Moving to ICD-10

When will we move to using the ICD-10 codes? The mandated implementation date has been pushed back from October 1, 2011 to October 1, 2013. By that date, use of the ICD-9 code set must be replaced by the ICD-10 code set.

Hospitals, and physician practices and health insurance companies should be gearing up for ICD-10 now. Most have not started or have begun only rudimentary planning. They should have identified staff to train on ICD-10 and develop training materials. Product requirements need to be determined.

One reason is that providers tend to see the change as more minor than it is; they see it as only a more extensive version of the yearly diagnosis code updates. Instead, transitioning from ICD-9 to ICD-10 is a huge project. It has been compared to the Y2K date correction in scale. Stakeholders include physicians, hospitals, other healthcare providers, and medical billing and health insurance claims staff, all of whom must be trained to use the new coding system. 

Technology vendors must update their medical record, billing, insurance and reporting software to simultaneously handle both ICD-9 and ICD-19 codes until transition is complete. Health insurance policies will also need to be updated to accommodate the newly-recognized diagnosis and procedure codes.

A Comparison of ICD-9 and ICD-10

Here is a comparison of ICD-9 and ICD-10:

ICD-9

13,000 diagnosis codes

3,000 procedure codes

3 – 5 numeric digit codes

Lacks laterality

Uses generic terms for body parts

Non-specific codes cause difficulty in analyzing data

Based on outdated technology

Limits DRG assignment

ICD-10

68,000 diagnosis codes, plus the ability to add more

Symptoms can be better linked to diagnoses in the new codes

87,000 procedure codes, plus expandability

3 – 7 alphanumeric character codes, allowing for greater specificity and detail

Provides laterality

Uses detailed descriptions for body parts

Detail allows better data analysis for medical research/reporting and healthcare purchasing

Works with current technology and will work with the new HIPAA form

Allows DRG definitions to better recognize new technologies and devices

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Tags: ICD-Codes, ICD-9 Codes, ICD-10 Codes, EMR, EHR

Limitations of ICD-9 Codes

The US still uses the old ICD-9 coding system. The limitations of this outdated system are increasing as new diagnostic and treatment procedures become available, because 

1) ICD-9 does not have the ability to add new codes for them. 

2) The same is true for new diagnoses. 

3) The system also cannot provide granularity of sub-classifications of diagnoses or related problems from socioeconomic or lifestyle issues. 

4) Moreover, because one of the main uses of the ICD codes is in the medical billing – health insurance payment transaction, and that transaction is now almost universally done electronically, there is a need for the transaction to be able to use the new HIPAA electronic transaction forms. ICD-9 codes are not set up to do this.

What does this mean?

One thing it means is that healthcare providers cannot always give the most accurate diagnosis and procedure information. This generates more work on the part of health insurance companies, as claims analysts must review ambiguous codes in billing, and medical reviews must be done case-by-case for tests and treatments that might otherwise be standardized by codes. It means valid medical care bills are sometimes denied or that payments for them are determined incorrectly because the true value cannot be easily seen from the codes. 

It can potentially seriously affect patient care, as inaccurate coding can lead to missing the true diagnosis and prescribing the wrong treatment. It means that public policy does not have the most accurate information from their research. And it means that, because the US is behind a whopping 153 other countries in getting up to speed, we do not have the capability of interoperability with them.

Tags: ICD Coding | EMR | EHR

ICD-10 Codes

ICD (International Classification of Diseases) codes are medical diagnosis and procedure codes used for billing and health insurance reimbursement, automated decision support and government statistical reports on morbidity and mortality. In fact, they are used around the world – not a US creation, the ICD coding system is published by WHO (the World Health Organization, a UN agency) And they’ve been around a long time: Version 1 was created in 1900, with precursors to the ICD codes existing as early as 1853. 

ICD-10 is the latest revision. To the US healthcare IT industry, ICD-10 seems like the next big thing, but in fact it’s been in existence since 1990. To date, 153 nations use the ICD-10 codes, though not all of them use the coding system in its entirety. In the US, ICD-10 codes are “not currently valid for any purpose or use,” according to the National Center for Health Statistics, a division of the CDC. The government does use the codes for mortality reporting, according to the American Health Information Management Association, but that is about all.

The US still uses the old ICD-9 coding system. The limitations of this outdated system are increasing as new diagnostic and treatment procedures become available, because ICD-9 does not have the ability to add new codes for them. The same is true for new diagnoses. The system also cannot provide granularity of sub-classifications of diagnoses or related problems from socioeconomic or lifestyle issues. Moreover, because one of the main uses of the ICD codes is in the medical billing – health insurance payment transaction, and that transaction is now almost universally done electronically, there is a need for the transaction to be able to use the new HIPAA electronic transaction forms. ICD-9 codes are not set up to do this.

Tags: EMR | EHR 

Meaningful Use Stage 2

EHR standards get tougher under finalized meaningful use stage 2

Federal officials soften some proposed requirements and officially delay the deadline to upgrade to the next electronic health record phase, but doctors wanted more leeway.

Washington Starting as early as 2014, physician practices will be required to achieve more difficult objectives to demonstrate meaningful use of electronic health records to earn federal bonuses and prevent future penalties.

The Centers for Medicare & Medicaid Services finalized its requirements for stage 2 of the EHR incentive program in an Aug. 23 regulation. The final rule mandates that doctors meet a larger number of core objectives — and stricter guidelines for some of those objectives already in place — during the next part of the three-stage program. Physicians also must adopt and demonstrate meaningful use of EHR systems by Oct. 1, 2014, or be assessed a 1% penalty from Medicare.

Doctors who successfully adopt early enough can earn up to $44,000 over five years from Medicare, or up to $63,750 over six years from Medicaid. Demonstrating meaningful use of a paperless record will become required annually to prevent penalties that will take effect starting in 2015. CMS reports that about 55,000 physicians had earned Medicare incentives through June 2012 under the less-stringent stage 1. Slightly more than 34,000 had earned Medicaid bonuses.

Several organizations representing physicians and other participants have urged CMS to design the program to be more flexible so it encourages even greater EHR use. Organized medicine groups, including the American Medical Association, had called for the administration to soften the stage 2 meaningful use requirements that it outlined in a proposed rule issued in February.

The AMA “has provided ongoing input since the inception of the EHR incentive program and has urged greater flexibility to make the program more reasonable and achievable for physicians,” said AMA Board Chair Steven J. Stack, MD. “In a comment letter submitted by the AMA and 100 state and specialty medical societies in May, recommendations were outlined to eliminate physician roadblocks and encourage greater physician participation.”

The Association and the other societies that signed onto the comment letter were reviewing the final rule, Dr. Stack said. He said he hoped the review would find changes that promote adoption and meaningful use of EHRs by physicians.

Stages 1 and 2 each require meeting 20 total objectives, but stage 2 makes mandatory some EHR measures that are optional for stage 1, such as whether the electronic systems can incorporate clinical laboratory test results. Other measures stay the same but have higher thresholds, such as a requirement that EHRs send more than 50% of applicable prescriptions electronically, up from more than 40%. The number of required core set measures goes up to 17 in stage 2 from 15 in stage 1. Physicians also must choose and comply with three out of six additional “menu” set measures, as well as report at least nine clinical quality measures.

Some additional time granted

The effective date of stage 2 has been one of the most contentious issues for the program. After physicians and others complained that early adopters of paperless systems would be forced to meet the more stringent requirements sooner than those who waited a year, the White House floated a plan in late 2011 to set the earliest possible stage 2 deadline for doctors to 2014 instead of 2013. The final rule released in August makes that delay official.

Physicians who earned EHR bonuses in 2011 and 2012 would be required to meet stage 2 requirements starting in 2014. Doctors who start achieving meaningful use in 2013 or later would report under stage 1 rules for two years before moving onto stage 2, regardless of whether they incur any noncompliance penalties for being late adopters. Despite the effective delay for early adopters to 2014, a significant majority of comments on the proposed version of the rule said that deadline still was too aggressive. “Some commenters suggested that the time was insufficient regardless of resource constraints, while others suggested that currently vendors of [EHR systems] lack the necessary capacity to make the necessary upgrades to their products and implement them for their customers in time,” CMS acknowledged in the final rule.

The physician organizations specifically asked that CMS delay the start of stage 2 until 2015. The agency rejected the request, saying it “would have a ripple effect through the timeline of stages.” However, CMS did give physicians some more time to make the necessary changes to their systems by requiring only a three-month reporting period in 2014, meaning EHRs would not necessarily need to be upgraded by the start of the year.

Reporting periods for meaningful use will be three months long regardless of what stage an eligible professional is following, said Rob Anthony, a health specialist with the CMS Office of E-Health Standards and Services, during an Aug. 24 seminar. Also beginning in 2014, a physician group can submit a meaningful use attestation for all of its eligible professionals in one file, saving the practice from entering each individual’s information separately.

Demonstrating meaningful use during stage 2 will rely on patients interacting with physicians and EHR systems online. For instance, CMS had proposed that eligible physicians send a secure EHR-based message to at least 10% of unique patients. Another proposed measure directed doctors to provide half of their patients with the ability to view online information about their care and ensure that a minimum of 10% did so.

Many commenters objected to these measures, because physicians would be held accountable for patient inaction on a measure. The AMA and other medical societies recommended the patient measures be made optional, but CMS did not follow the advice.

“While we recognize that [eligible professionals] cannot directly control whether patients use electronic messaging, we continue to believe that [eligible professionals] are in a unique position to strongly influence the technologies patients use to improve their own care, including secure electronic messaging,” CMS said. The agency did, however, reduce the reporting thresholds for those measures from 10% to 5% in the final rule. CMS also will exclude physicians from the requirements when they practice in areas without sufficient Internet access.

Some organizations reviewing the final rule lauded the agency for including some additional flexibility for incentive program participants.

“Extending the start for stage 2 until 2014 was a necessary step to permit medical groups sufficient time to implement new software,” said Susan Turney, MD, president and CEO of the MGMA-ACMPE, the entity formed by the merger of the Medical Group Management Assn. and the American College of Medical Practice Executives. “Permitting group reporting will reduce administrative burden, as will lowering the thresholds for achieving certain measures such as mandatory online access and electronic exchange of summary of care documents.”

Doctors can seek penalty exemptions

Agency officials carved out several hardship exceptions to the noncompliance penalties, and some will require the reporting physician to complete an application prior to the penalty’s assessment. The exemptions are available for physicians who:

    * Have insufficient Internet access for any 90-day continuous period between Jan. 1, 2013, and July 1, 2014.

    * Are new to Medicare.

    * Encounter extreme circumstances outside the physicians’ control, such as practices closing, natural disasters, EHR vendors going out of business and similar scenarios.

    * Practice in multiple locations and have a lack of control over the availability of EHR systems.

    * Have a lack of face-to-face visits or other patient interactions, or the need to provide follow-up care.

In 2014, CMS also will align reporting for the clinical quality measures component of meaningful use with the Medicare physician quality reporting system so doctors are not facing two different reporting standards. PQRS, a separate program from the EHR initiative, will penalize physicians starting in 2015 for not reporting certain quality measures to the government.

ADDITIONAL INFORMATION:

What EHR upgrades will be required?

Stage 2 of the federal electronic health record initiative will include 17 core measures and six additional “menu” objectives, from which a physician would choose at least three. Doctors must use their EHR systems to meet requirements for at least 20 measures, including all 17 in the core set.

Core set

    * Use computerized physician order entry (more than 60% medication, 30% lab and 30% radiology orders)

    * Prescribe permissible drugs electronically (more than 50%)

    * Record patient demographics (more than 80%)

    * Record and chart changes in vital signs (more than 80%)

    * Record smoking status (more than 80%)

    * Use clinical decision support (at least five interventions)

    * Incorporate clinical lab results into EHR (more than 55%)

    * Generate lists of patients by specific conditions (at least one list)

    * Identify patients who need reminders for preventive or follow-up care (more than 10%)

    * Provide at least half of patients with access to health information (more than 5% use access)

    * Provide clinical summaries for patients within one business day (more than 50%)

    * Identify patient-specific education resources (more than 10%)

    * Communicate with patients on relevant health information (more than 5%)

    * Perform medication reconciliation during care transitions (more than 50%)

    * Send summaries of care during referrals (more than 50%)

    * Submit electronic data to immunization registries (ongoing submissions during reporting period)

    * Protect EHR information

Menu set

    * Access imaging results through EHR (more than 10%)

    * Record patient family health histories (more than 20%)

    * Record electronic notes (more than 30%)

    * Submit electronic syndromic surveillance data to public health registries (ongoing submissions)

    * Identify and report cancer cases to a public health registry (ongoing submissions)

    * Identify and report noncancer cases to a specialized registry (ongoing submissions)

Specialty physician use of EHRs

In 2011, nearly 510,000 physicians were eligible for Medicare electronic health record incentives, but only about 50,000 were awarded bonuses during the first year of the initiative. The Government Accountability Office found that about 14% of general practice physicians and 8% of specialists earned incentive payments for EHR meaningful use.

Specialty	Portion awarded EHR bonus
Gastroenterology	18.1%
Cardiology	16.6%
Pulmonary disease	16.3%
Urology	15.7%
Endocrinology	15.6%
Otolaryngology	14.1%
Neurology	11.9%
Surgery	9.3%
Oncology	8.6%
Dermatology	8.4%
Obstetrics-gynecology	8.2%
Physical medicine	7.3%
Ophthalmology	6.5%
Psychiatry	1.9%
Radiology	1.5%

Source: http://www.ama-assn.org/amednews/2012/09/03/gvl10903.htm

Tags: EMR | EHR

EMR – Will It Help Only Physicians?

An electronic medical record (EMR) is a computerized medical record created in a physician’s office or hospital. It is an electronic version of paper based medical records that have been serving customers till now. However, with the advancement of information technology, the industries across different verticals are making the best use of automation to improve the quality, productivity and ROI of their business. Healthcare industry being not an exception to the rule, has started realizing the importance of automation and particularly EMR.

Though EMR is a new buzz word in the healthcare industry, a question often disturbs patients – is EMR only for doctors? As far as the adoption of EMR in a physician’s clinic or hospital is concerned patients are often disturbed as regards the benefits of implementing the system. A large no. of patients have a feeling that the system would only benefit doctors, would interfere with security issues, would result into appointment and treatment delays.

According to health IT experts, it would be absolutely wrong to say that EMR is meant only for doctors. In fact, EMR has to benefit both doctors as well as patients. The implementation of the system has to benefit doctors as well as hospitals with improved work flow, increased productivity and ROI. As far as patients are concerned the whole exercise of implementing the system is based on the ultimate goal of providing better medical care to the patients. The focus of the software product is on making life easier for patients with improved work flow and quality of care.

If we carefully analyze meaningful use criteria, which being introduced by US government for availing various incentives for implementing EMR, the ultimate goal of achieving meaningful is to bring about significant improvement in the quality of patient care. So it is the patients who are ultimately going to be benefited from EMR implementation, hence it wouldn’t be right to say that “EMR is only for doctors”?

Top 10 Must Have Features in an EMR for Physicians

Just as every medical specialty has its unique requirements; all physicians have their own preferences for what is most important to them in selecting their EMR Software. Here is a universal list of the top 10 must-have features in an Electronic Medical Records Software (EMR Software). The list includes the important technology and day to day usability features. The list also takes into account the features that physicians deem important in the context of being eligible to receive a number of incentive payments available from the multitude of agencies (federal and state) for implementing EMR / EHR software, that fulfill the requirement in demonstrating meaningful use of EMR / EHR software.

1) A fully Integrated EMR Software System

2) Integration of EMR Software with ePrescription

3) An EMR system that supports PQRI Automation

4) EMR with tracking capability

5) Secure access to EMR records

6) Integrated patient portal

7) EMR with simple / easy-to-use templates

8) Document and image management

9) Voice and handwriting recognition capabilities

10) Meets all regulatory and compliance requirements

Your EMR Software must satisfy all mandatory Federal and State regulatory and compliance reporting, general reporting requirements, and appropriate coding documentation.  The other upside of requiring that these features be built-into your Electronic Medical Records Software, is that this is extremely important to qualifying each provider in your practice to receive all the incentives available for EMR from Federal and State agencies.

If all you did was to require these top 10 must-have EMR Software features from a vendor, you can rest assured that you will also get the other essential, most up-to-date, and easy to roll-out and use functions, found in the leading EMRs like Claimat EMR today!

Choosing a Right EMR and Migration of Data

EMR (or electronic medical record) is the electronic version of manual patient medical records. The world is going digital to reap the benefits of digital technology and medical industry is not an exception to the rule. EMR is the new buzz word in the medical industry for the benefits it can deliver to doctors, hospitals as well as patients. However, the success to a great extent depends on selecting a right “EMR system” for the practice.

Selecting a right EMR system for the practice or hospital is not an easy task. There are numerous vendors providing a wide range of systems, each with a different set of functionalities. In this situation the task of choosing a most suitable system becomes very difficult. In case wrong or unsuitable electronic medical records software is chosen for the practice, instead of streamlining the process it might make the task more difficult.

There are certain points that need to be taken into consideration when choosing an EMR for the practice. At first, taking note of the existing system of records management is very important. Then defining current and future practice needs is of utmost importance. Before choosing a system one should also compare a no. of available options in the market and also ensure that the vendor provides with training and long term support.

Once a right or suitable EMR is selected for the practice the next important task being data migration. The basic setup tasks need to be considered before migration can be started. The migration must be done very carefully so that the product works fine. However, certain bugs can not be eliminated at this stage. Truly speaking, it takes about 6-12 months (and sometimes longer) for a practice to become comfortable with an EMR system and get the bugs worked out.

Reluctance to Change into EMR

Electronic medical records (EMR) software is a program which makes the storage of patient medical records much easier. The records which contain a patient's medical history are kept in an electronic format and are readily accessible by authorized medical personnel.

With the use of electronic medical software the medical staff is better equipped to streamline their workflow and make it more productive and efficient. It cuts back on time that, in the past would be spent on manually updating and filing records or searching for a particular record. All the relevant information can be acquired with a few clicks of the mouse and can be accessed by more than one person at a time.

However, in spite of a large no. of advantages, there is reluctance to change into EMR . There are many reasons cited for the reluctance such as:

1) High initial cost of license acquisition, computer hardware and implementation.

2) Difficulty as regards migration into a newer system.

3) Time and cost involved in acquiring training.

4) Operational and upkeep costs.

5) Data security issues.

Above all, healthcare professionals are doubtful as regards the success of EMR implementation. Most of them are not sure if EMR electronic medical records software would deliver the required results.

Benefits of EMR in Medical Terms

Healthcare has always been competitive, and with the advent of modern technology those medical service providers who use this technology in an efficient manner are the ones who are going to thrive. One of the main components of modern medical record keeping is EMR (electronic medical records) software, which enables you to store and access patient records electronically.

While the benefits of quality EMR software are abundant, here are few main reasons why EMR software will be a vital asset for your healthcare facility:

1) First and foremost, EMR software improves the overall function of your healthcare facility.

2) EMR can be easily stored as electronic files in secure locations.

3) EMR makes the process of file management very easy as it can store a very large amount of data at ease.

4) The history of the treatment and the prediction and detection of problems becomes very easy and fast.

5) The EMR creates the conditions for easy analysis of the medical records which would otherwise have been a very tedious job.

6) The electronic storage of the data is very economical as compared to the large amount of paper work that was required traditionally.

7) The professionals and the practitioners associated with the health care industry reap huge benefits from the EMR at times of emergency situations.

Above all, EMR (electronic medical records) helps to improve the quality of patient service, thereby enhancing the patient satisfaction.