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Welcome to Craneware's blog.

This blog is the place to go for discussions related to the many facets of healthcare revenue integrity. Here, Craneware experts share their thoughts and report on industry trends… and encourage you join the conversation with your own unique experiences and opinions. Craneware client or not, there's something for everyone to learn and discuss.

It’s that time of year: CY 2017 IPPS Proposed Rule

by Craneware26. April 2016 09:19

By: Joan Hoover, Healthcare Consultant, Data Development

Can you believe we are beginning to see Medicare information on the FY 2017 IPPS proposed rule already? Didn’t we just deal with the 2016 rules? Well, it’s true. On April 18, 2016, Medicare posted the FY 2017 IPPS proposed rule.

We are just beginning to review its contents, but we do know the rule contains a proposal to remove the 0.2% adjustment to inpatient payments to account for the increase in expenditures due to the implementation of the two midnight rule. We also know the rule contains information on the The Notice of Observation Treatment and Implication for Care Eligibility Act (the NOTICE Act.) The NOTICE Act requires hospitals to provide notice to observation patients who have received observation for more than 24 hours, in which information is provided on the reason for the observation status and the implications of such.

Stay tuned! We will provide more information on the IPPS proposed rule in mid-to-late May, so keep up with us here or follow us on Twitter @craneware. In the meanwhile, please post your comments and questions about the proposed rule here and we’ll share answers.

Six months with ICD-10. Now what?

by Craneware22. April 2016 10:29

By: Yvette DeVay, Outpatient Coding Consultant, Data

We are now six months into the implementation of ICD-10 and without industry-wide metrics to evaluate our transition. Independent surveys report productivity reductions ranging anywhere from 30-45 percent on the inpatient side and an outpatient reduction of 20-40 percent. These numbers are significant and likely to lead to a disruption in the revenue cycle.

With industry-wide data unavailable, the responsibilityof tracking ICD-10’s impact is left to healthcare providers. So how do you go about doing this? The Centers for Medicare and Medicaid Services’ published document, ICD-10:  Next Steps for Providers Assessment and Maintenance Tool Kit, recommends facilities monitor progress through the use of Key Performance Indicators. The article lists numerous indicators including: Days to Final Bill; Claims Rejection and Denial Rates; Coder Productivity; Query Volumes; Unspecified Code Usage; and Incomplete/Missing Charges. Not all indicators apply to all facilities, so choose based on the needs of your organization. The analysis of subsequent findings provides an avenue to identify and address issues of productivity, reimbursement and claim submission.

A successful monitoring process does not end with discovery though. Be certain to utilize your findings in a manner that provides additional value above and beyond ICD-10. Implement a systematic approach for staff involvement, clinical documentation, coding improvements and most importantly education. One way to do this is to develop an inclusive education and outreach program. Be certain educational resources are distributed in a timely manner and employ a physician champion. Physician champions are key to successful education programs, as they facilitate communication between health information management, physicians and clinical documentation improvement staff. Training physicians provides the best opportunity for the capture of clinical information resulting in correct coding, reduced queries and ultimately, timely clean claims.

What are the results of your ICD-10 transition? How are you monitoring your facility’s progress? We’d love to hear from you.

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Code Freeze Ends with Release of New ICD-10-CM/PCS Codes

by Craneware12. April 2016 13:40

By Yvette Devay, Outpatient Coding Consultant, Data

 

The ICD-10 implementation is behind the healthcare community. The transition has been referred to as smooth and successful. However, it is time to return to the systems normal cycle of annual updates. The partial code freeze comes to an end October 1, 2016.

 

During the freeze, only limited updates capturing new technology and disease were made to both code sets. These years of limited change has left ICD-10 in need of numerous code changes and now is the time to face the update task. Based on numbers discussed at the ICD-10 Coordination and Maintenance Committee meeting of March 9-10, 2016, this is no small task.

 

What to Expect?

 

There are 1,956 new codes, 313 deletions and 351 revised codes proposed for the 2017 release of ICD-10-CM. The codes are posted and can be viewed on the Centers for Disease Control and Prevention National Center for Health Statistics website.

 

Updates to ICD-10-PCS nearly double those proposed for ICD-10-CM. We will be entering fiscal year 2017 with 75,625 ICD-10-PCS codes. Of the total number, 3,651 are new codes and 487 code revisions. These codes have been approved for the October 1, 2016 release. However, after the recent March meeting, it is likely more changes to the code set will occur. The complete list of proposed new and revised codes ICD-PCS codes is available on the Centers for Medicare and Medicaid website.

 

The details behind the proposed codes can be found in the ICD-10 Coordination and Maintenance Committee’s meeting agenda. What do you think of the numerous proposed code changes? How will you prepare to implement the updates? We’d love to hear from you.

 

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