ICD-10: The facts you need to know

health care 2014 icd-10

2014: A year of health care transformation.

With new initiatives in the areas of Meaningful Use, claims reporting, and ICD-10The Ohio Department of Medicaid is doing its utmost to support medical providers with information they need to know. This year brings the implementation of ICD-10, which is a tremendous undertaking for our industry.

The ODM website shares that International Classification of Disease (ICD) codes are used in virtually every healthcare setting, including inpatient and outpatient hospital settings and physician offices as well as in professional, medical services.  As the 10th edition, ICD-10 will replace the current ICD-9 code set.  All HIPAA covered entities are required to comply with the new code set regulations.

Claims for all health care services on or after October 1, 2014 and inpatient hospital with date of discharge on or after October 1, 2014 must use ICD-10 diagnosis & inpatient procedure codes.

ICD-10 offers a number of benefits to Ohio Medicaid, some of which include:

    • Enhanced code specificity,
    • Improved ability to measure the quality of health care services.
    • Enhanced accuracy of data analytics and reporting.
    • Improved processes to identify fraud and abuse.
    • Improved ability to identify populations and members for targeted outreach and case management.

Ohio Medicaid continues to work toward implementation of ICD-10 by the compliance date of October 1, 2014.  They are actively engaged with sister state agencies, managed care plans trading partners, and many provider associations to ensure that all Ohio medical providers will be ready for the transition.

CLICK HERE for the ICD-10 Ohio Medicaid Provider Q&A, which provides information you need to know. Cornerstone Alliance continues to support our provider partners as the health care industry prepares for monumental changes and the transition toward implementing ICD-10.

ICD-10 QA

To further support our members, Cornerstone will be sponsoring an educational seminar on February 11th:

2014 Coding & Government 

Update Regulations

presented by: B.J. Hohenstein RN, CCS, CCS-P, FCS, PCS

Our goal is to enable our members and provide needed tools to implement coding updates. We hope you can join us! Don’t hesitate to contact us if we can support your medical office in any way.

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Keeping up with the NEW this Happy New Year

Should old acquaintance be forgot,
and never brought to mind?
Should old acquaintance be forgot,
and old lang syne?

For auld lang syne, my dear,
for auld lang syne,
we’ll take a cup of kindness yet,
For auld lang syne!

 Out with the old… in with the new! Even as the last words to the traditional Auld Lang Syne were sung, cheers and tinsel were flying through the air. Let the celebration begin – the new year is here!

Happy New Year from all of us at Cornerstone Alliance. This promises to be a very exciting year in the healthcare industry as we move forward with ICD-10, Value-Based Care, and many new opportunities to serve the ones we exist for: our patients.

Cornerstonepho.com website happy new year

The past year was one of moving forward in many ways for Cornerstone. We moved into the realm of social media and updated our website to make it more user-friendly and consistently up-to-date. Our goal is to provide our members with a value-added service and a portal for information. We know you are busy, so we hope to save you time by having information you need readily available at your fingertips.

new this month cornerstonepho.com Our new “New This Month” tab will be the place where we will provide information as we receive it to keep everyone “in the know” as we receive updates. Instead of providing information quarterly or even monthly, we’ll add documents that we know you’ll need as soon as possible. Bookmark this tab – and make it a favorite!

credentialing cornerstonepho.com newAnother tab you’ll want to check is our “Credentialing” tab. Not only do we offer information about what credentialing is and why it’s important, we’ll provide our list of new providers in an easy-to-follow format. At the bottom of our “New Providers” page is a link where you can access full contact information for each new provider so you’ll have it available to use anytime.

cornerstonepho.com about us newBe sure and check out our “About Us” tab. Of course it gives you information about us and what we do, along with our history and mission statement. We also share a couple of testimonials that you can click on to view, along with resources to keep you updated with recall news, recent FDA updates, drug interactions, and current developments in the medical field.

Each of our staff members is ready to support you as we bring on 2014 with anticipation and excitement. Don’t hesitate to contact us, and be sure to let us know if there’s something we can add to our website that will be of help to you. Happy New Year!

happy new year

5 Ways to Help Ensure Medical Claims Can Be Processed

ensure medical claims can be processedHealthcare providers are facing more challenges than ever when it comes to making sure medical claims are paid. Medical offices are not only implementing healthcare reform provisions, payers are constantly updating policies for reimbursement and pre-certification, along with making coding changes.

Add to that the October 1st, 2014, ICD-10 deadline. With ICD-10 increasing the number of CM and PCS codes from ICD-9’s 17,000 to a formidable 141,000, it’s enough to make any medical office staff member a bit nervous.

The challenge?
Potentially lower reimbursements.

It’s simple. If the correct code is not submitted for the service provided, the claim cannot be processed and it won’t be paid accordingly. But with more than nine times as many codes coming, mistakes are bound to increase – at least temporarily.

The plan?
Stay on top of changes to ensure medical claims can be processed.

Need to ease the transition to ICD-10? Here are 5 things to check to ensure medical claims can be processed and paid as promptly as possible:

1. Check payer’s websites monthly for updates

It is important that office staff check payer’s websites monthly for updates. Many times a claim isn’t processed or paid correctly due to a change in a policy by a payer. Some offices send payer updates, but many do not.

2. Check alpha and numeric coding

Coders often confuse the number “0” (zero) with the letter “O” and the number “1” (one) with the letter “l.” Good news: The letters O and I excluded in the ICD-10 system to avoid confusion with the numbers 0 and 1.

3. Check diagnosis and procedure codes needed to process the claim

It is imperative that both the diagnosis and the procedure are coded. Another must: Check accuracy and ensure complete coding of records and medical records. Functional errors, including records that coded incompletely or codes associated with the wrong medical test, will result in an unprocessed claim.

4. Check medical records

With the implementation of ICD-10, it is important to check specifics found in medical records to ensure prompt claims processing. For example, the coder must specify specific type of chest pains, which may mean looking at the information in the medical record that differentiates them from atypical pains.

5. Check codebooks for accuracy and don’t rely completely on coding software

To cut down on errors, practice management software prepared for the ICD-10 transition may be implemented. This can be a time- and sanity-saving means of moving into ICD-10. However, it’s important for coders to continue referencing codebooks and not develop an over-reliance on coding software.

Taking time to check a few simple areas can help ensure that medical claims can be processed quickly and paid as promptly as possible. As medical providers prepare for moving to ICD-10, taking time to check now can result in a smoother transition. Cornerstone Alliance serves Allen, Auglaize, Hancock, Hardin, Logan, Mercer, Paulding, Putnam, Shelby and Van Wert counties in Ohio. Please contact us if we can be of service to you!