The document discusses the transition to using ICD-10 codes for medical diagnoses and procedures instead of ICD-9 codes. ICD-10 will provide significantly more medical coding options, with ICD-10-CM containing over 68,000 diagnosis codes compared to around 14,000 in ICD-9-CM. ICD-10-PCS will contain over 72,000 procedure codes instead of around 3,800 in ICD-9-CM Volume 3. The compliance date for fully implementing ICD-10 is October 1, 2013, with claims after that date requiring the use of ICD-10 codes. The transition affects health care providers, payers, lawyers, and their clients.
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.
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
ICD-10 Transition Update: What Health Lawyers Need to KnowPYA, P.C.
This document provides an overview of ICD-10 and the transition from ICD-9 to ICD-10 for healthcare organizations. It discusses the regulatory timeline requiring compliance by October 1, 2014, the differences between ICD-10-CM for diagnoses and ICD-10-PCS for procedures, organizational and financial impacts, and risk mitigation strategies for the transition. The transition represents a significant change that will impact coding, clinical documentation, claims processing, billing systems, and vendor relationships. Proper planning is needed to assess readiness and minimize risks to operations and revenue during the transition period.
ICD-10 Is Really Here: What Does That Mean To Compliance Officers?PYA, P.C.
This document provides an overview of a presentation for the Tennessee Hospital Association's 2015 Fall Compliance Conference on ICD-10 implementation. The presentation covers the current regulatory status of ICD-10, an overview of industry testing successes and challenges, how ICD-10 will be used for outcome-based and population health data in the future, and what to expect regarding claim denials. It also discusses bills in Congress regarding ICD-10 transition and provides examples of Medicare coverage determination changes.
ICD-10 Transition Presentation: What Health Lawyers Need to KnowPYA, P.C.
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.
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.
This document discusses preparing Alabama hospitals for the transition to ICD-10 coding. It identifies key areas of organizational impact, highlights the importance of change management and effective communication. A tool called the Loss of Effectiveness Index is introduced to assess change readiness across departments and leadership. The presentation emphasizes developing a change management plan that involves stakeholders, assesses training needs, and monitors readiness through multiple phases until the ICD-10 implementation date.
Accounting Update Overview with a Healthcare SlantPYA, P.C.
PYA Principal and Director of Audit Services Doug Arnold presented during East Tennessee State University’s 38th Annual Accounting, Auditing, and Tax Updating CPE conference. His presentation covered many recent Accounting Standards Updates, but leaned toward their applications in healthcare.
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.
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
ICD-10 Transition Update: What Health Lawyers Need to KnowPYA, P.C.
This document provides an overview of ICD-10 and the transition from ICD-9 to ICD-10 for healthcare organizations. It discusses the regulatory timeline requiring compliance by October 1, 2014, the differences between ICD-10-CM for diagnoses and ICD-10-PCS for procedures, organizational and financial impacts, and risk mitigation strategies for the transition. The transition represents a significant change that will impact coding, clinical documentation, claims processing, billing systems, and vendor relationships. Proper planning is needed to assess readiness and minimize risks to operations and revenue during the transition period.
ICD-10 Is Really Here: What Does That Mean To Compliance Officers?PYA, P.C.
This document provides an overview of a presentation for the Tennessee Hospital Association's 2015 Fall Compliance Conference on ICD-10 implementation. The presentation covers the current regulatory status of ICD-10, an overview of industry testing successes and challenges, how ICD-10 will be used for outcome-based and population health data in the future, and what to expect regarding claim denials. It also discusses bills in Congress regarding ICD-10 transition and provides examples of Medicare coverage determination changes.
ICD-10 Transition Presentation: What Health Lawyers Need to KnowPYA, P.C.
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.
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.
This document discusses preparing Alabama hospitals for the transition to ICD-10 coding. It identifies key areas of organizational impact, highlights the importance of change management and effective communication. A tool called the Loss of Effectiveness Index is introduced to assess change readiness across departments and leadership. The presentation emphasizes developing a change management plan that involves stakeholders, assesses training needs, and monitors readiness through multiple phases until the ICD-10 implementation date.
Accounting Update Overview with a Healthcare SlantPYA, P.C.
PYA Principal and Director of Audit Services Doug Arnold presented during East Tennessee State University’s 38th Annual Accounting, Auditing, and Tax Updating CPE conference. His presentation covered many recent Accounting Standards Updates, but leaned toward their applications in healthcare.
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
As healthcare is a language “all its own,” PYA Principal David McMillan presented “Learning the New Language of Healthcare" at the Georgia Society of CPAs' 2014 Healthcare Conference.
The recent extension of the ICD-10 deadline was greeted with mixed reactions throughout the healthcare industry. Some favored an extension, while others preferred to move ahead with the change. In this webinar, we look at the pros and cons of the delay and how it will affect providers and patients. Reactions from other vendors are also presented.
The Top Ten Issues in Physician Practice Acquisition and ValuationPYA, P.C.
A webinar hosted by The National Association of Certified Valuators and Analysts (NACVA) and presented by PYA Consulting Principal Darcy Devine outlines ten common, but often complex, issues that arise during the physician practice acquisition process. The webinar took place Friday, February 13, 2015. “Don’t Stumble Coming Out of the Gate—The Top Ten Issues in Physician Practice Acquisition and Valuation” is geared toward health system and physician practice financial executives as well as business valuators working with those entities.
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.
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.
HRSA requirements for a compliant sliding fee scaleCompliatric
The Health Center Compliance Manual outlines the requirements of both the program legislation and implementing regulations. The most recent updates to the Manual from HRSA provided some needed clarification in a number of areas, including the Sliding Fee Discount Program that is central to the Health Center Program. This webinar will outline the Sliding Fee requirements and provide examples and best practices for Community Health Centers to consider.
Medical Necessity-- What it Means and 2018 UpdatePYA, P.C.
This presentation addresses the concerns for instituting best practices in tackling medical necessity denials. Including what it means and what it affects, an update on 2018 CMS medical necessity determinations and new initiatives, and details regarding the types of, and criteria for, medical necessity determinations. Admission criteria for skilled nursing facilities and inpatient rehabilitation facilities, as well as the use of Advanced Beneficiary Notification and Hospital-Issued Notice of Non-Coverage (including the outcomes and penalties for not using ABNs or HINNs) are also discussed.
The Mercy Freedom Program was established as a patient-centered, hospital-based community program focused on prevention and using financial incentives to motivate patients to comply with clinical preventive care standards. The program empowers patients to actively participate in their health, generates individualized disease prevention plans, and provides discounted prescriptions as incentives for compliance. A software system was developed to automatically generate patient reminders and track prevention metrics. The program saw improved health outcomes and reduced costs for patients, physicians, and the hospital.
On July 31, 2014, the Centers for Medicare and Medicaid Services (CMS) issued the Final Rule under the Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities to be implemented on October 1, 2014. This seminar will discuss the impact of Fiscal Year 2015 Medicare payment rate increases for Skilled Nursing Facilities (SNFs) and will review the most recent Office of Management and Budget (OMB) statistical area delineations affecting the SNF PPS Wage Index. Learn about the revision to the existing COT OMRA policy. Additionally attendees will be apprised of updates to Chapter 8, Section 30 of the Medicare Benefit Policy Manual (Pub. 100-02) which directs providers on coverage decisions for reasonable and necessary treatment of patient’s illness or injury.
The document discusses the revenue cycle process in healthcare organizations. It begins with the front-end process which includes patient scheduling, registration, insurance verification, and preauthorization. It then discusses the middle process which involves clinical services, documentation, case management, coding, and charge capture. The revenue cycle is described as the financial circulatory system of healthcare that begins when a patient initiates care and ends when payment is received. Success depends on people, tools/technology, and processes working together effectively.
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/
Join HRG Executive Director of HIM Coding, Teresa Tate as she discusses telehealth documentation issues and identifies how to best avoid these issues. She will discuss patient consent & the differentiation between payers, the time factor & how to understand when telehealth is NOT separately reimbursable.
Entering the Final Stretch - Preparing for New Affordable Care Act ObligationsPSOW
This document summarizes a presentation on how the Affordable Care Act will affect emergency medical organizations as employers and providers. Key points include:
- As employers, emergency organizations with 50 or more full-time employees must comply with "pay or play" rules starting in 2015, which require offering affordable health insurance or paying penalties.
- As providers, emergency organizations will face increased fraud enforcement from expanded oversight and penalties under the ACA. The Office of Inspector General will examine Medicare claims data and review transports for medical necessity.
- All non-grandfathered health plans must cover essential health benefits, including emergency transport services. Presenters advise emergency organizations to understand and prepare for new ACA obligations and opportunities.
The Uncertain Future of Medicare Add-Ons and Pass-ThroughsBESLER
With so many changes resulting from the Patient Protection and Affordable Care Act (ACA) and other potential initiatives under consideration, a significant amount of your organization’s future Medicare revenue may be at risk. The trend to reduce and/or revamp payment methodologies comes at a time when hospitals face shrinking or non-existent margins. Revenue sources potentially on the chopping block include Medicare Bad Debt, Nursing Allied Health, Graduate Medical Education, Wage Index adjustments, and transplant, to name a few. Additionally, the Office of Inspector General (OIG) continues to add reimbursement-related topics to its annual Work Plan, expanding the areas for potential paybacks or penalties.
Affiliation Strategies for At-Risk Community HospitalsPYA, P.C.
PYA Senior Healthcare Consulting Manager Michael Ramey presented “Affiliation Strategies for At-Risk Community Hospitals” with Jay Hardcastle, partner at Bradley Arant Boult Cummings at the AHLA Health Care Transactions Program. The presentation helped:
1. Identify factors affecting the continued financial viability of community hospitals.
2. Introduce the importance of board/management being proactive in evaluating potential affiliation alternatives before reaching a dire state.
3. Discuss the request-for-proposal process.
4. Explore legal structures to retain the best value for the community via appropriate models (i.e., management agreement, lease, acquisition, joint operating agreement, joint venture, affiliation).
5. Provide lessons learned from recent hospital transactions.
Fair Market Value: What Rural Providers Need to Know PYA, P.C.
PYA Principal Tynan Olechny and Senior Manager Annapoorani Bhat provided important information for rural providers related to fair market value and commercial reasonableness considerations during a National Rural Health Association webinar, “Valuations: What Rural Providers Need to Know."
The Skilled Nursing Facility (SNF) “Program for Evaluating Payment Patterns Electronic Report” (PEPPER) was released in April 2014 by CMS. Join Keri Hart, MS, CCC-SLP, CHHRP-QT, RAC-CT, in this in-depth interpretation of the elements of the PEPPER. Keri will detail how to interpret your PEPPER and discuss the practical application of this critical information to your Skilled Nursing Facility’s practice. Follow along with your own PEPPER report to develop an action plan to ensure compliance with Medicare regulatory requirements and ensure accurate reimbursement for clinically appropriate care provided.
CMS introduced this new annual report for Skilled Nursing Facilities in August 2013. PEPPER data is shared with both Medicare Administrative Contractors (MACs) and the Medicare Recovery Audit Contractors (RACs). This important report details your facility-specific Medicare claims data in certain targeted areas and compares your facility to other SNFs Nationally, by State and by Jurisdiction (Medicare Administrative Contractors/Fiscal Intermediaries).
The document provides an overview of ICD-10 and the transition from ICD-9 to ICD-10. It discusses the key organizations involved in ICD coding including CMS, WHO, AAPC and AHIMA. It outlines the timeline for transitioning to the 5010 transaction standards by 2012 as a prerequisite for the ICD-10 implementation deadline of October 1, 2013. The document details the improvements in specificity and functionality provided by ICD-10 codes as well as the impact of the transition on providers, payers and other stakeholders.
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.
The document provides an overview of ICD-10, including definitions of ICD-10-CM and ICD-10-PCS, key differences from ICD-9, code structure changes, the October 1, 2015 implementation date, resources available, potential impacts of implementation, stakeholders involved, and considerations for revenue cycle management and readiness.
Mediscribes, Inc. is one of the fastest growing transcription & document management systems providers in United States, We Provide rendering cost-effective consolidated
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
As healthcare is a language “all its own,” PYA Principal David McMillan presented “Learning the New Language of Healthcare" at the Georgia Society of CPAs' 2014 Healthcare Conference.
The recent extension of the ICD-10 deadline was greeted with mixed reactions throughout the healthcare industry. Some favored an extension, while others preferred to move ahead with the change. In this webinar, we look at the pros and cons of the delay and how it will affect providers and patients. Reactions from other vendors are also presented.
The Top Ten Issues in Physician Practice Acquisition and ValuationPYA, P.C.
A webinar hosted by The National Association of Certified Valuators and Analysts (NACVA) and presented by PYA Consulting Principal Darcy Devine outlines ten common, but often complex, issues that arise during the physician practice acquisition process. The webinar took place Friday, February 13, 2015. “Don’t Stumble Coming Out of the Gate—The Top Ten Issues in Physician Practice Acquisition and Valuation” is geared toward health system and physician practice financial executives as well as business valuators working with those entities.
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.
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.
HRSA requirements for a compliant sliding fee scaleCompliatric
The Health Center Compliance Manual outlines the requirements of both the program legislation and implementing regulations. The most recent updates to the Manual from HRSA provided some needed clarification in a number of areas, including the Sliding Fee Discount Program that is central to the Health Center Program. This webinar will outline the Sliding Fee requirements and provide examples and best practices for Community Health Centers to consider.
Medical Necessity-- What it Means and 2018 UpdatePYA, P.C.
This presentation addresses the concerns for instituting best practices in tackling medical necessity denials. Including what it means and what it affects, an update on 2018 CMS medical necessity determinations and new initiatives, and details regarding the types of, and criteria for, medical necessity determinations. Admission criteria for skilled nursing facilities and inpatient rehabilitation facilities, as well as the use of Advanced Beneficiary Notification and Hospital-Issued Notice of Non-Coverage (including the outcomes and penalties for not using ABNs or HINNs) are also discussed.
The Mercy Freedom Program was established as a patient-centered, hospital-based community program focused on prevention and using financial incentives to motivate patients to comply with clinical preventive care standards. The program empowers patients to actively participate in their health, generates individualized disease prevention plans, and provides discounted prescriptions as incentives for compliance. A software system was developed to automatically generate patient reminders and track prevention metrics. The program saw improved health outcomes and reduced costs for patients, physicians, and the hospital.
On July 31, 2014, the Centers for Medicare and Medicaid Services (CMS) issued the Final Rule under the Medicare Program: Prospective Payment System and Consolidated Billing for Skilled Nursing Facilities to be implemented on October 1, 2014. This seminar will discuss the impact of Fiscal Year 2015 Medicare payment rate increases for Skilled Nursing Facilities (SNFs) and will review the most recent Office of Management and Budget (OMB) statistical area delineations affecting the SNF PPS Wage Index. Learn about the revision to the existing COT OMRA policy. Additionally attendees will be apprised of updates to Chapter 8, Section 30 of the Medicare Benefit Policy Manual (Pub. 100-02) which directs providers on coverage decisions for reasonable and necessary treatment of patient’s illness or injury.
The document discusses the revenue cycle process in healthcare organizations. It begins with the front-end process which includes patient scheduling, registration, insurance verification, and preauthorization. It then discusses the middle process which involves clinical services, documentation, case management, coding, and charge capture. The revenue cycle is described as the financial circulatory system of healthcare that begins when a patient initiates care and ends when payment is received. Success depends on people, tools/technology, and processes working together effectively.
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/
Join HRG Executive Director of HIM Coding, Teresa Tate as she discusses telehealth documentation issues and identifies how to best avoid these issues. She will discuss patient consent & the differentiation between payers, the time factor & how to understand when telehealth is NOT separately reimbursable.
Entering the Final Stretch - Preparing for New Affordable Care Act ObligationsPSOW
This document summarizes a presentation on how the Affordable Care Act will affect emergency medical organizations as employers and providers. Key points include:
- As employers, emergency organizations with 50 or more full-time employees must comply with "pay or play" rules starting in 2015, which require offering affordable health insurance or paying penalties.
- As providers, emergency organizations will face increased fraud enforcement from expanded oversight and penalties under the ACA. The Office of Inspector General will examine Medicare claims data and review transports for medical necessity.
- All non-grandfathered health plans must cover essential health benefits, including emergency transport services. Presenters advise emergency organizations to understand and prepare for new ACA obligations and opportunities.
The Uncertain Future of Medicare Add-Ons and Pass-ThroughsBESLER
With so many changes resulting from the Patient Protection and Affordable Care Act (ACA) and other potential initiatives under consideration, a significant amount of your organization’s future Medicare revenue may be at risk. The trend to reduce and/or revamp payment methodologies comes at a time when hospitals face shrinking or non-existent margins. Revenue sources potentially on the chopping block include Medicare Bad Debt, Nursing Allied Health, Graduate Medical Education, Wage Index adjustments, and transplant, to name a few. Additionally, the Office of Inspector General (OIG) continues to add reimbursement-related topics to its annual Work Plan, expanding the areas for potential paybacks or penalties.
Affiliation Strategies for At-Risk Community HospitalsPYA, P.C.
PYA Senior Healthcare Consulting Manager Michael Ramey presented “Affiliation Strategies for At-Risk Community Hospitals” with Jay Hardcastle, partner at Bradley Arant Boult Cummings at the AHLA Health Care Transactions Program. The presentation helped:
1. Identify factors affecting the continued financial viability of community hospitals.
2. Introduce the importance of board/management being proactive in evaluating potential affiliation alternatives before reaching a dire state.
3. Discuss the request-for-proposal process.
4. Explore legal structures to retain the best value for the community via appropriate models (i.e., management agreement, lease, acquisition, joint operating agreement, joint venture, affiliation).
5. Provide lessons learned from recent hospital transactions.
Fair Market Value: What Rural Providers Need to Know PYA, P.C.
PYA Principal Tynan Olechny and Senior Manager Annapoorani Bhat provided important information for rural providers related to fair market value and commercial reasonableness considerations during a National Rural Health Association webinar, “Valuations: What Rural Providers Need to Know."
The Skilled Nursing Facility (SNF) “Program for Evaluating Payment Patterns Electronic Report” (PEPPER) was released in April 2014 by CMS. Join Keri Hart, MS, CCC-SLP, CHHRP-QT, RAC-CT, in this in-depth interpretation of the elements of the PEPPER. Keri will detail how to interpret your PEPPER and discuss the practical application of this critical information to your Skilled Nursing Facility’s practice. Follow along with your own PEPPER report to develop an action plan to ensure compliance with Medicare regulatory requirements and ensure accurate reimbursement for clinically appropriate care provided.
CMS introduced this new annual report for Skilled Nursing Facilities in August 2013. PEPPER data is shared with both Medicare Administrative Contractors (MACs) and the Medicare Recovery Audit Contractors (RACs). This important report details your facility-specific Medicare claims data in certain targeted areas and compares your facility to other SNFs Nationally, by State and by Jurisdiction (Medicare Administrative Contractors/Fiscal Intermediaries).
The document provides an overview of ICD-10 and the transition from ICD-9 to ICD-10. It discusses the key organizations involved in ICD coding including CMS, WHO, AAPC and AHIMA. It outlines the timeline for transitioning to the 5010 transaction standards by 2012 as a prerequisite for the ICD-10 implementation deadline of October 1, 2013. The document details the improvements in specificity and functionality provided by ICD-10 codes as well as the impact of the transition on providers, payers and other stakeholders.
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.
The document provides an overview of ICD-10, including definitions of ICD-10-CM and ICD-10-PCS, key differences from ICD-9, code structure changes, the October 1, 2015 implementation date, resources available, potential impacts of implementation, stakeholders involved, and considerations for revenue cycle management and readiness.
Mediscribes, Inc. is one of the fastest growing transcription & document management systems providers in United States, We Provide rendering cost-effective consolidated
A McKesson Perspective for Physicians: ICD-10-CM/PCSrmsspeciality
Your health information management and medical billing systems are foundational to your revenue cycle and ICD-10 transition. Ensure these foundational systems are updated and fully tested. Learn more about the ICD-10 transition from McKesson.
Preparing and Implementing a Comprehensive ICD-10 Testing StrategyCognizant
This paper describes a testing strategy that, if healthcare organizations begin now, can help ensure compliance without endangering critical business operations.
This document provides an overview of the transition from ICD-9 to ICD-10 coding systems in the United States. It discusses the key changes and differences between ICD-10-CM diagnosis coding and ICD-10-PCS inpatient procedure coding. It outlines the risks associated with the transition such as claim denials and delays. It provides checklists and recommendations for provider training and testing to facilitate a smooth transition.
The document outlines Baptist Health System's multi-phase approach to implementing ICD-10 across their health system. Phase 1 involved developing an implementation plan and assessing impacts. Phase 2 was preparation, including training, testing, and financial analysis. Phase 3 was "go-live" preparation with extensive training, testing, and ensuring systems were ready. Phase 4 involves post-implementation follow up. Despite the ICD-10 delay, Baptist Health is continuing forward with their implementation plan to be prepared. Effective communication is emphasized as key to the process.
Public Speaking - Informative Speech PowerPointZhen(Jane) Qin
The speaker discusses the implementation of the new ICD-10 diagnostic codes that went into effect on October 1st, 2015. The speaker introduces ICD-10, explaining that it is the 10th version of the International Classification of Diseases coding system used to classify diagnoses and treatments. The speaker notes that the transition to ICD-10 will impact healthcare providers, insurance companies, and patients, requiring more time and money from providers and insurers while helping ensure patients receive accurate reimbursements.
This document provides an overview of the transition from ICD-9 to ICD-10 diagnosis and procedure coding standards. It discusses key dates in the timeline of ICD revisions and adoptions. The United States will transition to ICD-10 on October 1, 2014. The document outlines the increased specificity of codes in ICD-10 compared to ICD-9 and shows examples. It recommends action steps for healthcare providers to prepare for ICD-10 over a 12-24 month period. These include assessing impact, developing a project plan, estimating costs, and testing with payers and vendors. The transition requires training staff on ICD-10 and changes to documentation, coding and billing processes.
- ANSI 5010 is a new standard for electronic health claims that must be implemented by January 2012, before the 2013 transition to ICD-10 codes. Many practices have yet to achieve compliance or have a plan for doing so.
- The top obstacles to compliance are competing EHR/meaningful use priorities, limited technical resources, and payers, vendors, and clearinghouses not being ready. Practices need help from billing services to navigate these challenges and ensure compliance.
- Failure to comply could lead to claims denials and payment delays, costing practices significantly. Practices must work urgently with compliant billing partners to smoothly manage the transition.
We feature experts Stanley Nachimsom of Nachimsom Associates and Michael Palatoni of Athena Health to review WEDI survey results and share small practice/physician update on ICD-10 implementation. Visit floridablue.com/icd-10, your complete ICD-10 resource.
The document discusses the upcoming transition from ICD-9 to ICD-10 diagnosis and procedure codes that all US physician practices must implement by October 1, 2013. ICD-10 will expand the number of codes almost eight-fold and require greater specificity in clinical documentation. Physician practices need to begin preparing now by creating an implementation task force, developing education programs for coders and physicians, assessing staff and resources, and ensuring IT systems are updated to support the new codes. Failure to prepare could negatively impact reimbursement and cash flow.
ICD-10 Transition Preparation and Preparedness 7.17.15 11.21amTodd Morris
The document provides an overview of the transition from ICD-9 to ICD-10 coding that will go into effect on October 1, 2015. It describes the key differences between ICD-9 and ICD-10 coding structures and new features included in ICD-10. It also outlines the plans and timelines of TMC and JBS Software Solutions to implement the transition, including internal education efforts, database upgrades, and tools that will be available to facilitate the change.
“Unified ICD Services (UIS)” brings custom built clinical intelligence for doctors to determine correct ICD-10 diagnosis, surgical codes with faster and smarter approach. UIS additional features would provide more specific data up front to doctors/physicians to less follow-up and fewer denials after claims submission”.
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 Open Line Friday 9/18/2014 - Payer Update Florida Blue
This document provides information about an upcoming webinar titled "Navigating to ICD-10: A Payer Update with Humana & Florida Blue". The webinar will take place on September 19, 2014 from 9:30-10:30 EST and will feature panelists from Florida Blue, Mayo Clinic, Baptist Health South Florida and other organizations. The webinar will provide an update on ICD-10 implementation strategies from Humana and Florida Blue, discuss next steps for providers, and allow time for participant questions.
Similar to ICD-10 Transition: What Health Lawyers Need to Know (20)
“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.
The proposed rule would significantly impact physician compensation by re-valuing outpatient E/M services. It increases reimbursement for E/M codes but reduces the conversion factor, resulting in higher payments for some specialties and lower payments for others. This redistribution could increase revenue for specialists providing many E/M services but decrease revenue for proceduralists. Employers may need to adjust physician contracts to account for these changes. The rule also introduces new E/M guidelines and codes effective 2021, requiring preparation from medical practices.
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 document provides information on the $100 billion Provider Relief Fund established by the CARES Act to reimburse healthcare providers for expenses or lost revenues attributable to COVID-19. It summarizes that $30 billion has been distributed based on providers' 2019 Medicare billings, with no repayment obligation. It outlines the attestation process to accept funds within 30 days and confirms that providers must comply with terms including using funds only for COVID-19 care and not balance billing uninsured patients. The document advises on accounting, compliance, and tax implications of the relief funds.
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.
ITES KPO BPO IT sector in the country has increased at an incredible rate o...yashwanthkumar517728
ites KPO and BPO,IT sector in the country has increased at an incredible rate of 35% per year for the last 10 years reinforces the view that India is world class in IT
The IT sector is one of the largest employers of women, and therefore, can play a crucial role in women empowerment and the reduction of gender inequalities.
Monthly Market Risk Update: June 2024 [SlideShare]Commonwealth
Markets rallied in May, with all three major U.S. equity indices up for the month, said Sam Millette, director of fixed income, in his latest Market Risk Update.
For more market updates, subscribe to The Independent Market Observer at https://blog.commonwealth.com/independent-market-observer.
5 Compelling Reasons to Invest in Cryptocurrency NowDaniel
In recent years, cryptocurrencies have emerged as more than just a niche fascination; they have become a transformative force in global finance and technology. Initially propelled by the enigmatic Bitcoin, cryptocurrencies have evolved into a diverse ecosystem of digital assets with the potential to reshape how we perceive and interact with money.
13 Jun 24 ILC Retirement Income Summit - slides.pptxILC- UK
ILC's Retirement Income Summit was hosted by M&G and supported by Canada Life. The event brought together key policymakers, influencers and experts to help identify policy priorities for the next Government and ensure more of us have access to a decent income in retirement.
Contributors included:
Jo Blanden, Professor in Economics, University of Surrey
Clive Bolton, CEO, Life Insurance M&G Plc
Jim Boyd, CEO, Equity Release Council
Molly Broome, Economist, Resolution Foundation
Nida Broughton, Co-Director of Economic Policy, Behavioural Insights Team
Jonathan Cribb, Associate Director and Head of Retirement, Savings, and Ageing, Institute for Fiscal Studies
Joanna Elson CBE, Chief Executive Officer, Independent Age
Tom Evans, Managing Director of Retirement, Canada Life
Steve Groves, Chair, Key Retirement Group
Tish Hanifan, Founder and Joint Chair of the Society of Later life Advisers
Sue Lewis, ILC Trustee
Siobhan Lough, Senior Consultant, Hymans Robertson
Mick McAteer, Co-Director, The Financial Inclusion Centre
Stuart McDonald MBE, Head of Longevity and Democratic Insights, LCP
Anusha Mittal, Managing Director, Individual Life and Pensions, M&G Life
Shelley Morris, Senior Project Manager, Living Pension, Living Wage Foundation
Sarah O'Grady, Journalist
Will Sherlock, Head of External Relations, M&G Plc
Daniela Silcock, Head of Policy Research, Pensions Policy Institute
David Sinclair, Chief Executive, ILC
Jordi Skilbeck, Senior Policy Advisor, Pensions and Lifetime Savings Association
Rt Hon Sir Stephen Timms, former Chair, Work & Pensions Committee
Nigel Waterson, ILC Trustee
Jackie Wells, Strategy and Policy Consultant, ILC Strategic Advisory Board
Calculation of compliance cost: Veterinary and sanitary control of aquatic bi...Alexander Belyaev
Calculation of compliance cost in the fishing industry of Russia after extended SCM model (Veterinary and sanitary control of aquatic biological resources (ABR) - Preparation of documents, passing expertise)
“Amidst Tempered Optimism” Main economic trends in May 2024 based on the results of the New Monthly Enterprises Survey, #NRES
On 12 June 2024 the Institute for Economic Research and Policy Consulting (IER) held an online event “Economic Trends from a Business Perspective (May 2024)”.
During the event, the results of the 25-th monthly survey of business executives “Ukrainian Business during the war”, which was conducted in May 2024, were presented.
The field stage of the 25-th wave lasted from May 20 to May 31, 2024. In May, 532 companies were surveyed.
The enterprise managers compared the work results in May 2024 with April, assessed the indicators at the time of the survey (May 2024), and gave forecasts for the next two, three, or six months, depending on the question. In certain issues (where indicated), the work results were compared with the pre-war period (before February 24, 2022).
✅ More survey results in the presentation.
✅ Video presentation: https://youtu.be/4ZvsSKd1MzE
Poonawalla Fincorp’s Strategy to Achieve Industry-Leading NPA Metricsshruti1menon2
Poonawalla Fincorp Limited, under the leadership of Managing Director Abhay Bhutada, has achieved industry-leading Gross Non-Performing Assets (GNPA) below 1% and Net Non-Performing Assets (NNPA) below 0.5% as of May 31, 2024. This success is attributed to a strategic vision focusing on prudent credit policies, robust risk management, and digital transformation. Bhutada's leadership has driven the company to exceed its targets ahead of schedule, emphasizing rigorous credit assessment, advanced risk management, and enhanced collection efficiency. By prioritizing customer-centric solutions, leveraging digital innovation, and maintaining strong financial performance, Poonawalla Fincorp sets new benchmarks in the industry. With a continued focus on asset quality, digital enhancement, and exploring growth opportunities, the company is well-positioned for sustained success in the future.
What Lessons Can New Investors Learn from Newman Leech’s Success?Newman Leech
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The Vadhavan Port Development is poised to be one of the most significant infrastructure projects in India's maritime history. This deep-sea port, located in Maharashtra, promises to transform the region's economic landscape, bolster India's trade capabilities, and generate a plethora of employment opportunities. In this blog, we will delve into the various facets of the Vadhavan Port Development: what to expect in and beyond its completion, and how it stands to influence the future of India's maritime and economic sectors.
Vadhavan Port Development _ What to Expect In and Beyond (1).pdf
ICD-10 Transition: What Health Lawyers Need to Know
1. ICD-10 Transition:
What Health Lawyers Need to Know
American Bar Association
Emerging Issues in Healthcare Law Conference 2012
February 23, 2012
Prepared for ABA – Emerging Issues in Healthcare Law Conference 2012 Page 0
February 23, 2012
2. Learning Objectives
• Increase your overall awareness about ICD-10 and its
pervasive impact on your client base
• Highlight the potential financial and regulatory impacts
• Explore how to prepare your clients for the change that
ICD-10 will enable
• Discuss Risk Mitigation opportunities for your clients as
you prepare for the migration to ICD-10
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3. What is ICD-10?
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4. What is ICD-10?
• ICD-10 is a medical coding system
• 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
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5. What’s 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 and the National Center for Health
Statistics within the Centers for Disease Control
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February 23, 2012
6. ICD-10 Is Really Two Different
Code Sets
• The 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
• There is no relationship between the two code sets –
they have completely different structures and uses
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February 23, 2012
7. How Big Could It Be?
ICD-9-CM ICD-10-CM & ICD-10-PCS
Diagnosis: 14,025 Diagnosis: 68,069
Procedures: 3,824 Procedures: 72,589
820.02, Fracture of midcervical section of S72031A, Displaced midcervical fracture of right femur,
femur, closed initial encounter for closed fracture
S72031G: Displaced midcervical fracture of right femur,
subsequent encounter for closed fracture with delayed
healing
S72032A: Displaced midcervical fracture of left femur,
initial encounter for closed fracture
S72032G: Displaced midcervical fracture of left femur;
subsequent encounter for closed fracture with delayed
healing
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February 23, 2012
8. The ICD-10-CM
“Official Guidelines”
• As with ICD-9-CM, ICD–10–CM is supplemented by a set of
“Official Guidelines” that are designated as part of the ICD-
10-CM code set by the HIPPA “medical data code set”
regulations (45 CFR 162.1002(C)(2))
• The Official Guidelines provide detailed guidance on the
use of the ICD-10-CM code set
• The 2012 ICD-10-CM Official Guidelines are available from
http://www.cdc.gov/nchs/icd/icd10cm.htm#10update
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February 23, 2012
10. What’s 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
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February 23, 2012
11. The ICD-10-PCS
“Official Guidelines”
• CMS has released a set of “Official Guidelines” for ICD-10-PCS
• Like the ICD-10-CM Official Guidelines, the ICD-10-PCS Official
Guidelines are designated as part of the ICD-10-PCS code set by
the HIPPA “medical data code set” regulations (45 CFR
162.1002(C)(3))
• The 2012 ICD-10-PCS Official Guidelines are available from
https://www.cms.gov/ICD10/11b15_2012_ICD10PCS.asp#TopOf
Page
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February 23, 2012
12. When is it official?
Per the Department of Health and Human Services, the
compliance date for implementation of ICD-10-CM and
ICD-10-PCS is October 1, 2013.
January 1, December January 1, December January 1, October 1,
2010 31, 2010 2011 31, 2011 2012 2013
• Payers and • Internal testing of • Payers and • External testing • All electronic • Claims for
providers should Version 5010 providers should of Version 5010 claims must use services
begin internal must be begin external for electronic Version 5010 provided on or
testing of Version complete to testing of Version claims must be after this date
• Version 4010
5010 standards achieve Level I 5010 for complete to claims are no must use ICD-
for electronic Version 5010 electronic claims achieve Level II 10 codes for
longer accepted
claims compliance Version 5010 medical
• CMS begins
compliance diagnosis and
• Providers should accepting
inpatient
form ICD-10 Version 5010
procedures
sponsorship claims
team • CPT codes will
• Version 4010
continue to be
claims continue
used for
to be accepted
outpatient
services
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February 23, 2012
13. ICD-10 Code Comparison Examples
Tobacco Abuse Diabetes Mellitus Fracture of Radius
ICD-9-CM: 1 Codes ICD-9-CM: 10 Code ICD-9-CM: 33 Codes
ICD-10-CM: 5 Codes ICD-10-CM: 318 Codes ICD-10-CM: 1818 Codes
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February 23, 2012
14. ICD-10-CM Code Comparison
Examples
Mechanical Suture of Artery Angioplasty
complication of other
ICD-9-CM: 1 Code ICD-9-CM: 1 Code
vascular device,
implant or graft ICD-10-CM: 276 Codes ICD-10-CM: 854 Codes
ICD-9-CM: 1 Code
ICD-10-CM: 156 Codes
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February 23, 2012
15. The GEMs
• CMS has developed a bi-
directional crosswalk, referred
to as the General Equivalence
Mappings (GEMS), between
ICD-9-CM and ICD-10-CM/PCS
• There are GEMs for over 99
percent of all ICD–10–CM
codes and for 100 percent of
the ICD–10–PCS codes
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February 23, 2012
16. Practical Mappings
GEM Examples – ICD-9 to ICD-10
ICD-9-CM: 902.41 Injury to renal artery
ICD-10-CM GEM: S35.403A
Unspecified injury of unspecified
renal artery, initial encounter
ICD-9-CM: 50.24 Percutaneous ablation of
liver lesion or tissue
ICD-10-PCS GEM: 0F503ZZ
Destruction of Liver, Percutaneous
Approach
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February 23, 2012
17. Impact of ICD-10 on
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
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February 23, 2012
19. Current State of ICD-10
Providers will not be able
to report ICD-9-CM codes
No Grace Period
for services on or after
October 1, 2013
Date of Discharge will be There will be no delays in
used for hospital IP the implementation date of
settings ICD-10
Prepared for ABA – Emerging Issues in Healthcare Law Conference 2012 Page 18
February 23, 2012
20. Who is impacted by ICD-10?
Everyone!!
• Front – Scheduling, Access Areas • Documentation Analysis
• Middle – Coding, CDI, Case
Health • ICD-10 Education
Management
Information • Process Improvement
• Back – Billing, Reimbursement Management • Monitoring
Physician Revenue Information Post Acute
Office Process Technology Services
ICD-10
• IT Systems
• Capability, Communication
• Functionality
• Staffing Effectiveness • Vendor Preparedness
• Assessment of Revenue
Impact • Physician Documentation
• Process Improvement
Operational
Physician • Physician Integration
• Decision Support Reporting Planning
• Physician Performance
Impact
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February 23, 2012
21. Pervasive Change
If you care for a patient, handle a medical record, and/or process a claim
your workflow will be profoundly impacted by the migration to ICD-10
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February 23, 2012
24. Expected Total Project Cost
Minich-Pourshadi, Karen. “ICD-10 Puts Revenue at Risk.” HealthLeaders Media Intelligence (July 2011), p. 19.
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February 23, 2012
25. Expected Denial Reasons
Minich-Pourshadi, Karen. “ICD-10 Puts Revenue at Risk.” HealthLeaders Media Intelligence (July 2011), p. 22.
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February 23, 2012
26. Summary Financial Impact
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, 2013
– Claims-error rates will increase from 6% to 10 % (The
average current rate is close to 3%)
• According to the American Society of Clinical Oncology, 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
Prepared for ABA – Emerging Issues in Healthcare Law Conference 2012 Page 25
February 23, 2012
27. Pro Forma ICD-10
Implementation Budget
Cost Area 2011 2012 2013 2014 2015 2016
Total Training $ - $ 40,500 $ 468,000 $ 27,000 $ - $ 535,500
IS Staff Augmentation $ 115,000 $ 1,240,000 $ 840,000 $ 265,000 $ 50,000 $ 2,610,000
HIM Coding Staff Augmentation $ - $ 35,000 $ 180,000 $ 165,000 $ 65,000 $ 545,000
Revenue Cycle Staff Augmentation $ - $ - $ 135,000 $ 220,000 $ 220,000 $ 575,000
IS Software Upgrades $ 75,000 $ 430,000 $ - $ - $ - $ 505,000
Technology Upgrades $ 10,000 $ 10,000 $ - $ - $ - $ 20,000
New Software $ - $ 1,700,000 $ 380,000 $ 280,000 $ 280,000 $ 2,640,000
Reports and Forms $ - $ 150,000 $ 115,000 $ - $ - $ 265,000
Interface and Other Testing $ - $ 260,000 $ 260,000 $ - $ - $ 520,000
TOTALS: $ 200,000 $ 3,865,500 $ 2,378,000 $ 957,000 $ 815,000 $ 8,215,500
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February 23, 2012
29. Current Compliance Environment
• Recently created regulatory agencies charged with improving efficiencies
within the healthcare delivery system and reducing the incidence of
improper payments include:
– Zone Program Integrity Contracts (ZPIC)
– Medicare Drug Integrity Contractor (MEDIC)
– Medicaid Integrity Contractors (MIC)
– Medicaid Recovery Audit Contractor Program
– Medicare Recovery Audit Contractor Program (RAC)
– Health Care Fraud Prevention and Enforcement Team Task Force (HEAT)
– Fraud and abuse provisions of Patient Protection and Affordable Care Act of
2010 (ACA) and related administrative roles
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30. Current Compliance Environment
• Recently enacted legislation
includes:
– Fraud and Abuse Provisions of ACA:
Implications for Providers
– Expanded False Claims Act (FCA);
Implications for Providers
– Amended Federal Sentencing
Guidelines; Implications for Providers
– HIPAA Privacy Standards
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31. ICD-10 Impact on Compliance Risk
• 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.
– It is important to note that ICD-10 conversions include manual review
and monitoring due to the significant differences in language and
structure between ICD-9 and ICD-10
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33. Risk Mitigation Strategies
Data Integrity –
prepare for delayed
accepted batches IT Preparedness –
Budget for potential prepare for payor
cash flow impact /vendor delays
Key Areas of
Rightsize staff to Compliance Risk
Adjust AR Reserves
handle increased as Needed
volume
Denial Tracking Tool HIM Preparedness
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34. Thrive in the Transition
The realization of the opportunities, and the avoidance of the
risks associated with the migration to ICD-10 will
Impact fundamentally depend on the individuals within your
Awareness
Definition organization. Specifically, their ability to thrive within this
changing environment.
Change
To support this, create a holistic approach that:
Readiness
Assessment • Illustrates the impact of the ICD-10 migration across the
organization;
Collaborative • Diagnostically assesses the readiness of individuals to
Sponsorship accept and thrive in a changing environment;
Design
• Design a sponsorship model that leverages the nature of
the healthcare industry and intuitively distributes
Training responsibility; and
Blueprint
Construction
• Developing a blueprint that pulls together all the training
effort required across the organization for success.
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35. Risk Mitigation: “The Must Do’s”
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
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36. Risk Mitigation Strategies
Review existing software, including interfaces, to ensure its ability to successfully
transition to ICD-10
Train clinical and administrative staff on new code sets, technological changes as
well as fraud, waste, and abuse regulations and reporting
Review Third Party agreements to ensure any vendors involved in billing
processes will be compliant with ICD-10 requirements
Ensure clinical documentation procedures reflect the increased level of detail
required by ICD-10
Contract with outside entities to audit six (6) to twelve (12) months of claims
submitted by an organization to identify any activity that might be considered
fraudulent
Take immediate corrective action where necessary
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37. Focused Specifics: Documentation
1. Focus on good documentation, which
directly impact accurate billing and
payment timing
2. Be aware of new ICD-10
documentation guidelines in order to
evaluate provider documentation for
appropriateness, thoroughness, and
completeness
3. Take great care to document
procedures, labs, and diagnostics
performed in order to capture the
essence of the total care provided
during hospital admissions
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38. Focused Specifics: Collaboration
4. Collaboration, transparency, and
communication between payers
and providers
5. Train and problem solve through
the use of task forces
6. Encourage CMS to continue
perfecting payment groupers and
mappings
7. Collaborate with other healthcare
stakeholders to create an industry
test bed
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39. Establish dialogue and candid discussions
with your primary third party payers now
• Learn how each one plans to prepare for
ICD-10 changes, ask if they are
implementing new rules for claims
submission or re-submission
• Share your plans for implementing these
changes with them
• Identify shared goals and objectives to
ensure a combined approach, minimizing
disruption to either’s coding processes
(win-win)
• Work all denials and rejects aggressively
to eliminate their occurrence and ensure
more first time third party payer payments
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40. 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
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42. Contact Information
Thank you for allowing us to present this information to
you. We appreciate the opportunity to work with you and
your organization.
Denise Hall, RN, BSN Neil W. Kunkel
Principal SVP, General Counsel & Secretary
Pershing Yoakley & Associates, P.C. Capella Healthcare
678-441-0645 615-764-3015
dhall@pyapc.com Neil.Kunkel@capellahealth.com
www.pyapc.com www.capellahealth.com
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February 23, 2012