MACRA Changes Health Care Economics with a Focus on ChildrenMACRA Background: A final rule released on Oct. 14, 2016 by the Centers for Medicare and Medicaid Services (CMS) details the final regulations for implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), the historic Medicare reform law that repealed the Sustainable Growth Rate (SGR) formula [...]
ICD-10 Implementation, Consulting, and Conversion programs have changed since the first projects started in 2009. For providers, in 2013 and 2014 we forecast more ICD-10 implementation consulting programs focused on first understanding the ICD-9 claims history via an ICD-10 financial risk assessment including ICD-10 analytics and ICD-10 clinical documentation via a chart review. The implementation consulting [...]
ICD-10 codes have expanded significantly for the cardiology and vascular surgery specialties. However, many of the concepts such as laterality (left, right) are spread across the human circulatory system. Therefore, understanding ICD-10 for these specialties can be facilitated by understanding the medical concepts underlying these codes. Our team can assist with physician training, delivered by [...]
ICD-10 for orthopedics includes the most number of codes, however orthopedics concepts such as laterality (left, right) type of fracture, severity of fracture, issues such as how the fracture is healing are now spread across all bones of the human body. Therefore while there are many more codes, there are a few key concepts that [...]
a focus on income support has remained constant. We can assume that based on recent U.S. policy certain incentives and regulations will continue in healthcare and that the general effect will be to encourage scale and specialization. The main difference between healthcare and agriculture is that interoperability is essential for the former and will create cooperatives focused on data sharing just as in agriculture smaller providers have historically joined forces to achieve economies of scale and reduce redundant processes.
In healthcare, the federal Patient Protection and Affordable Care Act (PPACA) introduces a new income definition—Modified Adjusted Gross Income (“MAGI”) for determining Medicaid income eligibility across the country. MAGI, pronounced the same way as the Biblical term, will be a regular figure in future accounts of who has access to the best prices for health care coverage and will be relevant for Insurance Exchanges ("HIX").
One strategy is to continue to move ahead on ICD-10 process impacts, systems planning, and overall budgets but depending on readiness, get your consulting firm to help with both the requirements documentation and strategies for clinical documentation that don’t’ exist now. Why? The WEDI / NCHICA timeline suggests that health care providers should have started planning for ICD-10 about 18 months before the CMS announcement of a delay.
August 28, 2012 Angela Braly, the CEO of WellPoint is stepping down.
ICD-10 Claim Date of Service Spans Mandate, Mapping ICD-10 to ICD-9 Auto Adjudication Questions Posted
In the ICD-10 Consortium social network this week, health plans posted questions regarding processing ICD-10 claims that have date of service periods that span the mandated timeline as well as an outreach to other health plans regarding the pros and cons of receiving an ICD-10 claim, mapping it to an ICD-9 to adjudicate it. Also, ICD-10 is expected to impact auto adjudication rates for plans.
Discussion has been that ICD-10 is a steppingstone to ICD-11, so it is probably a good thing to do.
Health care providers should ensure that the EMR vendor is on track toward ICD-10 compliance, however they should not rely on their EMR vendor as the panacea. Most hospital systems we work with have many more ancillary systems in radiology, etc. that are also impacted, and the EMR isn't the core system of record (yet) for everything that goes on in a hospital.