Steps You Can Do to Prepare for ICD-10

OOA Incoming President Dr. Jason Miller will provide one-hour of practice management CE at each of his President’s Nights in the 12 Ohio zones starting in late August. Contact your Zone Governor for details or email the OOA.

The ICD-10 transition is only two months away –   October 1, 2015.  Are you ready?

Steps You Can Do to Prepare for ICD-10

Following are steps that optometric practices can take to prepare.  The key is to start now (see Additional Links and Resources below for specific timetables for ICD-10 transition).

  1. Go to the Centers of Medicare and Medicaid Services website. Here you can find up-to-date information on ICD-10, e-mail updates, webinars and links for specific provider information as well as timelines for implementation.

http://cms.gov/Medicare/Coding/ICD10/index.html

  1. Evaluate your current documentation. Look at your current records to see how your clinical documentation would be graded in ICD-10.  Remember, the purpose of ICD-10 is to more accurately describe each patient’s condition. Documentation is what drives coding.  Is the history you documented comprehensive enough to fully describe the encounter which will go along with your findings?  One helpful tip would be to practice and improve on your everyday documentation which is driven by each clinical condition.  This will allow you or your coder to have enough information for ICD-10 classification.
  2. Determine who in the office will be affected. Evaluate all aspects of your practice where ICD-9 is currently used.  Examples include authorizations, pre-certifications, physician orders, medical records, superbills, EHR systems, coding manuals and public health reports.  Discuss ICD-10 with key staff members.  Make sure all systems you integrate with are ready to go on October 1, 2015. Allow every affected individual ample time to understand these changes and provide the necessary training.
  3. Know your top codes. There are several programs, websites and services available to help navigate the new ICD-10 codes and allow a comparison to ICD-9.  Look at the current top 10 or 20 ICD-9 codes used in your practice and find out what the ICD-10 codes will be.  These same programs will also allow you to compare ICD-10 codes to their previous classification.  Document these codes as a guide to improve accuracy when ICD-10 comes around.   A main difference will be the greater specificity of these various diseases and condition.  Examples:

http://www.aapc.com/icd-10/codes/

http://www.icd10data.com/.

Although it sounds overwhelming, taking the time to prepare ahead of time will save some stress on October 1, 2015 when the change must occur.  Encourage doctors and staff in your practice to concentrate on medical record documentation that will help choose the correct code when necessary.

Available ICD-10 Resources:

There are many resources available to prepare your practice for ICD-10 available on the Center of Medicare and Medicaid Services website.  The following links provide useful tools to guide your practice as you e transition to ICD-10.

– American Optometric Association

www.aoa.org

An optometry focused ICD-10 webinar series provides thorough and accurate information. AOA members who have an ICD-10 question that is not answered in AOA resources can direct a question to AOA’s coding experts.

 

– CMS Provider Resources http://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html

o   FAQ:  ICD-10 Transition Basics

o   ICD-10 Transition: An Introduction Fact Sheet

o   ICD-10 Basics for Medical Practices

o   ICD-10 Basics for Payers

o   The ICD-10 Transition: Focus on Non-Covered Entities

o   Checklists, Timelines, and Implementation

o   Implementation Planning

o   Communicating About ICD-10

o   Medscape Education:  Webinar and Articles Available

 

– American Association of Professional Coders – www.aapc.com

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Optometrists’ Integration with Accountable Care Organizations Obvious Key to Health Care Delivery and Cost Containment

By Charles B. Brownlow, OD  PMI, LLC drbrownlow@pmi-eyes.com

As healthcare continues to evolve, providers have been inundated with new policies, regulations, and code sets that they must master in order to be compliant, but also to simply survive. If you are like many ODs, you have spent the last few years focusing on EHR implementation, Meaningful Use (MU), new HIPAA regulations, and, of course, the looming transition to ICD-10. Those issues are all very important to you and your patients, but have you also been paying attention to Accountable Care Organizations (ACO), and how you can be part of them?

An ACO is a group of providers who are jointly held accountable for the care of a group of patients.  The concept is unique, in that the providers are expected to work with the payer in achieving measurable quality improvements and reducing the rate of spending growth. These groups of providers are often part of large health systems and hospital groups, but they can also be a collaboration of a number of smaller providers.

The President of Blue Cross and Blue Shield of North Carolina recently stated: “Even if federal health overhaul is rejected by the Supreme Court or revamped by Congress, the market must continue to change. The [health care delivery/payment] system that brought us to this place is unsustainable. Employers who foot the bill for workers’ health coverage are demanding that Blue Cross identify the providers with the highest quality outcomes and lowest costs.”

Although we might believe that ACOs would not be interested in talking to individual eye doctors, this is not actually the case. In order for an ACO to prove “quality,” one of the items on which they are measured is whether their diabetic patients have a yearly eye exam. This is one of the items factored into their HEDIS score. Very few ACOs have enough eye care providers included on their panels to provide that volume of care. For that reason, they will need to partner with sufficient numbers of individual optometrists to fill in that gap. Failure to integrate optometric services into the ACOs creates an unnatural barrier to patient care, and it hampers the ability of doctors to provide seamless and effective care for their patients.

Using optometrists has also been proven to lower insurers’ costs in urgent eye care situations. The American Optometric Association commissioned a study by SCIO Health Analytics in 2013 to determine the potential benefit of providing appropriate eye care services in different settings (eye care professional’s office, emergency department, and primary care provider’s office). The results of the study indicated that if the cases analyzed had been treated at an optometrist’s office, the cost would have been less than 10% of what was actually spent.

To maximize the savings of eye care services, barriers to optometric care need to be eliminated. Often vision plans are not integrated with health plans.  Instead, they separate “routine” eye care and medical services. This creates an artificial separation between ‘Eye Health’ and ‘Vision’ benefits, and it creates a barrier to patients receiving essential eye care.

The AOA has created a great resource at http://www.rethinkeyecare.com. The amount and quality of information is fantastic. Visit this site to learn more about ACOs, how they work, and to access guides on how to get your practice involved. You can also see a list of all the ACOs in your state at www.aoa.org.  If you are not at least informed regarding the potential changes to the delivery of healthcare through ACOs, your efforts in MU and ICD-10, may be for naught.

Remember…As an association member, you and your staff are able to send questions directly to Dr. Ames at drames@pmi-eyes.com or Dr. Brownlow at drbrownlow@pmi-eyes.com

House Bill 213

By Executive Director Keith Kerns, Esq.

State Representative Tom Brinkman (R-Cincinnati) recently introduced House Bill 213 into the Ohio General Assembly.  HB 213 would require that all professional licenses be renewed on a biennial basis.

The bill would impact several regulated professions, including: auctioneers, pawn brokers, real estate agents and appraisers, sanitarians, hearing aid dealers, private investigators, nursing home administrators, contractors, dieticians, pharmacists and opticians and optometrists.  Physicians, dentists and other health professionals currently renew on a biennial basis and are not included in the bill.

The bill would essentially bring all professions into alignment with a two-year renewal process, yet the benefit behind such a change appears unclear.  In fact, the change could prove to be detrimental for licensees.  A long gap between renewal periods carries several logistical challenges.  Changes in practice location that are not properly recorded with the appropriate licensing agency may result in licensees failing to receive renewal notices.  Additionally, licensees may simply forget when a license is to be renewed because of the amount of time between renewals.

Failing to renew a license can be a significant problem in some professions.  For example, in the dental industry, which maintains a biennial renewal process, several hundred dentists would fail to renew their licenses every two years resulting in an automatic suspension from practice.  Not only did this result in the dentists experiencing licensure discipline, it also caused some dentists to be canceled from insurance contracts because they did not maintain a license free from encumbrances.  The problem was so significant that the legislature stepped in to create a grace period for renewals in dentistry.

In contrast, the annual licensure renewal process that exists for optometrists is a system that works.  OOA members and others within the profession understand and comply with the current renewal process.  In fact, the State Board of Optometry reports no significant problem with optometrists failing to renew licenses in a timely manner.

The State Board of Optometry operates at a high professional level within their operating budget and is well-equipped to perform the licensure renewal process on an annual basis.  While there might be other professions and licensing boards for which biennial licensure may be helpful, in optometry there is no known benefit to the public, the licensees or the state.

The OOA has requested to have optometry removed from HB 213 and will continue to monitor the bill as it is debated in the legislature.   Be sure to visit www.ooa.org to view the latest updates on HB 213 and other important legislative issues.

House Bill 157

By Executive Director Keith Kerns Esq.

This Bill would change Ohio’s medical liability system.

House Bill 157, introduced by State Representative Jim Butler (R-Oakwood), would dramatically alter Ohio’s medical injury compensation program and make other changes to how Ohio administers the Medicaid program. Rep. Butler hopes to accomplish three primary goals with the legislation: lowering Medicaid spending, lowering overall healthcare spending and applying Medicaid savings to care for needy populations.

To accomplish this mission, his bill would create hospital ER diversion programs, institute price transparency for healthcare services, promote small business health coverage through Multiple Employer Welfare Arrangements (MEWAs), incentivize Medicaid recipients to utilize preventative services and reduce defensive medicine by establishing a new Medical Injury Compensation System.  The 386 page bill is aggressive and would impact nearly every stakeholder in the healthcare industry.  For optometry, one provision in the bill stood out as a cause for concern.

HB 157 calls for the creation of a new Health Care Professional Standards Board.  This board would be comprised of three members appointed by the state medical board, one member appointed by the state dental board, one member appointed by the state chiropractic board, one member appointed by the state board of pharmacy, two members appointed by the state board of nursing, and one member appointed by the state board of optometry.  The new board would have immense authority.  It would be charged with investigating malpractice claims brought against providers, imposing discipline against providers, maintaining a database of claims and complaints and establishing the standard of care for health professionals.

While important functions, all of these activities are currently being performed within state or federal government.  State regulatory boards, including the Ohio State Board of Optometry, maintain access to the National Practitioners Data Bank (NPDB) in order to review and investigate malpractice awards.  The boards also establish the standard of care for a profession and impose discipline when warranted.  Finally, the Ohio Licensure System provides public information on formal actions taken against health care providers and the NPDB tracks similar information for use by government entities and insurers.  Simply stated, the functions delegated to the Health Care Professional Standards Board are duplicative and would only serve to create another costly level of bureaucracy within health care system.

The OOA has communicated these concerns to Rep. Butler and other members of the House of Representatives.  At the same time, the OOA acknowledges that medical liability laws are a key component to establishing a cost-effective health care delivery system that keeps medical professionals in Ohio.  But recent tort reform efforts, including the establishment of caps on damages and the creation of a statute of repose, are already helping to achieve these goals.  For optometry, malpractice rates and the number of licensed optometrists are stable in Ohio.  So while there is always value in searching for ways to improve our medical liability system, the current structure appears to be working.  Dramatic changes, such as the creation of a Healthcare Professional Standards Board, could disrupt this stability.

The OOA will continue to monitor HB 157 and other bills impacting the practice of optometry.  Be sure to visit www.ooa.org to view the latest updates on these important legislative issues and to get involved in the OOA’s Key OD grassroots advocacy program.

Reasons to Contribute to the OOPAC as an OOA Member

By Rebecca Brown, OD

As optometrists we care about our patients.  We have literally dedicated our lives to becoming better practitioners.  We work hard to become better doctors and to provide better services and a higher quality of care to our patients.  It is only logical that we also share a concern for the future of our profession.

The easiest way for us to protect the future of optometry in Ohio and allow us to continue offering excellent patient care is to annually contribute to the Ohio Optometric Political Action Committee (OOPAC).  Still less than one out of four Ohio optometrists contribute to OOPAC.

Unfortunately many of us do not understand the importance of giving money to OOPAC.  Money given to OOPAC is contributed to people seeking public office in order to assist with political campaign expenses.   Recipients of OOPAC contributions are candidates who are considered supporters of our profession.  Recipients of PAC money have often already demonstrated their commitment to optometry by creating or supporting laws that have directly benefitted optometry and our patients.

The reality is that every optometrist can make a difference by giving to OOPAC.  Sure large contributions are good, and the more money we give the more we can help friends of optometry, but even small contributions make a difference.  As stated earlier less that 25% of optometrists contribute to OOPAC.  A higher percentage of giving demonstrates that our profession is educated about and unified regarding our commitment to helping elect people that support optometry.  Your giving sends a message to lawmakers that as optometrists we are committed and willing to stand together to advocate for policies that help our profession and better serve our patients.

ICD-10; Transition Tips from inside the Trenches

OOA President-Elect Dr. Jason Miller will be the featured speaker at each of the Zone President’s Nights in the fall. In addition, new OOA Executive Director Keith Kerns will provide a legislative update and looks forward to meeting the members in each Zone.

Dr. Miller will speak about ICD-10. A summary (one hour practice management ce)

ICD-10; Transition Tips from inside the Trenches

The conversion to ICD-10 will change many aspects of Optometric practice. It requires improved record documentation and plays a larger role in the delivery of health care. This course will discuss steps to help make the conversion a success. From the front office to the examination room to the billing office, it will uncover tips to help with that transition leading up to October 1, 2015 and into the future.

Mark your calendar and plan to attend your Zone’s President’s Night.

President’s Night Zone meeting dates are as follows:

Zone 1 (Mansfield) – September 14

Zone 2 (Cleveland) – September 9

Zone 3 (Canton-Akron)- September 2

Zone 4 (Youngstown)- August 24

Zone 5 (Zanesville)- September 24 

Zone 6 (Athens)- September 21

Zone 7 (Portsmouth)- September 3

Zone 8 (Cincinnati)- August 26

Zone 9 (Dayton)- August 27

Zone 10 (Lima)- September 16

Zone 11 (Toledo)- October 14

Zone 12 (Worthington)- September 23

 

 

 

Good News/Bad News?

By Charles B. Brownlow, OD (drbrownlow@pmi-eyes.com)

Medicare Fee ScheduleThanks to the tireless efforts of our AOA leadership and staff (along with the AMA and other provider associations) the US Congress has finally ditched the flawed formula used for creating Medicare Fee Schedules each year.  For a decade or longer, the formula had created Medicare’s schedule in November of each year.  The release of each of those schedules, including significant cuts in reimbursement, would launch a flurry of lobbying activity by the health care providers in order to reverse the cuts.

Some years the lobbying was effective prior to the end of the year but in most cases it took until mid to late first quarter of the following year to make the corrections.  That resulted in Medicare having to reconsider and correct any claims submitted and paid during the months of the ‘wrangling’.  This year’s correction took longer, but it is more significant, in that it changes the whole process.  From now on, the official Medicare Fee Schedule will have an across the board 0.5% increase, with additional adjustments made via enhancements.  The enhancements will be paid based to providers who demonstrate completion of or compliance with incentives that the Centers for Medicare and Medicaid Services will announce each year.  So, the schedule will have a 0.05 increase, but actual payments to each provider will be adjusted up or down based on performance.  Good news?  Bad news?

ICD-10I was one of a very few who believed that the American Medical Association was going to swing its weight around at the last minute, in conjunction with the ‘Medicare Fee Fix’ and kill ICD-10.  I wasn’t surprised, though, when the last minute past on April 14 without any such ‘assassination’.  That means that barring any totally unexpected action by Congress in the next few months, October 1, 2015 will indeed be the date that ICD-10 will become the only method for coding diagnoses in the US.  After that date, ICD-9 will only be used with claims for services that were performed on or before September 30, 2015.

Many doctors and staff have been delaying their preparation, hoping that ICD-10 would simply go away.  For those of you in that situation, it’s time to gear up and get educated.  Personally, I think most of us will be pleasantly surprised at how smoothly that process will run. Here are some suggestions for getting ‘geared up’ for ICD-10:

Within the next month or so, whether you are currently using paper or electronic records you should…

  • Purchase the full ICD-10 manual (about $100, 1,100 pages, American Medical Association, amastore.com), and provide time for each doctor and key employee to familiarize her/himself with the layout of the manual (Note: laminated quick find aids and listings abridged for eye care are all right, but should not be used without the full, unabridged manual)
  • Identify 20-30 diagnoses that are frequently identified in your practice (open angle glaucoma, macular degeneration, corneal foreign body, etc.)
  • Work in teams, with doctors and staff learning together
  • Avoid trying to ‘convert’ ICD-9 to ICD-10. Instead, use the Tabular Index (alphabetical) at the front of the manual to look up each diagnosis, eg, non-proliferative diabetic retinopathy with macular edema. The listing is under ‘Diabetes, retinopathy’ in the index, run your finger down to ‘non proliferative, with macular edema’ and find the code, E11.321
  • Turn to the page associated with that diagnosis and you’ll see ‘Type II diabetes mellitus with mild non proliferative diabetic retinopathy with macular edema’, with that code, E11.321
  • Continue through the other diagnoses you’ve identified
  • Refer back to the introduction and guidelines sections of the manual as questions pop up

If you are using electronic records, check with the company to determine

  • Whether they’ve done their testing and are prepared for the big day
  • Whether you will need to do anything special to be sure that ICD-9 and ICD-10 are applied appropriately up to and through October 1
  • Whether the EHR will permit you to choose a diagnosis with the software automatically suggesting the appropriate ICD-10 code
  • Whether the company will provide training guides for docs and staff related to ICD-10

In July or before, have additional sessions to list common diagnosis codes and refer to the AMA ICD-10 manual to identify the proper codes.  For those using electronic records, there should be additional training session guidelines established by the developers.  For those still using paper charts, there is already lots of information available from the AOA at http://www.aoa.org and search for ‘ICD-10’.  There are many, many great articles, tips, webinars, etc. available there to assist in the training process.

I believe that the transition to ICD-10 will be easier than most people think.  ICD-10 is better than ICD-9 in several ways, including the ability to report a many-faceted diagnosis, such as the diabetic retinopathy example above, with a single six or seven character code, rather than two or three four or five character ICD-9 codes.  The closer we get to October 1, the more resources there will be available, as it will be to the advantage of all the players in the system; doctors, staff, insurers, Medicare, etc.; if all are well prepared and trained.  Good news?  Bad news?  It’s up to each of us to make sure the news is as good as it can be; by accepting the reality of ICD-10, preparing for it, and applying it.

Helping Older American’s with Vision Loss

By Joan Nerderman

Eye care in someone’s home is always EYE opening and can be so rewarding.   I have had the opportunity for the last 13 years to go into patient homes and nursing homes with a senior Ohio State University optometry extern who has expressed an interest in helping people in these areas of need.

What better way for an extern to experience the need, than to see the patient’s environment and the visual challenges: like the TV that’s only 6 feet away and at an angle or seeing them reading the newspaper in their dimly lit house. Often the suggestions to some of these problems are as simple as can the TV be put in a new location or do you have any gooseneck lamps in the house?

With just a few tools by your side like a hand held slit lamp, trial lenses and frame, eye chart (we have a simple one we tape to the wall and measure test distance), tonopen, Perkins or Icare tonometer, small lensometer is nice, drops and your BIO/panoptic, you can visit the patient it their home, and make small adjustments to help improve their life.  One of the most rewarding patients was one who had terrible neck contractures and cataracts.  Although no one could do surgery in her position we were able to get her a stand magnifier that allowed her to see the one thing she wanted–her grandson’s wedding pictures.

Also seeing the interaction of the externs with the fading population of WWII veterans, warms my heart. We can’t always get them seeing great but we can help advise those who may not otherwise get out for vision care, gain some vision independence.

Rick Cornett’s Retirement

On Sunday March 29 OOA members and friends celebrated the retirement of Rick Cornett.

OOA President Dr. Gossard, Dr. Augsburger, Dean Zadnik and Dr. Roark spoke.

OOA Past Presidents conducted the “passing of the gavel” ceremony concluding with Rick who gave the closing remarks.

Congratulations, Rick! Thank you for your outstanding years of service to the OOA.

Blogs or Books? Guesses or Guidelines? It’s time to get serious about good medical records.

By: Charles B. Brownlow, OD  (drbrownlow@pmi-eyes.com)

Several years ago, I found myself jumping from one eye care chat room to another, trying in vain to correct bad information about patient care and record keeping that kept popping up there.  It seemed that my colleagues in eye care would rather ‘take a poll’ of other ODs and staff (who didn’t know the answer either) rather than go to the only true authorities.  After getting totally frustrated in that ‘Whack a Mole’ environment, I respectfully and quietly withdrew from the milieu, and I haven’t missed it one bit.

Over a decade ago, during the ramp up to HIPAA, the rules changed essentially clarifying that Current Procedural Terminology (©American Medical Association), ICD-9, and the Documentation Guidelines for the Evaluation and Management Services (99000 visit codes) were the sole acceptable references for codes and definitions for the vast majority of health care services.  That thought clarifies nearly everything in health care…All a health care provider needs to do to learn about the logic of health care delivery, good medical record keeping, and accurate choices of procedure, visit and diagnosis codes is purchase the current year’s CPT and a fresh ICD manual and download the 1997 Documentation Guidelines from CMS.gov.

Based on the questions that I get every day from ODs and staff from around the country, it’s pretty clear that a majority of those offices do not have those key references available in-house, or they are not current, or they just don’t refer to them when question arise.  That’s pretty sad, I think.  CPT is available through our AOA.org/marketplace at $100 a copy.  The Documentation Guidelines are a free download (.pdf or Word) at cms.gov.  ICD-9 and ICD-10 are available as complete manuals for around $100.  So, for between $200 and $250 per year, key staff and doctors could become ‘experts’ on the chat room scene real quickly.

I’ll provide a couple of examples to support my point.  One of the long-raging arguments among eye doctors; at least twenty years; has been whether the CPT definition of the comprehensive ophthalmological service (92004/92014) includes a dilated fundus examination as a requirement.  The definition has not changed since 1992 and it has never included that requirement!  The CPT definition clearly lists “…examination with cycloplegia or mydriasis” among the tests that the service “…often includes, as indicated”.  “Often includes” does not equate to “includes” or “is required.”

I think the confusion may come from the requirements for the ‘comprehensive physical examination’ for the evaluation and management services (99000 codes), but it was made very clear back when the 99000 codes were introduced nearly twenty years ago that the CPT definitions are unique and distinct for each set of visit codes and that there are no crosswalks or comparisons between the two.  In short, “external and ophthalmoscopic examinations” are required elements for 92004/92014…Dilation is not.

One of the national speakers in the medical record area continued to state that dilation was a requirement. Every year I would hear that, refer to my then current CPT book for confirmation that I was still right, and shoot off an email to suggest that the speaker ‘change his tune’.  Months later, I’d hear that the message had not changed.  Finally, early one year, with the ink barely dry on my current copy of CPT, I heard again that dilation was required.  Instead of emailing again, I picked up the phone and called. “Hey, how are you doing?  Keeping out of trouble?  Family doing fine”, etc.  After about 30 seconds of small talk I dropped my challenge.  “It’s right there in the definition”, the speaker replied. Then it hit me and I responded, “Which CPT book says that?”  “Why, the (Brand X) CPT, of course”, he parried.  FLASH!  The lights snapped on.  He wasn’t using the only official CPT book, the AMA CPT, he was using a cheap imitation, the book that continues to confuse the issues, the (Brand X) CPT!

As with so many things, we must accept no substitutes.  If I’m ever in court, I’ll want an attorney who knows the laws and, when pressed, is able to refer to the current, official statutes that pertain to the case.  I’m not going to be very comfortable if the attorney attempts to reassure me by saying that she got the information off a blog or chat room, or that he called a couple of friends or read it in a novel.  The same is true with medical records.  The care you provide had better be consistent with accepted modes of practice; the standards of care; and the medical records you keep must demonstrate clear connections between the needs of the patient and what was done, and your choices of procedure and visit codes must have been chosen by comparing the content of the chart and the definitions in AMA CPT and the current ICD listings.

Relying upon trusted resources and references can help us avoid hassles and sometimes disasters.  I know you’ve been putting this off for a long time.  Just do it today.  Get your 2015 copies of CPT and ICD-9 (and ICD-10).  Read the introductions at the front of the CPT book and the front of the 1997 Documentation Guidelines.  And then refer to those key references when questions pop up.  You’ll sleep better…You’ll find yourself chuckling quietly when you ‘listen’ in on a discussion in a chat room or read somebody’s blog…Then, without typing a response, you’ll go to the references, double check your understanding of the question, and live happily ever after.  You’re welcome.