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icd-10

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Medicare Announces Delayed Decision on Vaults and New Codes Until 2016

Yell hallelujah, hell yeah or wahoo, whatever your chosen exclamation might be because Medicare just made your month!  The Centers for Medicare and Medicaid Services (CMS) have granted the wishes of everyone in the radiation oncology industry with their release of the final 2015 Medicare Physician Fee Schedule.

The decision not to remove the cost of the vault as a direct practice expense when calculating reimbursement rates for 2015 is a money saving (read: life saving) move for radiation oncologists. Additionally, CMS has decided to continue to pay for some of the eliminated treatment codes from 2014. They will do this by creating g-codes for those eliminated codes and continuing to reimburse physicians at the same, previous rate.

These two updates will result in a 0% reduction for radiation oncology providers, which is great news compared to the 8% reduction rate we were facing!

So who is to blame for those celebratory high-fives you’re all giving right about now? We can all give a huge thanks the American Society for Radiation Oncology (ASTRO) as they led an advocacy campaign designed to keep the payment cuts CMS proposed in July from going through.  Over 160 bipartisan members of Congress, along with several radiation oncology industry stakeholders, wrote letters to CMS discussing the impact of the reimbursement cuts, begging them to reconsider. Thankfully these efforts did not go without notice and the MPFS final rule states that CMS will be delaying its decision regarding these hot button issues for one more year.

In addition to this, CMS released their 2015 Hospital Outpatient Prospective Payment System (HOPPS) final rule, though this week they will be issuing the final rules, so stay tuned!

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Medical Billing Questions to Ask - Radiation Oncology

Are you asking yourself the right questions?

Are you asking yourself the right questions?

Revenue cycle management can be a cumbersome component of running your practice and managers often become so comfortable with current protocols that they don’t recognize how industry changes are impacting their business.  Once it becomes apparent that something needs to be done to improve collections, where do you start? The questions and concerns can become overwhelming, but the worst thing you can do is avoid change and remain at a standstill. How are practices supposed to know what questions to ask themselves and the companies they are considering outsourcing to?

We sat down with Universal Health Network’s (UHN) CEO Peter Wall last week at ASTRO 2014 in San Francisco and discussed the questions he advises potential new clients to ask themselves.


  • With extensive coding changes on the horizon, who is going to train your staff?
  • How much will that training cost you?
  • How much time will that training take up?
  • Who is acting on your behalf with local representatives to fight increased reimbursement cuts proposed by CMS?
  • How will you make up for the revenue lost with these inevitable cuts?
  • How do you measure and improve the efficiency of your revenue cycle management process?
  • Can your billing protocols be simplified?
  • How much money each month could you be losing due to ineffective processes?
  • If you decide to outsource, how will the cash flow transition work?
  • Do you have anyone fostering relationships with payers across the board? Ex: Insurance Providers, Medicare, Medicaid etc.
  • Can you provide cost estimates for all kinds of payers if a patient requests it?
  • What is your biggest fear regarding outsourcing your billing?  Is it fear of the unknown, fear of losing control or fear of wasted revenue?

Coding changes and reimbursement cuts account for just the first round of adjustments radiation oncology practices and organizations will need to make in order to remain successful.  The team at UHN has been working to stay ahead of the curve in regards to industry changes, urging practices to see that they can do better. 

Wall commented saying, “We tell our clients, don’t settle for your current income. Don’t you want to be making more? You could be collecting up to $10,000 more each month, we want to help make that happen.”

 

UHN’s goal is to be a resource powerhouse for radiation oncology practices, giving them the tools to increase revenue and improve their processes. To discuss the customized answers to the aforementioned questions that UHN can provide to your practice, simply fill out the form below.

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ICD-10 for Radiology Ramifications

This article was originally posted on McKesson's Imaging Talk Blog: Written by: Nicole Wichlei


When the new ICD-10 system is implemented on October 1, 2015, which is the most recent date set for its onset, many changes will accompany the transition, including a dramatic increase in the number of codes. The increase will be helpful to practitioners, including those in radiology, because it allows them to improve the specificity they use when documenting why a patient was seen and what care was given.

The current ICD- 9 system is more than 30 years old—think of all of the advancements medical imaging has experienced in that time. That means that ICD-9 contains outdated radiology information terminology and limited data and simply does not align with how physicians today practice. Updating to ICD-10 for radiology requires in-depth work and preparation by practitioners throughout your medical organization. As we prepare for ICD-10’s implementation, your staff will see the following changes:

Increasing Number of Codes. There will be more than four times as many codes under ICD-10 as there are under the current ICD-9 system. The number of codes will increase from the 14,000 currently used to more than 69,000, requiring radiologists and referring physicians alike to be extremely particular with radiology information, diagnoses and documentation.

Decreased Productivity. As healthcare organizations adopt the new system, productivity is expected to go down while staff members adjust to the changes. A report from the American Hospital Association states that physicians should ensure that they have provided sufficient documentation for coders, being particularly aware of any laterality specifications that may be required. Coders will see the biggest changes, and a loss of productivity for them could affect medical organization’s revenue cycles.  Within medical imaging, ICD-10 for radiology means anticipating a potential drop in efficiency and adjusting schedules and work load as needed.

Growing Requirements in Clinical Data Reporting. Another change that will affect radiologists is in the area of clinical data reporting. Radiologists by design have to rely on referring physicians and others for documentation. How referring physicians document proof of medical necessity may affect radiologists’ reimbursement.

The American College of Radiology recommends that members start preparing now for the change. Healthcare facilities should update billing software, train staff, and test the new systems as soon as possible. The Centers for Medicare and Medicaid Services (CMS) estimates that testing will take up to 19 months, and recommends that organizations test claims, eligibility verification, quality reporting and other transactions to ensure that ICD-10 codes are being processed correctly well in advance of the deadline.  The ACR has webinars, podcasts and even timelines available for referral.

Someone once said the only constant is change, and physicians know this well. ICD-10 implementation may have been delayed, but now is the time to get ready for the change. ICD-10 for radiologists means learning, testing and reporting so that when next October comes, you can transition as smoothly as possible.

Learn how McKesson and its Qualitative Intelligence Communication System (QICS ™) can help your healthcare organization better prepare for ICD-10. Learn more about these workflow solutions:

  • QICS™ for Coding Discrepancy Management
  • QICS™  for Critical Results Management
  • QICS™ Physician Quality Review System (PQRS)

Related posts:

  1. Tackling ICD-10 Migration with an Integrated HIM Approach
  2. Mountains of E-Work | How to Better Manage Healthcare Workflow
  3. The Next Level of Radiology Peer Review: Enterprise-wide Education and Improvement
  4. Simplifying The Radiology Peer Review Process
  5. Radiology Workflow Improvements Possible With Gamification: More Than Pong

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