Health Care Compliance Watch : New York Health Care Compliance Lawyer & Attorney : Ilana Sable : NY Physician Representation Law

The Centers for Medicare and Medicaid Services ("CMS") have launched a series of outreach tools and social networking initiatives in an effort to effectively educate and update providers on the constantly changing rules, regulation and coverage activities affecting their practices. Below are three new informational tools that providers are encouraged to access and follow:

(1)   CMS YouTube Channel. While geared toward both beneficiaries and providers, the CMS You Tube channel features a catalog of educational videos on an array of healthcare-related topics, including Recovery Audit Contractors and Process Based Quality Improvements. The YouTube Channel is a recommended for providers looking to access basic information on key media issues.

(2)   Medicare Quarterly Provider Compliance Newsletter. The quarterly newsletter is intended to help physicians, providers, suppliers and their billing staffs understand how to avoid certain billing errors and other improper coverage activities when dealing with the Medicare Fee-For-Service program. You can find Volume 1, Issue 1 here (pdf). 

(3)   MLN Matters Articles. MLN Matters are national articles designed to inform the physician, provider, and supplier community about the latest changes to the Medicare program and are prepared in consultation with clinicians, billing experts, and CMS subject matter experts.  The MLN Matters Articles provide ready access to Medicare coverage and reimbursement rules in brief, accurate and easy to understand format and explain critical and up-to-date provider information in an effort to reduce the amount of time that providers need to incorporate these changes into their Medicare-related business functions. 

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For the past few weeks, my inbox has been flooded with a wave of literature focused on the upcoming conversion to the ICD-10 coding system. In almost every instance, the subject line has an extremely serious message such as “don’t be left behind” or “avoid delays in claims processing.” While I am typically an advocate for preparation and being a “go to” person, I do not see the benefit in a health care practice’s extremely early study and implementation of the ICD-10 coding system. The CMS mandated conversion date is three years away (currently set for October 1, 2013) and the entire health care industry currently uses ICD-9.

To date claims processors, insurance carriers, billing and coding programs, electronic health records systems - not to mention Medicare and Medicaid - have not yet converted to ICD-10 and are not prepared to support, receive and/or process medical bills coded to ICD-10. Furthermore, a health care practice will be hard-pressed to find a billing and coding program or an EHR system that fully supports ICD-10. 

The alarm surrounding the conversion to ICD-10 is reminiscent of the alarm surrounding the health care industry’s conversion to electronic claims processing a few years back. The similarity exists in that whether or not a practice is ready to implement a new system, namely, electronic claims processing or ICD-10 coding, the practice’s unilateral implementation is useless until processors, carriers and payors are ready to interface with the new system. The lesson learned is that the health care industry, as a whole, needs to jump on board with this type of massive system overhaul. Once the industry is ready for conversion, there will be a plethora of information, training, demonstrations and hassle for the taking.

For more information on the implementation date, logistics and so forth, see the dedicated ICD-10 page on the CMS website.

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