The Medical Practice Management Association® (MGMA®) just wrapped up its annual conference with record attendance last week. As I participated in the meeting, I was struck by the diversity of the audience. While the more traditional attendees from large practices were present, the meeting also appeared to draw quite a few smaller practices this year, such as those in the one-to-three provider range.

That probably shouldn’t be surprising. Many vendors are seeing an uptick in the number of small practices now embracing and adopting electronic health records (EHRs), and MGMA presents a logical place to gain information, network with other providers, and learn how to address common implementation stumbling blocks. Basically, MGMA has the playbook on how to implement this type of technology, and smaller practices as well as newer ones can benefit from this knowledge.

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By this point, everyone in the healthcare industry is aware that the deadline to transfer to HIPAA 5010 is January 1, 2012—which is only two away at this point!

Even though many practices and technology vendors have been preparing for this change for a year or two, many organizations still have questions about how 5010 is going to impact them. And they are also wondering what they should be doing right now to be sure their practice is completely prepared for HIPAA 5010.

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Last week, I had the pleasure of attending the Medical Group Management Association’s annual meeting in Las Vegas. During the conference, I was excited to speak with other practice managers, physicians and technology vendors about the constant changes in the medical field – including how people handle ongoing issues such as denials management and revenue cycle management.

In addition to these insightful conversations, I had the honor of leading an educational session about preparing for the pending 5010 and ICD-10 transitions. During the hour, I provided tips about how every practice can prepare for the implementation of both 5010 and ICD-10, especially focusing on how practices can ensure that they have mitigated the possibility of revenue cycle disruptions during the transitions. During the session, there were many great questions and I was happy to see people starting to think about the transition to ICD-10. In addition, Healthcare Finance News wrote a quick synopsis of the session, which you can read here.

I look forward to hearing how people take these recommendations and apply them to their own practice. As your organization works towards both implementation deadlines, let everyone know how it is going by adding a comment in the boxes below.

The process of preparing for and converting to ICD-10 has many moving parts. As practices, health plans, and other vendors work toward the October 1, 2013 deadline, I have been hearing lots of questions about how to successfully manage the conversion. Today, I will answer a few of the more commonly asked questions pertaining to the conversion.

At this point, what stage should our payers be in regarding ICD-10 implementation? Should they be ahead of us?

Since payers and vendors will lay the technology groundwork for what practices must do to successfully transition to ICD-10, they should be well into their ICD-10 work plan and ahead of where practices are today. Most large health plans are in the midst of readying themselves for the new code set and may be starting small tests. It is a good idea to reach out to your payers to understand their progress to date, as well as how you can work with them to make the ICD-10 transition as smooth as possible.

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With the transition to HIPAA Version 5010 quickly approaching, practices must verify that their health information technology (HIT) vendors will be ready for the change. If not, practices risk significant disruptions to cash flow on the January 1, 2012 implementation date. The conversion will affect most major healthcare transactions and nearly all technology, practices and HIT vendors—all who need to make sure they are fully prepared. While every vendor must take specific steps to get ready, clearinghouses bear the rather unique burden of ensuring that claims will cross smoothly between payers and practices.

For practices, it is important to begin communicating now—especially with clearinghouses—to determine whether testing is necessary and, if so, what the 5010 testing schedules are. Past experience with conversions to the current 4010A1 standard and the National Provider Identifier (NPI) suggests the 5010 transition will be the smoothest and least risky if staggered by payer over the course of 2011. Practices can assess progress on the part of their clearinghouses by watching for a few preparation milestones.

Click here to read the entire article I wrote for Tennessee Medicine and learn which milestones you should be looking for from your clearinghouse.

Are your appeals letters designed for maximum mileage? Medical organizations send detailed, persuasive appeal letters every day. Despite these well-written efforts, many appeal letters result in “Denial Upheld.”  This is not the end of the road, but rather a case for Level II appeals.

Join us on Thursday, November 3 at 1:00 pm EDT, for a free webinar: Increase Revenue – Take Your Appeals to the Next Level. Register Now.

During this hour, you’ll hear industry expert, Tammy Tipton, president of Appeal Solutions, the leading denial management training and resources company, discuss how to:

• Easily customize your appeal letters for Level II appeals – ensure that none of your higher level appeals are rejected due to “no new information.”
• Use carrier appeal form letters most effectively – payer-specific appeal customizations can make a significant difference.
• Address poor quality appeal review – you have the right to request a review by higher level personnel.

Don’t let a denied appeal become a write-off. Take your appeals to the next level.

Participants can earn 1.0 Continuing Education Unit (CEU) from the American Academy of Professional Coders (AAPC) by attending.

Register Now. 

In the great TV series “M*A*S*H,” the character Radar could hear incoming helicopters carrying wounded soldiers from a long distance away  and he would yell “Incoming!” as they were getting close to the hospital. Well, the 5010 launch date is January 1, 2012 and all I can say is…. “Incoming!” Hopefully, most practices have been working diligently with their technology vendors, so they do not anticipate a large volume of new payer rejections when 5010 is implemented. However, it’s still a good idea to have your ‘radar’ ready and know how to quickly spot these rejections if they do occur.

The first step is to spot new rejections that you have not seen before. Assuming you use a clearinghouse, you will probably have access to data detailing each rejection category and rejection message. In this case, you can easily compare the top rejection messages for January 2012 to the previous few months. You should be on the lookout for any messages that are new – these can be easily spotted because the previous months will have zero rejections for that message.

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A few weeks ago I had a great conversation with the editor of ICD-10 Watch about the pending transition to HIPAA 5010 and what it means to all practices in the nation. During this exchange, we discussed how National Testing Day went back in August and how my own company is preparing for the transition. After a short time, we turned our focus to what practices should be doing right now to get ready for 5010—including the different items that practices should be doing if they have a clearinghouse or if they file directly with payers.

The editor then proceeded to write a great column about this conversation, where he eloquently shared my tips for all of those that have not yet started to prepare. Now, I truly believe that all practices can prepare for the transition and still have time, but if you are beginning to stress about the transition, you can read the entire article here.

For a long time, the practice I work at – North Platte Nebraska Physician Group – used a clearinghouse that made us feel as if we were sending claims into thin air. Although we were sending claims electronically, we never knew where they were in the processing cycle. Too often, we found ourselves bumped up against timely filing limits that hurt our reimbursement.

So we searched for a new clearinghouse that would provide the tools and the customer service we needed to improve our financial picture. After an in-depth review of our options, we selected an Internet-based organization for its terrific customer service, plain English reporting, and easy ability to view claims all the way through the revenue cycle. This new system has helped cut our timely filing reductions, decrease the number of duplicate claims, and improve our accounts receivable (A/R) tremendously.

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Thank you to everyone who joined us on September 22 for our latest webinar, 5010 and ICD-10: Ensure Minimal Impact for Your Practice. During the one-hour event, industry expert Rhonda Buckholtz, CPC, CPMA, CPC-I, CGSC, COBGC, CPEDC, CENTC, the American Academy of Professional Coders’ Vice President of ICD-10 Education and Training, discussed how careful planning can ensure organizations have minimal financial and operational disruptions when 5010 and ICD-10 are implemented and what steps your practice can be taking now to prepare both business and clinical staff members for the pending changes.

To learn more about how your practice can improve its ability to track quality measurements and prepare your staff for the 5010 and ICD-10 changes, click here to download the webinar recording.

This program meets AAPC guidelines for 1.0 Core A or 1.0 CPCO specialty CEUs. On Demand product requires successful completion of a Post-Test for continuing education units.