Hospitals, Physicians, and Clinical Pathology Laboratories Scramble to Prepare for Use of Form 5010 Beginning January 1, 2012

November 9, 2011
Some medical laboratory organizations risk coming up short on the deadline for implementation of 5010 standards.

Less than eight weeks remain before the January 1, 2012, deadline for implementation of Form 5010. Every sector of the healthcare system—from government and private payers to hospitals, physicians, pathologists, and clinical laboratories—is involved in this important healthcare reform.

Many providers and payers are scrambling to meet the Health Insurance Portability and Accountability Act (HIPAA) version 5010 compliance deadline. This is the latest version of standards for the conversion of electronic health records (EHRs).

The Centers for Medicare and Medicaid Services (CMS) continues to maintain a hard line position regarding the deadline, according to an article in Modern Healthcare. “There is no wiggle room,” Denise Buenning, Director of the Administrative Simplification Group in CMS’ Office of E-Health Standards and Services, stated. “We’re holding fast to the date.”

Survey Shows One-Third of Healthcare Industry Not Prepared
That concerns some industry experts and hospital and group practice technology leaders. They believe CMS may need a contingency plan for non-compliant organizations.

Although, the healthcare industry appears to be making progress toward the conversion, a recent survey hints at trouble ahead. In this survey, reported by Healthcare IT News, a significant number of healthcare entities indicated that they are not yet prepared for 5010 implementation in Healthcare IT News. The ICD-10/5010 Readiness Survey was conducted by the Healthcare Information and Management Systems Society (HIMSS).

“Many healthcare providers are making great strides [toward compliance],” said John Casillas, HIMSS Senior Vice President, Business-Centered Systems, in an HIMSS press release. “While only 38% had a 5010 implementation plan in place in May 2010, by December, that number had jumped to 52%.”

However, at least a third of the survey respondents reported that they either: 1) did not have a plan for testing; or, 2) would not test until fourth quarter 2011. This is why experts predict that a last-minute testing crunch will tax to the limited the resources of payers and claims clearinghouses. “The result could delay or negate receiving payment,” noted Joe Miller, one primary author of the survey and former chair of the HIMSS Medical Banking and Financial Systems Committee.

According to the survey, 66% of respondents planned to upgrade their systems to meet compliance requirements, while 19% planned to use a clearinghouse. The obstacles to testing named by the survey respondents included: Payers not ready (67%); Competition for resources (53%); Vendors not ready (50%); Clearinghouses not ready (47%).

The survey also revealed that providers say their number one reason for lack of full attention to 5010 implementation is their the need to devote resources to other projects. An impressive 66% of respondents cited adoption of EHR (electronic health record) systems and the need to meet meaningful use criteria as their top priority.

The HIMSS survey was based on 256 usable survey responses from hospitals and integrated delivery networks (69% of the total respondees), practices and clinics (18%), and other providers, such as long-term care facilities (13%).

5010 is the latest version of healthcare transaction standards, noted HIMSS in its press release. The 5010 platform focuses on the electronic exchange of administrative and financial information between healthcare providers and health plans for patient care services, including eligibility inquiries, service (treatment) authorization and referrals, claims status requests, claims, and remittance advice (claims payment).

5010 Compliance Required to Support Other Mandated Changes
Adherence to the 5010 deadline is critical for several reasons. For one, conversion to 5010 impacts some of the provisions of the Affordable Care Act—including the operating rules—that are predicated on the adoption of the 5010 platform.

The HIMSS press release noted another reason. The federal government has mandated that all U.S. hospitals must use the revised ICD-10 system of coding diagnoses and procedures by October 1, 2013. HIMSS notes that this change represents the biggest overhaul in healthcare in the last 30 years. CMS’ Buenning maintained that further delay for compliance is out of the question, Modern Healthcare reported.

Rady Children’s Hospital (RCH), San Diego, is an example of a provider who may not meet the deadline for 5010 compliance. Albert Oriol, RCH’s Chief Information Officer, told Modern Healthcare that, although RCH has taken the necessary steps toward compliance, it is still unable to submit 5010-compliant claims to all of its business partners.

Take, for instance, Medi-Cal. Medi-Cal is California’s Medicaid program. It is jointly administered by the California Department of Health Care Services (DHCS) and, ironically, CMS. Medi-Cal represents close to 50% of RCH’s business, Oriol said. The hospital has not started 5010 testing with Medi-Cal.

But Oriol doesn’t seem too worried. He expressed confidence that, even if Medi-Cal fails to meet the upcoming 5010 deadline, the state will have a contingency plan to keep operations going, possibly by using a clearinghouse.

Clinical laboratory managers and pathologists should already be involved in testing their lab organizations’ 5010 capabilities with payers serving their region. With the January 1, 2012 deadline fast approaching, this early preparation can be important to insuring that lab claims are processed in a timely and accurate fashion.

—Pamela Scherer McLeod

nTelagent Teams With Promantra to Offer a Complete Healthcare Revenue Cycle Management Solution

Promantra and nTelagent have partnered to offer acute care providers a streamlined platform to manage their entire revenue cycle processes – beginning with pre-registration and ending with final claim resolution.

November 8, 2011 (Somerset, N.J.) --- nTelagent, Inc., a leader in pre-registration and point-of-service payment solutions for acute care providers across the U.S., and Promantra, Inc., a leading revenue cycle management company specializing in medical transcription, medical coding, and billing and claims management, have joined forces to offer a complete revenue cycle management platform for acute care providers.

“Our partnership will allow acute care providers to work with a single vendor to handle their entire revenue cycle process, from pre-registration, to payment and claims management,” Earl Winter, nTelagent CEO, said. “This will empower them to create more efficient processes and improve their revenue cycle, and, most importantly, allow them to increase focus on their primary mission – patient care.”

“Healthcare reimbursement requirements are constantly changing,” Terry Kile, Promantra VP of Sales, said. “It is an immense task for acute care providers to keep up with the changes in reimbursement, and ignoring that responsibility completely drains the facility of its revenue stream. nTelagent and Promantra’s collaboration enables acute care facilities to excel in revenue cycle management from pre-registration through final claim resolution.”

Both Promantra and nTelagent are focused on providing high-quality solutions to customers and are accustomed to handling the challenges that come with the new world of healthcare payments, including reimbursement changes and ever-increasing patient-due amounts.

Winter continued, “Thanks to this new partnership, our patient access and business office professionals have the tools they need from start to finish. With nTelagent, they can begin the registration process, including upfront collections, efficiently and correctly, and with Promantra, they can handle the middle and end of the revenue cycle process to ensure maximum results.”

“Acute care financial service professionals have a demanding position. Our teamwork will minimize the number of vendors necessary to achieve a high-value revenue cycle, improve internal accountability and streamline the entire process,” Kile concluded.

For more information about how your facility can put the nTelagent/Promantra team to work for you, visit www.ntelagent.com and www.promantra.net.

About Promantra
Promantra’s comprehensive solutions in Revenue Cycle Management (RCM) increase and streamline compliance while saving medical facilities money. Promantra’s proven capabilities accelerate the revenue cycle to increase productivity, speed payments, decrease costs and improve patient service. In addition, Promantra’s experienced health-care team analyzes Explanation of Benefits (EOBs) and claims and acts immediately to recover the due amount. All of which means health care facilities can focus on the core business - providing better health care. Promantra has successfully transitioned multiple accounts across various states and platforms to improve collections, operating margins, and reduced A/R days.

About nTelagent, Inc.
nTelagent's total point-of-service solution, the Retail Application for Healthcare, guides patient access staff through each patient encounter via real-time, customized scripts. From insurance verification to payment processing, registration is fast, simple and accurate for all patients: insured, uninsured and those qualifying for financial assistance. nTelagent's clients increase upfront cash and cash on hand, reduce AR days and bad debt, reduce or eliminate back-end denials, and follow consistent practices on all registrations. Online: www.ntelagent.com

Media Contacts:
For Promantra: Dana Myers danadmyers@comcast.net 717-405-7307
For nTelagent: Laura Campbell laura@laura-campbell.com (615) 579-6599

The 7 most overlooked ICD-10 issues:

The clock is ticking…has your organization addressed these critical ICD-10 issues?
Much of the conversation in the recent past on the transition from ICD-9 to ICD-10 has focused on the many new diagnostic codes. However, read below for seven commonly overlooked issues. With less than two years to have the process working effectively—ensure your organization has addressed all ICD-10 issues—whether you outsource the problems or not.

The 7 most overlooked ICD-10 issues:
1) Your system must be able to assign ICD-9 and ICD-10 codes as appropriate to the carrier, or you’ll need to run two different systems.
2) Know who is capable of what coding system. Train both coders and non-coders on the new processes.
3) When a claim transfers from Medicare to secondary insurance that is not capable of ICD-10, you won’t get paid.
4) Have a contingency plan for getting claims processed correctly; all the while being aware that many insurance companies and medical entities are using "drop to paper" as their contingency plan.
5) Will your clearinghouses be able to accept both ICD-9 and ICD-10 at the same time for at least six months of time to handle the transition?
6) Have you tested your system and your clearinghouse(s) system for 5010? If you have not passed with both by November 1, 2011, you have a lot of scrambling to do.
7) You may need to have a line of credit to keep your organization going financially while all the pitfalls are found and ironed out.

Proper ICD-10 planning and education will help avoid these issues:
BridgeFront is a recognized leader in healthcare online education for Revenue Cycle and Compliance. Just announced are courses on ICD-10 and HIPAA Version 5010. For weekly ICD-10 tips, visit our website at www.icd10-education.com.

Why BridgeFront clients return year after year:
"We have chosen the right company to do business with." – Allegan General
"I am so pleased with the BridgeFront product." – Kaiser Permanente
"Excellent curriculum." – CHRISTUS Health
"Long story short, you rock." – INTEGRIS Health

Contact me for a free trial or online demonstration:Learn more...ask me about our free e-learning trial and our quick online demonstrations. Contact me at carolj@bridgefront.com or (866) 447-2211.

Enjoy the tips,
Carol Johnson
BridgeFrontDelivering Innovative Education & the Care You Deserve
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4400 NE 77th Avenue, Suite 275
Vancouver, WA 98662Phone: (866) 447-2211
Email: carolj@bridgefront.com
Web: www.bridgefront.com
Blog: www.bridgefront.info

Denial Management - Best Practices ………Your thoughts????

A good denial management process is not simply about working on denials, it is about systematically gathering the data required to eliminate denials. Working on denials is like pumping water from your basement when a pipe bursts. Denial management is about fixing the pipe so you no longer need to pump water from the basement.

Over the years we have learnt that three elements are typically missing from a practice or medical Provider's denial management process: data, filtering/sorting methodologies, and feedback to systematically correct errors. Most practices & practice management systems do not properly track denials - at least not in the form in which they are typically used (i.e., they may have the capability, but only if properly implemented and used). The practice management systems that do track denials typically overwhelm the practice with data that is difficult to utilize for high level denial management. Finally, even if the data is captured and can be properly utilized, most practices do not have a systematic way to get the information back into the billing process in a manner that prevents the denials from occurring again in the future.

Below is a list of few common denials:
· Claim denied for Missing / Additional information
· Claim denied as Duplicate
· Claim denied for Prior-Authorization / Referral
· Claim denied as Inclusive
· Claim denied as not medically necessary / Pended for medical notes
· Claim denied as non covered service
· Claim denied for eligibility
· Claim denied for late filing
· Claim denied as CPT – Dx mismatch

Here’s a proven methodologies I would like to suggest.

Focus on key fundamentals like Prevention, Analysis and Tracking.

Prevention:
Prevention focuses on actions that can be taken upstream in the patient encounter to prevent denials from occurring in the first place. Prevention can be introduced anywhere in the patient encounter such as: Pre-admit/Pre-registration, Scheduling, Admit/Registration and Billing.

Analysis:
The process of analyzing and aggregating similar denials is strategic in denial management. Analysis and segregation is a forerunner to follow-up process and hence it is a fundamental step in denial management.

Tracking and Trend Management:
Besides keeping a track of the denial trend from payers, you need to actively monitor the payment patterns from various payers and set-up a mechanism to alert when a deviation from the normal trend is seen. This is important in understanding the causes of claim denials and enhancing long-term efficiency and drastically reducing lost revenue.

Your Thoughts ?????

Chirag Patel
Billing Consultant
Ph: 408-856-6651
chiragb@promantra.net

Electronic Health Records (EHR) Management and Challenges in Long Term Care Industry

The four most critical challenges faced by the Long Term Care industry today.

Shortage of Nursing Staff : One of the major challenges in the nursing homes today is shortage of adequate nursing staff. This has a direct impact on the service provided by the nursing staff as the residents have to wait for assistance from the nurses. In other words, the residents’ activities of daily living (ADLs) like bathing, dressing, eating, medication etc…are at times not being done in a timely manner. Hence it is very important for the nursing homes today to have adequate nursing staff.

Complex Regulations : Proper documentation and management of medical records is the most integral part and is a mandatory requirement for any Long Term Care facility. Nursing staff has been efficient in adhering to these requirements. But this is not the case in all Long Term Care Facilities. Errors may occur in cases where documentation is done manually. This increases the risk of regulatory citations and this can be avoided with a proper Electronic Health Records system in place. It would be any added advantage if your EHR software has both financial and clinical systems integrated under one system to take care of both financial and clinical functions in one platform.

Rising Operational Costs : Rise in operational cost directly impacts the cost of treatment given to the resident. Long Term Care facilities must have effective systems in place to controls costs. One option is to outsource their financial and clinical documentation part as this is a time consuming activity. This not only reduces the cost as there is no need to have additional staff assigned to perform these activities but also allows the LTC staff to focus on their core activity of providing quality health care to the residents.

EHR Management : It is very important to have a right EHR system in place. A lot of Long Term Care Facilities end up acquiring a system which is generic and not a customized platform. In this case LTC facilities are paying for software which has some of the functions which they might never use or which does not have some of the functions and are doing it manually. Hence it is very important to identify a right vendor who can provide you a customized and cost effective solution for your EHR software.

Any comments are welcome.

For further questions on effective EHR management call 408-856-6651 or e-mail chiragb@promantra.net

Accelerating your Revenue Cycle process

Promantra Synergy Solutions is a HIPAA compliant organization and has over six years of experience providing Healthcare BPO services to Hospitals and Physician Groups. Our comprehensive billing solutions provide better compliance at lower costs, enabling our clients to focus on their core business that is, providing better health care.

We have all the capabilities that can improve and accelerate your revenue cycle process, so you can achieve higher productivity, faster payments, decreased costs, and improved patient service by effectively providing the following across multiple specialists:

> Patient demographic entry
> Insurance Eligibility verification
> Medical transcription
> Procedure Coding
> Diagnosis Coding
> 100% Charge capture
> Reducing your current aging AR bucket
> Collections
> Identifying root cause of claim denials
> Follow-up on denied claims
> Follow-up on pending claims
> Resubmission of claims
> Real time reporting / customized reporting

With a robust team working on transitioning and stabilizing processes with the client expected quality and turn around time, Promantra can assure you savings up to 30% to 40% on your current operational expenses. We look forward to present our credentials and walk you through our service offerings in detail.

Chirag Patel
E-mail : bd@promantra.net / chiragbp@promantra.net
Phone : 408-856-6651

Why Outsourcing to India Spells Good Business

Outsourcing is one of the strategies to respond to unprecedented market situations. The prevailing climate makes outsourcing even more vital for any business. It not only helps you survive the adverse economic climate but also thrive in unfavorable times, like economic meltdown. Outsourcing can actually add many dimensions to your business. In addition to cost cutting and immediate savings, outsourcing can also add other verticals to your business, like, controlling your cash flow, liquidity issues thereby encouraging your growth prospects. The goal is to help your organization come out strong and competitive, especially in times of financial turbulence.

The prospect of outsourcing service provider companies is large. Companies now are in search of providers that can help them with their knowledge, capability and expertise. Companies now look for providers with a good track record of success. This helps them in developing their faith that the providers can help them in bringing dramatic changes in their business. Promantra has that expertise, experience, flexibility, scale and reach that can help an organization in bringing down their cost of expenditure and increasing their margins of profits.

At Promantra, we have:
More than five years of experience in outsourcing
· Successful and satisfied clients
· More than 450 experts with strong domain knowledge
· A 24/7 round the clock delivery model

Establishing an Outsourcing Contact with Promantra can help you in:

· Improving your bottom-line performance
· Increasing efficiency
· Reduction in operational costs
· Better utilization of technology

Outsourcing is the most important tool in minimizing your cost and maximizing your profit without compromising for the quality of work. With a vast population of English speaking graduates, today India is the destination for outsourcing almost all business processes.