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2019 Final Rule for Therapists

The Centers for Medicare and Medicaid Services released the Final Rule of the 2019 Medicare physician fee schedule (MPFS). It mainly includes adding physical and occupational therapists as eligible clinicians for 2019 MIPS performance year.

Pharmacy Benefit Managers and Prescription Drugs

Pharmacy Benefit Managers (PBMs) are professionals that administer prescription drug plans for payers, employers, and CMS programs with the goal of lowering prescription drug costs, improving convenience, and ensuring patient safety for payers and their beneficiaries. PBMs reduce prescription drug costs and improve quality for patients, employers, unions, and government programs by: Engaging patients to…

(620) 840-2219
UM technology
(215) 355-9434

The technological capabilities have changed the shift from volume to value-based care. The combination of value-based delivery with actionable intelligence and new care delivery models, and value-based payment with new reimbursement models with selected provider networks have pushed providers and payers to operate across a transparent, administratively simple, shared ecosystem. Nalashaa can help in mitigating…

Benefits of Utilization Management

Utilization Management is an integral part of the US healthcare ecosystem used by health insurers or Pharmacy Benefit Managers (PBMs) to evaluate the appropriateness, medical necessity, and efficiency of healthcare services rendered to patients. Utilization Management aims to: Improve the quality of service at the right cost, in the right setting Address the clinical activities of…

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Opioid Crisis and Technology

Headlines on opioid epidemic are engrossing the United States. There are tremendous impacts of opioid overdosage across the care continuum with no single solution. Impacts of Opioid Crisis The opioid epidemic is affecting the United States economy adversely. Opioid over-prescribing is shrinking the number of eligible workers (Krueger, 2017) The Hardest Hit workgroup is between…

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Areas where technology helps providers cope with the new changes Identity Management EMPI solution to detect duplicate records Duplicate records provide a splintered view of patient’s medical history, leading to unnecessary services/tests putting the patient at risk. In addition, many denials are due to the inability to identify patients correctly based on the data provided.…

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QHP review tools

The CMS provides issuers with a number of review tools to check their plans for errors in the QHP application that would result in correction notices following submission. Issuers should run each of the below tools, as applicable to their issuer type (e.g. SADP/QHP) before uploading materials to HIOS or SERFF to identify and rectify…

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Home Health Finalized Rules

CMS finalizes the calendar year 2019 and 2020 payment and policy changes for Home Health Agencies and Home Infusion Therapy suppliers. The 374-page rule sets out conditions for home health agencies to be able to participate in federal Medicare and joint federal-state Medicaid programs. Finalized Calendar Year (CY) 2019 Medicare payment updates Finalized quality reporting…

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Qualified Health Plan

The Patient Protection and Affordable Care Act (PPACA) and applicable regulations assert that health plans, including SADPs, must meet a number of standards in order to be certified as a QHP. With so many criteria to be met, let us discuss a few guidelines for payers to ensure a seamless QHP certification. QHP Accreditation Things…

An Introduction to Qualified Health Plan

The Affordable Care Act (ACA), defines QHP as an insurance plan certified by the Health Insurance Marketplace which provides Essential Health Benefits (EHBs), follows established limits on cost-sharing, and meets other requirements outlined in the application process. QHPs offer the core set of benefits, including preventive services, mental health, and substance abuse services, emergency services, prescription drugs and,…

(502) 657-9136
PHM solutions and challenges
Current PHM solutions and associated challenges

In the previous section we discussed the technologies available to enhance a PHM solution, and how it helps the healthcare industry. Current PHM solutions aim to achieve PHM goals by helping physicians identify care gaps, prevent medical errors and improve patient outcomes. However, there are challenges associated with most PHM solutions. Some of the current…

PHM Technology
reproduction cost

Healthcare organizations need to have technological capabilities within their care delivery processes to effectively use data to manage the cost and quality of care. To pursue more aggressive risk-based reimbursement models, these capabilities need to be expanded strategically and proportionately. In the previous post, we discussed the benefits of having a supreme Population Health Management Strategy.…

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(630) 886-1516

Population Health Management is the systematic process of patient data gathering, analyzing and managing patient’s data in the health care system. The changes in the healthcare industry are impacting traditional hospital reimbursement models. Before the introduction of the Patient Protection and Affordable Care Act, hospitals were reimbursed based on the volume of procedures through models like fee-for-service.…

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The data being made available through Blue Button 2.0 initiative provides opportunities to leverage this data for meaningful purposes. Depending on the motivation of the user of these systems, the purpose and approach may differ.

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BlueButton 2.0 Use Cases in Healthcare Ecosystem

Blue Button 2.0 is creating a data-centric ecosystem for Medicare beneficiaries. By facilitating access to patient health history, it has the potential to drive down Medicare spending and improve health outcomes.

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Home Health
(810) 208-6855

With the finalization of the Home Health Grouping Model, the CMS intends to shift from paying for volume to paying for value by eliminating therapy visits as a factor in payment determinations. The HHGM is expected to meet or exceed industry quality standards in healthcare by incentivizing home health providers. It also has the capability to remarkably influence the operations of home health agencies and healthcare industry as a whole.

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Home Health Grouping Model

The current case-mix adjusted payments under the Home Health Prospective Payment System (HH PPS) are therapy driven, and beneficiaries with low-income, living in under-served areas have a high severity of illness. Ideally, the Home Health (HH) payment should be determined by the patient characteristics and should equally weigh a non-therapy service. In the CY 2018…

(515) 313-4609

Cloud is the new generation platform that is evolving with a goal to solve traditional problems and to optimize resource utilization. Decades of learning is impeccably implemented in a cloud platform to continuously improve and to meet the demands of modern technology. Applications like Azure update their functions with improvements almost every week to stay…

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Benefits and Flexibility of Cloud Deployments Over Traditional Deployments

Cloud is the new generation platform that is evolving with a goal to solve the problems associated with traditional deployment. The infrastructure on the cloud could be chosen and provisioned in such a way that the costs are optimized. The applications can be deployed on a bare minimum infrastructure and later scaled up depending on…

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Blockchain usecases

Blockchain holds the potential to transform healthcare industry by assimilating the disparate processes in the pharmaceutical industry and healthcare ecosystem. This provides a milestone resulting in reduced costs, improved regulatory compliance, increased data flow, and improved patient experience and outcomes. Let’s have a look at some major use cases of blockchain in healthcare. Interoperability: Cohesive…

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Blockchain and Data Transmission

For a data-intensive industry like healthcare sector, blockchain is a reforming technology, which could revolutionize the way data is managed. The traditional way of a centralized database system is vulnerable to attacks from hackers posing major business risks. Blockchain technology could streamline the sharing of medical records in a secure way, protect the patient’s sensitive…

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Though the final version for Interpretive Guidelines is not released, CMS released a draft on the final CoPs for HHAs providing specifics on all the sections under CoPs. Check out our blog to know more.

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(601) 861-6911

Medication adherence is defined by the World Health Organization as the degree to which the person’s behavior corresponds with the agreed recommendations from a healthcare provider. It includes whether patients take their medications as prescribed as well as whether they continue to take a prescribed medication. Typical non-adherence to medications is 50% and 24-90% in mental health. The…

Nalashaa’s MU3 Certification Process

So far we have discussed the challenges and solutions of MU3 implementation and the process of the certification. To discuss further and to impart knowledge, Nalashaa HealthCare is organizing a Webinar on Medicaid MU3 2018. Through the webinar we intent to share tips and tricks on the fastest path to certification, managing the proctor relationship,…

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MU3 Certification Management Handbook

In the previous section, we have discussed the challenges while implementing MU3 and the how to solve them like an expert. Now that we have an understanding of the challenges to be expected and the ways to tackle them, we will get into the processes of MU3 certification. Though it might look like a lot…

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(440) 882-1280

According to The Centers for Medicare and Medicaid services (CMS), by the start of 2019, hospitals will be required to use 2015 certified EHR technology. Though, ample time is given for the implementation, there are some major challenges up ahead for the certification, especially when it comes to the thresholds of meeting some of the…

(319) 531-6266

Primary care practices have been given the added responsibility of coordinating advanced patient care with physicians, to ensure quality care is delivered, where and when required. More than 10% primary care practices have been recognized as Patient Centered Medical Homes or PCMHs. These would bridge the gap between treatment and coordination. There are some great…

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Value-based reimbursement has reached its tipping point and is here to stay. Of the payers and providers surveyed in the latest McKesson report, just 3% was exclusively fee-for-service. Value-based reimbursement is a proven strategy that will continue to take market share away from fee-for-service operations. What remains, however, are a few questions. How soon is…

Value-Based Healthcare is Forcing EHR Innovation

Modern electronic health records (EHR) has come to represent an umbrella term for health information technology (IT). Basically, all the tech running a hospital system. That often means installing separate solutions for each department and cobbling together an interface that fails to truly integrate the data. It’s a system that was designed to support a…

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Here as we wrap up our 3 part series on FHIR, we will discuss the business implications which FHIR brings along with it. If you have not read Part 1 or Part 2, please do so to understand more about FHIR and why it stands for the changing, better times for the healthcare industry. Business…

Part 2: FHIR – The Holy Grail

In the previous week, we have the Part 1: From HL7 to FHIR, where we discussed about HL7 and the shortcomings which we have all come across while working with it in today’s times. The changing times needed a better and well equipped interoperability standard, from where we have FHIR. Here we shall go deeper…

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Part 1: From HL7 to FHIR

In this digital era, every individual wants to see updated health data as he/she moves around the healthcare ecosystem i.e. providers, patients and caregivers should have the data available, discoverable and easily understandable. Furthermore, to support business intelligence, analytics, clinical decision support and other machine-based processing, the data must be structured and standardized in a…

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Is your EHR ready for CCM workflows?

Chronic care management (CCM) is a recent service eligible for a modest monthly reimbursement from Medicare. While the additional revenue can be healthy for your bottom line, ineffective workflows can quickly drain your potential revenue and even bring you into the red. Smart use of existing electronic health records (EHR) can help close the gap,…

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Overcoming the Technical Challenges of Chronic Care Management

The new payment model for chronic care management (CCM) offered by Medicare is a positive step toward value-based reimbursement. CPT code 99490, the latest introduction, seems simple on the surface: provide 20 minutes of non-face-to-face oversight and preventative care each month for patients with chronic disease. That requirement, however, belies its true technical challenge. Finding…

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(720) 202-1835

MACRA Medicare Access and CHIP Reauthorization Act (MACRA) is an Act that makes fundamental changes to the way Medicare payments to physicians are determined, how they are updated, and how they incentivize physicians. This act: Repeals the Sustainable Growth Rate(SGR) methodology for determining updates to the Medicare physician fee schedule(MPFS), establishes annual fee updates in…

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Modified Stage 2 for EHR Incentive Program

All the providers will need to take into account the new Final Rule released by CMS in October. Here’s all what you need to know about the Modified Stage 2 for EHR Incentive Program in 2015 through 2017. Goals for the Modification: Align with Stage 3 to achieve overall goals of programs Synchronize reporting period…

(708) 550-9578
HIPAA Technical Safeguards

With OCR raising the seriousness levels of all covered entities in the healthcare Eco-system, it’s important for providers as well as Independent Software vendors (ISVs) to comprehend the various requirements that HIPAA imposes. The write-up below touches upon these requirements from a software capability perspective. Technical safeguards focus on the technology that stores or processes…

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Data driven healthcare solutions is to be the way ahead for the healthcare industry. Gone are the days when personal experience and word of mouth were the drivers behind healthcare decisions. Today’s patient needs numbers to validate what you have to say, and these numbers should be made available to them to make an informed…

How Clinical Data gains importance in the face of Incentive Payouts for Healthcare Payers?

Researchers at University of Washington Tacoma have developed a machine-learning predictive analytics tool that forecasts with 82 percent accuracy the probability a patient will be readmitted within 30 days. In 2011, the federal government estimated that 30-day Medicare readmissions for all causes cost a whopping $26 billion annually, with $17 billion being attributed to avoidable…

(951) 772-9370
ICD-10 – Bringing in practicality to the anxiety

Amongst all the legislative activities, we still have October 1, 2015, as the date set for now as the deadline for ICD-10 code set switch-over. The Centers for Medicare & Medicaid Services announced last Monday that it would work with the American Medical Association (AMA) to ease the transition to ICD-10. For the first 12…

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March 8 – 14 was the patient safety awareness week, and as we at Nalashaa look deeper into our goal – accountable healthcare; we will be understanding Patient Safety Reporting in this post. Patient safety event reporting is one of the quality improvement requirements as mandated by the Affordable Care Act (ACA).  At a Senate…

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QOPI – Aiming to assess and improve cancer care

Quality Oncology Practice Initiative (QOPI) is a program by the American Society of Clinical Oncology (ASCO) exclusively for outpatient chemotherapy clinics and practices, to work as a tool to measure performance and target improvements. In 2012, the number of registered QOPI participants was 200, spread across 42 states. In a period of 2 years, the…

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PQRS Claim-based Reporting

As discussed in previous post, PQRS reporting can be done using various methods: Claims-based Registry-based Qualified Electronic Health Record (EHR) Qualified Clinical Data Registry (QCDR) Group Practice Reporting Option (GPRO) PQRS Claim-based reporting The eligible professional must satisfactorily report on 50% of eligible instance for individual measure or 20 patients when reporting a measure group…

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PQRS is an abbreviation for Physician Quality Reporting System formerly known as the Physician Quality Reporting Initiative (PQRI). It is a reporting program that uses a combination of incentive payments and negative payment adjustments to promote reporting of quality information by eligible professionals (EPs). Payment Adjustments The program provides an incentive payment to practices with…

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ICD-10: How to leverage the data?

ICD-10 has always been linked to billing, and this is one of the biggest areas, no doubt. But, the data collected via ICD-10 coding practices will find uses in a much wider arena. Moreover, these can be seen as the added benefits of having a thoroughly tested, and well – implemented ICD-10 coding system. Apart…

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Urgent care clinics or minor emergency setups are springing up all over riding on the need for quick medical assistance and owing to the waiting periods at regular hospitals. One of the main difference between these clinics and regular hospitals is these clinics do not take Medicaid, and hence are not required to attend to…

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The healthcare industry is undergoing a significant change with connected health being the way ahead. To create effective connections, we need to ensure a network architecture which will help in serving the needs of all those involved, from care givers to lab technicians to patients. Blue button initiative is a step in patient empowerment, allowing…

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(862) 596-5699

The healthcare industry is undergoing a significant change with connected health being the way ahead. To create effective connections, we need to ensure a network architecture which will help in serving the needs of all those involved, from care givers to lab technicians to patients. Blue button initiative is a step in patient empowerment, allowing…

Genetics Cloud: A tremendous aid to medical screening

Cloud computing can help in considerably reducing the time and effort put in by genetic researchers by storing and analyzing individual gene sequences at a much faster rate than what can be done locally on a system. Further these gene sequence information which is stored on the cloud can prove to be far more effective…

(406) 514-8876

The mobile health monitoring space is a staggering USD 9 billion as of today, and is only getting bigger. Wearable technology will make the process of health data collection simpler, and empower a large user base. Fitbit, Jawbone, Nike, Withings are some of the names which have made it big in the wearable devices space.…

ICD-10 switch for non-covered entities

The switch to ICD-10 coding standards is mandatory for all HIPAA-covered entities that use electronic medium for claim transactions. Ideally, this standard does not apply to those which will operate via paper claims. But, there are many non-covered entities that are making the transition to ICD-10 coding standards, even though they are not required to…

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Wearable technology, the hope for those living with Parkinson’s

Parkinson’s disease (PD) is a slow degenerative disease which kills the brain cells causing tremors and some extend of rigidity, and loss of motor functions. It eats away at the dopamine releasing neurons, resulting in a drop in dopamine within the brain, causing the locomotive difficulties in patients. The most common side effect for patients…

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ICD-10 testing strategy for 2014

With the delay in ICD-10 in late March 2014, there has been a general aura of unsettlement in the healthcare IT space, with providers being unsure on what is expected of them, and by when. In the AHIMA summit held in April 2014, 88% of the healthcare participants were unhappy with the ICD-10 delay and…

(212) 378-0357
Wearable technology and cloud: The next generation of healthcare

Recently, we spoke about personalized medicine and the role they play in today’s medical practice. These solutions have successfully helped to monitor and manage the medical conditions of many patients. Last week, Miss Idaho proudly displayed her insulin pump during one of the rounds of the beauty pageant, and was applauded by the jury and…

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Cloud based EHR are gaining momentum and is almost set to surpass the traditional client server EHR systems. Many small practices see the benefits associated with the cloud and having the EHR in the cloud seems to be the most compelling proposition for many of them. For a cloud based EHR system, the practice data…

(334) 528-8382
Future of Healthcare: Personalized Medicine and Digital Health

This is the first part to a series which will cover the role of healthcare IT in biotechnology and medical sciences. The future of healthcare lies in two major components: Digital Genetics Let us understand how these two major advancements in healthcare will change the face of the industry. Genetics At present, the healthcare practice…


The Blue Button initiative was aimed at allowing patients to download their EHR information from their MyHealth accounts and opening up the healthcare content from inaccessible sources. The aim was to make this file ‘very simple’ and hence this information was provided in a plain text or PDF format. These formats are only usable for…

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(334) 666-3586

Computer Assisted Coding or CAC has gained importance with the ICD-10 implementation road map underway at most healthcare providers. The CAC software will help preserve accounts receivable and accounts payable resulting in accurate, compliant medical coding and reimbursements. Traditionally this process was performed by coders, but with the recent changes in the coding standards, and…

Blue Button+: A guide for EMR/EHR/PHR ISV’s (Part 2)

We had previously discussed the methodology for Bluebutton+ to access data in the EMR/EHR/PHR system in the first part of our discussion. In the previous post we had skipped the registration process, which we will be covering in this part. The goal of Meaningful Use aims to provide consolidated information for patients and healthcare providers.…

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A Successful mHealth strategy crucial for Meaningful Use

The mHealth market is forecasted to reach $58.8 billion by 2020. For Meaningful Use Stage 2 incentive pay outs, one of the key essentials is that the providers need to successfully engage patients in their own health decisions. Why do we need a mHealth strategy? To move towards these goals and to comply with accountable…

How is the HL7 interface affected by the ICD-10 codes?

HL7 interface engine is an integration platform specifically for the healthcare industry and its numerous legacy systems. The data from these legacy systems are under many circumstances non compatible with other systems in the network and at many times with the payer systems. HL7 also provisions for integration with outsourced services like teleradiology, hence lowering…

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Blue Button+: A guide for EMR/EHR/PHR ISVs (part 1)

What do you need to know about the Blue Button+? The Blue Button initiative started in 2010, to empower patients with their health data and improve quality of patient -clinician interaction. Blue Button+ extends the concept to include standardized data formats and added features for trusted, automated exchange of healthcare data, and advanced parsing to…

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As the Senate passed the bill putting into motion the ICD-10 delay, there are many questions which have been popping up. There are many providers who have been ready or who would be ready by the October 1, 2014 deadline and for them to roll back to the previous coding practice would be wasteful and…

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ICD-10: A cloud approach

Does this mean things should be slowing down? This is a golden opportunity for healthcare ISVs who are preparing to embrace cloud and provide easily scalable solutions to move ahead with their plans. A hosted service model or Software- as-a-service (SaaS) certainly offers potential in easing the pains of organizations in the midst of HIPAA…

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What do we mean that ICD-10 is more specific?

While there are dozens of minor distinctions between ICD-9 and ICD-10 the three fundamental changes are: There is expanded detail for many conditions (e.g., viral hepatitis has been expanded from ICD-9 070, a single 3-digit category, to ICD-10 B15-B19, five 3-digit categories Conditions were transferred around the classification (e.g., hemorrhage has been moved from the…

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ICD-10: Effective Implementation and Testing

ICD-10 codes need to be implemented by the practice management, billing and EHR vendors to ensure a smooth transition and bill reimbursements. One of the major risks in this transition process is having a vendor not prepared in assisting you with updated, tested software. Without proper guidance and a chalked out schedule from the vendor,…

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Payers are gearing up for the testing phase of ICD-10, one which is bound to be cumbersome and a long process. There are numerous partners involved in the process, and working with various providers and clearinghouses ensuring they accept the codes, will require adequate testing procedures to be put in place. ICD-10 testing process by…

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Centre of Medicaid Services conducted a ICD-10 testing routine to smoothen claims processing prior to the October 1, 2014 deadline. March 3 -7 2014 was the week wherein a limited number of providers could conduct ICD-10 testing through local MACs (Medicare Administrative Contractors). This brief period worked as a good dry run to practice the…

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(302) 658-5257

The new ICD-10 coding system is to be implementation in the coming 7 months, and there are many assumptions which can cause an unfavorable result of this implementation process. Here we try to look at the common beliefs which have plagued this implementation process Myth: HHS will grant an extension beyond Oct. 1 2014 Fact:…

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(575) 655-8489

Emergency department physicians face a broad scope of medical emergencies and quick decisions are made, impacting the patient well being. Under such circumstances, putting more burdens on physicians is unfair and unwise. The transition to ICD-10 will require added responsibility on the physicians to document diagnosis in an ICD-10 suited manner to ensure correct billing.…

(604) 421-9409
Major Differences Between ICD-9 and ICD-10

The ICD-10 code set is not just a simple update to the ICD-9 code set. They are both different in the fundamental structure and concepts, and it is important to understand the differences between them for a smooth transition from ICD-9 to ICD-10. Differences between ICD-9 and ICD-10 ICD-10 codes are very specific as opposed…

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ICD-10: With 8 months at hand, things to do now

ICD-10 CM diagnosis codes and ICD-10 PCS procedure codes for patient services will be effective as of October 1 2014. Many providers have been actively getting their software upgrades in place from vendors, but they have not been communicating with all the parties involved to ensure that the transition process proceeds smoothly. Many key stakeholders…

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Stage 2 of Meaningful Use sets goals for healthcare professionals more rather than for technology. But, this does not mean that there would not be technology changes which would be required, as the core is electronic records which are to be used in a meaningful manner by medical practitioners and hospitals. The following tabulates the…

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(806) 393-1690

The US healthcare system is to begin using Clinical Modification ICD-10-CM for diagnosis coding and Procedure Coding System ICD-10-PCS for inpatient hospital procedure coding by October 1, 2014. It has been suggested by the Centers for Medicare & Medicaid Services (CMS) that this process should be done over a long duration to ensure seamless implementation,…

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