Blog | In Record Time, Inc. | 1-800-788-4960
Revenue cycle roundup: March 2020
COVID-19 has brought with it a whole host of operational and financial changes with which hospitals are grappling. Take a few minutes to read these newsworthy developments that may help your organization navigate COVID-19 while continuing to provide patients with high-quality care. Wishing you, your families, and your colleagues health and wellness in the months ahead.
Note new guidance for coding, billing COVID-19
As COVID-19 cases continue to rise, coders must be prepared to capture cases using new CPT and ICD-10-CM codes. Here’s what you need to know:
Report CPT code 87635 for COVID-19 testing, and be sure to review the American Medical Association’s (AMA) guidance published in CPT Assistant on how to report this code.
The AMA has provided helpful advice, including 11 coding scenarios, that can help coders maintain compliance when reporting COVID-19-related services.
Note that COVID-related services, including testing, isolation/quarantine, and vaccination, are generally covered as Essential Health Benefits under Medicare, and many private payers are following suit.
Increased patient volumes raise HIM questions, concerns
A new report finds that hospital readiness for COVID-19 varies significantly nationwide and that many hospitals are unprepared for a potential influx of patients. Authors of the report cite several recommendations to increase surge capacity such as canceling elective surgeries; using halls, conference rooms, and amphitheaters to increase physical capacity; speeding the discharge of patients well enough to leave, and more. However increased staffing shortages add a layer of complexity. The situation has become so dire that President Trump recently deployed Navy hospital ships to coronavirus hot zones.
All of these developments raise questions about the overall impact on HIM departments nationwide. Are managers prepared to prioritize cases and audits? Are they ready to move all staff offsite? How might they handle unexpected absences due to positive tests or quarantines? Are they connected with a coding vendor that can provide back-up support? These are just a few of the questions managers should be asking.
CMS loosens telehealth requirements during COVID-19 crisis
Per new CMS guidance, effective March 6, 2020, Medicare will pay for office, hospital, and other visits furnished via telehealth across the country and including in a patient’s place of residence. However, providers must use an interactive audio and video telecommunications system that permits real-time communication between the distant site and the patient. Important to note: The Office for Civil Rights will waive penalties for HIPAA violations against providers using FaceTime or Skype. Be sure coders understand these changes—and that they know when to report telehealth versus and virtual check-ins and e-visits.
Office of the National Coordinator publishes 21st Century Cures Act Final Rule
Patients will soon have free and secure access to their data, according to the 21st Century Cures Act Final Rule that requires providers to open their EHR systems through standardized application programming interfaces. The rule requires providers to share all electronic health data within 24 months, though some experts argue the timeline should be expedited in light of COVID-19. Is your organization prepared for these new requirements? And more importantly, does your organization promote documentation and coding integrity, both of which will be paramount as patients access their data?
New cancer registry collects data on cancer patients with COVID-19
The CCC19 Registry is a multi-institutional collaborative effort to collect data on patients with cancer suspected or confirmed as having COVID-19. Twenty-five cancer institutions have already begun participating in answering survey questions that collect data on demographic information, COVID-19 diagnosis and course of illness, cancer diagnosis and treatment details, and information about the healthcare professional. Principle investigator Jeremy L. Warner, MD, MS encourages all providers to participate.
For more information about these developments, contact In Record Time at 800-788-4960.
Revenue cycle roundup: February 2020
February brings a whole host of newsworthy developments: New codes for coronavirus (COVID-19) and vaping-related disorders, sepsis hospitalizations on the rise, and more. Check out these five stories that should be on your radar this month:
Z codes help providers capture social determinants of health (SDOH)
The use of Z codes for SDOH is on the rise, according to a new CMS report. Between 2016 and 2017, the unique beneficiary count for Z codes increased by 4.69%. The top five most utilized Z codes for Medicare FFS beneficiaries in 2017 are as follows:
Z60.2: Problems related to living alone
Z63.4: Disappearance and death of family member
Z65.8: Other specified problems related to psychosocial circumstances
Z63.0: Problems in relationship with spouse or partner
The CMS report also provides the top 10 chronic conditions, age distribution, sex distribution and more among Medicare beneficiaries with Z codes in 2017.
A recent study published in Health Affairs indicates that hospitals are focusing most frequently on interventions related to housing, employment, and food security. Coded data is critical to ensure that these interventions are successful. Does your organization report Z codes so it can move the needle on SDOH and value-based care?
CDC issues interim coding guidance for coronavirus (COVID-19)
New interim coding guidance for healthcare encounters and deaths related to 2019 novel coronavirus (COVID-19) provides information on how to code the following scenarios:
Acute bronchitis confirmed as due to COVID-19
Acute respiratory distress syndrome due to COVID-19
Bronchitis not otherwise specified (NOS) due to the COVID-19
Confirmed exposure to COVID-19
COVID-19 associated with lower respiratory infection NOS or acute respiratory infection NOS
COVID-19 associated with respiratory infection NOS
Pneumonia confirmed as due to COVID-19
Possible exposure to COVID-19 that’s ruled out after evaluation
Suspected, possible, or probable COVID-19
CMS also issued a new code for coronavirus lab test. As of April 1, 2020, the Medicare claims processing system will accept new HCPCS code U0001 for dates of service on or after February 4, 2020. Is your organization capturing all of these codes correctly?
Cancer registry data drives 2019 State of Lung Cancer report
The American Lung Association used data from the North American Association of Central Cancer Registries to create its most recent State of Lung Cancer report. The report found a five-year lung cancer survival rate of 21.7 percent nationally, ranging from 26.4 percent in Connecticut to 16.8 percent in Alabama. This is up from 17.2% a decade ago. Registry data is critical in terms of helping the American Lung Association and other organizations understand cancer rates and prevention.
CDC and NCHS implement a new diagnosis code for vaping-related disorders
Effective April 1, 2020, hospitals can report ICD-10-CM diagnosis code U07.0 for vaping-related disorders. View the ICD-10-CM FY 2020 April Addenda to learn more about this code. Be sure to prepare physicians for documentation requirements, and work with coders to capture this new code that will help the CDC investigate the outbreak of vaping-associated lung injuries.
Sepsis hospitalizations, costs are on the rise
The dollar amount is staggering: Sepsis hospitalizations cost Medicare more than $40 billion in 2018, according to a recent study published in Critical Care Medicine. The study found a year-over-year increase in the total number of sepsis deaths and a year-over-year increase in the total cost of sepsis care independent of coding. More specifically, authors state the following: “Although the rise in the use of explicit diagnosis codes might reflect increasing patient and provider awareness of sepsis and possibly financial incentives to use those codes, the observed steady rise in the severest sepsis diagnoses with objective findings (such as septic shock) suggests that sepsis in fact may be becoming more common as opposed to more commonly coded.” Does your organization use coded data as a foundation for better understanding this high-cost diagnosis?
For more information about these developments, contact In Record Time at 800-788-4960.
Revenue cycle roundup: January 2020
There’s truly never a dull moment when it comes to news that impacts today’s hospitals. Here are five newsworthy developments that should be on your radar this month:
Widespread effects of India’s proposed Personal Data Protection Bill remain unclear
Proposed legislation in India would give residents more control over their online data, though it’s unclear whether that control will be undermined by the fact that the government would have far fewer restrictions to access and use that data. The New York Times reports that Facebook and Amazon, for example, would need to seek explicit permission for most uses of an individual’s personal data. On the other hand, the government would be able to direct any company to provide it with any personal data (including anonymized or other non-personal data) so it can better target the delivery of services or formulate of evidence-based policies. The bill is currently with a joint committee of parliament.
This legislation raises an important question: If U.S.-based hospitals choose to outsource coding and revenue cycle functions, will the India government automatically have access to U.S. protected health information, and if so, to what degree? And what might the government do with that data if anything? These are important considerations for any CFO weighing the pros and cons of revenue cycle outsourcing.
Diagnosis codes help providers address an emerging healthcare crisis: Human trafficking
The Washington Post reports that providers are using several relatively new ICD-10-CM diagnosis codes to capture suspected and confirmed cases of human trafficking. More specifically, the Centers for Disease Control and Prevention added new T codes to report for cases of suspected and confirmed forced labor and sexual exploitation as well as Z codes for the examination and observation of human trafficking victimization. This development speaks to the power of medical codes. Does your facility take advantage of these codes to understand and address challenges within your population?
Tumor registrars are making headlines, collecting critical data for research
The Washington Times recently profiled a tumor registrar working at Mississippi-based Baptist Memorial Hospital-Golden Triangle. The story, which focuses on the registrar’s daily responsibilities, highlights the importance of sending accurate data to state and national cancer registries. This data is ultimately used for research and to improve patient care. Most important takeaway point? Cancer registrars play a critical role in improving outcomes under value-based care.
Financial forecasting analytics are widely underutilized, according to Black Book survey
A recent Black Book survey found that among health system CFOs with implemented analytics and decision support programs, only 15% say they use the technology for financial forecasting and strategic planning. As the industry relies more frequently on this technology, there will always be a need for data integrity. Without accurate and comprehensive coded data, CFOs won’t be able to rely on these analytics with confidence.
AMA publishes a checklist to help providers prepare for major E/M overhaul
Significant changes are coming in 2021, but the time to prepare is now. The American Medical Association published a checklist as well as a variety of other resources to help physicians understand the changes and what they’ll mean in terms of documentation and code assignment. Work with your coding vendor to prepare for these changes and begin proactive physician education.
Revenue cycle roundup: December 2019
Staying on top of hospital revenue cycle news is no small task—especially during the busy holiday season. That’s why we’ve done the work for you. Check out these four recent newsworthy stories that could impact your hospital in the near future.
Most hospitals will receive a positive value-based payment adjustment in fiscal year 2020
The results of the CMS hospital value-based purchasing program are in, and the good news is that the majority of hospitals (55%) are on the plus side with the highest-performing hospital receiving a 2.93% positive payment adjustment. As expected, the bad news is that some hospitals will see a negative payment adjustment with the lowest-performing hospital incurring a net decrease in payments of -1.72%. How does your hospital’s value-based payment adjustment compare? Is it time for a financial tune-up?
Hospitals required to make standard charges public in 2021
CMS finalized a rule requiring hospitals to provide healthcare consumers with information about facility-specific standard charges (i.e., gross charges, payer-specific negotiated charges, the amount the hospital is willing to accept in cash from a patient, and the minimum and maximum negotiated charges) starting in 2021. Organizations must provide this information in two ways:
1. Comprehensive machine readable file that includes medical coding information and a description of the item or service
2. Display of shoppable services in a consumer-friendly manner
The civil monetary penalties for noncompliance will be steep: $300 per day. What is your organization doing to prepare for greater transparency? How will you avoid consumer confusion? A trusted coding partner can help.
Blue Cross Blue Shield of Massachusetts partners with PillPack by Amazon Pharmacy to improve the customer experience
Blue Cross Blue Shield of Massachusetts recently announced it would partner with PillPack by Amazon Pharmacy to help members taking multiple daily prescriptions better manage their medications. Among PillPack’s many services include a 30-day supply of pre-sorted mediations delivered to members’ doorsteps, customed dosing packaging, 24/7 access to pharmacists, and more. Could this type of partnership enhance medication adherence while also improving the patient experience? And more importantly, what’s the ‘lesson learned’ for healthcare organizations seeking to move the needle on reducing readmissions and improving clinical outcomes?
Out-of-network care at in-network hospitals costs the industry $40 billion annually
Using 2015 data from a large commercial insurer, researchers at Yale University found that out-of-network providers (specifically anesthesiologists, pathologists, radiologists, and assistant surgeons) providing care at in-network hospitals billed higher negotiated rates that translated to $40 billion in healthcare spending. The study abstract states the following: ‘When physicians whom patients do not choose and cannot avoid can bill out-of-network for care delivered within in-network hospitals, it exposes patients to financial risk and undercuts the functioning of health care markets.’ Healthcare organizations beware: The push for greater pricing transparency and a reduction in surprise medical bills could shift the tides. How might these changes affect your revenue?
New CPT revenue opportunities take effect January 1
A whole slew of new CPT codes take effect January 1, some of which could be revenue opportunities for system-owned physician practices. In particular, there are six new CPT codes for e-visits, five new CPT codes for health and behavior assessment and intervention, and two new CPT codes for home blood-pressure monitoring. Is your coding vendor up-to-date on these changes, and can it help you ensure coding compliance?
In Record Time, Inc. Celebrates 20 Years of Service in the HIM Industry
In Record Time, Inc. is pleased to announce its 20th anniversary partnering with countless organizations to provide coding, abstracting, auditing, oncology data management, ICD-10 training,revenue cycle management, and HIM clerical services. The company is honored to be able to recognize this milestone, and it celebrates the clients that have made the company’s success possible.
In Record Time established its humble roots in 1995 during a time when organizations were just starting to transition their medical record departments to health information management departments. In a paper-based world, In Record Time assisted clients with assembly and analysis of paper records as well as loose filing. As organizations transitioned to electronic health records, In Record Time responded by providing scanning functions and top notch coding services via a secure remote platform. As third-party auditors increased their volume of audits and scrutiny of documentation, In Record Time responded by auditing clients with that same level of detail and also implementing an internal QA process to ensure consistency and accuracy. As HIM departments shifted their attention to ICD-10, In Record Time responded by providing back-up coding support, dual coding services, and thorough ICD-10 training for its own credentialed coding staff.
In Record Time knows that the world of HIM is in constant flux and that clients need a partner that can adapt to change quickly while providing cost-effective services.
“I think HIM is a very dynamic industry. You can always expect the unexpected. We’ve had the foresight to evolve and change with that,” says Renee Klarberg, MPS, RHIA, who originally founded the company after having worked in various large acute care hospitals for many years.
What began as a small enterprise, In Record Time has grown exponentially, and its dynamic team boasts highly-experienced and credentialed coding and compliance personnel, certified tumor registrar professionals, and seasoned HIM operations and information technology staff, all of whom are based in the United States.
Although In Record Time has evolved commensurate with technology, the customer service principles on which the company was founded remain the same. Since its inception, the company has provided personalized and high-quality services based on a foundation of open and honest communication. Each client is unique, and In Record Time strives to provide services that can easily be adapted to changes in staffing and coding volumes.
“We’re very old fashioned in a sense. My biggest rule is that you always have to respond to your client within 24 hours,” says Douglas L. Klarberg, JD, vice president, who followed in Renee’s footsteps when he joined the family business in 2008. “We pride ourselves in building solid relationships with our clients, and we take these relationships very seriously. Our number one priority is to work hard and provide the highest quality services to our clients.”
Looking ahead to ICD-10
In Record Time understands the workflow and staffing challenges inherent in ICD-10. Using a proprietary tool, In Record Time can accommodate workflow fluctuations associated with ICD-10 and provide ample coding support during a time when productivity is expected to decrease significantly.
“Our expertise in being able to help clients gear up quickly for very large projects is an asset when it comes to ICD-10,” he says. “We also have an extensive network of coders with whom we’ve worked over the years. We’re constantly sourcing and testing candidates as well.”
In Record Time also knows that there continues to be many unknowns with ICD-10. How will it truly affect coding productivity in a live environment? Will the volume of queries increase? What will happen if denials are on the rise?
“Just as we’ve adapted to change in the past, our approach to ICD-10 will be no different. We’ll work right beside our clients to ensure their success. It’s a team effort, and we’re there to provide all of the support that our clients need,” he adds.
Come celebrate with us!
Be sure to stop by our booth at AHIMA’s 87th Convention and Exhibit in New Orleans September 26-30, 2015 to celebrate our anniversary as well as the industry’s monumental transition to ICD-10. We’d love to reconnect with colleagues and meet many new ones as well. Come and share your story with us.
About In Record Time, Inc.
In Record Time, Inc. is a national consulting firm on the leading edge of Health Information Management protocols. We are proud to offer the full spectrum of HIM services. In Record Time offers expertise in all aspects of Health Information Management. Our team is comprised of skilled professionals including Directors of Health Information Management, Credentialed Coders, Cancer Registry Specialists, and an in-house Information Technologies staff. Our customer service and attention to detail is unsurpassed in the industry. In Record Time offers innovative, cost-effective remote HIM solutions for any size facility. For more information, visit http://www.inrecordtime.net/.