Tuesday, April 17, 2012

New ICD-10 deadline will be Oct. 1, 2014

New ICD-10 deadline will be Oct. 1, 2014

Washington Federal health officials are using an administrative simplification rule to propose delaying by one year the implementation of new diagnosis coding sets used for billing medical services.

ICD-10 diagnosis codes would be required for billing physician services starting on Oct. 1, 2014, according to the April 9 proposed rule from the Dept. of Health and Human Services. Currently, doctors and hospitals use the ICD-9 standard, which contains far fewer individual codes but also permits less specificity when making diagnoses. The proposed rule is expected to be finalized this year after a 30-day comment period.

The American Medical Association led the movement to push off the ICD-10 implementation deadline, citing concerns about doctors’ ability to be compliant by Oct. 1, 2013. The substantial number of new codes that must be learned, combined with initial problems with implementing the new 5010 electronic transaction standards that are a prerequisite for taking on the new code sets, presented a substantial burden for physician offices, the AMA said.

Physicians also were being asked to meet several other quality and health information technology initiatives at the same time as the coding upgrade, including adoption of electronic health records and participation in the physician quality reporting system. The October 2013 deadline would have come at a particularly inopportune time, the Association has said.

Marilyn Tavenner, acting administrator of the Centers for Medicare & Medicaid Services, signaled to physicians that HHS was re-evaluating the ICD-10 deadline during the AMA National Advocacy Conference in Washington on Feb. 14, but she did not indicate how long the implementation delay would be. The proposed rule formalizes the one-year delay and a plan to establish a unique identifier for health plans.

The proposed rule is the latest in a series of administrative simplification policies authorized by the national health system reform law. HHS estimates that cutting red tape for health professionals and plans will save them up to $4.6 billion in administrative costs during the next decade.

Requiring each health plan to have a single, unique identifier is designed to eliminate problems that arise when plans and other third-party administrators use different identifiers that lack a standard length or format. This can result in processing, payment or eligibility mix-ups, HHS said.

“These important simplifications will mean doctors can spend less time filling out forms and more time seeing patients,” HHS Secretary Kathleen Sebelius said in a statement.

Monday, April 9, 2012

ICD-10 to ICD-11

Why we can't skip ICD-10 and go straight to ICD-11 

Since the recent announcement by CMS that ICD-10 implementation will be delayed for certain healthcare entities, some industry pundits have argued, "Let's just skip ICD-10 and go straight to ICD-11."

Skipping ICD-10 assumes that we haven’t started implementing ICD-10. Well, the U.S. did start—19 years ago.

What have we been doing for the last 19 years?

Federal agencies kicked off ICD-10 implementation in 1993 by preparing to develop a clinical modification of ICD-10 (a U.S. version), then getting a grant and assigning a contractor to develop a clinical modification. Ditto for a procedure coding system.

There were extensive comment periods for both systems, testing of both systems, more comment periods, preliminary crosswalks, adoption of the WHO version of ICD-10 for mortality reporting in 1999, pilot studies, cost analysis studies, coding guidelines and references published, letters urging the adoption of ICD-10 as a HIPAA standard, hearings, and public domain mappings.

There were programs launched to train ICD-10 trainers and a CMS pilot project to convert MS-DRGs, more letters and ICD-10 industry conferences.

Then came the proposed rule, final rule, adoption of HIPAA 5010 in part to accommodate ICD-10 codes, then extensive government outreach programs, and ICD-10 MS-DRG grouper pilot software released for testing, followed by many, many payment, code edit, and care management systems converted to ICD-10.

The quality measures were converted; there was 5010 preparation, more outreach and education, and modifications to both ICD-10 code sets via public process every year since 2003.

And, of course, don’t forget advocacy or resistance from one or another sector of the industry at and between every step taken above and still going on.

Changing from ICD-9 to ICD-10 is not something that just happens on a certain date. To drag this lumbering, squabbling bunch of groups that form the U.S. healthcare system to undertake a change of this magnitude takes time. We can’t skip ICD-10 because we have already spent 19 years getting this close to implementing ICD-10. (2013 would have made it an even 20, a milestone for an effort that began the year the World Wide Web was born!)

It has taken us 19 years to get this far. Unless we willfully ignore our own human nature, we should expect the same slow-mo street fight to implement ICD-11, lasting roughly two decades. This letter (PDF) from the National Committee on Vital and Health Statistics contains an excellent 20-year history of ICD-10 in this country.

We could have skipped ICD-10 in 1993—it’s a bit late now.

Let’s go ahead and implement ICD-10 in 2013 or 2014, and decide now to implement ICD-11 in 2024. Maybe if the healthcare industry sets the timeline up front, we could cut the implementation timeline in half. Planning now for ICD-11 would have the added benefit of establishing a new expectation in the industry—that regular upgrades to any system that facilitates the exchange of data is normal and expected. Postponement as a strategy for doing nothing will not fly any more.

Sutherland, Genpacte Eye Apollo BPO

Sutherland, Genpact eye Apollo BPO

MUMBAI: Back office majors Sutherland Global Services and Genpact are in the final race to acquire Apollo Health Street, the healthcare business process outsourcing (BPO) arm of Apollo Hospitals, in a deal valued at over Rs 1,100 crore ($220 million), said two separate sources briefed on the matter.

Sutherland, which has put in a higher bid, may be the front-runner to buy the asset even though both contenders are completing the due diligence process. Apollo Hospitals and associates hold about 54% stake, while Temasek Holdings, One Equity Partners and other financial investors have the remaining shares in the 12-year-old BPO firm. Barclays and Kotak Mahindra Capital are advising the promoters on the potential sale process.

The transaction is expected to value Apollo Health Street at about two times revenue , which is estimated at a little over $100 million. Apollo counts the BPO unit as a noncore investment and has been open to divesting its interest, though in the past it has stated intention to retain part of the shareholding. "We are open to strategic partnerships but there is nothing as yet," said a top Apollo executive, who didn't want to come on record. One of the sources mentioned earlier said Apollo may decide to fully exit or retain a stake.

"It can still swing both ways," he added.

Apollo Health Street takes up the outsourced financial and technology work for the big healthcare service providers , helping them to run profitable and efficient operations . It has 12 delivery locations , including four in India. The Prathap C Reddy family owned Apollo Hospitals is India's largest healthcare service provider with a network of 54 hospitals.

A Genpact spokesperson declined to comment on speculation, while an emailed query to Sutherland remained unanswered at the time of going to press.

The acquisition may help players like Sutherland and Genpact to scale up in the healthcare BPO market, which is expected to benefit from US president Barack Obama's reforms extending insurance cover to more Americans and the transitioning to an advanced classification of disease coding. The combined opportunity pool could be as big as $20 billion in the next five years.

BPO biggies like the $1.6-billion Genpact have been on the prowl for buyouts to bolster business verticals like healthcare and insurance. Last year, the NYSE-listed firm acquired Headstrong and EmPower Research, as part of a plan to expand consulting and business research practices.

The privately-held Sutherland , backed by Standard Chartered Private Equity and Oak Investment Partners, was founded by ex-Xerox employee Raj Vellodi in 1986. Its clients are from the retail, banking, insurance, healthcare, telecommunications and travel & hospitality sectors, and have global delivery centres in United States, Canada, Mexico, Philippines, United Kingdom and India, employing 25,000 people.

Thursday, April 5, 2012

CCS Exam Content Outline

 CCS Exam Content Outline:

 Number of Questions on Exam:

 81 Multiple Choice (18 unscored/pretest)
 8 Multiple Select (2 unscored/pretest
 12 medical record cases

Exam Time: 4 hours – no breaks

DOMAIN I. Health Information Documentation (10%)

1. Interpret health record documentation using knowledge of anatomy, physiology, clinical disease processes, pharmacology, and medical terminology to identify codeable diagnoses and/or procedures.

2. Determine when additional clinical documentation is needed to assign the diagnosis and/or procedure code(s).

3. Consult with physicians and other healthcare providers to obtain further clinical documentation to assist with code assignment.

4. Consult reference materials to facilitate code assignment.

5. Identify patient encounter type.

6. Identify and post charges for healthcare services based on documentation.

DOMAIN II & III. Diagnosis & Procedure Coding (64%)


1. Select the diagnoses that require coding according to current coding and reporting requirements for acute care (inpatient) services.

2. Select the diagnoses that require coding according to current coding and reporting requirements for outpatient services.

3. Interpret conventions, formats, instructional notations, tables, and definitions of the classification system to select diagnoses, conditions, problems, or other reasons for the encounter that require coding.

4. Sequence diagnoses and other reasons for encounter according to notations and conventions of the classification system and standard data set definitions (such as Uniform Hospital Discharge Data Set [UHDDS])

5. Apply the official ICD-9-CM coding guidelines.


1. Select the procedures that require coding according to current coding and reporting requirements for acute care (inpatient) services.

2. Select the procedures that require coding according to current coding and reporting requirements for outpatient services.

3. Interpret conventions, formats, instructional notations, and definitions of the classification system and/or nomenclature to select procedures/services that require coding.

4. Sequence procedures according to notations and conventions of the classification system/nomenclature and standard data set definitions (such as UHDDS).

5. Apply the official ICD-9-CM coding guidelines.

6. Apply the official CPT/HCPCS Level II coding guidelines.

DOMAIN IV. Regulatory Guidelines and Reporting Requirements for Acute Care

(Inpatient) Service (5%)

1. Select the principal diagnosis, principal procedure, complications, comorbid conditions, other diagnoses and procedures that require coding according to UHDDS definitions and Coding Clinic for ICD-9-CM.

2. Evaluate the impact of code selection on Diagnosis Related Group (DRG) assignment.

3. Verify DRG assignment based on Inpatient Prospective Payment System (IPPS) definitions.

4. Assign the appropriate discharge disposition.

DOMAIN V. Regulatory Guidelines and Reporting Requirements for Outpatient

Services (6%)

1. Select the reason for encounter, pertinent secondary conditions, primary procedure, and other procedures that require coding according to UHDDS definitions, CPT Assistant, Coding Clinic for ICD-9-CM, and HCPCS.

2. Apply Outpatient Prospective Payment System (OPPS) reporting requirements:

a. Modifiers

b. CPT/ HCPCS Level II c. Medical necessity

d. Evaluation and Management code assignment (facility reporting)

DOMAIN VI. Data Quality and Management (4%)

1. Assess the quality of coded data.

2. Educate healthcare providers regarding reimbursement methodologies, documentation rules, and regulations related to coding.

3. Analyze health record documentation for quality and completeness of coding.

4. Review the accuracy of abstracted data elements for data base integrity and claims processing.

5. Review and resolve coding edits such as Correct Coding Initiative (CCI), Medicare Code Editor (MCE) and Outpatient Code Editor (OCE).

DOMAIN VII. Information and Communication Technologies (3%)

1. Use computer to ensure data collection, storage, analysis, and reporting of information.

2. Use common software applications (for example, word processing, spreadsheets, and e-mail) in the execution of work processes.

3. Use specialized software in the completion of HIM processes.

DOMAIN VIII. Privacy, Confidentiality, Legal, and Ethical Issues (4%)

1. Apply policies and procedures for access and disclosure of personal health information.

2. Apply AHIMA Code of Ethics/Standards of Ethical Coding.

3. Recognize/report privacy issues/problems.

4. Protect data integrity and validity using software or hardware technology.

DOMAIN IX. Compliance (4%)

1. Participate in the development of institutional coding policies to ensure compliance with official coding rules and guidelines.

2. Evaluate the accuracy and completeness of the patient record as defined by organizational policy and external regulations and standards.

3. Monitor compliance with organization-wide health record documentation and coding guidelines.

4. Recognize/report compliance concerns/findings

CCS Exam Specifications

CCS Exam Specifications

Multiple Choice Section - The multiple choice section will consist of 81 single response multiple-choice items (63 "scored" and 18 "pre-test" items). Pre-test items are unscored items that are included in the examination to assess the item's performance prior to using it for operational use in a future examination. The pre-test items are scrambled randomly throughout the examination and do not count toward the candidate's score.

Multiple Select Section - The multiple select section will consist of 8 multiple response items (6 "scored" and 2 "pre-test" items). Pre-test items are unscored items.

Fill in the Blank Section (Medical Record Cases) - The fill in the blank section will consist of 12 medical record cases, which contains six outpatient records and six inpatient records.

Inpatient diagnoses and procedures are to be coded with ICD-9-CM volumes 1-3; ambulatory care diagnoses are to be coded with ICD-9-CM volumes 1 and 2; and ambulatory care procedures with CPT. 

The total testing time for the exams is 4 hours