This past week was a whirlwind as April 14 kicked off the annual AAPC National Conference, which was held in Orlando this year from April 14-17 at the Walt Disney World Coronado Springs Resort. The AAPC’s national conferences offer coding and billing professionals an opportunity to network and learn from industry experts and also provides an opportunity to meet AAPC folks from the advisory board and other areas of the AAPC overall.

Each year, the AAPC selects a different host city for the conference and literally thousands of attendees come from all over the U.S. and other countries to attend dozens of educational sessions, with approved CEUs and get up-to-date insight on the latest and greatest in the industry, including ICD-10.

This year’s Orlando Conference was a huge success and had an enormous turnout of both attendees and vendors. The conference offered attendees two full sessions on ICD-10 Code Set Training and a total of more than 72 individual educational sessions to choose from to earn up to 18 CEUs. And just like it does every year, the national conference provides access to the AAPC’s critically acclaimed Anatomy Expo, which was simply amazing!

For those who are unable to attend the AAPCs National Conference, there are several excellent alternatives for webinars and workshops. You do not have to be certified to purchase either of these educational modes of learning and earning CEUs. AAPC webinars, which can be either on-demand or live, offer full multimedia presentations and live querying with an approved instructor. These can be purchased either on an individual basis or on a corporate level to include an entire organization.

For more information from the AAPC and a listing of upcoming webinars, please click here.

The AAPC also offers workshops, which is another great alternative if you are unable to attend the national conference. Workshops provide attendees with the means to learn detailed information on a variety of hot topics that are critical to this industry and provide up to six CEUs per attendee. Workshops are, on average, four hours in length of live presentation from industry leaders and are offered in more than 40 cities in the U.S. To earn the designated CEUs, each attendee must complete an quiz online, post workshop.
For more information from the AAPC on workshops, please click here.

Final Thoughts

Attending the AAPC’s national conference this year was an excellent opportunity for me to see how this great organization really upholds its standard for excellence and industry professionalism for both medical billing and coding. I often found myself remembering why I initially got into health care — to have a rewarding career that offered growth with continual education, allowed for networking opportunities with colleagues, and afforded me the opportunity to pursue a lifelong goal of writing and educating others, as well as starting my own business.

Don’t miss next year’s national conference in Nashville from April 13-16.

I hope to see you there, but until then —

Happy Coding!
Holly
Follow me on Twitter: @hollycassano

Last week, I blogged about the AAPC’s newly-launched credential, the Certified Professional Biller (CPB), which is now available on the AAPC’s website. As I mentioned last week, the CPB credential qualifies for college credits via the University of Phoenix, for those students who wish to pursue a degree in addition to earning certification.

This week, I wanted to provide some additional information on what’s included in the exam that leads to this credential. The CPB Exam has 200 multiple choice questions, and those who sit for this proctored exam will have up to five hours and 40 minutes to complete it. In the event of a failing grade after the first exam, the AAPC offers one free retake that must be used within a year of the first attempt. There are a total of eight separate sections on the CPB exam, and you can start on any one of the eight sections once the test has begun.

Tip

Since the test has 200 multiple choice questions, that means that on average, each question should be answered in less than two minutes. So the best way to tackle the exam is to start in the section you feel you know best and answer those questions first and do the same for the rest of the sections. Do not leave any questions unanswered.

The CPB exam covers the following categories:

• Billing Regulations – 25 questions: Below are some of the areas that will be included on the exam:
  • National Correct Coding Initiative (NCCI)
  • Local Coverage Determination (LCD)
  • National Coverage Determination (NCD)
  • Incident-to billing
  • Global packages
  • Unbundling
• Coding – 15 questions: Below are some of the areas that will be included on the exam:
  • CPT
  • ICD-9-CM
  • HCPCS Level II
  • Modifiers
• Case Analysis – 50 questions: Below are some of the areas that will be included on the exam:
  This section of the exam will involve sample case studies and require the ability to analyze source documents and determine billing actions based on payer policies and related areas.
  • Remittance advices
  • Payment policies
  • Appeal letters
  • Preauthorizations
  • Accounts receivable reports
  • Claims follow-up reports
• Billing – 28 questions: Below are some of the areas that will be included on the exam:
  • Auditing of billing processes
  • Superbill/encounter forms
  • Demographics
  • Retention of records
  • Electronic claim submission
  • Telephone courtesy
• Reimbursement & Collections – 28 questions: Below are some of the areas that will be included on the exam:
  • Collections
  • Claim editing tools
  • Payer and patient refunds
  • Provider credentialing
  • Patient dismissal
  • Professional courtesy
• Types of Insurance – 40 questions: Below are some of the areas that will be included on the exam:
  • Managed care
  • Government payers
  • Worker’s compensation
  • Third-party payers (automobile/no-fault, liability, etc)
• HIPAA & Compliance – 10 questions: Below are some of the areas that will be included on the exam:
  • HIPAA privacy
  • Health care fraud and abuse
  • Billing compliance

The AAPC recommends that prior to sitting for the CPB exam, those who have no or very little experience in medical billing should take the CPB course. It is also recommended, but not required, to have an associate degree. The CPB course consists of 80 hours of study and students are given a four-month period of time to complete the modules.

For the month of April, the AAPC is running special savings on their new CPB course that includes the exam and a few other items for $1,195 (member price). This is a savings of almost $620 of the standard price of $1,814.95.
For more information on the AAPC’s CPB course, please click here.

To access the AAPC’s Exam Locator, please click here.

Final Thoughts

I strongly recommend obtaining certification, whether it be in medical billing or medical coding, as it shows potential employers that you are serious about your career and that you are considered a highly-trained professional in this fast-growing and rewarding industry. Pursuing a degree simultaneously or after certification is always an option and for those who can do both, again, I highly recommend that as well. Either way, you will position yourself to land the job you desire, making a good income with job security.

Happy Coding!
Holly
Follow me on Twitter: @hollycassano

Every spring, the AAPC holds its trademark, or gold standard event, the national conference. Thousands of AAPC members and corporate sponsors gather together in a different city each year and listen to industry experts on coding, billing, and regulatory and compliance changes. In past years, ICD-10 has been included in the various conference sessions, but this year marks the one-year date from implementation on Oct. 1, 2014. The focus on ICD-10 this year will really bring with it the much-needed reality check for those providers, facilities, and coding and billing professionals who have not been preparing adequately or at all for ICD-10 implementation.

The national conference is being held next week in Orlando from April 14-17. The conference allows local chapters to meet and network with others from different cities in the U.S. and provides opportunities for the chapters to put a spotlight on contributions their chapter has made over the past year to the industry. Members are also given opportunities to advance their careers and connect with the AAPC and many vendors who help sponsor this annual event.

The conference will offer more than 60 individual educational sessions for the attendees, which is generally anywhere from 2,000 to 3,000. Attendees are first to know about new vendor products and can check out the AAPC’s storefront in the exhibition hall.

The event always has live coverage from a variety of sources and one of the many sources that will be covering this year’s conference are the folks from ICD10 Monitor’s “Talk Tuesday.” Talk Tuesday will be airing live coverage via a podcast on Tuesday, April 16, 2013, from 10 a.m. through 10:30 a.m., EST.

The podcast is entitled “Special Edition 2013 AAPC National Convention.”

This year’s podcast will feature Rhonda Buckholz, the AAPC’s vice president of ICD-10 training and education. Buckholtz, who holds the extensive credentials, including the CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, and CPEDC, will be presenting on the following ICD-10 topics at the AAPC National Conference: “ICD-10-CM: Endocrine, Nutritional and Metabolic Diseases, Mental and Behavioral Disorders.”

Also on the podcast will be Stephen Spain, MD, Michael Miscoe, Esq. and Annie Boynton

To listen to Talk Ten Tuesday’s live podcast from the AAPC’s National Conference this year and hear what Rhonda Buckholz has to say about ICD-10 implemetation, please click here to register in advance.

The AAPC will offer 16 sessions on ICD-10 that will be split between two sessions. For those who are certified coders or who will be certified prior to Oct. 1, 2014, these sessions will be useful in preparing for the mandatory ICD-10-CM Proficiency Assessment, which you must pass to continue as a credentialed coding professional.

The sessions offer complete training in the specified areas and will include some examples that attendees will be given to practice their ICD-10-CM coding skills.

Included among the 16 tracks are the following (courtesy of the AAPC’s website):

• ICD-10-CM: Overview and Coding Guidelines; speaker: Katherine Abel, CPC, CPMA, CPPM, CPC-I
• ICD-10-CM: Infectious Diseases, Pregnancy, Newborn and Congenital Malformations, Deformations, and Chromosomal Abnormalities; speaker Brenda Edwards, CPC, CPMA, CPC-I, CEMC
• ICD-10-CM: Neoplasms, Diseases of the Blood, and Factors Influencing Health Status and Contact with Health Services; speaker: Susan Ward, CPC, CPC-H, CPC-I, CEMC, CPCD, CPRC
• ICD-10-CM: Endocrine, Nutritional and Metabolic Diseases, Mental and Behavioral Disorders; speaker: Rhonda Buckholtz, CPC, CPMA, CPC-I, CENTC, CGSC, COBGC, CPEDC
• ICD-10-CM: Diseases of the Nervous System, Eye and Adnexa, Ear and Mastoid Process and Symptoms, Signs and Abnormal Clinical and Laboratory Findings; speaker: Jacqueline J Stack, CPC, CPC-I, CEMC, CFPC, CIMC, CPEDC
• ICD-10-CM: Diseases of the Circulatory and Respiratory Systems; speaker: Cynthia Stewart, CPC, CPC-H, CPMA, CPC-I
• ICD-10-CM: Diseases of the Digestive System, Diseases of the Skin and Subcutaneous Tissue and Diseases of the Genitourinary System; speaker: Betty Hovey, CPC, CPC-H, CPMA, CPC-I, CPCD
• ICD-10-CM: Diseases of the Musculoskeletal System and Connective Tissue, Injury, External Causes and External Causes of Morbidity; speaker: Raemarie Jimenez, CPC, CPMA, CPC-I, CANPC, CRHC

For those who will be attending these breakout sessions at the conference, a great tool that will assist you with ICD-10-CM coding clarification can be found on the AAPC’s website. They provide a color-coded case example that illustrates the greater specificity that will be required for ICD-10.

To access the case example from the AAPC, please click here.

Final Thoughts

I will be attending conference this year and will be tweeting and blogging about it daily. I strongly suggest that everyone tune in to Talk Ten Tuesday’s live podcast with featured guest speaker Rhonda Buckholz and get the latest information on ICD-10-CM.

Happy Coding!

Holly

Follow me on Twitter: @hollycassano

Mobilizing like-minded professionals around a common set of topics creates an optimal atmosphere for learning, discussion, and networking. When you combine that with the latest in medical news, innovation and research from experts in the field, you can see why medical conferences are a calendar staple for many professionals across the industry.

Conferences are often organized by professional associations, and include guest speakers, workshops, demonstrations, panel discussions, and exhibits. Conferences can be a great way to keep abreast of new regulations, such as federal health care reform, or changing technologies and innovations. The chance to earn Continuing Medical Education (CME) credits is often another reason to attend — many healthcare professionals are required to earn CMEs to maintain their credentials and practice.

Exploring a new city and taking a break from the daily routine is another perk of going to a medical conference. Many conferences build in social events like a chance to play at the Waldorf Astoria Golf Club at the American Medical Group Association’s (AMGA) annual conference or cocktail hours, and dinners.

In a field as vast as health care you can probably find a conference or meeting for every facet of the medical world. Here is a small sampling of the biggest, most notable conferences held annually in the United States.

• Medical World Americas is a forthcoming three-day medical conference scheduled to kick off April 28, 2014 in Houston, Texas. Modeled after MEDICA, the world’s largest medical trade fair held in Germany, this conference is bound to attract top tier medical experts. Speakers and exhibitors will present medical products, equipment, and technology across the spectrum of prevention, diagnostics, therapy, and rehabilitation.
  • Specifics likes costs, programs and speakers are yet to be announced — you can sign up for updates here.

• American Academy of Dermatology Annual Meeting hosts its annual meeting in March. The attendees at the 2013 71st annual meeting in Miami Beach, Fla., attended sessions ranging from live cadaver dissections to health care policies. 2014 registration fees will be announced as the meeting approaches.
  • The academy also hosts a five-day summer meeting, which is scheduled to kick off July 31, 2013, in New York City. Early registration is $410 and late registration is $490 for most attendees — there are reduced costs for students and office staff.

• American College of Cardiology Scientific Session & Expo rotates around the country, and landed in San Francisco for the ACC.13 on March 9-1, 2013. This year the conferences focused on the transformation of cardiovascular care. Here is a list of media coverage from the 2013 event.
  • Registration fees range from $1,000 to $250 depending on attendee position, role and session attendance.
  • ACC.14 will be held in Washington, DC, from March 29-31, 2014.

• Association of VA Surgeons Annual Meeting the 37th Annual Surgical Symposium will be held April 21-23, 2013, in Milwaukee, Wis. Attendees will hear from keynote speaker Dr. Julie Freischlag, the William Halsted Professor, Chair of the Department of Surgery, and Surgeon-in-Chief at The Johns Hopkins Hospital in Baltimore, Md. The agenda is listed here.
  • Registration is $325-400 for doctors and $200-225 for students.

• The Association for Research in Vision and Ophthalmology (AVRO) Annual Meeting is considered one of the largest gathering of eye and vision researchers in the world, and will be hosted on May 5-9, 2013, in Seattle, Wash. The program for the event includes two keynote speeches, networking events, research presentations, and several social events.
  • Fees range from $275 to 400.

• American Diabetes Association Annual Scientific Sessions will be held June 21-25, 2013, in Chicago. The conferences features over 3,000 presentations on diabetes prevention, diagnosis, and treatment.
  • Registration for ADA members is $415-500, and non-member fees range from $725 to $825.

• American Psychiatric Association Annual Meeting celebrates its 166th anniversary this year. President Bill Clinton will deliver the keynote address at this year’s conference, which will be held May 18-22 in San Francisco.
  • Attendees can select either gold or standard with registration ranging from $350 to $900.
  • Here is a list of future conference dates and locations.

• American College of Physicians hosts the Internal Medicine conference, which will be held in San Francisco, Ca. from April 9 to 13. The conference features a variety of hands-on learning opportunities and courses, providing participants with the opportunity to earn 30 CME credits.
  • Registration is between $599 and $669.

• iHT Health IT Marketing Summit hosted by the Institute for Health Technology Transformation combines the best of technology and medicine. This year’s event was held March 26-27 in San Francisco, and aimed to interrupt typical conference expectations with an agenda that included panel debates and interactive roundtables. Here is a rundown of the agenda and speakers.
  • Registration was $595 for the 2013 event.

• Urgent Care Association of America Annual Convention will be held April 8-11, at the Walt Disney World Dolphin Hotel in Orlando. The conference will feature programs on growing urgent care centers and film radiology technology, among others. Registration information is available here.

• American Academy of Professional Coders National Conference is dedicated to the business side of the medical world as the nation’s largest training and credentialing organization. The conference agenda covers a host of topics in the world of codes, audits, and medical costs and revenue. This year’s event will be held April 14-17 at the Walt Disney World Resort in Orlando.
  • Registration is $845 for members and $1,145 for non-members — but that steep cost also includes a one-day admission to Disney World!

Conferences are one way the professional healthcare community stays active, informed, and engaged with the technological and policy changes in the medical field. And because they are often held during the spring or summer months in sunny vacation spots, conferences are also an enticing way to break up the day-to-day cycle of patient care.

It’s a chance to get in a little R&R and some networking while engaging with top professionals and experts in the field — a reinvigorating educational and social experience. With such a wide variety of topics, themes and cities, just about any health care professional will be able to find a conference that sparks their attention and interest.

Recently, the AAPC launched its new medical billing credential — the Certified Professional Biller (CPB), which is nationally recognized. The credential is separate from a certified coding credential, but it teaches some coding basics, with a core focus on medical billing on the provider side of health care. A bonus of this new certification is that it also qualifies for college credits for students who attend the University of Phoenix.
The CPB credential will teach those students interested in a career in medical billing the necessary skills to work in a provider office-type setting and about the various aspects of revenue cycle management. Some of the skills that are required for a medical biller include:

• Claim submission
• Denials management
• Payer appeals
• Accounts receivable
• Payment posting
• Adjustments
• Refunds
• Payer policies
• Local Coverage Determinations (LCD)
• National Coverage Determinations (NCD)
• Current Procedural Terminology (CPT)
• ICD-9-CM
• HCPCS Level II
• HIPAA
• False Claims Act
• Fair Debt Collections Act
• Stark Rules

A medical biller will have a variety of duties on any given day in a health care practice and this will vary depending on the size of the practice and if there are also certified coders employed. Generally, a typical day for a medical biller will be composed of checking out patients after they see a provider and coordinating charge entry of the day’s encounters. They will run various electronic clearinghouse reports after they submit entered claims. They will check the clearinghouse reports for any pre-submission errors and have them corrected for timely submission.

Another aspect of a medical biller’s daily interactions includes communication with providers in the practice and other health care staff, such as a certified coder. It is important that medical billers and coders work together cohesively to assist providers with documentation issues that may negatively impact claim submission and ultimately, timely reimbursement. It is of the utmost importance that a medical biller accurately comprehends how to interpret a patient’s medical record in order to be able to accurately handle the claims process from start to finish.

The AAPC course for billers is a total of 80 hours and can be completed at the student’s pace, within a four-month period or less — for those that are able to do so. A student’s enrollment starts from the date of purchase and they are able to log in whenever they want to start. The AAPC recommends that a student complete a minimum of one module per week in order to stay on schedule. The AAPC also allows students to email course-related questions to professional coaching staff.

The cost for the AAPC’s Certified Professional Biller (CPB) course is as follows:

• The course alone: $1,495
• Practice exam $59.95
• Exam $260
• Total $1,814.95
• Special April savings $619.95
• Total member price $1,195
• If you add a student membership for $70, you will access the April member special price

For more information on the AAPC’s Certified Professional Biller (CPB) course, please click here.

To access the AAPC’s Distance Learning Application, please click here.

Final Thoughts

Obtaining certification is more the norm these days for those interested in either medical billing or medical coding and is what the majority of quality employers require from a candidate in order to be considered for a position. Pursuing a degree is not required, but is also an option and gives that candidate a well-rounded education that will make them attractive to potential employers.

Happy Coding!

Holly

Follow me on Twitter: @hollycassano

In addition to the roles above, becoming certified in any area of the medical profession is an excellent way to both directly and indirectly serve the health needs of your local community. Like most careers in the medical profession, there is certainly no lack of training and certifications required of those who seek to contribute their talents to the industry.

The good news is that many of the certifications you need may be easier to obtain than you think. Below is an overview of several different certifications and their corresponding occupations within the medical profession.

Medical Certifications Offered by the National Healthcareer Association

These days, there are several certifications that medical professionals can obtain to expand their career prospects within the healthcare field. The following list of five unique medical certifications offered by the NHA provides only a sampling of the medical occupations that currently accept certification.

1. Pharmacy Technician (CPhT)

Certified Pharmacy Technicians are typically responsible for receiving and filling prescription requests from patients and doctors, as well as maintaining and establishing patient prescriptions records.

In order to become a Certified Pharmacy Technician, or CPhT, candidates are required to complete the ExCPT exam. This exam will test your knowledge of regulations and technician duties, drugs and drug products, and the process of dispensing medication.

2. EKG Technician (CET)

Certified EKG Technicians are experts at operating machines that monitor the health of a patient’s heart. In addition to administering tests, EKG technicians may also be responsible for reviewing and delivering results to a physician and scheduling follow-up appointments.

The process of becoming a Certified EKG Technician, or CET, requires that candidates pass an EKG technician exam, which requires that your skills are evaluated on-the-job. The NHA posts a helpful test plan on their website that should give you an idea of what the EKG technician exam might be like.

3. Operating Room Surgical Technician (CORST)

A Certified Operating Room Surgical Technician, or CORST, is typically responsible for prepping an operating room for surgery by sterilizing surgical tools, setting up equipment and being available to assist nurses or physicians when needed.

To become an operating room surgical technician, candidates must successfully pass a certification exam that includes up to 200 questions that relate to a CORST’s duties and responsibilities. For more information, the NHA provides an extensive handbook on the exam for candidates to refer to.

4. Medical Laboratory Assistant (CMLA)

A Certified Medical Laboratory Assistant, or CMLA, is responsible for being on-hand to assist in the analysis of specimens sent to the medical lab, such as blood and other bodily fluids. The CMLA may also be responsible for maintaining and operating lab equipment, in addition to other lab-related duties.

In order to become a Certified Medical Laboratory Assistant, candidates must pass the CMLA exam, which covers several topics, including chemistry, hematology, immunology and general laboratory procedures. For more information and a sample test, CMLAprep.com is a great resource to check out.

5. Electronic Health Record Specialist (CEHRS)

Certified Electronic Health Record Specialists are primarily responsible for making sure patient records are compliant, assisting with the submission of claims to insurers and reviewing patient records for completeness. Unlike medical billers and coders, who interpret medical records for billing purposes, electronic health record specialists audit and maintain internal records held by the healthcare provider.

Becoming a Certified Electronic Health Record Specialist, or CEHRS, requires the successful completion of a certification exam that tests your knowledge on health records, software and equipment usage, as well as medical billing and charting. The NHA provides a comprehensive handbook that CEHRS candidates can use to familiarize themselves with the role before diving headfirst into the exam.

Certification Options for Medical Billers and Coders

Given the complex scope of medical billing and coding these days, it is critical for healthcare providers to employ one, or several, certified professionals to handle the task of medical business operations. As a result, medical billing and coding specialists are perhaps two of the most essential roles for maintaining a healthcare provider’s bottom line.

While the two occupations are typically grouped together, they both have unique differences. A medical coder is mainly responsible for ensuring that a doctor’s diagnosis, for example, is accurately translated into the correct code for insurance reimbursement. A medical biller, on the other hand, is required to have an extensive knowledge of both provider and insurance billing procedures, as well as the many laws that regulate the way healthcare providers can collect on medical debts.

Today, there are many ways to become a certified medical biller or coder. Below is a selection of certifications currently available for you to consider.

1. Certified Medical Reimbursement Specialist (CMRS)

The American Medical Billing Association currently offers a robust selection of training courses and materials that are designed to help you prepare for and successfully complete the Certified Medical Reimbursement Specialist (CMRS) exam. The certification and training offered by the AMBA is considered to be the most comprehensive around for the medical billing profession.

Once a candidate enrolls, he or she has up to 45 days to complete the exam through the association’s online portal. It typically takes about 3-4 weeks for candidates to receive their certification once they pass the exam. The AMBA allows candidates to retake the exam twice for free after a 30-day (but no more than 60-day) waiting period.

2. Certified Billing and Coding Specialist (CBCS)

In addition to the several medical certifications discussed earlier in this article, the NHA also offers a certification exam for medical billers and coders, known as the Certified Billing and Coding Specialist (CBCS) exam.

While the CBCS exam offered by NHA is less extensive than the CMRS exam proctored by the AMBA, it does test candidates on relevant topics, such as medical terminology, coding, claims processing and ethics. The CBCS exam is comprised of 100 multiple choice questions and candidates are allotted 100 minutes (1 hour and 40 minutes) to complete the exam.

3. Certified Professional Coder (CPC)

Another great option that is specific to prospective medical coders is the Certified Professional Coder (CPC) credential offered by the AAPC. Unlike the two certifications above, however, a CPC credential requires a deeper knowledge of medical coding and terminology.

The CPC exam is comprised of 150 multiple choice questions that can be answered with the aid of approved coding manuals. Candidates will have 5 hours and 40 minutes to complete the exam with one free retake should your first attempt be unsuccessful.

Medical Certification Is the Way to Go!

Even though several of the medical professions listed above do not specifically require candidates to obtain certification in their field, not being certified can be a serious disadvantage. In fact, competition for jobs in healthcare can be fierce, with several job candidates opting to obtain multiple certifications in their chosen field, as opposed to just one.

Luckily, there are plenty of options for you to obtain certification for your chosen field within the medical profession. The choices detailed in this article are only a few of the many training and certification options at your disposal—most, if not all, of which can be completed online.

If you’ve been considering a career as a medical biller, coder, or even another role within the medical profession, take some time to find out more about the certifications that interest you. Not only will becoming certified in your chosen specialization benefit the healthcare provider that employs you, but it could have a very positive impact on your future career prospects in the healthcare field.

Last week, I discussed some of the provider concerns about the impending transition to ICD-10 on Oct. 1, 2014. Some of the concerns that providers have with the transition included not having enough time to implement the necessary IT/staffing changes in order to be compliant, and they expressed concerns over costs for implementation.

Clearly, these are all valid concerns, but as I stated last week, there has been some potential propaganda about costs and training to some degree from some vendors. Unfortunately, that seems to have led to a somewhat panicked state for some providers on what they will need to do to be prepared for the transition.

ICD10 Monitor conducted a very interesting poll in March 2012 that addressed the health care community’s readiness at that time. They published the results via their “Talk Ten Tuesday” forum. The following reflects the results of the polls that were conducted by ICD10 Monitor:

ICD10Monitor’s Talk Ten Tuesday Poll on March 13, 2012:

Poll Question: What do you think is the best amount of time to delay?

Poll Responses:

A – 6 months 11%
B – 1 year 27%
C – 2 years 6%
D – 3 years 5%
E – Not At All 51%

ICD10Monitor’s Talk Ten Tuesday Poll on March 27, 2012

Poll Question: When is your organization planning to do your coding data analytics to assess potential revenue impact under ICD-10?

Poll Responses:

A. We already have 18%
B. Sometime in 2012 51%
C. Sometime in 2013 10%
D. We are not planning on doing 7%
E. Not applicable to my organization 15%

ICD10Monitor’s Talk Ten Tuesday Poll on June 10, 2012

Poll Question: What do you think your biggest coding challenge will be with ICD-10?

Poll Responses:

A. Lack of physician documentation 77%
B. Getting coding staff educated 9%
C. Lack of coding staff/maintaining coding staff 9%
D. Lack of coding tools 1%
E. Not applicable to me 4%

I found these to be extremely interesting, as these results seem to express a different view in the health care community than what the American Medical Association (AMA) stated in their letter to Centers for Medicare & Medicaid Services (CMS) recently. Of particular interest was the fact that of those polled, 51% indicated that there should not be a delay in ICD-10 implementation, compared to 5% who stated that it should be delayed by three years. This is in sharp contrast to what the AMA stated was the general view from the provider community and yet CMS conceded to a year delay in order to allay the AMA’s concerns.

Also of interest was that 51% of those polled indicated that they would start data analytics sometime in 2012, versus only 7% who said they would not be doing anything at all and 15% who said it didn’t even apply to them. Also a sharp contrast to what the AMA indicated, was a concern from the provider community.

Lastly, the poll returned an overwhelming 77% who indicated that the number one concern and coding challenge was regarding physician/provider documentation. This was an area that the AMA seemed to have left out of the area of concern and in turn addressed it by indicating providers will have to hire more staff and pay for training in order to be able to handle the additional documentation requirements of ICD-10. Ironically, the lack of coding staff came in at 9% in comparison to the whopping 77% concerned over provider documentation, not cost/training/hiring of additional staff. Documentation is the same issue that challenges coding and billing professionals today in ICD-9, where providers are dealing with a fourth of the diagnosis codes in comparison to ICD-10’s approximately 64,000 codes.

Readiness Tips

Clearly, documentation is a core concern in the health care community, and there are a variety of ways in which a practice can get a jumpstart on dealing with the additional specificity requirements of ICD-10. Some of the ways that a practice can ramp up their documentation is by implementing some of the following recommendations:

• Identify the top 20 diagnosis codes used in your practice for your specialty and make a crosswalk chart to ICD-10-CM codes as a reference tool.
• Start coding both ICD-9 and ICD-10 in charts/superbills (obviously do not submit yet) to gain practice by utilizing the most common diagnosis codes.
• Conduct a baseline audit of about 25 charts per provider to address documentation issues and how they are connected to current specificity and medical necessity with diagnosis code and CPT code selection and identify any risk.
• Communicate any risk findings back to providers and show them how to overcome identified risks with documentation, as well as show them how the chart would need to be documented in an ICD-10 environment versus ICD-9.

The AAPC has begun developing some great ICD-10 coding resources to assist the health care community with the transition and specificity requirements by posting ICD-10 reference guides that may be downloaded for free off their website.

They premiered three guides in the following areas:

• Non-pressure Chronic Ulcer Resource
• Fractures
• OB/GYN Coding

These guides offer great insight for correct coding and documentation of these areas in an ICD-10 environment.

To access these guidelines from the AAPC, please click here.

Final Thoughts

I will again remind everyone that the overall anticipated benefits of ICD-10 transition will allow for many needed improvements in our health care system and that providers and staff will see accurate payments for current and new procedures, will spend less time appealing denied and/or rejected claims, and have better means to report and manage chronic disease processes. Ultimately, this will benefit both providers and patients as it will result in improved clinical outcomes by being able to identify conditions via higher levels of specificity and earlier identification of disease.

Happy Coding!

Holly

Follow me on Twitter: @hollycassano

Medical billing and coding is constantly being updated. Billing/coding professionals and providers have a responsibility to stay abreast of these changes in order to maintain compliance, and one of the ways that the Centers for Medicare & Medicaid Services (CMS) communicate these changes is via their carrier websites under the title of “Hot Topics.” Hot Topics consist of published regulatory and interpretational/clarification changes relevant to the health care industry that pertain to all settings in which health care services are rendered. The bottom line of these communications is for billing/coding professionals and providers to understand the many different components involved in generating a clean and compliant claim.

What makes coding and billing issues hot topics?

• New requirement in the language of a CPT-4 /ICD-9 code that is required in order to report to payers
• Additions/deletions of CPT-4/ICD-9 dodes
• Updated or new interpretations to a standing practice or health care reimbursement policy practice or policy
• Provider errors that arise from the results of government audits and are now subject to investigation or under review by the OIG, HHS, CMS, RAC auditors, etc

What billing/coding professionals and providers have to remember is that all services must meet what CMS deems as “reasonable and necessary” in order to be reimbursed for services rendered to patients. The majority of commercial payers also follow these or similar guidelines. What CMS means by “reasonable and necessary” is that a service must be relevant to “reasonable and necessary” care for the diagnosis and treatment or must be rendered to “improve the functioning of a malformed body member.” Additionally, the service(s) must be considered “safe” and effective and not experimental in nature, must be appropriate and include the duration and frequency that would be considered suitable for the level of service provided. Lastly, all must be supported clearly in the provider’s documentation.

Examples of billing/coding hot topics

• CPT code changes published every Jan. 1 – includes new, revised, and deleted codes
• ICD code changes published every Oct. 1 – includes new, revised, and deleted codes
• Provider signature legibility issues – signature legibility on documentation – requires signature log or attestation from provider that indicates signature is theirs – for validation and compliance
• Provider e-signatures on electronic health records (EHR) must be closed by rendering provider not by another source and not left “open” for more than 24 hours for validation and compliance
• Provider signatures on all orders – requires ordering providers signature for validation and compliance
• High volume of reported outpatient claims greater than $50,000 – red flag for potential erroneous claims
• High volume of reported inpatient claims greater than $200,000 – red flag for potential erroneous claims
• Place of Service Errors – Outpatient/POS 22 VS Office/POS 11 – potential for erroneous services being reported under incorrect POS in order to recoup a higher reimbursement
• Modifier use (25, 59) – modifier 25 potential for erroneous reporting of separate services, when they either were not provided or should be included in other service and the same for modifier 59
• Incorrect leveling of an Evaluation and Management service (E/M level) – i.e., new patient visit billed instead of established patient visit as it has a higher reimbursement
• Global Surgery Days Billing E/M level for post-operative visit, when the visit is included in the 90-day post-op period
• Billing of E/M on the same day as a scheduled procedure for the same reason as procedure (it’s included) – can only bill if the decision for surgery was made the same day.
• Teaching physicians (TP) at teaching hospitals using a checkbox in lieu of writing a linking statement that shows the TP was personally supervising
• Medically Unnecessary Services – evaluation of services to determine if medical necessity has been met for a service based on payer coverage determinations
• Cloning of electronic health records – when providers copy/paste the electronic documentation from one DOS for a patient into another – new DOS instead of taking new information for the visit – the OIG is concerned about “canned” documentation that does not reflect individual patient condition. Documentation that is copied from prior visits may not be relevant or medically related to the service
• Coverage changes – National Coverage Determinations (NCDs) – Medicare often will issue a special policy determination for a service or procedure and once it is published all CMS providers/payers must adhere to the NCD
• Local Coverage Determinations (LCDs) – These are published locally by Medicare Administrative Contractors (MAC). They clarify CMS policies and also make policy for services not discussed specifically by CMS. Additionally, they provide coding claims processing advice from payers to providers

Final Thoughts

It is important to remember that as a billing/coding professional, you are only as good as the information you review and keep abreast of. Sign up for email updates to stay ahead of regulatory changes that affect medical billing and coding and ensure compliance for yourself and your providers.

Hot Topic resources

• CMS
• CMS Coverage Database
• OIG

The Society for Vascular Ultrasound publishes a list of all the Medicare Administrator Carrier’s websites; please click here to access it.

Happy Coding!

Holly

By Holly Cassano, CPC

ICD-10 implementation is progressing as the health care industry prepares for the final switch on Oct. 1, 2014. On the provider side, the transition will involve comprehension of the diagnosis component, ICD-10-CM, and ramping up their documentation skills so that the billers and coders in their practices can extrapolate the necessary information into codes that payers will accept for timely reimbursement. That is really the learning curve for ICD-10-CM, which speaks to the ongoing issue of documentation specificity that has been ongoing since the advent of ICD-9.

ICD-10-CM will have crosswalks from ICD-9 codes to ICD-10-CM, so the actual process of translating from one code set to another will be fairly seamless, as long as coding and billing staff prepare with the providers by reviewing the WHO’s free training program and utilize something like Optum’s Encoderpro professional to assist with the crosswalking of the codes. The AAPC also offers paid training and many free resources for the health care community to assist with the transition.

The main issue raised by the American Medical Association (AMA) this past December in a letter to the Centers for Medicare and Medicaid Services (CMS) is targeted primarily on the IT side of things for ICD-10 implementation. The AMA stated that the targeted date of Oct 1, 2014, would be a significant burden on the provider community as providers have to dedicate additional resources to participate in several CMS quality programs such as PQRI and adoption of electronic health records (EHR) reporting systems.

The AMA indicated that if providers are not compliant with these measures, CMS will invoke penalties starting in 2015 for those that have not participated in these programs. The AMA stated that revoking ICD-10 implementation “will help keep adoption of EHRs and physician participation in delivery and payment reform models on track.” Additionally, the AMA stated that “Physicians will be responsible for all of these costs, which, depending on the size of a medical practice, will range from $83,290 to more than $2.7 million,” the letter stated.

The cost of implementation on the IT side could be a potential hit to some in the provider community if they have not planned in advance of the deadline. As with HIPAA implementation, there was quite an upheaval within the health care community, but somehow, the majority survived implementation, and we are all better for it and have learned the added value of protecting PHI. CMS’s goal is not to force any undue burden on the provider community and certainly it is not to force a practice to close its doors.

It would seem to me that if the providers reach out to the AAPC, AHIMA, HIMSS, and the WHO, that they would gain insight as to what the actual associated costs for implementation should be. There has been so much of what I call “ICD-10 propaganda” since the original implementation announcement a few years ago on costs to comply, that I think there are many companies out there who are overstating actual costs to providers for practice implementation and it is causing a virtual “the sky is falling” effect.

I understand the CMS measures, but these have been in effect for several years as well and it is not a new process, so CMS’s response to the AMA this past February was in line with just that, when they stated the “The mandated transition by billers throughout the health system to the more complex ICD-10 diagnosis codes will go forward without any further delays” in a Feb. 6 letter to the AMA.

Marilyn Tavenner, who is the acting CMS administrator, indicated in her response to the AMA that if CMS ceased ICD-10 implementation, “which has been ongoing since 2009, (it) would mean relying on outdated ICD-9 codes that soon will be incompatible with general health care needs and new technologies.”

Tavenner also stated that “Many in the health industry are under way with the necessary system changes to transition from ICD-9 to ICD-10,” and that “Halting this progress midstream would be costly, burdensome, and would eliminate the impending benefits of these investments. Many private and public sector health plans, hospitals and hospital systems, and large physician practices are far along in their ICD-10 implementation and have devoted significant funds, resources, and staff to the effort.”

CMS has furthered the concern from the provider community by stating that “the agency believes ICD-10 is an important factor for several integrated programs that will modernize the health care system so it can provide better care, improve health, and lower costs.”

Lastly, that these measures, which includes ICD-10 implementation are supported by CMS as Tavenor stated, “Together, they move America’s health care system towards better coordinated care through greater interoperability and ease of transmitting electronic data; better quality measurement and reporting of clinical outcomes data; and lower costs achieved through operational efficiencies.”

Final Thoughts

ICD-10 implementation will prove more costly on some levels to facilities versus private practices, as facilities will be dealing with both ICD-10-CM and ICD-10-PCS for diagnosis and procedural coding. The majority of facilities have already begun preparations in advance of the implementation date and so will not face as many challenges on Oct. 1, 2014. Private practices are dealing with a more defined set of repeat diagnosis codes, not the entire gamut of ICD-10-CM, and so in comparison, training, costs, and implementation will prove to be less cumbersome, as long as they start now or have already started preparations for the transition.

Free Resources

Bridgefront has several webinars on ICD-10 education, including this one on anatomy and physiology that can be accessed via the below link.
Title: The Impact of Anatomy and Physiology on Revenue
Synopsis: Instructs and educates on anatomy and physiology skills for coding and billing, and discusses preparation for ICD-10-CM/PCS.
Click here to sign up for this webinar.

ICD-10 resources for latest news

• ICD-10 Watch
• Fierce Healthcare (put ICD-10 in the search bar)

Happy Coding!

Holly

Follow me on Twitter: @hollycassano

The interview process can truly be grueling for many newly certified medical billing and coding professionals. Having been on both ends of the spectrum, I honestly can say that I prefer doing the interviewing rather than being the interviewee. One thing you should keep in mind is that having confidence in yourself is key to a having a good interview versus a bad interview. You want to remember that you are the driver of your destiny in this industry, and being well prepared is paramount to landing that job!

Now I will tell you there are many ways to conduct an interview that can either make it a smooth process or uncomfortable. As an employer, I feel that we have a responsibility to set the candidate at ease and therefore get more natural responses to questions versus handling the process as if being a member of the Spanish Inquisition from centuries ago, illiciting canned responses from a nervous candidate.

Now that is just my opinion on interviewing, so as a candidate, you will be presented with many different types of interviewing styles. The best way to navigate through them all successfully is to know what types of questions you will have to field and the best way to reply to them. I have assembled a short list of potential questions and answers that you can use as a guide for the interview process.

• Can you explain the type(s) of certifications you have?
  Certification in medical billing will put you miles ahead of non-certified candidates, and you want to make sure you list these on your resume for the employer to review. If you have more than one, make sure you list all of them and be prepared to show proof of certification.
• What specialties have you worked in and please describe them?
  Make sure that whatever prior experience you have listed on your resume, that you are able to go into detail about that specialty during the interview and what your role was for the billing of those visits.
• Please explain what CPT codes/ICD-9 codes you have used most frequently.
  Just run through the main evaluation and management codes and any procedure codes with most frequently billed diagnosis codes in a general manner for the interview.
• What is your understanding of medical terminology?
  Emphasize any medical terminology courses you have taken for your certification and give a brief answer with a possible example for the specialty that you are interviewing for to illustrate that some basic medical terms and how they relate to the billing process.
• Please explain HIPAA/PHI rules.
  Explain that as a certified professional you understand the nature of the privacy laws and what PHI is and how to adhere to the guidelines on disclosures. Make sure that you give a basic explanation of what the providers/staff are responsible for.
• Please explain your familiarity with electronic medical records (EMR) systems.
  Nowadays, most practices utilize some form of EMR, as it allows for universal access to patient records for all providers and staff within the practice. If you have experience working with an EMR, explain briefly your prior experience and what system(s) you have worked on. The majority of practice management software programs are either incorporated into an EMR or are interfaced with one.
• Please highlight the various payers you have worked with.
  This is where you can illustrate what you are bringing to the table and demonstrate your problem-solving skills by indicating the payers you have worked with and how you handle reimbursement/denials/appeals with those payers in a timely fashion. This is also the time to indicate your experience working on an accounts receivable report to resolve these types of claim issues with payers. Demonstrate measureable results and give some quantified responses as to your contributions to reduced collections ration by the percentage and how you accomplished this. An example of providing quantitative results of your actions might be “I reduced accounts payable by 75%” or “I reduced unpaid claims by 50%.”

Final Thoughts

Invariably, questions may come up that you have not had experience with previously and the best way to handle this is to indicate that you are capable of working independently and that if you come across something while on the job that you are unfamiliar with, you will look to secure a solution with minimal or little supervision. State that you are a “take charge” person and that you do not require one-on-one supervision after your initial training. Employers want to hire individuals who are “self starters” and can jump into a position and hit the ground running, so highlight that as a strength.

Freebies

All Things Medical Billing is a great site and offers some really terrific free tools for those in the medical billing/coding industry. I have pasted two links for you to check out. One is their free 15-page medical billing and coding career guide, which I highly recommend, and a medical billing claim flowchart, which explains the lifecycle of an insurance claim.
Please click here to access All-Things-Medical-Billing.com’s career guide.
Please click here to access All-Things-Medical-Billing.com’s health care claim processing flow chart.

Happy Coding!

Holly

Follow me on Twitter: @hollycassano