Tuesday, January 27, 2015

ICD-10 Codes in Non-Claim HIPAA Transactions

Most everyone involved with ICD-10 knows that the HIPAA 837 Healthcare Claims Transactions (Professional, Institutional & Dental) contain ICD-10 diagnosis and procedure codes and, therefore, must be considered when making their systems and processes ICD-10 compliant. But what other HIPAA transactions contain ICD-10 diagnosis and procedure codes?

Based on the amount of information shared on the web and some cursory research I’ve performed looking for information and guidance on non-claim HIPAA transactions impacted by ICD-10, it appears that not many people are aware that there are other HIPAA transactions that can also contain ICD-10 codes.

Which Non-Claim HIPAA Transactions Contain ICD-10 Codes?

WEDi has published a document titled “ICD-10 Impact to HIPAA Transactions”  that identifies all HIPAA transactions impacted by ICD-10. These HIPAA transactions include the following:

Healthcare Eligibility Benefit Inquiry and Response (270 & 271)

These two transactions includes the following:

1. Diagnosis Codes and a Diagnosis Code Qualifier for each code
2. Procedure Codes and a Procedure Code Qualifier for each code

Benefit Enrollment and Maintenance (834)

This transaction includes Diagnosis Codes and a Diagnosis Code Qualifier for each code.

Healthcare Services Review – Request for Review and Response (278)

1. Diagnosis Codes and a Diagnosis Code Qualifier for each code.
2. Procedure Codes and a Procedure Code Qualifier for each code.
3. Surgical Procedure Codes and a Surgical Procedure Code Qualifier for each code.

But We’ve Already Addressed this via our 5010 Upgrade!

Just because your organization is 5010 compliant doesn’t necessarily mean you’re out of the woods with your HIPAA transactions when it comes to ICD-10. Most 5010 upgrades merely tested the format of 5010 transactions and their ability to carry ICD-10 codes and qualifiers. Little, if any, focus was likley given to making sure ICD-10 procedure and ICD-10 diagnosis codes were correctly assigned to the transactions and that the transactions were correctly processed in applications: front-end or downstream. 

And it seems unlikely many organizations got into testing various processing scenarios.

Special Processing Scenarios. Like What?

There are some special processing scenarios organizations may want to consider when addressing the 278 Healthcare Services Review transactions. For instance,

What is the appropriate response to a 278 referral inquiry if the inquiry is submitted after 10/1/2015 but the original referral request was submitted prior to 10/1/2015? Is it ok to respond with a transaction containing ICD-9 codes? Will the transaction even pass any transaction compliance checks performed by your EDI tools or clearinghouse?

What about a request for a referral extension? Referrals submitted prior to 10/1/2015 will contain ICD-9 codes and would typically be valid for up to a year. If a referral request extension is submitted on 10/2/2015, which ICD code set should be used? 

I’m sure there are other considerations.

It’s Imperative!

As WEDI states in the document I noted above: “it is imperative that we have a clear understanding of where the ICD-10-CM and ICD-10-PCS codes are used in the transactions required under HIPAA and used in the health care industry to exchange diagnosis and procedure information.

Friday, December 26, 2014

List of Healthcare-Related "Top 10" Lists

It's that time of year! In case you've missed any, here's a collection of what I think are some of the better "Top 10" lists pertaining to healthcare-related topics. For more "top" information throughout 2015, consider following me on Twitter.

Last Updated: 1/05/14 @ 18:00 pm MST

General Healthcare

Providers & Payers


How to Purchase Health Insurance: Collection of Info, How-To's & Tips

The following is a list of articles and blog posts on the topics of purchasing health insurance and using health insurance once it's purchased. I shared these via my twitter account throughout 2014. For more information of this nature, consider following me on Twitter.

Purchasing Coverage

Using The Marketplace

Provider Networks

Subsidies & Related

Out of Pocket Costs

Glossaries & Terminologies


General Tips

Prescriptions, RX and Pharmacy Related


Sunday, December 14, 2014

Beyond the #ICD10Matters Hashtag - Some Ideas for Supporting ICD-10

There sure is a lot of activity being generated recently by those who support ICD-10 and those who are against ICD-10. Hardly a minute goes by that I don’t see a tweet espousing that #ICD10Matters and that there should be #NoDelay to ICD-10. Then in the next minute I see tweets calling for a 2 year delay or outright cancellation of the ICD-10 mandate. Or a blog post about those silly ICD-10 codes with references to flaming water skies and walking into lamp posts. To me, many of these tweets – regardless as to which side they take - are mostly all fire and no heat and provide little, if any, information in support of their position. I suppose ICD-10 rallies and rah-rah support is fine; but there has got to be a better way.

A Better Way?

How might social media be better used to support the ICD-10 mandate and to assist those needing to make the transition from ICD-9 to ICD-10? Since I’m on the side supporting ICD-10, I’d like to offer up some ideas to those wanting to use social media - in particular Twitter and blogging platforms - to advance the implementation of ICD-10.

1. Be clear as to who you are trying to reach.

ICD-10 impacts solo practitioners and small practices different than large group practices; certain specialties more or less than other specialties; professionals different than hospitals/facilities. And providers different than health plans. This recent post provides some good insight into how ICD-10 impacts some physician’s differently than others.

Also, consider the role or persona of the person you are trying to reach. Physicians, Coders, HIM/CDI specialists, Office Managers, etc. all have different needs, views and perspectives.

2. Leverage the pain points of certain medical specialties.

ICD-10 will impact certain medical practices to a greater degree than others. I suggest messages carrying content on specific needs and hot-button issues relative to a specific medical practice subset will better resonate and get attention.

3. Provide some value – not just a meaningless Hashtag

Sharing content that supports your position - specialty-specific information, best practices, reference materials, places to go for specific info, lessons learned, etc. – lends credibility and authority to your message.

4. Draw attention to the Big Picture and The Future

Consider how to tune the target’s focus away from basic ICD-10 compliance and toward the importance ICD-10 has on new reimbursement models many providers will be dealing with in the near term. Share the importance of ICD-10 coding in terms of risk adjustment comorbidity, accuracy, and compliance. Call out Medicare and Medicaid’s focus on managed care, accountable care, bundled payments, patient centered medical homes and other payment models that shift risk to providers; and how diagnosis coding and ICD-10 is an important part of participating in these programs.

5. Ensure your message is seen and can be seen

The #NoDelay, #ICD10Delay and #ICD10Matters hash tags have been used to help identify ICD-10 content. I’d say the #ICD10 hashtag is the most commonly used tag and should be included in every message shared.

6. Consider leveraging “healthcare IT” and related social media-based events

- There are lots of opportunities to get your message in front of those who are impacted by ICD-10. Consider leveraging the following:

- Work your message into various tweet chats. There are some popular chats like the #hitsm tweetchat#hcsm tweetchat and others where ICD-10 and closely related topics provide a forum for sharing your support for ICD-10 and spreading good information.

- Hold your own tweet chat on ICD-10. There have been several chats where ICD-10 is discussed. It seems there should be more. Who's game?

- The HIMSS 15 Conference is coming soon. You can be assured ICD-10 will be a topic of interest and the HIMSS conference should provide opportunities for spreading good ICD-10 information.

- Check the Editorial Calendar’s of primary healthcare media publications and schedule your ICD-10 promotion around the salient topics and timelines noted in those schedules.

What Other Ways Can You Suggest? 

How Can I Help?

Let me know if there's any way I can help with advancing your specific message in support of ICD-10. Leave a comment here. Send me an email at shimcode@gmail.com. And consider following me on Twitter.

Friday, November 28, 2014

Quotes and Facts from AHIP #OpsTech Conference in Phoenix

Last part! Parts 1, 2 & 3 highlighted select tweets covering a range of topics emanating from the AHIP OpsTech Forum held in Phoenix, AZ on November 17th through the 19th. In this final part, tweets sharing quotes and facts from speaker presentations are listed.

Note: See Part 1 for disclaimer about sources of these tweets.

Quotes, Quotes and More Quotes

As #health plans, we must earn RIGHT to introduce #digitalhealth solutions (to not be "creepy"), by meeting BASIC needs.

If you think of ALL things that touch #health, #payer #HCP involved in fraction of each event. Social care matters for total health

Schulte on where to focus investment: We’re looking for things that are pioneering rather than incremental.

I wanted to learn about healthcare technology, not buy someone else's technology. Sneaky vendors everywhere!

@GeisingerHealth's Steve Strongwater likens the fee-for-service system to an addiction, says it's tough to break.

Ignagni: We need to be able to give people data and information in real-time to help them make decisions about their health.

Triple-weighted STARS question: are you feeling better this year, than last? Complex answer: socioeconomic impacts #health.

Ignagni: We can’t have affordable coverage without affordable prices going into the premium dollar.

Ignagni: We can’t put our head in the sand or hand out a blank check if we are going to meet the goal of sustainability.

Willliam Taylor (@practicallyrad): You can’t be content with doing things a little bit better or a little bit differently.

Taylor: Ask yourself, "What are the ideas that define how we do business & distinguish us from how everyone else does business?"

The only sustainable form of business leadership is thought leadership. B. Nordmark

Taylor reiterates that you can’t let what you know limit what you can imagine.

We have a #diabetes problem? Who knew? - Avery & Catholic #Health Initiatives @ #OpsTech http://t.co/WlvKpYwikp

@SusannahFox: It's not simply access to information, but access to each other that is going to make healthcare better.

Almost every other sector has been greatly impacted by the Internet. Except, perhaps, healthcare!

Don't be futurists. Be nowists. Harness tech trends to bend the curve on chronic disease and #healthcare costs - @susannahfox

Statistics and Facts (Trust but verify!)

Breadcrumb: >80% of #healthplans expecting membership growth, much stronger confidence than last year. More data soon!

Invest 90-95% in simple, incremental improvements in fundamentals (access, delivery), 5% on game-changing. - @WellPoint

FEB '14 @RAND @HealthAffairs study 300K @Teladoc participants affirmed: 94% single-contact resolution rate (as to only 80% post-ED)

Data quality costs the healthcare organizations an estimated 8.2 million dollars, annually! #datagovernance

U.S. Annual Healthcare Spending Is A Stunning $3.4 Trillion, Says Study http://t.co/G6tzPd8GG0 via @forbes

Diabetes patients with complications cost health plans $20,700 annually per member. http://t.co/3bAhX09SFh

Close to 1/3 Americans don't have bank accounts, rely on manual check processing. Challenge. http://t.co/9YFmrp8jKM

Ignagni: "We can't have a healthcare system that's 50% higher in cost than other countries."

Yet somehow we do. @danmunro: Ignagni: "We can't have a healthcare system that's 50% higher in cost than other countries.

"75% of people who have #HC insurance worry that #HC costs will jeopardize their future retirement http://t.co/vEMandGXGG

Schneider on transparency: 70% of consumers are saying they want to see hospital prices and quality data online @WellPoint

Gerardi @BlueCrossMN: At current trajectory, specialty drugs would account for 35% of total medical spend in 5 years.

Dr Gerardi warns that drug costs may become 35% Healthcare costs in 5 years

46% employers plan to have #telemedicine benefit in place by end of 2014. - Stat from @Teladoc

95% consumers prefer phone consult to video. Surprising, w/ #smartphone capabilities/availability? "Give consumers what THEY want!"

Interesting tidbit for morning: Avery Telehealth guarantees a 30% reduction in re-admissions for their #mHealth solution clients.

Reading and Reference Matter

Planning on attending the session on #consumer trust and transparency? Read this before you go. http://t.co/5QdbVVkGLn

Digital Therapeutics: New Category of Medicine Being Pioneered by Omada Health http://t.co/ijOTteOMf7

Good resource: "Ignagni: Changing the Game to Deliver a 21st Century Health System for Patients” http://t.co/kQjgYuQIJH

Health Care Value In Three Simple Words: Affordability. Stability. Quality. http://t.co/1XehjTQSDN

@AHIPEducation #OpsTech is being archived here, have a look: http://t.co/eznYngeoQs

All the data and research I'm about to share at #OpsTech is freely available at http://t.co/NmLLb466Z2 and http://t.co/Hj5lNgaoxJ

Great story (via @SusannahFox) on info taking 200 yrs to get citrus included in sailors' diet to prevent scurvy http://t.co/cEUS3oERO6

@AccoladeInc Thank you! Just posted one of the "fairy tales" I shared at #OpsTech - http://t.co/ZpgcVkW3iK

One or Two In Every Crowd

Don a mustache for charity and take a knowledge challenge at the @edifecs booth. #OpsTech http://t.co/E2fr2va0cp

Thinking neon sneaks have become my fave statement accessory. They've certainly been a conversation piece! #OpsTech http://t.co/9qux9LSUOH

Tuesday, November 25, 2014

More Tweets from AHIP's #OpsTech Forum – Part 3

Downtown Phoenix, AZ with South Mountain 

In Part 1 and Part 2 of this multi-part series highlighting select tweets from the AHIP OpsTech Forum held in Phoenix, AZ on November 17th thru 19th, I highlighted tweets on healthcare consumers, consumerism, how health plans can support healthcare consumers, pricing transparency, telemedicine, and remote monitoring. In this 3rd Part, tweets on the topics of healthcare policy, patient engagement, pharmacy, and innovation are presented.


Ofman argues that b/c most other countries come from a single-payer system, their policy solutions may not be our policy solutions.

Pearson thinks if we keep seeing Sovaldi-like situations, it will create a demand for change. @ICER_review

Ofman counters, saying if you look at pricing from 2- to 5-year window you may see a much bigger problem than a 10-20 year window.

The work of making deep-seated, meaningful change; that's the work of our lifetime. It's why you're all here. @FastCompany founder

3 industry revolutions that have already changed #healthcare landscape. - @RWJF @SusannahFox http://t.co/lGpgvOv0YH

Patient Engagement

1) Identify what matters most, 2) Measure intent, 3) FOCUS on what's most crucial - how @WellPoint strives for engagement.

Continuous #health engagement: traditional participants in this industry need to partner/adapt. @KPShare http://t.co/DdRZP7fYw7

Good retail orgs have figured out how to extract $ in meaningful, positive consumer engagements. #Healthcare has NOT.

"Delicate balance of engaging and delivering clinical needs depends on creating trust and shared goals"

David Schulte of KP Ventures at : http://t.co/tladRQ7IH0 meets patients where and when they are ready to engage."

Training #HCPs to engage w/ #patients remotely proves challenge to wide #telemedicine adoption. As challenging as reimbursement?

Results of #telemedicine #patientengagement 6M pilot: 0 ED visits, 0 urgent care, LOTS of engagement action. http://t.co/2TcsS3dldL

Over time, #diabetes #patients adapt, engage, take control w/ #mhealth support. Goal: self-manage. http://t.co/HSyYEyJrRi

B/w 2005-2014, #socialmedia engagement grew from 8%-74% population. #Healthcare, you listening? @SusannahFox http://t.co/960It97zHF

90% have Internet, 60% have #smartphone, 75% use #socialmedia @RWJF powerhouses discuss future of engagement http://t.co/HbSGJc9gq5

Tools ARE sexy (think #health #gamification), but tools alone are not going to engage & retain a member. Tools must provide value.

Healthplans and Payers

Who's @ crux of challenges in #healthcare industry? They think it's us (#health #payer). Most #patients don't see us as advocates.

Ignagni on provider partnerships: We see an individual in every encounter; this data can be used to empower PCPs to improve care.

Ignagni: Health plan-provider partnership is the secret to sustainable, affordable care - See more at: http://t.co/Dvkp735a0G


Sovaldi looks like it will haunt payors in years to come

Pearson @ICER_review: Soon we’ll have one-time drugs w/a lifetime benefit; the idea of value & managing affordability is important.

Pearson @ICER_review: Even with “cost-effectiveness,” the budget impact could still be a big issue when multiplied.

Pearson @ICER_review says some policy options include changing IP rules, changing financing mechanisms, lowering the price.

Innovation, Innovation, Innovation
Focus on bending cost curve through innovation. They seem to get it. Others too focused on buzz.

With rapid tech advances, health plans will continue to embrace their role as data innovators. http://t.co/jXWW3myWLM

3 perspectives : payor, pharma, policy to explore 'balancing innovation N affordability'

Ofman: Identify low-value care so there’s room to pay for innovation. @Amgen

Gerardi @BlueCrossMN: The costs of drugs is payment innovation, payer-provider partnership discussions.

My2c: #Digital can unlock innovation in #healthcare but challenge is #inclusivity: accessible, affordable, acceptable to all

#Innovation is the act of using what you already know to get past what you THINK. - @FastCompany founder paraphrasing mentor

You can't let what you know limit what you can imagine. - @FastCompany founder on #healthcare #innovation

The opportune place for #innovation in #healthcare is in customer experience. (Think we all agree, lacking!)- @FastCompany founder

Most exciting #innovation in #healthcare: capturing / amplifying / understanding C2C conversation. -@SusannahFox http://t.co/pJloOTz5Vp

The most exciting #innovation in #healthcare is people talking to each other via internet, mobile, social - @SusannahFox

Accelerating #healthcare #innovation: align care delivery, engage w/ consumers, modernize infrastructure. http://t.co/JGc1fXYBuB

How Many More Parts?

I think I have two more; tweets from the OpsTech conference containing quotes from presenters, various interesting statistics, and some tweets pointing to good reads and reference materials.