Switch to ICD-10 should prove very costly
By anne
Created Aug 27 2008 - 4:11am
Providers are far from done in their struggles to implement the new National Provider Identifier number, which has proved to be every bit as troublesome as the industry predicted. But apparently, HHS was determined to raise the angst level further. With its recent announcement that it was pushing for an October 2011 deadline for the industry to switch from ICD-9-CM to ICD-10 codes, health organizations are bracing themselves for millions in additional IT and operational expenses.ICD-9-CM codes, which are used for electronic claims processing, remittance, advice, eligibility inquiries, referral authorizations and more, have been in place for 30 years, but most other developed nations around the world use ICD-10 codes. The new code set will allow clinical IT systems to record far more specific and rich diagnostic information than ICD-9 codes, as it contains more than 155,000 codes, while ICD-9 contains only 17,000.As the switch occurs, brace yourself for reimbursement nightmares. HHS admits that the switch--like the NPI cutover--could initially cause significant cash flow problems for providers because of the increased risk of payment hold-ups due to coding and systems problems. HHS is predicting that claims-error rates will rise between 6 and 10 percent, up from a normal 3 percent rate typically seen for annual updates of ICD-9. (If NPI experience is any indication, that's probably a pretty conservative error estimate--so expect significantly worse cash holdups than HHS is predicting.)Meanwhile, as readers know, such a switch will prove to be immensely complex, not to mention quite costly, on the IT front. While estimates vary from one consulting firm to another, HHS estimates the cost of the switch at $1.64 billion industry-wide, including $356 million in training costs, lost productivity costs of $572 million and system change costs of $713 million.
Friday, August 29, 2008
Monday, August 25, 2008
Great press about CASE MANAGERS!
Wall Street Journal
Aid From Unlikely Sources
By JILIAN MINCER
August 24, 2008
When a serious medical crisis occurs, your insurance company may provide more than hospital coverage.
A growing number of plans offer specially trained case managers to help patients during a major illness.
Different from disease-management programs, which focus on patients with a chronic condition such as asthma or diabetes, the case-management services are for patients with costly and complex medical conditions such as cancer or an organ transplant. These managers -- typically nurses -- help patients with everything from avoiding duplicated tests to finding the best-priced prescriptions and other services.
(CLICK BELOW FOR THE REST OF THIS ARTICLE): http://online.wsj.com/article/SB121954162768766735.html?mod=dist_smartbrief
Aid From Unlikely Sources
By JILIAN MINCER
August 24, 2008
When a serious medical crisis occurs, your insurance company may provide more than hospital coverage.
A growing number of plans offer specially trained case managers to help patients during a major illness.
Different from disease-management programs, which focus on patients with a chronic condition such as asthma or diabetes, the case-management services are for patients with costly and complex medical conditions such as cancer or an organ transplant. These managers -- typically nurses -- help patients with everything from avoiding duplicated tests to finding the best-priced prescriptions and other services.
(CLICK BELOW FOR THE REST OF THIS ARTICLE): http://online.wsj.com/article/SB121954162768766735.html?mod=dist_smartbrief
Wednesday, August 20, 2008
AHCCCS Numbers Jump
Arizona's Medicaid population has grown by 56,500 people over the last 12 months.
The number of enrollees in the Arizona Health Care Cost Containment System, the state's Medicaid health care program, stands at 1.12 million, up 5 percent from August 2007. That comprises nearly 18 percent of the state's 6.3 million residents. Another 1 million Arizonans do not have health insurance, according to St. Luke's Health Initiatives.
Sixteen percent of Maricopa County's 3.8 million residents are enrolled in AHCCCS.
The number of enrollees in the Arizona Health Care Cost Containment System, the state's Medicaid health care program, stands at 1.12 million, up 5 percent from August 2007. That comprises nearly 18 percent of the state's 6.3 million residents. Another 1 million Arizonans do not have health insurance, according to St. Luke's Health Initiatives.
Sixteen percent of Maricopa County's 3.8 million residents are enrolled in AHCCCS.
Friday, August 15, 2008
2nd Article in RACS Series!
RACS and Case Management: Medicare Patients Can’t Be Pushed to the Bottom of your Priority List Anymore
August 15, 2008
By Randi Ferrare
for the Arizona Case Management Blog
If your hospital is as typical as the majority of the hospitals across the country, your Case Management department may be engaged in the preparation for RACS because of your involvement in the appeal process. However, if this is the only role your organization thinks Case Management can play, that could cost your organization millions of dollars.
During the 3 year RAC demonstration project, CMS had an overwhelming 40-45% denial rate. 99% of those denials were categorized as either services that could have been rendered in an outpatient setting or the inpatient stay was not medically necessary. When it came down to it: the denials were for unnecessary hospitalizations.
Unlike the demonstration project in Florida, New York and California, the new yet-to-be released CMS RAC contract will have a provision that the RAC is only allowed to ask for medical records for patients that had an admit date of October 2007 or later. This creates an opportunity to do a stellar job concurrently while the patients are still in-house.
Case Management needs to treat Medicare as they do managed care. The days of reviewing Medicare charts every three days are gone. Chart review should occur every day, along with making sure that the patient’s care is progressing and moving toward discharge.
So considering that fact, you are probably saying, “Our caseloads are too high to manage that work”. You are probably correct; most Case Management departments across the country are grossly understaffed, sometime with caseloads as high as 40 -45 patients per Case Manager. Not only does that effect job satisfaction and departmental turnover, but it greatly impacts LOS, denials, and patient throughput. All of these key indicators are vitally important to the financial health of the hospital.
You don’t have to be a rocket scientist to realize that you need staff and internal processes that will be able to handle the additional duties and workload that a RAC audits brings.
So, now what? Well, the first step is to engage your immediate supervisor, CFO, CEO - basically anyone that can assist you in hiring enough Case Managers to get their caseloads to a more manageable level of 15-20 cases per manager.
How do you do that? Educate upper management and provide a cost benefit analysis to them that substantiates your need for more staff.
August 15, 2008
By Randi Ferrare
for the Arizona Case Management Blog
If your hospital is as typical as the majority of the hospitals across the country, your Case Management department may be engaged in the preparation for RACS because of your involvement in the appeal process. However, if this is the only role your organization thinks Case Management can play, that could cost your organization millions of dollars.
During the 3 year RAC demonstration project, CMS had an overwhelming 40-45% denial rate. 99% of those denials were categorized as either services that could have been rendered in an outpatient setting or the inpatient stay was not medically necessary. When it came down to it: the denials were for unnecessary hospitalizations.
Unlike the demonstration project in Florida, New York and California, the new yet-to-be released CMS RAC contract will have a provision that the RAC is only allowed to ask for medical records for patients that had an admit date of October 2007 or later. This creates an opportunity to do a stellar job concurrently while the patients are still in-house.
Case Management needs to treat Medicare as they do managed care. The days of reviewing Medicare charts every three days are gone. Chart review should occur every day, along with making sure that the patient’s care is progressing and moving toward discharge.
So considering that fact, you are probably saying, “Our caseloads are too high to manage that work”. You are probably correct; most Case Management departments across the country are grossly understaffed, sometime with caseloads as high as 40 -45 patients per Case Manager. Not only does that effect job satisfaction and departmental turnover, but it greatly impacts LOS, denials, and patient throughput. All of these key indicators are vitally important to the financial health of the hospital.
You don’t have to be a rocket scientist to realize that you need staff and internal processes that will be able to handle the additional duties and workload that a RAC audits brings.
So, now what? Well, the first step is to engage your immediate supervisor, CFO, CEO - basically anyone that can assist you in hiring enough Case Managers to get their caseloads to a more manageable level of 15-20 cases per manager.
How do you do that? Educate upper management and provide a cost benefit analysis to them that substantiates your need for more staff.
Tuesday, August 12, 2008
2nd Article in RACS Series coming soon!
Stay tuned for the next installment in the Article series on Medicare RACS. It will be posted to the blog soon!
Steve
Steve
Friday, August 1, 2008
Article: Medicare adds to do-not-pay list
By KEVIN FREKING
ASSOCIATED PRESS WRITER
WASHINGTON -- Medicare is adding to its do-not-pay list for hospitals two new categories of preventable conditions it won't cover, a much smaller number than it had been contemplating.
Last year, the Centers for Medicare and Medicaid Services set new ground by determining it no longer pay would extra costs for treating certain preventable conditions, referred to as "never events." An example of a never event is a transfusion with the wrong blood type.
Medicare officials announced Thursday that it no longer will pay the extra-care costs associated with treating dangerous blood clots in the leg following knee or hip-replacement. The program also will not pay extra for complications stemming from poor control of blood sugar levels.
To view the rest of this article click here:
http://seattlepi.nwsource.com/national/1152ap_medicare_hospital_payments.html
ASSOCIATED PRESS WRITER
WASHINGTON -- Medicare is adding to its do-not-pay list for hospitals two new categories of preventable conditions it won't cover, a much smaller number than it had been contemplating.
Last year, the Centers for Medicare and Medicaid Services set new ground by determining it no longer pay would extra costs for treating certain preventable conditions, referred to as "never events." An example of a never event is a transfusion with the wrong blood type.
Medicare officials announced Thursday that it no longer will pay the extra-care costs associated with treating dangerous blood clots in the leg following knee or hip-replacement. The program also will not pay extra for complications stemming from poor control of blood sugar levels.
To view the rest of this article click here:
http://seattlepi.nwsource.com/national/1152ap_medicare_hospital_payments.html
Monday, July 28, 2008
My Apologies!
Many of you found the blog even though I misguided you! Many of my emails communicated the wrong link so thanks for getting here through your own navigation!
Please pass the word along that this blog does not have the traditional "www" in front of it, which was my mistake. It is simply: http://azcasemanagement.blogspot.com
Thanks for letting your friends and collegues know!
-Steve
Please pass the word along that this blog does not have the traditional "www" in front of it, which was my mistake. It is simply: http://azcasemanagement.blogspot.com
Thanks for letting your friends and collegues know!
-Steve
Monday, July 21, 2008
Article Series: RACS and Case Management- First Article!
RACS and Case Management
Here it Comes: Permanent CMS RAC Audits Expanding to a State Near You
By Randi Ferrare for the Arizona Case Management Blog
July 21, 2008
Unless you have been comatose in an intensive care unit, you’ve heard horror stories about the CMS RAC (Recovery Audit Contractor) demonstration project that, along with the real estate market, has been wreaking havoc for the last three years in Florida, California and New York.
This unbounded, wildly successful program has allowed CMS to recoup “overpayments” totaling close to $1 billion dollars, resulting in Congress passing a permanent CMS audit process to roll-out to all states by 2010.
The “RAC” will be called the “MAC” (Medicare Administrative Contractor).
During the demonstration project period, I made many Hospital Administrators and Board of Directors aware of the urgency and reality of the CMS RAC audit program during presentations.
Often to lighten the somber mood in the room, I pointed out that the RAC audit program does have a silver lining to its unprecedented 40%-45% denial rate of reviewed medical records. That silver lining is the CMS Trust Fund.
The CMS Trust Fund ensures that monies spent by the generations following baby boomers into retirement, will be replenished with money that has been recouped from “unnecessary hospitalizations”. Hopefully to ensure that our subsequent generations will be able to collect Social Security benefits, as our parents and grandparents have.
Much to the dismay of hospital CFOs everywhere, the RAC program is expanding and can’t be avoided. As stretched as it is today with the ever growing debt of charity care and costly medical advancements in technology coupled with the physician demands for this latest technology, the healthcare dollar will only go so far. For the lucky few who have been able to have even the slightest positive bottom line, this program is a real threat and can’t be taken lightly.
For the hospitals on the front line during the RAC Audit program in the demonstration states, they are weary yet enlightened. Weary with all the added work, expense, staffing challenges and multiple process changes to deal with the audit. Enlightened because they are ahead of the curve.
For the hospitals that are yet to be part of the program, the task of preparing can be downright frightening.
To help get brought up to speed, there is a 62-page document titled, “ The Medicare Recovery Audit Contractor (RAC)- An Evaluation of the 3 Year Demonstration” available from CMS. You’ll find this document on the CMS website (located at http://www.cms.hhs.gov
). It contains a wealth of information, both good and bad. It is quite an impressive document, examining what worked, what didn’t, and what changes are in store for the permanent “MAC” program.
At the very least, take a quick look and thumb through it. To help your Hospital join the “enlightened” forward on the Executive Summary to your “powers that be”.
Click here to access a copy of The Medicare Recovery Audit Contractor (RAC)- An Evaluation of the 3 Year Demonstration:
http://ohcci.com/docs/RAC_Demonstration_Evaluation_Report.pdf
Here it Comes: Permanent CMS RAC Audits Expanding to a State Near You
By Randi Ferrare for the Arizona Case Management Blog
July 21, 2008
Unless you have been comatose in an intensive care unit, you’ve heard horror stories about the CMS RAC (Recovery Audit Contractor) demonstration project that, along with the real estate market, has been wreaking havoc for the last three years in Florida, California and New York.
This unbounded, wildly successful program has allowed CMS to recoup “overpayments” totaling close to $1 billion dollars, resulting in Congress passing a permanent CMS audit process to roll-out to all states by 2010.
The “RAC” will be called the “MAC” (Medicare Administrative Contractor).
During the demonstration project period, I made many Hospital Administrators and Board of Directors aware of the urgency and reality of the CMS RAC audit program during presentations.
Often to lighten the somber mood in the room, I pointed out that the RAC audit program does have a silver lining to its unprecedented 40%-45% denial rate of reviewed medical records. That silver lining is the CMS Trust Fund.
The CMS Trust Fund ensures that monies spent by the generations following baby boomers into retirement, will be replenished with money that has been recouped from “unnecessary hospitalizations”. Hopefully to ensure that our subsequent generations will be able to collect Social Security benefits, as our parents and grandparents have.
Much to the dismay of hospital CFOs everywhere, the RAC program is expanding and can’t be avoided. As stretched as it is today with the ever growing debt of charity care and costly medical advancements in technology coupled with the physician demands for this latest technology, the healthcare dollar will only go so far. For the lucky few who have been able to have even the slightest positive bottom line, this program is a real threat and can’t be taken lightly.
For the hospitals on the front line during the RAC Audit program in the demonstration states, they are weary yet enlightened. Weary with all the added work, expense, staffing challenges and multiple process changes to deal with the audit. Enlightened because they are ahead of the curve.
For the hospitals that are yet to be part of the program, the task of preparing can be downright frightening.
To help get brought up to speed, there is a 62-page document titled, “ The Medicare Recovery Audit Contractor (RAC)- An Evaluation of the 3 Year Demonstration” available from CMS. You’ll find this document on the CMS website (located at http://www.cms.hhs.gov
). It contains a wealth of information, both good and bad. It is quite an impressive document, examining what worked, what didn’t, and what changes are in store for the permanent “MAC” program.
At the very least, take a quick look and thumb through it. To help your Hospital join the “enlightened” forward on the Executive Summary to your “powers that be”.
Click here to access a copy of The Medicare Recovery Audit Contractor (RAC)- An Evaluation of the 3 Year Demonstration:
http://ohcci.com/docs/RAC_Demonstration_Evaluation_Report.pdf
Friday, July 18, 2008
Article: Disease Prevention Called a Better Bet
Disease Prevention Called a Better Bet
Wellness Programs Yield Greater Returns, Report Finds
By Megan Greenwell
Washington Post Staff Writer Friday, July 18, 2008; Page B03
An ounce of prevention in community health programs could save states hundreds of millions in health-care costs, a new study has found.
The report from the Trust for America's Health, a nonprofit health advocacy group, found that programs encouraging physical activity, healthy eating and no smoking were a better investment than those concentrating primarily on treatment.
TO VIEW THE REST OF THIS ARTICLE, CLICK HERE:
http://www.washingtonpost.com/wp-dyn/content/article/2008/07/17/AR2008071700990.html?hpid=moreheadlines
Wellness Programs Yield Greater Returns, Report Finds
By Megan Greenwell
Washington Post Staff Writer Friday, July 18, 2008; Page B03
An ounce of prevention in community health programs could save states hundreds of millions in health-care costs, a new study has found.
The report from the Trust for America's Health, a nonprofit health advocacy group, found that programs encouraging physical activity, healthy eating and no smoking were a better investment than those concentrating primarily on treatment.
TO VIEW THE REST OF THIS ARTICLE, CLICK HERE:
http://www.washingtonpost.com/wp-dyn/content/article/2008/07/17/AR2008071700990.html?hpid=moreheadlines
Monday, July 14, 2008
Article Series on Medicare RACS to begin!
Hello Case Managers! I hope you had a great weekend!
As promised, the series of articles on Medicare RACS will begin soon! Please check back to the blog as our guest author, Randi Ferrare, will present a very thorough review on this topic!
Thanks, Steve
As promised, the series of articles on Medicare RACS will begin soon! Please check back to the blog as our guest author, Randi Ferrare, will present a very thorough review on this topic!
Thanks, Steve
Tuesday, July 8, 2008
Article: United Healthcare Cuts Jobs, Phoenix affected.
UnitedHealth Ends Options Suits, Cuts 4,000 Jobs (Update2)
By Avram Goldstein
July 2 (Bloomberg) -- UnitedHealth Group Inc. agreed to the biggest settlement of lawsuits involving backdated stock options and said the company would trim 4,000 jobs after its membership fell and expenses for providing medical coverage rose.
UnitedHealth, the largest U.S. health insurer, said today it would pay $912 million to end two class-action cases over grants of stock options to executives. The Minnetonka, Minnesota, company last year restated earnings dating to 1994 because of a backdating probe that cost former Chief Executive Officer William McGuire his job in 2006.
The company today cut its annual earnings forecast for the second time. Health insurers have reported higher expenses and lower profits, driving down the six-member Standard & Poor's 500 Managed Health Care Index by 47 percent this year. The worst may now be over, analysts said after UnitedHealth's announcement.
TO VIEW THE REST OF THIS ARTICLE CLICK HERE:
http://www.bloomberg.com/apps/news?pid=20601087&sid=aIr_f.FU0g1w&refer=home
By Avram Goldstein
July 2 (Bloomberg) -- UnitedHealth Group Inc. agreed to the biggest settlement of lawsuits involving backdated stock options and said the company would trim 4,000 jobs after its membership fell and expenses for providing medical coverage rose.
UnitedHealth, the largest U.S. health insurer, said today it would pay $912 million to end two class-action cases over grants of stock options to executives. The Minnetonka, Minnesota, company last year restated earnings dating to 1994 because of a backdating probe that cost former Chief Executive Officer William McGuire his job in 2006.
The company today cut its annual earnings forecast for the second time. Health insurers have reported higher expenses and lower profits, driving down the six-member Standard & Poor's 500 Managed Health Care Index by 47 percent this year. The worst may now be over, analysts said after UnitedHealth's announcement.
TO VIEW THE REST OF THIS ARTICLE CLICK HERE:
http://www.bloomberg.com/apps/news?pid=20601087&sid=aIr_f.FU0g1w&refer=home
Monday, July 7, 2008
NEWS Article: Bush delays Medicare fee cut for doctors
Bush administration delaying Medicare fee cut.
By JIM ABRAMS, Associated Press Writer Mon Jun 30, 7:56 PM ET
WASHINGTON - The Bush administration said Monday it will delay paying doctors for treating Medicare patients in early July to give Congress more time to block a scheduled 10.6 percent fee cut.
To read the rest of this article, click this link:
http://news.yahoo.com/s/ap/20080630/ap_on_go_co/congress_medicare;_ylt=AoUb94R2Okp3dA3hapMWZ7rVJRIF
By JIM ABRAMS, Associated Press Writer Mon Jun 30, 7:56 PM ET
WASHINGTON - The Bush administration said Monday it will delay paying doctors for treating Medicare patients in early July to give Congress more time to block a scheduled 10.6 percent fee cut.
To read the rest of this article, click this link:
http://news.yahoo.com/s/ap/20080630/ap_on_go_co/congress_medicare;_ylt=AoUb94R2Okp3dA3hapMWZ7rVJRIF
Friday, June 27, 2008
Introducing a new blog guest Author! New article series to begin soon!
It is with great pleasure that I announce the association of Randi Ferrare as a new guest author on our blog! (Please see her bio on the right panel). We are fortunate to have someone as knowledgeable as Randi in the Case Management field writing on the blog. She will begin a series of articles on Medicare RACS and other topics starting in the month of July!
We look forward to having you Randi!
Thanks, Steve
We look forward to having you Randi!
Thanks, Steve
Tuesday, June 24, 2008
Responses!
Thanks so far to responses received for the post below. Keep them coming and I appreciate the participation! - Please remember to keep comments as P.C. and respectful. -even if they are anonymous :)
Steve
Steve
Friday, June 20, 2008
Local Case Manager Needs your advice! Please Help!
A Local Case Manager emailed me to post this question for some input and advice from the local Case Management Community. You can respond under the comment section and your response can remain anonymous. Thanks in advance for your input! (please note that comments will not show immediately)
I'm a hospital case manager and we have a patient whose residence is in another state. He came here to stay with family and look for a job, with the intention of moving if work was found. He is not sure if he wants to stay here or go back to his home state. Meanwhile, he became ill, was hospitalized and now is in need of dialysis. He is ambulatory and could probably be discharged from hospital except that he has no insurance and cannot be hooked up with OP HD. He will not qualify for AHCCCS as he is not a resident of AZ. Our hospital doesn't provide OP HD. We have applied for Medicaid in his home state but that could take a considerable length of time to come through, if he qualifies. One of my co-workers says we can't steer him to county. I'm not sure why we can't. Isn't Maricopa Hospital there to serve the indigent? Do you know of any options?
I'm a hospital case manager and we have a patient whose residence is in another state. He came here to stay with family and look for a job, with the intention of moving if work was found. He is not sure if he wants to stay here or go back to his home state. Meanwhile, he became ill, was hospitalized and now is in need of dialysis. He is ambulatory and could probably be discharged from hospital except that he has no insurance and cannot be hooked up with OP HD. He will not qualify for AHCCCS as he is not a resident of AZ. Our hospital doesn't provide OP HD. We have applied for Medicaid in his home state but that could take a considerable length of time to come through, if he qualifies. One of my co-workers says we can't steer him to county. I'm not sure why we can't. Isn't Maricopa Hospital there to serve the indigent? Do you know of any options?
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