Part 1 – ICD-10 is now down the stretch… now what does your practice do?

Part 1 – ICD-10 is now down the stretch… now what does your practice do?   Okay. Take a deep breath. Exhale. Doesn’t that feel good?   As many of us in the medical documentation world feel, this is becoming more and more the scene of uncertainty, anxiety, and “could we just get this ICD-10 over with?” feelings.  How soon we forget.   Remember Y2K?  The build up.  The hype.  Fear mongering. Predictions of end-of-world scenarios with images of digital and financial world implosions. Armageddon.   None of it materialized. But – and this is important – it didn’t materialize because redundant planning and execution of intelligent strategies were implemented at the strategic, tactical, and technical levels. Neither will any of the hyper-sensationalized scenarios about ICD-10 – from regulations to promulgation to implementation.   As a medical documentation organization, we here at iData, LLC have our own considerations and anxieties. iData engaged and employed national experts and is now wrapping up its preparation to handle large volumes of inpatient and outpatient coding. The good news is we can now share with you some strategies to help you prepare your practice for ICD10:   1. Your Practice is coming down the “stretch” – don’t expect another delay   Many medical practices got lucky when the ICD-10 implementation deadline was extended because they had procrastinated on learning it. While it is statistically possible the deadline could be postponed again, all indicators now suggest it is unlikely. Hope was a strategy, but it wont is this time. While the time to invest time and dollars in a measured way is virtually vanished, you still have time, even though it may look like a mad rush.  Believe it or not, there are a lot of physicians who have their head in the sand on this, and it’s going to come back to bite them.   For those of us just dipping our toes into this, you will quickly learn that it’s a radically different coding system from what ICD-9 is. There’s going to be a pretty steep learning curve, which will undoubtedly create an initial significant decline in productivity. We at iData have been immersing ourselves over the last 2+ years in the ICD-10 world and have sadly endured the disappointment, costs, and frustrations related to the delays as well as the complicated labyrinth involved in implementation. iData has now evolved its coding process to take on virtually every type of ICD-10-CM/PCS challenge with a mature, quality-heavy workflow. At the core of our business model is the employment of nationally recognized ICD-10 subject matter experts that actively assert their quality expertise for the benefit of our clients.   2. Budgeting bandwidth   Complying with ICD-10 requires a substantial investment, so make sure you plan for outlays to cover training, additional software or upgrades to your existing programs, and other costs. A small medical practice of 1-2 physician could expect to spend $5K-$15K to update their EHR system to manage ICD-10. If some members of your team have learned the system well, you may be able to offset some of the additional overhead by having them train others. At the end of the day, you will pay now or later. Believe us, managing this too little too late will be orders of magnitude costlier for your business.

The Big Era of Big Data: Risk and Reward in the Age of Digital Health Care

965897_data_01It’s how Wal-Mart discovered people buy more Pop-Tarts before a big storm. It’s how researchers in Canada discovered when vital signs are unusually stable there is a correlation to a serious fever 24-hours later.  It’s how air traveler’s can determine which flights are likely to arrive on time.  What is it?  Big data.  And it’s potential for tracking and predicting the future is, well, big!

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Planning for the Hospital of the Future

Red cross 1During the season of gratitude, we’re thankful for hospitals – and not just because they heal the sick.  They’re customers – and our interoperable clinical documentation services empower their mission.  Never before in history has the patient record received so much attention.  And our own industry is adapting to change along with the rest of the healthcare marketplace.  So we have a vested interest in learning what they’re innovating under pressure, and expanding patient base.

We wonder, wouldn’t they like to just close the doors for a day and think, plan and strategize?

Well, a few of them left their hospitals long enough to brainstorm with others in the name of progress.  In November 2013, U.S. News and World Report gathered hospital executives and experts to the first annual “Hospital of Tomorrow” forum.  One thing’s for certain – the times, they are a-changing.  The strongest will thrive, and they inspire us to do the same.

The Inaugural Launch

Cleveland Clinic CEO Toby Cosgrove launched the inaugural forum coordinated by US News & World Report with a keynote speech, discussing the issues with which hospitals are coping right now.   (Watch it here.)

A panel discussion about the changing face of hospitals and health care ensued, as did break out sessions that included topics such as staffing solutions, designing hospitals for the 21st century care,  absorbing the newly insured, and new strategies for preventing re-admissions. Big stuff.

As you can imagine, the Twitterverse lit up with discussion, collaboration and debate under @USNHOT13.  Round up the industry’s best and the brightest, and you’re bound to conjure varied opinions and passions!  Check out the tweets, pictures, quotes and musings posted during the conference.

For HIM’s and IT and records managers who didn’t get to go, check out a recap of two technology related issues discussed at the forum:

Uncovering the Power of Big Data

While navigating massive amounts of information is nothing new to hospitals, “Big Data” is the latest buzzword that’s got everyone talking.  In the context of medicine, innovative thinkers will figure out how to sift and utilize key data to predict and solve clinical issues, and also, to facilitate better hospital management.

According to the US News & World Report, Brad Ryan, a general manager at IMS Health stated, “Effective interpretation of Big Data can help identify which new technologies are working and which aren’t.” (Shameless plug:  iData’s customers enjoy the delivery of critical data that can be parsed, extracted and exploited for purposes other than the EMR.  In the future, what if treatment could begin before the patient experienced real symptoms, just indicators, for example?)

Is your hospital harnessing the value of the enormous amounts of data to collect genetic information, spot business trends and more?  It’s an enormous task and we’re curious how others are mining through to find the “diamonds” contained within.

Applying Technology to Hospital Business Needs

We often think of technology related to medicine in terms of patient care, such as robotic, or computer assisted surgery.  But one breakout session during the forum apparently discussed the need for technology to empower the business side of healthcare.

Troy Kirchenbauer, general manager of Aptitude LLC, an online direct contract market for healthcare, talked about the critical need for effective supply chain management.   Their platform serves as a transparent and open space in which hospitals negotiate and manage contracts.  Their service builds thriving partnerships between hospitals and suppliers, driving down costs, promoting compliance and improving efficiency in supply chain management. (Visit for more.)

We applaud the great work done by US News & World Report to knit together invested providers, legislators and vendors to sharpen the sword together for the good of everyone’s ultimate customer – the patient.  We look forward to hearing about the next forum.

For a full recap of the topics discussed at the forum, click here.  Want more tips, information and news related to healthcare documentation, IT and administration?  Sign up for our newsletter in the upper right hand corner!


Image courtesy of Dreamstine.

What’s a Medical History Worth? Security Breaches Spiking in 2014

data-security-1-1124500-mRetailers like Target aren’t the only organizations suffering high profile breaches in data security.  As predicted, the healthcare industry has been highly susceptible to data breaches, and the trend’s going to continue to spike in the rush to digitize health care records.  According to a piece in Computerworld, “Recent research from Experian suggests 2014 may be the worst year yet for healthcare data breaches, due in part to the vulnerability of the poorly assembled” Oh, that again.  The botched launch of and the organizational infrastructure behind the implementation is so complex that too many parties have access to personal data vulnerable to infiltration.  Plus, the industry is now adding another 7 million people to the rosters, expanding the opportunities for theft. The savvy bad guys, sinister hackers and wayward employees pose significant and costly threats.   Efforts toward protecting data security, for some once considered a nuisance and perhaps even a luxury, must become a top priority for healthcare providers at every level. Recently, SANS and Norse, private companies specializing in cyber security training and certification, issued a report claiming cyber attacks are responsible for epidemic breaches in healthcare data security.   Cyber criminals and nation-backed operators are constantly devising new ways of exploiting the Internet to carry out advanced persistent threats (APTs), malware infections, cyber espionage, and data and intellectual property theft.   Read the details here. Why do fraudsters want to get the skinny on your health care data?  Because it is valuable.  Identity thieves feast on records suitable for use, selling them for $10 to $12 on the low end to upwards of $50 if the information can be used for medical and insurance fraud.  It’s expensive for all involved – the consumer often pays, because they’re not always protected as in the case of retail commerce, but class action suits can also cost healthcare organizations a pretty penny. What are the risk factors associated with the surge in data breaches? -Lack of experience.   Many participants in the industry, including the sole practitioners, aren’t adequately trained in the skills required for data management. -Haphazard IT practices.  Even professionals can be careless.  Sometimes anti-malware software is installed but never turned on, for example. -Employee Error.  Problems also arise just out of error and carelessness – lost laptops, failure to shred paper, careless login practices, etc. What are key steps in protecting critical data on behalf of patients, and protecting your own organization from costly litigation?   Devise and implement a plan that includes installing the proper software, train employees about the potential risks and the importance of access integrity, and manage the recycling of aging hardware with extreme caution.  Easy, right!!? As always – hiring a professional to navigate the process is an investment that might cost now, but could save a lot more down the road.  (Just like hiring a company to manage transcription!)   Have something to add to the conversation?  Leave a comment or visit our page on Facebook!          

The ICD-10 Needs YOU

leading-the-pack-480908-sIt’s going to happen, right?  As soon as we finally cross the finish line to the ICD-10 transition, surely there will be plenty of skilled specialists on-hand to navigate the thousands of new codes to master. Well, not exactly. According to a piece in the ICD10 Monitor, “Limited coding resources long have been an industry reality. According to a June 2011 survey by the American Health Information Management Association (AHIMA), 40 percent of respondents said shortages were the result of a lack of qualified coders. This mirrors similar findings from a 2009 AHIMA survey on coding practices. In a discipline rife with change, the coder shortage problem only will exacerbate problems as organizations migrate to ICD-10.” Ouch. Truth is, despite continued unemployment, medical coders remain in high demand.  Their work ensures critical payments and reimbursements travel through the billing cycle, and preserves the integrity and accuracy of the patient narrative with regard to procedures, diagnosis and billing.   Theirs is a critical role done without fanfare, quietly underwriting the healthcare marketplace’s profitability and patient satisfaction. So why do we care? It is in our interest for skilled medical coders to be in plentiful supply, as coding and transcription reside hand in hand.  The reports we painstakingly transcribe, or the data we enter into the EMR are turned over to coders.  Our work feeds theirs, and in turn, their efforts ensure the text we transcribe is accurately input into the system. So what does it take to become an expert medical coder, able to leap tall buildings and wield 141,000 codes in a single minute? According to AHIMA, the following:
  • The ability to work independently
  • Strong knowledge of the medical terminology
  • Adept critical thinking and communication skills
Ideally, candidates for these careers are detail ninjas.  They naturally demonstrate a precision, and never accept the status quo.  They dig deeper, ask questions, check their sources, and dot their i’s and cross their t’s. While there is no specific formal education required, many employers seek candidates with a Certified Medical Reimbursement Specialist (CMRS) certification. The process takes roughly a year to finish, and includes information about basic physiology, anatomy and the sciences. Other important components of the certification include:
  • Medical terminology
  • Computer database management
  • Billing and coding procedures
  • Insurance procedures
Think you’ve got what it takes?  The opportunities for medical coders and specialists are only going to increase. As health care providers and hospitals scramble to determine whether to outsource, or train new talent internally, the savvy job seeker wins the race to October 1, 2014. Want to join in the conversation?  Leave a comment here, or on our Facebook page.

ICD-10’s Delay – a Victory for, Coders?

businessman-in-the-office-1-1287061-sBy now you’ve heard the collective yawn.  Or jump for joy, depending on the perspective. When congress announced last month it had approved a measure to delay the adoption of the ICD-10, the newest version of the standard codes for medical diagnosis and billing, the chatter centered around a common theme: Can we get on with it already? True, those who weren’t nearly ready for the conversion dodged a bullet.  But plenty of practitioners and hospitals had invested in the training and personnel required to make the transition a smooth one.  No easy feat either, as the ICD-10 adds thousands of new codes to the list. Despite one more in a long line of delays, the new roll-out date for the ICD-10 rollout, has now been officially set for October 1, 2015.  But the demand for the skills necessary to implement the new standard hasn’t slowed down.   One job that’s particularly hot?  Medical coders.   Wonder if it’s a job for you?  Or what in the world a coder does, in the first place? Yep, There’s a Code for that! Coding and medical transcription are often tossed around in tandem.  It’s true, they’re two sides of the same coin in some ways, as each plays a critical role in the accuracy of the patient’s medical record, and billing integrity.  Can you imagine the fallout of assigning the code for a heart murmur, instead of a heart attack? Yep – this is important stuff, although not quite as exciting as say, brain surgery. So what happens after the doctor examines the patient and deciphers all the aches and pains that need to be carefully recorded into the patient record? In traditional transcription, a clinician records data for digital storage that is relayed to the medical transcriptionist (MT.) The MT deciphers the data, creating notes which are transferred to the patient’s record or integrated into an electronic health record (EHR).   Sounds easy right?  Hardly!  Can you imagine trying to decipher accents, navigate background noise, and capture every single detail exactly right – no margin for error?  MT’s are typing ninjas with razor sharp listening skills. Once the data is integrated into the patient record, a medical coder is tasked with assigning one of thousands of possible ICD-9 (soon to be ICD-10) codes for each diagnosis, illness, disease, injury, etc. known to man.  Again, easy, right?  Not exactly.  Sharp-shooters need only apply, please. Medical billing then encompasses the process of billing the medical companies, using the transcribed medical information and the diagnosis codes, to give the insurance companies all of the pertinent data required to process payment of medical services.   Doctors are giving people, but of course in the end, they want to get paid. So for medical coders in the market for a new job, or job seekers considering a move to the healthcare business service sector, the preparation for the ICD-10 is spiking a  new demand.  Think you’ve got what it takes to be a coder?  A sharp analytical mind, a passion for finding information quickly, a zero-tolerance policy for mistakes?  You could either become a coder, or run a small country.  It’s up to you !      

Doctor, Heal Thy ICD-10 Worries – The game’s not just for Coders Anymore

965897_data_01Is your practice counting down to October 1, 2014 with fear, or anticipation? The transition to the ICD-10’s keeping just about everyone up at night – and not just coders either.  Everyone in the health care revenue cycle – physicians, payers and vendors – has got a stake in the game.  One company even coined an affliction for HIMs, coders and physicians alike – “ICD-10 Stress Syndrome. “ (Is there a code for that??) Like it or not; there are just 200 some days until the deadline.  (Cue the creepy organ music…)   And while HIMs everywhere are scrambling to prepare, doctors are most at risk for lack of readiness.  “If claims are not submitted accurately, physicians simply won’t be paid.  According to Beth Hertz’ piece in Medical Economics, “With less than a year until the one-day ICD-10 conversion … a physician’s ultimate life preserver is going to be planning and training,” says Shari Erickson, MPH, vice president of government and regulatory affairs for the American College of Physicians. The piece goes on to argue the leap from the ICD-9 to the ICD-10 is historically ambitious, requiring a much more precise detailing in reporting diagnosis.  Outpatient diagnostic codes will increase from about 13,000 to 68,000.  Go time to learn all those?  (How about time to just get to the bathroom between patient intakes?) The system requires training for everyone on the team – including coders, billers and providers. This is a ONE-DAY transition, so readiness has to happen immediately with plenty of preparation ahead of time.  Distress call! 5 Tips for Moving From Panicked to Prepared Keep calm and prepare on for a smooth transition on October 1st
  1. Small practices may want to secure a line of credit to mitigate cash flow issues temporarily if payers aren’t ready.  “It would be prudent to take out a credit line equal to about 5% of the total reimbursement for the year for the practice. “  -Michael F. Arigo, CPHIT, CPEMR managing partner of No World Borders
  2. Identify a Project Coordinator or Point Person.  Identify someone on staff who can assume responsibility for training, implementation, communication and accountability to keep the process on track for the big date.  Ideally this person is familiar with coding but if not, choose someone who will embrace the challenge and find the help they need.
  3. Fight the urge to get overwhelmed.  Keep it in perspective; learning every single new code isn’t necessary.  Become familiar with the ones used most often in your practice – identify the top 20 codes for medical and diagnoses procedures and start there.
  4. Connect with your EMR vendor.   If your practice uses an EMR, your vendor should be a great resource.  Be certain to connect with them to ensure delivery of software upgrades and ask if they offer training. 
  5.  CALL iDATA!  While clinical documentation has long been regarded by doctors as a necessary evil, physicians must become more involved in the process of ensuring documentation meets the high standards of the ICD-10 compliance.  Partnering with an expert company (like iData!) aligns physicians with expertise to ensure documentation – for which the ICD-10 environment requires considerably more detail – is captured accurately and efficiently.
 So don’t panic.  Just get prepared.  We can help!   Chime in here or on our Facebook page – or connect with me personally at Warmly, Kendall Tant, CEO, iData                       

9-1-1 for the ICD-10: One of the many Challenges facing HIM Departments

It’s always a relief when a deadline is extended, and the new ICD-10 implementation is no exception. According to HealthCare IT, in August, HHS announced a one-year delay as the launch date for compliance of the ICD-10 codes.  Beginning October 1, 2014, the ICD-10, or International Classification of Diseases, 10th Edition, will include some 155,000 codes for new procedures and diagnoses.  (Someone call a doctor for help!) Compare that number to the 13,000 found across the ICD-9, plus, an inclusion of twice as many categories and an introduction to alphanumeric categories.  It’s obvious the transition is going to be ripe with challenges.  HIMs are scrambling for readiness, and the Medical Group Management Association (MGMA) is after CMS to offer help and support to expedite critical coordination between practices, software vendors and health plan partners. “Very simply, the ICD-10 is behind schedule.  MGMA continues to advocate on behalf of members and provide tools and resources to help practice executives make the transitions to ICD-10 cost effective and less disruptive to their organizations,” said MGMA President and CEO Susan L. Turney, MD, according to the piece.  Increased demand for HIM staff meets Less Revenue:  Outsourcing fills the gap The switch is proving a daunting one for providers as they re-assess HIM strategies.  In his piece, “’Storm’s brewing for HIM,” HealthCare IT managing editor, Mike Milliard, cites findings from the KLAS (a company that measures healthcare vendor performance) study, HIM Services 2012: Helping to Weather the Storm, that claims the changes ushered in by the ICD-10 bring plenty of cost and disruptions all around. The burgeoning Boomer population – along with the boom of new patients – in the system and increased regulatory requirements means a spike in productivity demands across technology staffing.  Problem is, healthcare reform will decrease revenue streams from government payers, affecting HIM departments’ abilities to adequately provide staffing. The KLAS report discovered that providers are looking to outsourcing to fill the gap, particularly with regard to medical transcription, and specifically to clinical documentation providers to help with the transition to ICD-10 coding.  Hey – that’s us. According to the KLAS report, providers identify consistent differences in performance across transcription vendors in turn-around-time (what we affectionately call TAT), quality and satisfaction.  No surprise there. This is where a company such as iData – forgive us for saying so – shines.  Our expertly skilled documentation specialists thrive on challenges presented by the ICD-10 transition, because we can be a part of the solution.  Our robust, integrated, secure systems and services save our customers time and money, and boost physician productivity.  Our partnership can fill in the gap in staffing, and reduce the massive costs of implementing the ICD-10 into an EMR system, leaving your IT staff to focus on core business. So don’t be afraid of the big, bad ICD-10.  With us in your corner, we’ll take 155,000 worries off the plate.  

Habits: Breaking the Cycle, One Cookie at a Time

cccookiesWhat is it that you do over and again, without thinking?  Brushing your teeth is one.  It’s ingrained, automatic, a good habit.  Driving is another – it’s become routine, something you can do singing to your favorite tunes or chatting with your teenager. Consistent exercise is a positive habit, as is expressing love to our family or going to worship each week. Some habits are affirming, even powerful. Then there are those habits that aren’t so great for us, like smoking, or in business, staying with the same vendor because it’s just, well, habit.  Why can’t we just nix those habits, already? Because it turns out, habits are really tough to break without intentional effort.  What is a habit, exactly?   Oxford explains it this way:  “a settled or regular tendency or practice, especially one that is hard to give up.”  What’s the one thing you do you do over and again you wish you could just stop doing, never to look back? Charles Duhigg, New York Times reporter and author, asked himself the same question.  His answer?  Cookies.  Each day around 3:30, he’d head to the cafeteria for a chocolate chip cookie. He thought it was because he liked cookies, and his waistline revealed the story he worked on faithfully each day.  It was a habit he just couldn’t seem to kick.  Inspired by a revelation about the prevalence of habits in the military, he did a little investigative journalism himself, which he shared in his book, The Power of Habit:  Why we do what we do in Life and Business.   (Turns out he made his former habit work for him!)  During his self-study, Duhigg discovered that what he was after wasn’t really the cookie. By shaking up his routine, he discovered it was social connection he was really after.  The cookie led to a reward – in his case, time to chat with colleagues during a break.  It’s never about the cookie! Habits form, he argues, via a 3-part process.  First, there’s  a cue, or trigger, that tells your brain to go into automatic mode.  A cue could be a person, a place, a time of day, an image, an emotional state, and others.   The cue signals the launching of a behavior, then engaging in a routine, or the behavior itself, such as eating the cookie.  Finally, the reward reinforces the brain to remember the process going forward.  Are we really all the different from mice in this regard? Duhigg replaced his cookie habit with a new behavior attached to the reward of social interaction, tossed the cookies aside, and lost 12 pounds in the process.  Getting inspired? According to an NPR interview with Duhigg, “neuroscientists have traced our habit-making behaviors to a part of the brain called the basal ganglia, which also plays a key role in the development of emotions, memories and pattern recognition. Decisions, meanwhile, are made in a different part of the brain called the prefrontal cortex. But as soon as a behavior becomes automatic, the decision-making part of your brain goes into a sleep mode of sorts.”     So, like driving that becomes automatic – pun intended – breaking your own habits at home or work requires awareness, time and effort.  But habits can be transformed into adopting something powerful and positive.  Like golf. What about you?  Is a lingering habit holding you back from experiencing excellence?  Such as, for example, exploring other clinical documentation companies? At iData, we’d like to become your next hard habit to break. Read an excerpt from Charles Duhigg’s book here.  Then, chime in.  Share your experiences with us across social media, or make a comment on our blog post.