Thursday, May 26, 2011

ICD-10 Conversion: What Are You Most Concerned About?

We all know that as of October 1, 2013, health providers will be required to adopt the new ICD-10 code sets. A recent study by HIMSS Vantage Point noted that the greatest challenge (one-third of respondents) organizations face as they undertake ICD-10 conversion is a lack of staffing resources. Another 19 percent noted that a lack of synchronization between payers and providers would present challenges.

We know there are a lot of questions and concerns about the conversion. The good news is that when you work with Daymarck on your coding needs, you can have confidence that our certified coders are up-to-date on ALL the latest regulatory changes. 

Drop us a line or share your thoughts on the conversion in the comments section. We want to be there for you to make your coding as pain-free and as easy as possible.

Tuesday, May 17, 2011

The Old Adage: If It Is Not Documented, It Was Not Done

By Elizabeth E. Hogue, Esq.

The old adage, “If it is not documented, it was not done;” is unfortunately often true.  The consequences of failure to document may be severe in terms of allegations of fraud and abuse.  The Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services has repeatedly stated that providers carry the burden of proving that care was actually rendered to patients.  If practitioners are unable to prove that they rendered appropriate care because it is not documented, the OIG and other fraud enforcers may conclude that claims submitted by these providers are false claims. 

The consequences for submission of false claims are potentially severe.  The amount of the false claims may, for example, be tripled and providers may be required to pay this amount.  Millions of dollars and sometimes the ability of providers to continue their businesses may be at stake.

Consequences of submission of false claims also include suspension or exclusion from participation in the Medicare and Medicaid Programs, including Medicaid waiver programs, and other federal and state health programs such as Tri-Care.  Few providers can survive the loss of all reimbursements from both federal and state healthcare programs.

Providers also risk liability for negligence or malpractice when they fail to document  care provided.  Risks are greatly enhanced when providers make recommendations to patients that they reject, and neither the recommendation nor refusal are documented.  A recent case, Amos v. Louisiana Med. Mut. Ins. Co., No. 41, 302-CA (La. Ct. App. August 4, 2006) illustrates this point.

In this case, Dr. Rebecca L. Crouch treated Mr. Joseph Lee Amos for bleeding after bowel movements.  Mr. Amos eventually sought a second opinion from a different doctor.  The second physician Amos saw disagnosed colorectal cancer.

Amos sued Dr. Crouch and her professional liability insurer, Louisiana Medical Mutual Insurance Company.  He claimed that Crouch breached applicable standards of care when she failed to recommend and conduct diagnostic testing indicated by Amos’ symptoms.  Amos claimed that Crouch’s breach of standards of reasonable care caused a delay in diagnosis and treatment of his cancer.

In response, Crouch argued that she had, indeed, recommended to Amos that he undergo appropriate tests, but that he refused to allow such testing.   Crouch, however, had not documented the recommendation or Amos’ refusal.  Crouch testified that she remembered the conversation with Amos in which she recommended tests that he refused.

The Court concluded that the “absence in Mr. Amos’ medical records of any notations indicating that Dr. Crouch recommended he undergo either a proctoscopy or colonoscopy is circumstantial evidence from which the trier of fact could reasonably conclude that Dr. Crouch never made any such recommendations.”  In other words, because it was not documented, it is reasonable to conclude that it was never done.

If allegations of fraud in the form of false claims had also been made against Dr. Crouch because the care she provided to Amos was substandard, it is likely that the allegations against her would have been substantiated.

A word to the wise should be sufficient: Documentation is crucial to avoid fraud and abuse and to manage risks.

Contact Elizabeth Hogue

Office:  877-871-4062
Fax:  877-871-9739

© 2011 Elizabeth E. Hogue, Esq.  All rights reserved. 
No portion of this material may be reproduced in any form without the advance written permission of the author.

Monday, May 2, 2011

How to Work With Us

Daymarck is Pain-Free Coding

We want to make it easy for you to work with us. This is why we have established simple methods to help with your coding needs. Read below to find out what we need from you to ensure accurate and efficient coding.

What we need
To ensure accurate ICD-9 codes to be assigned, the following information is required: 
  1. Referral information (i.e. why patient was referred to homecare)
  2. OASIS/Comprehensive Assessment 
  3. Care Plan (it can be a draft) 
  4.  Medication list at the time of the assessment
Additional Information that helps us accurately code: 
  1. History and Physicals
  2.  Hospital Treatment Notes
  3.  Discharge Notes 
  4. Therapy Evaluations

It is also very important to NOT send irrelevant information such as maps, driving directions, and blank pages. By eliminating those types of non-pertinent information, we are able to maintain a quick turnaround time and keep your costs low.

How we get the data
The quickest and most cost effective way, as far as time, fees and production, is one pdf file uploaded for each patient or case that needs coded. But we know that isn’t possible for every agency or situation. Talk to us and we can come up with a solution that works for you.
Here are a few ways our clients send us the data:
  • Run a few reports and put them together using Adobe Acrobat Pro or Standard or similar pdf creator.
  •  Scan the paper and bind it together in one pdf file with the reports they ran out of their system.
  •  Give Daymarck remote access into their electronic system via VPN or other remote access methods and we run the reports and create the patient document (additional fees do apply).
  •  We accept faxes. Agencies who are on paper or prefer to print everything can then fax us patient documentation and it drops right into our system.
  • And, lastly, some agencies use a mix of both methods - they fax us a couple pages with a cover page and then we can remote in and get the info out of their system.