ICD-10 Strikes Back
Believe it or not, there is a method to the madness of ICD-10. The system was developed by the World Health Organization (WHO) as a means of standardizing the categorization of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. Officially known as the International Statistical Classification of Diseases and Related Health Problems, ICD is the standard international diagnostic tool for epidemiology, health management and clinical purposes. This system is designed to map health conditions to corresponding generic categories together with specific variations, assigning for these a designated code, up to six characters long. Thus, major categories are designed to include a set of similar diseases. ICD-6, adopted in 1949, was the first version of ICD that was deemed suitable for morbidity reporting. The combined code section for injuries and their associated accidents was split into two: a chapter for injuries, and a chapter for their external causes. With use for morbidity there was a need for coding mental conditions, and for the first time a section on mental disorders was added. Work on ICD-10 — the tenth revision of the system — began in 1983. It was officially copyrighted by WHO in 1990, though it wasn’t actually completed until 1992. It was then adopted relatively quickly by many countries of the world, starting with Australia in 1998. Today, ICD-10 is the most widely used statistical classification system for diseases in the world. For numerous reasons, but particularly due to the special interest groups that affect policy, the United States wasn’t able to get on board until August 2008. At that time, the Department of Health and Human Services proposed that ICD-10 be adopted in America — a move that was formalized in January 2009, establishing ICD-10 as the new national coding standard, with an implementation date of October 1, 2013. And if the prospect of changing over to ICD-10 wasn’t imposing enough, ICD-11 is “scheduled” to become the new standard in 2017 — though with the numerous delays in getting ICD-10 onto the books, it’s likely that ICD-11 will be pushed back for at least a few years.
I’m thinking of a number…
Why credit matters and what it takes to get the best rates available. Do you remember that commercial where the guy says he is thinking about a number between 500 and 800? He was talking about credit. If your credit is good that might not be enough. We have entered an age where it has to be great, but if it is you can look forward to cheaper insurance, lower interest rates and less hassle when you get a loan. 83 percent of Americans have an error on their credit report. ¼ of them are denied a loan they would have otherwise had. By simply having 1 additional point when closing on a loan it can be the difference of thousands of dollars in additional interest. So, whether you have good credit, or less than perfect credit – you may be unnecessarily leaking cash by not taking advantage of what is available to you through your existing lenders in today’s low interest rate environment. First, go to any of the credit monitoring agencies sites or google credit score and take a look at your credit. Do you see any errors? Misspelled name, wrong address, an account that doesn’t belong to you, or a late payment you didn’t know about. By clearing these issues up you can improve your score. Now, in the past 720 was a magic number for your credit, but if you can achieve 780 or higher there are simply better options and better interest rates available. After correcting your errors, now you can ask for better interest rates. For example: If you have credit card debt at an interest rate that was determined years ago or that was obtained when you may have had a lower credit score than you do now, you may be able to lower that interest rate. Just call up the credit card company and ask them to send you to the special promotions department or someone who can assist you in changing your credit card. This will send you to the right department that has the authority lower your rate. It’s as simple as knowing how to ask. Another case where using your credit can help you free up cash flow is in the case of a home mortgage. By calling up your existing lender and asking for a “streamline refinance” you may be able to lower your monthly payment with little cost and minimal effort! Simply ask your lender if you qualify and be sure that they understand that you may consider going elsewhere if they can’t help you. If the situation is right, your lender may lower your interest rate with little to no closing costs or without requiring full appraisal, or without you having to jump through the hoops associated with a conventional refinance. Always dress up your credit by monitoring and managing it properly. Then ask for lower interest rates, you could save hundreds (or more) of dollars per month on your existing debts! If you want to know 9 other areas where you can improve your credit, check out our Curriculum for Wealth series where I interview two credit experts and get right to the bottom of what to do. All the information you need in a concise and yes, this is bold, entertaining way. www.freedomfasttrack.com/cfw
Finding a Standard of Success
“How are you doing? How are your KPIs?” On a personal level, that question seems easy enough to answer. But when it comes to your practice, it’s not so simple. With so many factors in play — from patient visits to billing, from revenue to workflow — it can be a challenge to have everything go smoothly at the same time. Not only that, but it’s difficult to determine a proper standard by which to judge your practice performance. Ultimately, your bottom line depends on multiple Key Performance Indicators (KPIs) that together paint a picture of your business. A quick comparison of your KPIs to industry standards may also point to potential opportunities to increase cash flow, identify areas for potential growth, and even improve employee morale. One of the first KPIs to consider is Average Visit Duration. This is not merely the amount of time you spend with a patient, but also includes the time that you spend on billing, documentation, scheduling and other “overhead” related to that patient’s visit. For chiropractors, who tend to see many patients for brief visits, the Average Visit Duration highlights — once you subtract the time that’s actually spent on patient care — how much is wasted on the “busywork” of running a practice. Another KPI that’s a key concern is Annual Patient Visits (APV). This figure is derived by dividing the number of patient visits in a given year by the total number of patients seen during that year. An APV that is substantially lower than the industry average suggests that too many patients may be terminating their treatment before they complete it — and that could be seen as a compliance risk. On the subject of revenue, it’s a good idea to look at your Pay Per Visit (PPV). The PPV is the average pay for all of your services that you receive for one visit — including both the patient’s copay and the insurance reimbursement. In order to calculate your average PPV, just count all the payments you received over the course of one month, and divide it by the number of patient visits you had in that month. When comparing your PPV to the industry average, a lower number indicates that you are likely not getting fair reimbursement from insurance companies. And finally, if you take your APV and multiply it by your PPV, you get the PV, or Patient Value. This amount reflects the total payment for a single patient over the course of a year. In and of itself, a low PV doesn’t present an audit risk, but it does pose a different kind of problem: When your PV dips below a certain level, it’s your bottom line that suffers, and it becomes more difficult to stay in business.
All New Network Members in March 2014
Sixty-six new members across fifty-four practices joined Genesis Chiropractic Software and Billing Network in March 2014! There is strength in numbers due to the shared knowledge – we call it the “Billing Network Effect,” as the billing performance of each member practice improves in step with the total volume of processed claims in our chiropractic software. Please welcome our new Genesis network members: Kathryn Means and Tiffany Agler of 180 Chiropractic & Wellness, Franklin, TN. Anne Linder of Able Chiropractic, Apple Valley, MN. Dr. Graham Linck of Aliante Chiropractic & Integrated Health, LLC, Las Vegas, NV. Elizabeth Castor of All Health Chiropractic Center Inc., Royersford, PA. Steve Segovia of Backsmart Wellness Center, Edison, NJ. Rachel Reiser of Back To Health Chiropractic And Wellness, Winona, MN. Brian and Merissa Beard of Beard Family Chiropractic, Conway, AR. Zully Sanchez of Big Pine Key Chiropractic Inc., Key West, FL. Charlin Coley of Brittian Chiropractic Center, PLLC, Winston Salem, NC. Justin Kutz of CBP Spine Center, Windsor, CO. Ashley McCurley of Charles Cottier DC, Kilgore, TX. Shauna Smith of Chiropractic First, Mukwonago, WI. Samantha Fleming of Chiropractic Solution Center, PC, Virginia Beach, VA. Bryan Henss of Clairton Family Chiropractic, Fort Worth, TX. Stephanie Shaeffer of Discover Chiropractic, San Jose, CA. Melissa Sanchez of Dr. Derek D. Ferguson, Whippany, NJ. Mary Byrd, Gaye Lynn and Crystal Faulhaber of Dr. Glen R. Burford DC, Collierville, TN. Dr. Scott Richmond of Elite Spinal Rehab, PC, Urbandale, IA. Rachael Leboeuf of Family Healing Chiropractic, Charlotte, NC. Katalina Dean of Fort Bend Corrective Health Center, Missouri City, TX. Ashley Slominski of Freedom Chiropractic Health Center, Fargo, ND. Rachel Millsap of Freedom Family Chiropractic, Centerville, OH. Sheila Willis of Greenwood Family Chiropractic, Greenwood, IN. Jennifer Maciuk of Justin Ard DC, PLLC, Brentwood, TN. Jena Lujan of Hawk Nation Chiropractic, Manchester, IA. Carol Payne and Leah Wilson of Indy Family Chiropractic, Indianapolis, IN. Colton Kaminski and Kali Oestreicher of Infinity Wellness And Chiropractic, Plover, WI. Kelly Fennelly of Innerlink Chiropractic, Wixom, MI. Liz Halen of Jon Scott Chiropractic, Inc, Thousand Oaks, CA. Alyssa Anguiano of Keen Family Chiropractic, Austin, TX. Judy Kestner and Jessica Nelson of Kestner Family Chiropractic, Nashville, TN. Doreen Wiszowaty of Life Is Good Chiropractic, LLC, Brodheadsville, PA. Marie Welsh of Livingood Family Chiropractic, Cary, NC. Cycy Felty of Lombard Chiropractic, Lombard, IL. Sean Lamont of Lone Star Family Chiropractic, Katy, TX. Xavier Counts of Middletown Family Chiropractic, Middletown, KY. Jacqueline Morgan of Mission City Chiropractic, LLC, San Antonio, TX. Miroslaw Polanski, Danielle Soto and Cathy of Miroslaw Polanski, Brooklyn, NY. Tenisha Collins of Next Level Health, Rockford, IL. Summer Middaugh of Ozanne Family Chiropractic, LLC, Fayetteville, AR. Jan Lowenstein of Pete Lowenstein DC, Brick, NJ. Courtney Hays of Providence Chiropractic, Hermitage, TN. Janel Laban and Tesha Davilmar of Richard A. Henry DC PA, Lauderhill, FL. Dr. Mark Wolfman and Janelle Wolfman of Rivertown Family Chiropractic, Grandville, MI. Adreana Biskey of Rosemount Chiropractic, Rosemount, MN. Claudia Gallego of Shin Wellness, LLC, Miami, FL. Dustin Hirsbrunner of Smith Family Chiropractic, Austin, TX. Steven Martin of Sports & Spine Chiropractic, Dallas, TX. Danielle Flatmo of Stability Spine & Wellness, Seattle, WA. Patrice Mckinnon of The Balanced Spine, LLC, Issaquah, WA. Christine James of Total Lifesytle Chiropractic, PLLC, Scottsdale, AZ. Katie Boyd of Wells Family Chiropractic, Asheville, NC. Rebecca Scott and Tabitha Ashley of Wickiser Clinic Of Chiropractic, Anderson, SC. Evelyn K. and Sadie R. of Zenaptic Chiropractic, Vancouver, WA.
Building Blocks
A practice’s needs and concerns can stack up What’s the trade-off for Dr. Ben’s credit card dilemma? Ben added yet another piece to the enormous castle he and his son were building. Jonathan scooted around to see the other side and knocked down the eastern battlement. “Oh, shoot!” “That’s okay,” Ben assured him. “We’ll build it again. The building is the fun part anyway.” Carmen agreed, admiring the turrets. “That’s true of so much in life, isn’t it?” Ben smiled. “So, what did you decide about your credit card system? Were you able to negotiate a better rate?” “Not yet. The bank where we have our merchant account doesn’t seem to feel that we’re big enough to be bothered with,” Carmen grumbled. “Speaking of building. I’m going to do some comparison shopping, but I think I might just have to wait till next year to get much of an improvement in the fees.” “It is always based on volume,” Ben agreed, placing a block for a drawbridge. “I’m concerned about that for the practice, too. Manual processing can cost more than swiping, too, in addition to the possibility of errors.” “Do you think errors really happen much?” Carmen asked. “I don’t know about our office, but I read some startling statistics recently,” Ben said. “7.8 percent of recurring transactions are declined. That’s $780 for every $10,000 in transactions. And for that same $10,000 in manual transactions, you can expect another $15 lost just from address verification failures. If we do that every month, the amount we lose could pay for Jonathan’s college tuition by the time he graduates high school.” “That’s sobering.” “The fact that we have both a POS system and manual posting and recurring transactions also makes me wonder if we’re completely PCI compliant. Sending out paper bills and then taking the payment information by phone might not be completely correct — and those bills can cost $1.61 apiece, since I’m throwing statistics at you.” “Never mind the bills,” Carmen said. “The fines for being out of compliance can run you $25,000 a month. That’s high priority.” “So I’m looking into solutions, but integrating and automating everything is going to be expensive. The POS system is separate from everything else in the office, so we might have to make changes there, too. And that’s all in addition to the fees.” “It’s like when we first started our businesses. We used to have to run the numbers every time to make decisions. Now, we’re established, so we know what we’re doing most of the time. When something new comes up, though, we still have to run the numbers.” Jonathan stood and stretched up to add one more block to the top of a tower and it rocked, tipped, and crashed. After a moment of stunned silence, the little boy laughed, so Ben joined in. Building often is the fun part, he thought. What’s the trade-off for Dr. Ben’s credit card dilemma?
ICD-10 Delayed Until 2015
Author Rita Mae Brown said, “If it weren’t for the last minute, nothing would get done.” ICD-10 delayed! In the case of ICD-10, with a deadline looming mere months down the road, we were heading into a figurative “last minute” — when practices were beginning to hunker down and take the necessary steps to ready themselves for the switch from ICD-9. Now that Congress has moved the deadline from October 1, 2014 to October 1, 2015, practices may be feeling the temptation to put off further action. After all, the last minute just got delayed by a whole year, right? Don’t kid yourself. ICD-10 is a change of enormous proportions — one that cannot be avoided or ignored, and definitely not one that should be put on the back burner. The changeover will take time away from patient care, and could have a serious impact on your bottom line. The changeover adds an additional layer of complexity — essentially giving payers even more opportunity to reject claims. We’ve been working on this problem for more than a year, and are continuing to address it, in order to ensure that our clients are ready now. Our system is geared up to make the transition as painless as possible; you simply need to rip off the band-aid and commit to the process. The choice is yours: You can take Congress’ action as an excuse to put off what must be done, leading to another year of worry and hand-wringing. Or you can get yourself prepared now, and pass the time with confidence, knowing that there’ll be no last-minute hysterics, and that your claims will be backed up by a system that’s been built and programmed for your success. We will continue to offer continuing education webinars on ICD-10 delayed while keeping everyone informed about further changes and requirements. In the meantime, we encourage providers to evaluate their ICD-10 readiness and audit risk by scheduling a Practice Evaluation. Click on the link below to get started.
ICD-10 | Five Building Blocks | Q&A from Webinar
ICD-10 Questions and Answers ICD-10 is coming soon. As you get your practice ready for the ICD-9 to 10 changeover, you are bound to have questions regarding documentation and compliance. To help you get the answers you need, we have compiled all questions that were asked during our recent webinar “ICD-10 | Five Building Blocks,” along with the presenter’s responses. Feel free to add any new questions in the comment section below. Q: Where can I find CMS guidelines in written form? A: On CMS.gov, click on the Medicare link and you will find a link for both local and national coverage determinations. Q: When can I start finding ICD-10 codes within your software and submitting them? A: Our software already has all the ICD-10 codes listed; we are building the crosswalk now. We recently completed ICD-10 testing with Medicare, and were successful with our front-end edits. We are looking to have this available to practices by June, to really start testing and cross-walking. At this point, payers are not accepting claims with these new codes; they are not coming over until October 1, but we are testing with payers and clearinghouses directly. You will be able to see which ICD-9 codes correspond to the appropriate diagnosis 10 codes, side-by-side right in the travel card.
Who’s in Charge?
Credit cards are a necessary, but often expensive part of doing business. Could Ben handle credit cards better at his chiropractic practice? “It seems like things are going a lot better at the practice,” Carmen said, turning slowly so Ben could admire the dress she was trying on. Ben was seated in the dress shop, trying to keep their son quiet and still while Carmen found just the right dress for a friend’s wedding. “Yes — but where’d that come from? I thought you were completely focused on the important question of the sarong skirt versus the trumpet skirt.” “Tulip, actually, and yes, I’m very interested in that question. However, I also want to make sure you’re in a good mood before I start using our credit card.” Ben laughed. “I am in a good mood, actually,” he admitted. “The changes we’ve been making at the practice are really paying off. And that dress looks great.” “Good!” Carmen stepped back into the dressing room for a moment and returned with another dress. “Speaking of credit cards…” “I like that dress even better,” Ben offered. Their son ducked under a dress rack. Ben hauled him back out. “Speaking of credit cards?” Carmen was back in the dressing room, but she called through the door. “I’ve been thinking we need a change in our card processor at the pizzeria. The fees seem really high. How about yours?” Ben agreed that he felt his processing fees were high, too, admiring yet another dress. “That blue thing is very nice,” he said as his wife disappeared into the dressing room again. “But, you know, it’s better to pay the fees than not to get paid, and sometimes a patient has an outstanding balance that’s just too high for him to handle in cash.” Carmen stepped out with her arms full of bright fabrics and grabbed Jonathan’s hand. Ben joined her in the line to the cash register. “I guess it’s different at the restaurant,” she said. “We use a point of sale system the same way the store here does. If your transactions are mostly about getting old debts off your books…” “We have some payments through our POS system, both for treatment and for things like back supports and exercise equipment,” Ben said, “but there are also times when we call a client about a bill that didn’t get paid by insurance, and they ask us to put it on a credit card. Those get posted manually, so it’s easy to make mistakes or to miss them.” “I don’t think we have many mistakes in our credit card transactions,” Carmen said consideringly, “but sometimes a card is declined — and the customers have already eaten.” She reached the front of the line and placed her stack of dresses on the counter with a credit card on top. “We’ve had credit cards declined, too,” Ben said. “And as you say, we’ve already provided the services at that point. It’s a hassle to follow up, and I think maybe sometimes we don’t follow up. You can always make them wash dishes, right?” The kids laughed much more than the joke deserved, but Ben hardly noticed. “Hey, how many dresses do you need for one wedding?” “I couldn’t pick just one,” Carmen explained. “Plus, there are other dressy events in our future.” “Like what?” “I don’t know yet, but now that I have these dresses, I promise you there will be some.” Ben didn’t argue, but he was thinking about credit card transactions at the practice. Just how much were those transactions costing him? Could Ben handle credit cards better at his chiropractic practice?
Stop Your Staff From Fighting | Genesis Webinar | Q&A
Does your office staff argue about who is responsible for completing tasks generated by your patient visits? How do you assign those tasks to your staff? How can you see if the tasks have been completed? Can you track those tasks automatically? Do you micro-manage your employees? How can you foster teamwork, promote autonomy and reduce the time you spend on management? These are questions that each chiropractic practice owner has to answer. Each patient visit generates a list of tasks that need to be completed. Each patient needs an account set-up with their complete demographic information, their insurance information and other details you need to file insurance claims and to collect cash or co-payments. If you break those tasks into a step-by-step list, then how do you assign those tasks to a member of your staff? How do you determine if every task has been completed for every patient? What happens if steps are forgotten? How will your patients judge your chiropractic practice if your CA forgets something? Would your patients think your office is unorganized? Q: What’s the problem? A: Office staff including the front desk, the office manager and any employee chiropractors are supposed to make life easier for the practice owner. However they often inadvertently create additional challenges regarding patient retention, revenue and compliance. Many of these challenges are related to issues that the practice owner simply doesn’t have time for. If your staff goes on vacation or calls in sick then a backlog of tasks is created, resulting in tasks being forgotten about and mistakes being made. Every member of your team needs to be managed and be held accountable to ensure that each task is completed correctly. Q: Why is this problem important? A: The short answer is Cost, Compliance and Patient Attrition. Cost – Front office tasks prevent the practice owner from seeing patients, which is the only billable time for your practice. Mishandling of billing and collections results in lost revenue with denied claims and delayed payments. Ineffective patient relationship management leads to attrition. Compliance – Includes incomplete/incorrect documentation, interrupted care plans, incorrect CPT/Diagnosis codes, staff unfamiliarity with procedures and employee failure to collect co-pays leads to over payment by the Payers. Patient Attrition – Failure by staff to follow-up on no shows, incomplete care plans and patients with no future appointments. Q: Why is this problem difficult to solve? A: There’s high front office staff turnover which could be due to poor training, lack of knowledge and unorganized micro-management. Some staff have a poor attitude towards training on new procedures and systems and they’re more comfortable with the old way of doing things. There’s also a lack of redundancy leaving tasks undone when somebody is absent and the ultimate responsibility falls to the practice owner. Q: What’s the Genesis approach or solution? A: A complete practice management solution for your office. Improve staff teamwork with effective training to ensure optimal practice performance. Improve teamwork and staff autonomy with automatic checklists of tasks that need to be completed when patients are checked-in. Track practice goals to more easily improve the number of patient visits, increase revenue, submit every insurance claim, follow-up with every no show and schedule patients with no future appointments. Manage staff remotely on your laptop or your smart phone by tracking task completion. Genesis is a complete practice management solution that includes: office workflow patient relationship management and staff management while also incorporating everything else you need like: scheduling billing EHR claim scrubbing claim submission claim follow-up staff task checklists training, etc. Genesis also includes a Coach to ensure your practice uses everything in the most efficient way possible.
Note-Worthy
Staff and Office personnel have to work together to make transition easier. Can Ben’s self-improvement plans cause trouble for his staff? Pam looked up as Ben bustled into the office. “You’re energetic today!” “I’m feeling inspired,” smiled Ben. “We’ve made some smart changes in the practice, and we have more coming up, so I think I’m ready to tackle changes in documentation.” “I’m impressed,” said Pam, “but I hope you’re not going to make too many changes. I feel like I’ve had just about all the change I can stand.” Ben was surprised. “I don’t think this is going to be a problem, Pam. We know that the new ICD-10 codes that go into effect in October are going to require more detailed documentation. I’m just going to get a handle on the new requirements.” “I understand that,” Pam sniffed, “but I feel like I have just gotten to where I can completely understand your notes and pick out the important keywords for coding. If I have to get used to a whole new system… well, if it’s not essential, I’d rather we didn’t make any more changes, that’s all.” Ben took a seat. “You know there are a lot more codes in the ICD-10 system than with ICD-9 codes–” “Don’t I know it! Almost 70,000 total.” “And one of the reasons there are so many more is that the codes have to be a lot more specific. If you don’t have very specific clinical documentation, it’ll be easy to get the codes wrong.” Pam said nothing. “If we have too many coding errors, or inaccurate documentation, it becomes a compliance issue.” Pam frowned. “I see what you’re saying. We could face non-payment issues, or even be audited. That would be a lot more trouble than getting used to a new style in documentation.” “Exactly.” Ben stood and stretched. “Tell you what, I’ll work on my handwriting and punctuation at the same time.” Pam laughed — or, thought Ben, maybe it was a snort. Either way, he was ready to get on top of the new demands for documentation. It felt good to have a clear goal. Can Ben’s self-improvement plans cause trouble for his staff? See our ICD-10 page for more information and more blogs on the diagnosis codes.
