An ICD-10 quick and simple primer w/useful info and links

As of October 1, 2015, FFS (fee for service) Medical Claims will require ICD-10 codes for disease documentation in lieu of ICD-9 codes.

As noted in this July 7, 2015 letter to providers from CMS Administrator Andrew Slavitt , no claims submitted after October 1, 2015 will be processed unless diseases are documented with ICD-10 codes. And as usual, private insurers are following CMS’ lead and are requiring ICD-10 documentation for their claims as of October 1.

On the surface, going from approximately 16,000 ICD-9 codes to 68,000 ICD-10 codes seems daunting.

The good news is that there are simple tools to deal with this transition such as an ICD-10 …Read more

Predicting a Medical Practice’s Cash Flow in a Rapidly Changing and Punitive Healthcare Climate

Making intelligent decisions on a company’s future depends on a myriad of factors: Projected cash flow being a key metric.

Unfortunately, projected cash flow in a typical medical practice is getting progressively more difficult to ascertain. With the constant changes in healthcare, historical data may be an inaccurate measure of future revenue and a medical practice must continually adjust their projected revenues based on a number of factors.

Following are the few of the myriad items that can affect a clinic’s cash flow:

1). Expected reimbursement rates for patients who have enrolled through the government’s healthcare exchange….
2). Current penalties for Meaningful Use, PQRS and/or the related Value Based Modifier adjustment could reduce Medicare reimbursements up to an additional 9%. If a practice is not current on their Meaningful Use attestation and…
3.) Current actual reimbursement rates per CPT code broken down by insurance carrier compared to contracted…Read more

“My Medical Billing Company is Not Performing but I am Afraid to Lose Cash Flow by Changing Anything”

“My Medical Billing Company is Not Performing but I am Afraid to Lose Cash Flow by Changing Anything”. Such is the lament of many physician/CEO’s. With insurers increasingly denying claims for technicalities and for their own cash flow benefit, the problem of rejected claims is only increasing.

For the medical billing company, initial claims can be submitted in bulk which is where the economies of scale for the billing company come in.

The rejected claims have to be handled on a case by case basis.

If the rejected claims take more than a few minutes to work on for a billing company, then it does not make sense for the billing company to work on these rejections. This is simple economics.

The billing company would prefer to spend that same time submitting new claims, in bulk, generated from new office visits. This cycle goes on and on and the medical practice’s aging gets worse and worse until the claims become uncollectable.

How do you stop this crazy cycle? Basically, a practice has to grow a third arm and go outside their comfort zone. There are a few ways to attack this problem.

What Dr. Ben Carson Could Learn from Frank Underwood and the "House of Cards"

Perhaps Dr. Carson’s political shortcomings are also a reflection of many physicians’ dilemma. Logic would have it that if you are a great and dedicated clinician and care about your patients, then you should be successful as a physician. But as many physicians can attest to, being a great and caring physician is, unfortunately, becoming a smaller part of being successful as a physician.

Change is Good: How Doctors Can Remain Independent in 1000 Easy Steps or Less

Change is Good: How Doctors Can Remain Independent in 1000 Easy Steps or Less. If an entity is willing to take over a practice and pay the physician a salary, then it is pretty obvious that they see something that the physician is missing. They see receivables not collected, visits not properly billed, contracts not negotiated, employees not needed, appointments not made and books not kept. They see marketing not being done, IT deficiencies, operational inefficiencies and cost overruns. But more importantly, they also see positives such as a good established practice within a target demographic with existing patient, insurance and vendor relationships.