Prepare Now for ICD-10’s Uptick in Claim Denials

By A.J. Johnson, General Manager of Analytics Solutions, TriZetto Provider Solutions

Operational costs for providers continue to rise while reimbursement rates decline. The transition to ICD-10 is expected to compound this problem with denial rates projected to rise anywhere from 100 to 200 percent.1

Providers can offset these financial challenges by identifying, appealing, and tracking claims that were denied incorrectly. This can seem like an overwhelming task, so focus on harvesting your “lowest hanging fruit” to see a better return on your time investment. Here are two ways to identify which denials will yield the highest return when appealed.

  1. Focus on denials with the highest probability of getting paid. These are denials that you can most easily address, such as denials where information was missing from a field or where coding or data was incorrect due to human error. You can quickly fix this information and resubmit the claim for reimbursement.
  2. Other denials may be out of your control, such as denials due to a service that was never documented or benefit eligibility issues. You won’t be able to convince the payer to pay for undocumented services or change their fee schedule contract, so these denials are not worth your time to appeal. However, to help stop this type of denial from occurring in the future, you should go back and review your eligibility verification process to ensure it is working correctly.

Of all the efforts you put toward ensuring your organization is financially successful, managing denials may be the most critical step – TriZetto Provider Solutions’ commitment to aiding smooth transitions to ICD-10 is reflected in our service contracting. We offer Eyefinity customers access to several tools for analyzing current revenue cycles, collecting outstanding reimbursements, and planning for challenges you may face as a result of ICD-10.

Visit www.eyefinity.com/contactinfo/trizetto to find out how TriZetto Provider Solutions can help you start preparing today.

1 Work group for Electronic Data Interchange, White Paper: ICD-10 Critical Metrics, October 5, 2012

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Upcoming Meaningful Use Hardship Exception Deadline

Summer’s here, and the July 4 holiday weekend is around the corner. Before packing your bags or lighting up the grill, take a moment to review the meaningful use hardship exception guidelines. The deadline to apply for a hardship exception and avoid a 2016 payment adjustment is July 1 at 11:59 pm ET.

You do not need to file a hardship exception if any one of these scenarios applies to you:

  • You successfully demonstrated meaningful use in 2014;
  • You’re a hospital-based provider; or
  • You’re a new eligible professional who didn’t file Medicare or Medicaid claims in 2014.

You can only file for a hardship and avoid the payment adjustment if you weren’t able to achieve and report meaningful use due to circumstances outside of your control. For example, if you used a vendor prior to coming to Eyefinity who was not able to get their EHR software certified in time, you might qualify for a hardship.

The timeline for hardship exceptions and payment adjustments can be confusing since the payment adjustments occur two years after the participation year.

If you failed to participate in this calendar year… File for a hardship exception by this date… To avoid a payment adjustment in this year…
2014 July 1, 2015 2016
2015 July 1, 2016 2017
2016 June 30, 2017 2018

To help you determine if a hardship exception is right for you, use the Hardship Exception Tool. For more information about filing a hardship exception, refer to CMS’ Payment Adjustments and Hardship Exceptions page.

EHR: Your Transition Tool to ICD-10

By Robert L. Bass, OD, FAAO; and Robert Day, Jr., OD

Robert Bass

Robert L. Bass, OD, FAAO

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Robert Day, Jr, OD

The transition to ICD-10 represents a steep challenge for many practices.

Robert L. Bass, OD, FAAO, owner of Optometric Associates, PC, in Manassas, Va., and Robert Day, Jr., OD, owner of Broadway Eye Center in Garland, Texas, recently shared with ROB how they are using their electronic health record solutions to ease the transition to ICD-10 coding by the mandated October 1, 2015, deadline.

Dr. Robert Bass uses Eyefinity EHR, a cloud-based solution. Dr. Day uses ExamWRITER a server-based solution.

Read the rest of this article here: EHR: Your Transition Tool to ICD-10

Reprinted with permission from Review of Optometric Business.

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Is Your Software Up-To-Date?

software updateMaintaining your car, home, appliances, and personal health is important to ensure optimal performance. Your software is no different! Are you protected from computer security risks? Is your technology allowing you to run a profitable business while delivering a great customer experience?

If you are using Eyefinity Practice Management or Eyefinity EHR, you don’t have to worry about software updates. Being “in the cloud” means Eyefinity maintains your software, ensuring that you are always using the most up-to-date version of your cloud-based software.

If you are using one of our on-premises solutions, like OfficeMate/ExamWRITER, then you need to download and install the newest software update, OfficeMate/ExamWRITER 12.0. This version will prepare you for ICD-10. It’s a great idea to download and install this version by July 2015, so that you are prepared for the government’s ICD-10 cut over well before the October 1, 2015, deadline.

Keeping up to date with software partner patches is also important. For Example, if you are using the ExamWRITER ePrescribing Interface, there is an update that needs to be installed by June 30, 2015. Partners like DrFirst, make changes to upgrade their functionality which can impact the eprescribing integration with ExamWRITER. Small patch updates only take a few minutes to download and run and are important in preventing interruptions in services you depend on.

We all agree that there are benefits to be gained from the 30K, 60K, and 100K mile car tune ups. Annual physical and optometric exams are something you recommend to your own patients. Don’t forget about the importance of maintaining your software, too!

Technology That Lets You Be a Doctor – In Time for ICD-10

By: Dr. James Winnickwinnick, Stockton, CA

Early adopters are on the “leading edge” of change, but there are also those on the “bleeding edge” of change. We all know colleagues who moved into early electronic medical records years ago and are now on their second or third system. As a large practice, we didn’t want to fall into this scenario because it means having to deal with multiple episodes of pain associated with major system changes. Our goal was to do it once and do it right.

So, we have waited, watching for technology that will meet our practice needs, and looking for a solution that can fully integrate a PMS and an EHR. Until recently, the only reliable choice for PMS/EHR solutions were on-premises server-based systems, built around Windows-based programming. The cost of the hardware, combined with the dependency of the doctor to use a keyboard in the exam room, were major obstacles.  Thankfully, with the industry moving into cloud-based and iPad-compatible systems, these barriers have been dramatically reduced.

With just under six months left to make changes before the ICD-10 cutover, we’ve chosen the Eyefinity cloud platform.  The iPad application allows us the flexibility that we need to manage our large practice. The auto-coding capabilities of the system will make us ICD-10 compliant. And, we’ll be able to increase our efficiencies and bottom line. We’re confident that Eyefinity’s solutions will provide best-in-class technology and allow us to meet our ICD-10 deadline.

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Industry Behavior Insight Into the Challenge of ICD-10

By: Dr. James Winnickwinnick, Stockton, CA

My practice, like many others, has taken a “wait and see” approach to preparing for the ICD-10 transition. Optometrists, in general, are often slow to make major changes in their practices unless significant impacts to our income are recognized. This goes in both directions: dollars out and dollars in.

Most doctors carry a number in their heads that’s in the tens of thousands of dollars to upgrade or convert to a practice management system (PMS) and electronic health record (EHR) that will make their practice ICD-10 compliant. That’s a hard pill to swallow. So, we avoid this major expense for as long as possible. We continue with “business as usual” for as long as we can.

Unfortunately, because the ICD-10 changes will affect every aspect of our office flow, we can’t procrastinate any longer. Come October 1, 2015, if we don’t have a solution in place and we are not billing ICD-10 codes, we will not be able to collect reimbursements from third party payers. Everyone needs a plan and needs to put it into place now! Our practice chose to work with Eyefinity as our ICD-10 compliant solution because their cloud-based system dramatically reduces our costs of implementation. And, the auto-coding capabilities of the system will not only make it easy for us to use ICD-10 codes, but also increase our efficiencies and bottom line.

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Counting Down to ICD-10 – Do You Have a Plan?

By: Dr. James Winnickwinnick, Stockton, CA

As a private practicing optometrist, it seems like there are more and more pressures being applied on how we run our practices. One of the biggest looming pressures has been the implementation of ICD-10 codes. We’ve heard about this massive change in how we will have to bill and code our patient visits for several years. We’ve also heard all of the horror stories of how much more complex this system will be, as compared to the ICD-9 coding system that we’ve become accustomed to.

Our practices received a little breathing room last year, when the mandatory implementation of ICD-10 codes was delayed. But, despite the continued turbulence in Washington D.C. around health care administration, the senate passed H.R.2 April 14 without an amendment to postpone the ICD-10 cutover date. So, it looks like October 1, 2015, is a hard deadline for providers to start using ICD-10 codes. That gives us just under six months left to implement a solution for billing ICD-10 codes in our practice. Do you have a plan?

All Eyefinity products either are or will soon be ready for the ICD-10 transition. Go to the Eyefinity ICD-10 Resource Center to determine if you need to upgrade your on-premises software, or, if you’re already using an Eyefinity cloud product, when your software will automatically update with ICD-10 changes. Not on the cloud, but want to be? Eyefinity has a plan for that, too!

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