA) act. The implementation of the MACRA act impacts different type of organizations, one such being the Accountable Care Organizations (ACOs). ACOs are evaluated for payments on the basis of quality care and the cost factors associated in achieving their quality goals. Post MACRA implementation, all clinicians will receive payments as per the MIPS (Merit based incentive payments) and Advanced APMs (Advanced alternative payment models). ACO’s can register as APM entities and are eligible to receive payments under Advanced APMs. There is a third category of APM entities which participate in Advanced APMs models but do not meet the threshold of payments and patients set by CMS. Such entities fall into a category that is straddling the line between APM and the MIPS track, called MIPS APM (partially qualifying APM participants). This document discusses about the reporting, scoring and payments for the MIPS APM entities
Chronic Care Management Coding Guidelines Effective January 1, 2017Manny Oliverez
The Centers for Medicare and Medicaid Services (CMS) recently released new billing requirements for chronic care management services. CMS initiated these latest billing changes in order to improve payment accuracy for CCM services as well as reduce the administrative burden for providers.
Visit Our Website: http://www.CaptureBilling.com/
Quality and Outcome Framework (QOF) is a voluntary annual incentive programme for GPs in England, detailing practice achievement results. The primary objective of QOF is to drive the quality of primary care and reduce variations in the quality of care amongst GPs
Big Data: Implications of Data Mining for Employed Physician Compliance Manag...PYA, P.C.
PYA Principal Denise Hall, along with King & Spalding’s Michael Paulhus, co-presented “Big Data: Implications of Data Mining for Employed Physician Compliance Management” at the Health Care Compliance Association’s (HCCA) 19th Annual Compliance Institute.
This presentation covers the basics of Healthcare domain and the testing challenges faced there off.Good content for people having interest or working in Health Care domain.
Mercy Hospital Freedom Program“Hospital Based Preventive Care Program coupled with Patient Financial Incentives”
William D. Kirsh, DO, MPH
Medical Director,Department of Preventive Medicine
Exclusive Contracting and Incentivizing Quality in Your Hospitalist ProgramPYA, P.C.
PYA Principal Carol Carden co-presented a session along with Mark Easterly, Vice President of Legal Services for Houston Methodist, on “Exclusive Contracting and Incentivizing Quality in Your Hospitalist Program" at the AHLA Physicians and Hospitals Law Institute.
Healthcare Consumerism and Cost: Dispelling the Myth of Price TransparencyHealth Catalyst
The world of healthcare costs is confusing and messy for both patients and providers. Many providers don’t fully understand their costs and therefore struggle to meet the increasing pressure for greater price transparency for consumers. With price transparency rules finalized and implementation looming, many providers are racing against the clock to adapt business practices to meet regulations and communicate the implications to consumers. And each organization’s financial health depends on transparency, as uncertainty about costs keeps many patients from seeking care.
Deb Gordon, seasoned healthcare executive and author of the book, “The Health Care Consumer’s Manifesto: How to Get the Most for Your Money,” and Pat Rocap, Director of Cost Management Services at Health Catalyst, examine the relationship between cost and pricing as the path to transparency for consumers. Deb and Pat provide expert analysis and practical advice to help you become a savvier provider and consumer when it comes to healthcare pricing and spending.
- The implications of federal price transparency regulations.
- The connection between healthcare costing and pricing.
- How to start your organization’s journey to understand costs and why it matters.
- Why price transparency is important to both patients and providers.
Chronic Care Management in Post-Acute/LTC SettingPYA, P.C.
PYA Principal Denise Hall and PYA Manager Lori Baker presented an educational session, “Chronic Care Management in Post-Acute/LTC Setting” to members of The Vision Group during The Society for Post-Acute and Long-Term Care Medicine’s (AMDA) Annual Conference.
EMR ICD Coding and training for staff of medical recordsSrishti Bhardwaj
Computerization of medical Record;
Electronic medical record (EMR),
advantages of EMR,
ICD coding system :
application of ICD,
Minimum recording standards – training for staff and caregivers
Ben Quirk spoke to the South Florida medical group community about the impact of ICD-10 on the healthcare industry. It was a very informative talk that covered a lot of need-to-know details, including how ICD-10 relates to Meaningful Use and SNOMED.
PYA Consulting Manager Linda ClenDening primed attendees of the Tennessee Orthopaedic Society 2014 Annual Meeting with a presentation, “Preparing Now for ICD-10-CM,” which:
Covered the transition, impact, and operational aspects of ICD-10.
Provided a high-level review of what’s new in ICD-10 coding conventions and guidelines.
Reviewed common diagnoses/documentation requirements in ICD-10.
ICD-10 is an unknown terrain that the country is going toward. No one knows what to expect. Some expect productivity to decrease by as much as 50% due to its implementation. Some predict this new system will result in a shortage of coders. Is any of this true? This presentation will investigate the impacts – both foreseen and unforeseen – that ICD-10 implementation will have on radiology billing companies and radiology groups.
ICD-10 Presentation to Bays Medical Society January 2014Florida Blue
Collaboration between physicians, payers and others across the health care industry is critical to a successful ICD10 implementation. Florida Blue is here with resources and expertise as you begin your ICD-10 journey, but the time to act is now! Visit our site to get started: http://ow.ly/sGVfF
ICD-10-CM is the United States’ clinical modification of the World Health Organization’s (WHO) International Classification of Diseases (ICD) Tenth Revision. It is used to classify diseases and causes of illness recorded on health records, claims, and other vital information.
The U.S. Department of Health and Human Services (HHS) will require covered entities (i.e., health plans, health care providers, and health care clearinghouses) that conduct electronic HIPAA standard transactions to move from ICD-9 to the next generation ICD-10 code sets by October 1, 2015.
This webinar covers Health Information Technology (HIT) topics that are very much on everyone's mind today. From ICD-10 and SNOMED coding to MU and PQRS regs, this webinar will fill you in on the background and details you need to know. And if you're currently using an older version of NextGen/KBM, you'll find the upgrade info on those systems especially useful. Take advantage of this free information from Quirk Healthcare Solutions.
The transition to ICD-10 will affect several areas within your hospital, which means changes for most of your staff.
Areas include:
IT Systems Changes
Staff Education and Training
Business Process and Documentation Changes
Changes in Super-Bills Charges
Increased Documentation Costs
Cash Flow Disruptions
Reporting Changes
The ICD-10 Impacts presentation describes these changes and what they mean for your organization.
Use this presentation to educate and prepare your staff for the impacts of the new coding system so they are ready for the transition and the changes they will experience when the October 1, 2014 deadline hits.
Download the presentation here: http://bit.ly/13JjgG9
PYA Highlights Next Steps of Meaningful UsePYA, P.C.
At the 2013 AICPA Healthcare Industry Conference, PYA Principal David McMillan and Senior Manager Chris Wilson recently explored the “new normal” of meaningful use as compliance and strategic standards in new care/reimbursement-model development.
“CARES Act Provider Relief Fund: Opportunities, Compliance, and Reporting”PYA, P.C.
PYA Principal Martie Ross spoke at the virtual North Carolina Healthcare Association Critical Access Hospital Statewide Meeting. The two-day event, “Quality Focus is a Finance Focus,” provided critical access hospital leaders with the opportunity to network and review data-informed strategies as well as updates to the Medicare Flexibility Program Project. It also provided guidance on federal compliance and tracking of Provider Relief Funds.
In “CARES Act Provider Relief Fund: Opportunities, Compliance, and Reporting,” Martie gave an overview of the history of distribution of those funds as well as regulations and guidelines including:
Statutory Language
Reporting Requirements
Use of Funds Calculation
Expenses
Risk Management
Martie presented Thursday, March 4, 2021.
If you would like guidance related to Provider Relief Fund regulations, or for assistance with any matter related to strategy and integration, compliance, or valuation, contact one of our PYA executives at (800) 270-9629.
PYA Presented on 2021 E/M Changes and a CARES Act Update During GHA Complianc...PYA, P.C.
The Georgia Hospital Association (GHA) Compliance Officers Roundtable, an active GHA group that meets quarterly and includes educational sessions featuring government representatives, industry experts, and other thought leaders speaking about compliance-related issues, conducted their latest meeting virtually. PYA Principals Lori Foley, Tynan Kugler, and Valerie Rock were among the presenters at this quarter’s event. In their session, they:
Described key elements associated with 2021 E/M changes, and strategies for preparation and implementation.
Explained the impact of 2021 E/M changes on physician compensation and contracting, including potential mitigation approaches.
Presented key components of Stark Law and Anti-Kickback Statute final rules.
Provided an update on the CARES Act.
The Compliance Certification Board offered CEUs for this event, which took place on Friday, December 4, 2020.
Webinar: “Trick or Treat? October 22nd Revisions to Provider Relief Fund Repo...PYA, P.C.
On October 22nd, the Department of Health and Human Services released revised Provider Relief Fund (PRF) reporting requirements. Under HHS’ September 19 directive, “lost revenue” was defined narrowly as a negative change in year-over-year patient care operating net income. Now, HHS will permit providers to use PRF funds to cover the difference between their 2019 and 2020 actual patient care revenue with some adjustments for COVID-related expenses. The October 22nd notice is available here.
PYA Principals Martie Ross and Michael Ramey hosted a complimentary 30-minute webinar, “Trick or Treat? October 22nd Revisions to Provider Relief Fund Reporting Requirements” on Thursday, October 29th.
“Regulatory Compliance Enforcement Update: Getting Results from the Guidance” PYA, P.C.
PYA Principal and Chief Compliance Officer Shannon Sumner and Consulting Senior Manager Susan Thomas presented “Regulatory Compliance Enforcement Update: Getting Results from the Guidance” at the virtual 2020 Montana Healthcare Conference. They reviewed the sources of regulatory enforcement and investigation information—guidelines, statutory updates, best practices, settlements, case studies, etc.—available to healthcare organizations. They will also discuss how to interpret and implement the guidance in order to strengthen the compliance function and protect the organization. The presentation covered:
Compliance regulatory requirements for healthcare organizations.
Guidance available for consideration in organizational compliance programs.
Internal and external reporting to ensure regulatory requirements are met.
Best practices for implementation of guidance.
Case studies for illustration of guidance implementation.
“Federal Legislative and Regulatory Update,” Webinar at DFWHCPYA, P.C.
The Dallas Fort Worth Hospital Council (DFWHC) and PYA co-hosted an exclusive complimentary webinar, “Federal Legislative and Regulatory Update,” on Wednesday, September 23.
DFWHC President/CEO Stephen Love hosted a discussion with PYA Senior Manager Kathy Reep about concerns that have dropped from the radar during the last four months of COVID-19, addressing issues for which hospitals must prepare in approaching 2021. This session focused on these key areas:
Appropriate use criteria
Transparency
Site neutral payments
The future of the Medicare Trust Fund
The federal budget
Key provisions of the final rule for the inpatient prospective payment system for FY2021 and the proposed outpatient rule for CY2021
On-Demand Webinar: Compliance With New Provider Relief Funds Reporting Requir...PYA, P.C.
On September 19, the Department of Health and Human Services (HHS) published its Post-Payment Notice of Reporting Requirements. The Notice details the reporting requirements for all Provider Relief Fund (PRF) recipients that have received $10,000 or more in aggregate payments.
Under the PRF Terms and Conditions, a recipient may use the funds only for healthcare-related expenses and lost revenue attributable to coronavirus. The Notice provides the clearest direction to date regarding permissible uses of PRF funds.
PYA offered a 45-minute complimentary webinar that explained the new reporting requirements and delved into permissible uses. While many questions remain, we provided practical advice on the next steps in the reporting process.
The webinar took place Monday, October 5 at 11 a.m. EDT.
Webinar: “While You Were Sleeping…Proposed Rule Positioned to Significantly I...PYA, P.C.
You likely know from the headlines that the 2021 Medicare Physician Fee Schedule (MPFS) Proposed Rule slashes payments for surgical specialists. But the impact of the Proposed Rule is far broader, reflecting a fundamental realignment driven by the transition to value-based payments. In our webinar, “While You Were Sleeping…Proposed Rule Positioned to Significantly Impact Physician Compensation,” PYA experts addressed these proposals, helping you understand and prepare for the changes ahead.
Following this presentation, attendees were able to:
Understand how a handful of wRVU changes would alter Medicare reimbursement for nearly all physicians.
Appreciate the operational impact of these changes.
Recognize the challenges to existing physician compensation models.
Identify strategies and tactics to prepare for and manage these impacts.
Presenters include PYA Principals Angie Caldwell, Martie Ross, and Valerie Rock. The webinar took place Thursday, September 10 and was hosted in conjunction with the Florida Hospital Association.
If you have additional questions about the MPFS Proposed Rule and its impact on physician compensation or need assistance with any matter involving physician compensation, valuation, strategy and integration, or compliance, contact a PYA executive below at (800) 270-9629.
Webinar: “Cybersecurity During COVID-19: A Look Behind the ScenesPYA, P.C.
Cybersecurity breaches have been in the news almost daily for some time now. COVID-19 has amplified the problem, as “bad actors” seize upon the opportunity to take advantage of hospitals at their most vulnerable time. Given this climate and an aging HIPAA rule, it is difficult to anticipate and prepare for the future.
PYA Principal Barry Mathis presented “Cybersecurity During COVID-19: A Look Behind the Scenes,” on Wednesday, August 12, 2020. This one-hour, complimentary webinar was hosted by PYA in conjunction with the Montana Hospital Association as Part 2 of the Frontier States Town Hall Meeting.
Barry covered information related to HIPAA, cybersecurity, and a special behind-the-scenes view into the tradecraft of bad actors. This unique presentation included:
Recent enforcement trends by the Office for Civil Rights.
The current environment for ransomware.
An opportunity to watch as Barry logs onto the Dark Web and shows you first-hand how bad actors operate.
Ideas for managing cybersecurity threats.
On Friday, August 21, 2020, a webinar co-hosted by PYA prepared hospitals for a new rule taking effect on January 1, 2021, to address price transparency in healthcare. The Centers for Medicare & Medicaid Services published a rule in November 2019 requiring hospitals to establish, update, and make public a list of their standard charges for items and services they provide. In addition to the current requirement to post standard charges on their websites, the Final Rule requires hospitals to publish online, in a machine-readable format, their payer-specific negotiated rates for 300 “shoppable” services and their standard charges for all items and services provided, defined as the gross charge, payer-specific negotiated charges, discounted cash price, and the de-identified minimum and maximum charges.
As we approach January 2021, it is vital that hospitals understand the requirements of the pricing transparency rule and options for compliance. It is unlikely that this rule will “go away”–court decisions are always subject to appeal, and there is even concern that Congress is considering action that would transform these requirements from regulation to legislation.
During the complimentary webinar, PYA Senior Manager Kathy Reep discussed hospital requirements related to pricing transparency, and Chris Kenny, Partner in the Washington, D.C., office of King & Spalding, addressed concerns related to compliance and the legal challenges associated with the final transparency rule.
This webinar was presented in conjunction with:
Dallas-Fort Worth Hospital Council
Florida Hospital Association
Georgia Hospital Association
Kansas Hospital Association
Louisiana Hospital Association
Montana Hospital Association
Not a surprise to most — healthcare is making headlines on an international level. Though not front and center, still of importance to the hospital community are issues working their way through government agencies and the legislature.
As one of the keynote speakers of this year’s virtual Florida Institute of CPAs Health Care Industry Conference, PYA Senior Manager Kathy Reep presented a “Federal Legislative and Regulatory Update.” She covered a number of current issues affecting healthcare providers, including:
Price transparency.
Congressional action on surprise billing.
The Administration’s budget for 2021.
Medicare proposed rules related to hospital inpatient payments and post-acute care for FY2021.
The virtual event took place June 23-24, 2020.
Webinar: Post-Pandemic Provider Realignment — Navigating An Uncertain MarketPYA, P.C.
The COVID-19 pandemic will materially affect U.S. provider industry structure, as financial weaknesses are exposed, risk tolerances are tested, and uncertainties persist. As a result, provider mergers-and-acquisitions (M&A) activities across industry sectors will likely spike in the short- to medium-term future. Providers of all types need to be aware of, and prepared for, the changes they will face.
In this 45-minute joint webinar, PYA Principal Brian Fuller and Juniper Advisory Managing Director Jordan Shields provided a real-time assessment of the COVID-19 pandemic, as well as shared predictions for what the extending crisis means in coming years for M&A activity in the provider space.
The webinar took place Thursday, August 6, 2020, at 11 a.m. EDT.
Since March, PYA experts have closely tracked and carefully evaluated the pandemic’s impact on employed physician compensation. During this complimentary one-hour webinar, PYA Principals Angie Caldwell and Martie Ross highlighted five immediate considerations for hospitals and health systems to manage the storm. They also explored five longer-term considerations impacting future planning.
This webinar took place Friday, July 24, 2020, at 11 a.m. EDT, and was held in conjunction with:
Dallas-Fort Worth Hospital Council
Florida Hospital Association
Kansas Hospital Association
Montana Hospital Association
The COVID-19 pandemic has exposed organizational and industry weaknesses. To build a more resilient delivery system, leaders now must engage their governing boards in re-calibrating strategic plans, re-evaluating investments, and re-imagining hospitals’ and health systems’ roles in their communities.
In this 45-minute webinar, PYA Principals Martie Ross and Brian Fuller provided a framework for these critical discussions including root-cause analysis, market assessment, new realities, guiding principles, and strategic and operational priorities.
This webinar originally took place on Wednesday, June 24, 2020.
Webinar: Free Money with Strings Attached – Cares Act Considerations for Fron...PYA, P.C.
PYA, in conjunction with the Montana Hospital Association, recently co-hosted a Frontier States Town Hall Meeting webinar, “Free Money With Strings Attached: CARES Act Considerations for Frontier States’ Healthcare Provider Organizations.” Principals Lori Foley, Martie Ross, and David McMillan introduced the CARES Act Provider Relief Fund including distribution formulas, the attestation process, the verification and application process, and ongoing recordkeeping requirement. They also answered attendees’ numerous questions regarding these matters.
Webinar: “Got a Payroll? Don’t Leave Money on the Table”PYA, P.C.
Under the CARES Act, every employer with a payroll has an opportunity to retain cash–whether they have a PPP loan or not. What employers need to know right now.
The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) along with the Payroll Protection Program (PPP) offer all business owners relief, but the details can be confusing or overlooked.
Perhaps you don’t fully understand how the deferral of the employer’s share of Social Security taxes works. Maybe you wonder if the deferral even applies to you—good news, it does if you have a payroll!
Failure to fully understand your options could cost you money, at a time when “cash is king.”
As part of PYA’s ongoing commitment to sharing helpful guidance, Tax Principals Debbie Ernsberger and Mark Brumbelow outlined issues and opportunities within the CARES Act, and answered questions during a one-hour webinar that originally aired on Wednesday, May 20, 2020.
Webinar: So You Have a PPP Loan. Now What?PYA, P.C.
The CARES Act provides relief to small businesses through Paycheck Protection Program (PPP) loans, but receiving the loan is only the first part of the equation. PYA discussed what businesses need to know and do next.
Failure to fully understand the requirements for PPP loan forgiveness could cost employers money, at a time when every penny counts. Employers need to stay up-to-date on recent activities regarding the PPP loan forgiveness application, necessary documentation, and other best practices to ensure they are well-prepared for the next steps under the PPP.
As part of PYA’s ongoing commitment to sharing helpful guidance, Tax Principals Debbie Ernsberger and Mark Brumbelow outlined PPP loan forgiveness requirements and answered questions during a one-hour webinar on Wednesday, June 3, 2020.
Webinar: “Making It Work—Physician Compensation During the COVID-19 Pandemic”PYA, P.C.
What to do with your physician compensation plan in the face of the COVID-19 pandemic? It’s a question that leaves administrators searching for answers.
PYA Principal Angie Caldwell and Senior Manager Katie Culver introduced several key considerations for provider compensation during and after the COVID-19 pandemic. In PYA’s complimentary webinar, they:
Summarized the current environment impacting physician compensation associated with the pandemic.
Provided an overview of the Stark Blanket Waivers and opportunities created for physician compensation.
Described restoration and recovery strategies for physician resources.
PYA hosted this one-hour webinar Tuesday, April 28, 2020, at 11 a.m. EDT in conjunction with the Florida Hospital Association.
Webinar: “Provider Relief Fund Payments – What We Know, What We Don’t Know, W...PYA, P.C.
The federal government is now making CARES Act Relief Fund payments to Medicare providers. These payments are not loans—they do not have to be repaid or forgiven. However, this money comes with strings attached.
During PYA’s 30-minute webinar, Provider Relief Fund Payments—What We Know, What We Don’t Know, What To Do Now, PYA Principals Martie Ross and Lori Foley discussed:
The source of the funds.
The required attestation process.
Compliance, tax, and audit concerns.
The webinar took place Friday April 17, 2020.
Webinar: “Hospitals, Capital, and Cashflow Under COVID-19”PYA, P.C.
Hospitals and providers need to think creatively, strategically, and long-term about capital and cashflow under the pressures of the COVID-19 pandemic. A one-hour webinar hosted by PYA discussed the current state of capital markets for non-profit healthcare systems, and considerations for capital management, including the role of real estate assets.
PYA Principal Michael Ramey joined Realty Trust Group Senior Vice-President Michael Honeycutt and Ponder & Company Managing Director Jeffrey B. Sahrbeck to present “Hospitals, Capital, and Cashflow, Under COVID-19” In this webinar, they covered:
Hospital industry capital market updates and trends, including how the capital markets are responding to the crisis.
Access to capital under recent regulations.
Cash preservation techniques for hospitals considering real estate operations and assets.
The webinar took place Thursday, April 9, 2020, at 11 a.m. EDT.
PYA Webinar: “Additional Expansion of Medicare Telehealth Coverage During COV...PYA, P.C.
Late on March 30, CMS released an interim rule which, among other things, significantly expands Medicare telehealth coverage, even beyond the initial Section 1135 waivers. PYA’s complimentary one-hour webinar explained these changes and how they make telehealth an even more attractive option in response to the COVID-19 pandemic.
PYA Principals Martie Ross and Valerie Rock addressed the latest developments, including:
New reimbursement for telephone-only services.
Broader coverage for remote patient monitoring.
New payments for rural health clinics and federally qualified health centers.
Use of telehealth to meet supervision requirements.
New rules regarding coding and billing as well as the changed payment rates for telehealth services.
The webinar took place Friday April 3, 2020, at 11 a.m. EDT.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...
ICD-10 Transition Presentation: What Health Lawyers Need to Know
1. Page 0March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
American Health Lawyers Association
Institute on Medicare and Medicaid Payment Issues
March 26-27, 2014
ICD-10 Transition Update:
What Health Lawyers Need to Know
2. Page 1March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
• What is ICD‐10 and why is it
important to the healthcare
community?
• What is the current regulatory
status of ICD‐10?
• Organizational Impact –
Operational and Finance
• Readiness and Implementation
Strategies
Learning Objectives
3. Page 2March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
What is ICD‐10 and why is it
important to the healthcare
community?
4. Page 3March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
There’s A Code For That!
Source: http://www.youtube.com/watch?v=GWJQSmqRLRk
5. Page 4March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
What Are ICD Codes?
• The International Classification of Disease (ICD) codes
are the international classifications for all diseases and many
other health problems for purposes of health management,
including:
– Analysis of the general health of population groups
– Monitoring of the incidence and prevalence of diseases
– Monitoring other health problems in relation to other variables such
as the characteristics and circumstances of the individuals affected,
reimbursement, resource allocation, and quality
http://www.who.int/classifications/icd/en/
• ICD codes are now recorded on many types of health
records and are key components in reimbursement, quality
and utilization review, and other data management activities.
6. Page 5March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
• Replaces ICD-9 – Not a revised version of ICD-9
• ICD-10 represents a complete change from one
coding system to a new one structured in an
entirely new way
• Like all medical coding systems, it provides a way
to condense textual clinical information into “codes”
that can be used for billing and other data-based
applications
What is ICD-10?
7. Page 6March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
There is no relationship between the two code sets –
they have completely different structures and uses.
ICD-10 Is Really Two Different
Code Sets
ICD-10-CM
• International
Classification of
Diseases, 10th
Revision, Clinical
Modification
ICD-10-PCS
• International
Classification of
Diseases, 10th
Revision, Procedure
Coding System
8. Page 7March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
What’s ICD-10-CM?
ICD-10-CM
• Diagnosis Coding System – Used to report the patient‟s
condition (i.e., what‟s wrong with the patient)
• Direct replacement for ICD-9-CM Volumes 1 & 2
• Will be used in all settings – hospital inpatient, hospital
outpatient, physician office, etc.
• Like ICD-9-CM, developed and maintained by the World
Health Organization (WHO) and the National Center for Health
Statistics within the Centers for Disease Control
9. Page 8March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
What’s ICD-10-PCS?
ICD-10-PCS
• Procedure Coding System – Used to report surgical
procedures performed
• Direct replacement for ICD-9-CM Volume 3
• Only used in a hospital inpatient setting (and only for
reporting facility services)
• Like ICD-9-CM Volume 3, ICD-10-PCS was developed
and is maintained by CMS
10. Page 9March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
How Big Could It Be?
ICD-9-CM
Diagnosis: 14,000
Procedures: 4,000
ICD-10-CM & ICD-10-PCS
Diagnosis: 68,000
Procedures: 87,000
11. Page 10March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Key ICD-10-CM Changes
• Alphanumeric codes
• Expanded injury codes – grouped by anatomic site not
injury type
• Laterality (right vs. left)
• Obstetric codes include trimester
• Diabetes codes differentiate between I, II, drug, chemical
induced diabetes, or due to an underlying condition
(chemotherapy)
• Intraoperative and postoperative complications
• Visits – initial or subsequent
12. Page 11March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
ICD-10 vs. ICD-9
Issue ICD-9-CM ICD-10-CM
Volume of codes Approximately 13,600 Approximately 69,000
Composition of codes Mostly numeric, with E and V codes
alphanumeric.
Valid codes of three, four, or five
digits.
All codes are alphanumeric, beginning
with a letter and with a mix of numbers
and letters thereafter. Valid codes may
have three, four, five, six or seven digits.
Duplication of code sets Currently, only ICD-9-CM codes are
required. No mapping is necessary.
For a period of up to two years, systems
will need to access both ICD-9-CM codes
and ICD-10-CM codes as the country
transitions from ICD-9-CM to ICD-10-CM.
Mapping will be necessary so that
equivalent codes can be found for issues
of disease tracking, medical necessity
edits and outcomes studies.
Source: http://www.aapc.com/icd-10/faq.aspx#why
13. Page 12March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
ICD-10 Code Comparison
Tobacco Abuse
ICD-9-CM: 1 Code
ICD-10-CM: 5 Codes
Diabetes Mellitus
ICD-9-CM: 10 Codes
ICD-10-CM: 318 Codes
Fracture of Radius
ICD-9-CM: 33 Codes
ICD-10-CM: 1,818 Codes
14. Page 13March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
What are the benefits of ICD-10?
The new, up-to-date classification system will provide much better data needed to:
• Measure the quality, safety, and efficacy of care
• Improve quality reporting and scoring
• Reduce the need for attachments to explain the patient’s condition
• Design payment systems and process claims for reimbursement
• Conduct research, epidemiological studies, and clinical trials
• Set health policy
• Support operational and strategic planning
• Design healthcare delivery systems
• Monitor resource utilization
• Improve clinical, financial, and administrative performance
• Prevent and detect healthcare fraud and abuse
• Track public health and risks
15. Page 14March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
What can we learn from other
countries’ implementation?
• Planning and preparation are the keys to success
– Start now to allow time to understand the impact and
come up with solutions
• Education and training are all important
– Prepare for productivity loss and longer turn around
times
• Collaborate with others
– Share information and experiences to learn what
works and what to avoid
16. Page 15March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
There’s A Code For That!
Source: http://www.youtube.com/watch?v=j_mD8yDZD7M
17. Page 16March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
What is the current regulatory
status of ICD‐10?
18. Page 17March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
When is it official?
January
1, 2010
• Payers and
providers should
begin internal
testing of Version
5010 standards
for electronic
claims
December
31, 2010
• Internal testing of
Version 5010
must be
complete to
achieve Level I
Version 5010
compliance
• Providers should
form ICD-10
sponsorship
team
January
1, 2011
• Payers and
providers should
begin external
testing of Version
5010 for
electronic claims
• CMS begins
accepting
Version 5010
claims
• Version 4010
claims continue
to be accepted
December
31, 2011
• External testing
of Version 5010
for electronic
claims must be
complete to
achieve Level II
Version 5010
compliance
January
1, 2012
• All electronic
claims must use
Version 5010
• Version 4010
claims are no
longer accepted
October 1,
2014
• Claims for
services
provided on or
after this date
must use ICD-
10 codes for
medical
diagnosis and
inpatient
procedures
• CPT codes will
continue to be
used for
outpatient
services
Per the Department of Health and Human Services, the
compliance date for implementation of ICD-10-CM and
ICD-10-PCS is October 1, 2014.
19. Page 18March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
National Coverage Determinations
(NCDs)
• CMS is responsible for converting approximately 330
NCDs
• Not all are appropriate for translation
– Edits based on HCPCS
– Older obsolete technology or considered outdated
CMS has determined which NCD should be translated
and is in the process of completing system changes for
those NCDs
http://www.cms.gov/outreach-and-education/medicare-learningnetworkmln/mlnmattersarticles/downloads/MM7818.pdf
20. Page 19March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Local Coverage Determinations
(LCDs)
• According to CMS, LCDs are made by the
individual Medicare Auditing Contractor (MAC
– i.e. CAHABA)
• Contractors shall publish all ICD-10 LCDs
and ICD-10 associated articles on the
Medicare Coverage Database (MCD) no later
than April 10, 2014
http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8348.pdf
21. Page 20March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Industry Readiness Survey
• The Workgroup for Electronic Data Interchange (WEDI), the leading authority on the use of
Health IT to improve the exchange of healthcare information, announced submission of the latest
ICD-10 industry readiness survey results to the Centers for Medicare & Medicaid Services (CMS).
• Some key results from the survey include:
– All industry segments appear to have made some progress since February 2013, but have
not gained sufficient ground to remove concern over meeting the October 1, 2014
compliance deadline.
– About three-fifths of health plans have completed their impact assessment- and another one-
fifth are nearly complete. This shows moderate progress since the February 2013 survey
where approximately one-half had completed their assessment.
– The number of providers that responded „unknown‟ to when they would complete their
impact assessment, business changes, and begin external testing is down significantly from
the February 2013 survey; responses indicate the majority will not complete these steps until
2014.
– About three-fifths of vendors indicate they are already doing, or plan to begin customer
review and beta testing by the end of this year. This is down slightly from the two-thirds
indicated in the February 2013 survey.
Sources: http://www.wedi.org/docs/comment-letters/2013-wedi-icd-10-survey-results-letter.pdf?sfvrsn=0
http://www.wedi.org/news/press-releases/2013/04/11/wedi-provides-vital-icd-10-industry-readiness-survey-results-to-cms
22. Page 21March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Fact or Fiction
ICD-10-CM-based super bills will be too long or too complex to be of much use
Fiction (sort of)
• Practices may continue to create super bills that contain the most common
diagnosis codes used in their practice. ICD-10-CM-based super bills will not
necessarily be longer or more complex than ICD-9-CM-based super bills. Neither
currently-used super bills nor ICD-10-CM-based super bills provide all possible
code options for many conditions.
• The super bill conversion process includes:
– Conducting a review that includes removing rarely used codes
– Cross walking common codes from ICD-9-CM to ICD-10-CM, which can be
accomplished by looking up codes in the ICD-10-CM code book or using the General
Equivalence Mappings (GEM)
– Vendors electronic superbill and posting scrubber that assist physicians in the
transition to ICD-10
Source: http://www.whiteplume.com/learn-more/icd-10
23. Page 22March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
What do I need to do to get the
claim out the door?
• Medicare will begin accepting a revised 1500 (version
02/12) on January 6, 2014
– Allows for reporting of ICD-10 codes
– Use as many as 12 codes in the diagnosis field (the current
limit is four)
– Qualifiers to identify the following providers role (on item 17)
• Ordering, Referring, Supervising
• Starting April 1, 2014, Medicare will accept only the
revised version of the form
– The revised form will give providers the ability to indicate
whether they are using ICD-9 or ICD-10 diagnosis codes
24. Page 23March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
What do I need to know to get the
claim out the door?
• Reporting ICD-10 diagnosis codes
• Claims Submission of diagnosis codes
– ICD-9 codes no longer accepted on claims with date of service after
October 1, 2014
– ICD-10 codes will not be recognized/accepted on claims before
October 1, 2014
– Claims cannot contain both ICD-9 and ICD-10 codes--will be returned
as “Unprocessable”
• Date span requirements
– Outpatient claims-split claim form and use from date
– Inpatient claims-use only through date/discharge date for ICD-10
code submission
25. Page 24March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Once I get this claim out of the door,
am I going to get paid?
• The Department of Health and Humans
Services (HHS) anticipates that the percent of
returned claims following the ICD-10
implementation could be more than double of
what we have seen in the past with ICD-9
updates.
26. Page 25March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
DRG Assignment
• CMS did not address the impact of
ICD-10 on DRG assignment in the
ICD-10 Final Rule
• However, CMS and 3M have used
the GEMs to convert the MS-DRG
definitions from ICD-9-CM to ICD-10
• CMS and 3M found that the GEMs
were 95% to >99% effective in
converting the MS-DRGs to ICD-10
27. Page 26March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
ICD-10 Impact
28. Page 27March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Scope of ICD-10 Impact
• All HIPAA-covered providers and entities
– Includes, payers, health plans, DME,
pharmacy, vendors
• Other Code Sets
– No impact
» Current Procedural Terminology
(CPT) Codes
» Healthcare Common Procedure
Codes (HCPCS)
29. Page 28March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
ICD-10 Industry Impact
Hospitals
Pharmacy
Research Vendors
Payers/
Health Plans
Physicians
Home
Health
Laboratory
Business
Associates
30. Page 29March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Clinical
Documentation
• Accurate diagnosis
• Improved quality of care
Quality
• Pay-for-performance
• Public Reporting
Financial • Utilization management
• Cost containment
ICD-10 Transitional Impact
31. Page 30March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
ICD-10 Organizational Impact
• Physician Documentation
• Physician Integration
• Physician Performance
• Staffing Effectiveness
• Revenue Impact Assessment
• Process Flow & Improvement
• Decision Support Impact
• Documentation Analysis
• ICD-10 Education & Training
• Coding Production Impact
Physician
Office
Post Acute
Services
• Scheduling, ED & Access Areas
• DNFB, Coding, CDI
• Case Management
• Billing, Reimbursement
Health
Information
Management
ICD-10
Revenue
Process
Physician
Operational
Planning
Information
Technology
• IT Systems
• Capability, Communication
• Functionality
• Vendor Preparedness
32. Page 31March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Estimated Financial Impact:
Revenue Cycle
AR (Days
Increase)
Write-Off
(potential $
lost)
Incremental
Staff ($)
AR (Days
Increase)
Write-Off
(potential $
lost)
Incremental
Staff ($)
AR (Days
Increase)
Write-Off
(potential $
lost)
Incremental
Staff ($)
Staffing Impact (incremental) 95,545$ 47,773$ 23,886$
Medical Necessity / Denials 5.2 585,715$ 2.6 292,857$ 1.3 146,429$
Coding 3.2 1.6 1.6
Staffing Impact (incremental) 121,415$ 60,708$ 30,354$
Staffing Prep 60,000$
(creating/testing billing edits)
Billing Rejections / Denials 10.4 1,171,429$ 5.2 585,715$ 2.6 292,857$
Patient Access
Patient Financial Services
Health Information Mgt.
TOTALS 18.9 5.5 439,286$ 54,240$1,757,144$ 276,961$ 9.4 878,572$ 108,480$
FY2016
Revenue Cycle Metrics Revenue Cycle Metrics Revenue Cycle Metrics
FY2014 FY2015
Notes: See Key Assumptions for information on assumptions underlying these estimates. Figures may not add to Totals due to rounding.
33. Page 32March 26-27, 2014
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Provider Impact
• Value-based compensation
• Increased documentation time – up to 15%
• May affect patient volume
• Quality Measures/P4P – need to be determined
based on ICD-10 codes
• Difficult to measure impact of change – is it because
of code set or because of changes in underlying
practice?
32
34. Page 33March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Payers, Health Plans
Impact:
• Coverage determinations
• Payment determinations
• Medical review policies
• Actuarial projections
• Quality measurements
35. Page 34March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Compliance Impact
• A huge potential for double billing exists if two
systems (ICD-9 and ICD-10) remain in use during the
transition period:
– This scenario could potentially create unintentional billing
compliance risks.
– The shortage of experienced coding professionals also
poses a risk since medical coders nearing retirement age
may elect to retire rather than learn a new system.
• Additionally, the General Equivalency Mappings (GEMS) do not
provide a definitive map from ICD-9 to ICD-10 with only 5%
mapping accurately 1:1 with ICD-10 codes
– Because ICD-9 codes could map into multiple ICD-10
codes, this risk rises even more.
36. Page 35March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Coder Impact
• Need to know anatomy and physiology
• Need to know new code sets
• Decreased productivity – ICD-10 Watch:
Some studies suggest a 50% drop in coding
productivity
• Industry demand for more coding
professionals!
37. Page 36March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
ICD-10 Potential Financial Impact
• According to CMS, Estimated Organizational Cost by Bed Size
Bed Size Cost
400 + $1.5 Million – $5 Million
100 – 400 $500,000 – $1.5 Million
< 100 $100,000 – $250,000
Decrease in Cash Flow / Loss of Revenue
• Industry experts from CMS and AHIMA estimate the following:
– Denial rates will increase by 100% to 200%
– Accounts receivable days will be extended by 20% to 40%
– Healthcare organizations will be hindered with payment
declines for more than 2 years after the implementation
Date of October 1, 2014
– Claims-error rates will increase from 6% to 10% (The
average current rate is close to 3%)
38. Page 37March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Expected Denial Reasons
Minich-Pourshadi, Karen. “ICD-10 Puts Revenue at Risk.” HealthLeaders Media Intelligence (July 2011), p. 22.
39. Page 38March 26-27, 2014
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There’s A Code For That!
Source: http://www.youtube.com/watch?v=yKYwr31s4bk
40. Page 39March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Readiness and Implementation
Strategies
41. Page 40March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Strategy
Convene Implementation Taskforce
Multi-disciplinary
• Clinical, IT, HIM, Finan
ce, Compliance, Com
munications, Payer/Ma
naged Care
Contracting, Operation
s
Key stake
holders
• Identify who is
impacted and what
needs to be done
• Establish timeline
and designate
leaders
Designate
Physician Champion
42. Page 41March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Assessment
Organizational readiness
• Map a patient‟s encounter and look at every piece in the
organization touched by ICD-9
• Affected Areas
Financial/HIM/IT
• Billing systems, DRG
grouper, claims software, medical
record abstracting, encoding
software, case mix systems
Clinical
• Patient care protocols, medical
necessity, laboratory and pharmacy
systems, utilization, quality and case
management
Patients
• Patient registration and scheduling
systems, advance beneficiary
notice, preauthorization
43. Page 42March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Implementation Process
Processes Reports Work Flow
Information
Systems and
Software
All Forms of
Documentation
Analysis of all Departments
44. Page 43March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Roles
Role Task
Administrators Confirm capabilities, provide training, review processes
IT Staff Confirm integration in system and documentation
Providers
Outpatient: Document in support of ICD-10 code selected
Inpatient: CM and PCS codes will have to be supported
Billers
Understand how to look up codes, understand how to query
physicians, pull new LCDs
Coders
Understand ICD-10 guidelines and how to properly select ICD-10
codes base on documentation
45. Page 44March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Vendor Readiness
• Identify vendors affected by ICD-10 (billing companies,
medical transcription, home health, DME – start with
your Business Associate Agreements)
− What system changes/upgrades are needed?
− What costs are involved? Are they included in existing
vendor agreements?
− What customer support (implementation, testing, training)
will the vendor be offering?
46. Page 45March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Vendor Readiness
Our billing software vendor indicates they will be ready for
these transitions. What can I do in the meantime, besides train
for ICD-10 coding?
• Ask your billing software vendor for a detailed schedule of
deliverables and begin preparing to test implementation of the
modified software at your location.
• Be sure to verify the following:
– The vendor is addressing the ICD-10 upgrades
– The number and schedule of planned ICD-10 software releases
– Their ICD-10 conversion plan accommodates your clearinghouse
testing schedule
– Any related costs to your organization
– Customer support and training they will provide
47. Page 46March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Payer Readiness
• As with vendors – establish dedicated contact
• Evaluate payer readiness
– What‟s their implementation plan/timeline?
– Are they implementing new rules for claims submission or
re-submission?
– Will contract terms for coverage and billing change? Will
they require the provider to report the code with the highest
specificity?
– Will their payment and reimbursement schedules change?
– Will the claims appeal process change?
• Add language to current contracts to require ICD-10 compliance
• Share your plans for ICD-10 changes with them
• Establish regular meetings, compare implementation plans,
review and update contracts as necessary
• Medicare and Medicaid - Are they on track? When will they be
ready for end-to-end testing? What are their contingency plans?
48. Page 47March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Code Analysis
Review top 20-50 diagnosis codes
• Evaluate documentation currently in
the notes
• Crosswalk them to ICD-10
• Review new codes for additional
required codes, additional code
descriptions and “code also”
requirements
• Identify areas where additional
documentation will be required
49. Page 48March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
ICD-10 Impact on Physician Work Flow
• Will the EMR allow the physician to enter a descriptive
diagnosis rather than a specific diagnosis code?
• Is the physician prepared for the dramatic increase in
diagnosis codes now displayed on the drop-down list?
• How will the physician‟s workflow change when more
time is needed to assign the appropriate diagnosis
code?
• Can the EMR support a workflow that sends patient
encounters to coders for review and assignment of
the most specific diagnosis code based on the
physician‟s documentation?
50. Page 49March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Budget
• Cost of training/decreased staff productivity
• Cost of hardware/software upgrades
• Forms redesign
• Testing costs/Consulting services
• Vendor readiness – external testing
• Temporary maintenance of dual systems
• Cash reserves for denials increase, payment
delays, decreased productivity
Determine financial impact, budget, resources,
cash reserve needed for ICD-10 migration
51. Page 50March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Budget
How much emergency cash should providers keep in case of cash flow disruption?
• Review what happened to your organization with HIPAA 5010, this would be a good
baseline; with the transition of ICD-10 there will be delays in reimbursement.
• Vendors and clearinghouses have been working hard, but we will not know the true effects
until Oct. 1, 2014.
• It is recommended that you have up to several months' cash reserves or access to cash
through a loan or line of credit to avoid potential headaches.
• The amount of reserves you need to set aside will be impacted by the preparation work you
do for ICD-10.
• Will need to cover at a minimum practice operation expenses for three to six months:
– Medical supplies
– Payroll
– Rent
52. Page 51March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Implementation Issues
Training
• Will be required for various users
• Will require coder retraining
– Coding rules and conventions are similar, but not exactly
the same
• Some short-term loss of productivity is expected during the
learning curve
• Will require changes in data retrieval/analysis
• Will require changes to data systems
53. Page 52March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Training
Coding and Billing Staff
• Assess training needs and develop a plan
– Professional coding staff – ICD-10-CM
– Determine who will train staff and how
this will be accomplished
– Factor in time away from work, consider
post-testing and ongoing support
– Make ICD-10 proficiency part of your
coding staff‟s performance goals
» ICD-9-CM to ICD-10-CM Dual Coding
• Assign staff members to be the
“ICD-10 Experts” looking at the impact
from the billing to the clinical side
54. Page 53March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Training
Clinicians
• Physicians – focus on codes germane to their practice
• Review clinical documentation improvement efforts and develop new
strategies
• Incorporate documentation improvement as component to compliance
training
• Ancillary staff – identify needs and level of training needed, nursing,
financial services, quality, utilization, ancillary departments…
Information Technology
• Training to ensure that codes are accurately cross-walked in
organization‟s IT systems
55. Page 54March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Tiered Training Structure
56. Page 55March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
ICD-10 & EHR
• Analyze EHR for functionality and compliance
• Review templates, interfaces, default documentation, and level of detail
• Can the system accommodate the data format changes for ICD-10?
• What is the EHR vendor‟s timeline for the transition? When will their upgrades be available
for installation? Make sure that installation of upgrades is far enough in advance to
facilitate early testing.
• Will there be additional costs for the upgrade? Will multiple upgrades be required? Is there
a waiting list?
• Is the EHR vendor training its staff on ICD-10 system
upgrades?
• Can they ensure that the right components are in place to
select the more specific code?
• Will they have specialty specific codes?
• Will ICD-9 still be available for use and comparison?
• Does the system allow for dual coding?
57. Page 56March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
• Plan for dual ICD-9 and 10 codes for a brief period to address services rendered
before October 1, but discharged after October 1
• Monitor physician documentation to ensure ICD-10 compliance
• Monitor impact on claim-processing activity, claim denials, and rejections
• Audit coder productivity and accuracy
• Monitor patient satisfaction
• Post-transition Review
– What‟s working?
– What needs fixing?
• Schedule 30-day post-conversion claims assessment
ICD-10 Go Live, The Day After…
58. Page 57March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Priority List
Create an ICD-10 impact awareness throughout the organization
Ensure your foundational IS structure is actively preparing for the transition
Define your change approach to ensure you have defined the proper structure and
sponsorship
Develop projections of operational needs, including staffing and internal educational
training
Identify specific documentation gaps to determine focused educational needs
Calculate potential impact on financial results
59. Page 58March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
ICD-10 is not just a coder’s issue!
This transformation entails foundational changes to ALL
HIPAA-covered entities and providers
• In a nutshell, here are some key points to keep in mind going forward:
Senior management‟s
involvement is critical to
successful implementation!
• Risks of late or no implementation must be
understood
Problems should be expected!
• Develop action plans to manage them
• Have a back-up plan
Establish a budget. Develop a timeline and follow it!
60. Page 59March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
The future?
WHO is currently working on ICD-11
• They will build upon ICD-10
• The first draft was made available
online in July 2011 for review
• The final draft is expected to be
submitted to WHO's World Health
Assembly for official endorsement
by 2017
61. Page 60March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Key Resources
• ICD-10 Proposed and Final Rules
– http://edocket.access.gpo.gov/2008/pdf/E8-19298.pdf
– http://edocket.access.gpo.gov/2009/pdf/E9-743.pdf
• CMS Website on ICD-10
– https://www.cms.gov/ICD10/
• CDC Website on Classification of Diseases
– http://www.cdc.gov/nchs/icd.htm
• CMS ICD-10-CM Quick Reference Guide
– https://www.cms.gov/ICD10/11b14_2012_ICD10CM_and_GEMs.a
sp#TopOfPage
62. Page 61March 26-27, 2014
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There’s A Code For That!
Source: http://www.youtube.com/watch?v=IVhyUsGTxiE
63. Page 62March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Questions?
64. Page 63March 26-27, 2014
Prepared for AHLA – Institute on Medicare and Medicaid Payment Issues
Contact Information
Denise Hall, RN, BSN
Principal
Pershing Yoakley & Associates, P.C.
678-441-0645
dhall@pyapc.com
www.pyapc.com
Julie Chicoine, Esq., RN, CPC, CPCO
Wexner Medical Center at
The Ohio State University
614-293-2007
julie.chicoine@osumc.edu
www.medicalcenter.osu.edu
Thank you for allowing us to share our thoughts and
expertise with you.
Editor's Notes
This is the code for ‘struck by pig’: W55.42
So we have more codes… what does that mean to me and my hospital????
This is the code for ‘driver of SUV injured in collision with fixed or stationary object in traffic accident’: V47.51
WHO IS IMPACTED
These are the codes for ‘falling on escalator’: W10.0xxA, ‘bit by sea lion’: W56.11xA, and ‘alcohol intoxication’: F10.12
This is the code for ‘fire aboard spaceship’: V95.44