The differences between ICD-9 and ICD-10 stem from the aims of the newer coding standard. Of particular interest to specialty practices, ICD-10 will much more adequately and accurately describe care and will serve much better for reimbursement purposes, for which ICD-9 was never intended. For ICD-10 to deliver these advantages, it must offer a much larger number of codes. ICD-9’s smaller format restricted its code capacity, which had simply hit its limit. That’s why ICD-9 is being retired on October 1, 2015, in the transition to ICD-10, which affects coding for patients covered by any health insurance, not just Medicare or Medicaid. Specialty practices with insurance reimbursements need to focus only on ICD-10-CM, which is for all diagnosis coding, and can ignore hospital inpatient coding’s ICD-10-PCS.

Meaningful use holds a catch for specialists; some requirements are inapplicable to certain specialties, yet there are no “blanket” exclusions for which any affected practices can qualify. CMS publishes a specialist tipsheet that helps in identifying which exclusions may apply, but specialist practices are completely responsible for evaluating “whether they meet the exclusion criteria for each applicable objective.” As specialists who participated in meaningful use Stage 1 prepare to advance to Stage 2, there are two important factors to consider regarding the choice of an electronic medical record (EMR) technology partner: The EMR must be ONC-ACB certified for meaningful use Stage 2. The EMR should also ideally be designed specifically to support the practice’s specialty.

Most specialty providers have a general sense of the distance between where they stand today with ICD-10, and where they need to be when the ICD-10 transition officially occurs on October 1, 2015. The actual size of that gulf is largely a matter of the electronic medical record (EMR) in use. If the EMR will do all that it can (and should) to automate the transition, the ride to ICD-10 should be pleasantly smooth.

With healthcare’s shift towards value-based reimbursement models and an emphasis on quality of outcomes over quantity of services performed, there is also a push for physicians to dig deeper into their reporting. In order to encourage improved quality measures reporting, the Centers for Medicare & Medicaid Services (CMS) created the Physician Quality Reporting System (PQRS). The program, created in 2007, has both non-reporting payment penalties and reporting payment incentives for physicians who treat patients covered by Medicare Part B. Those who don’t participate in 2014 face a 2.0 percent payment penalty for Part B claims which will be assessed in 2016. Likewise, those who do report quality measures via PQRS are eligible to receive a 0.5 percent payment bonus on all claims in 2014. At first glance, the list of quality measures that can be submitted to PQRS is daunting, and many do not apply to specialty practices. Luckily for most specialty practices, the respective trade associations have done the legwork and have pulled out the applicable measures that can be used for submission. As such, specialty practices should check their association’s website for guidance in navigating the submission process.

As many in the industry noted, Stage 1 Meaningful Use (MU) was largely geared toward general practices, and has been described as a “one size fits all” approach that did not take into account the varied nature of specialty providers. Although there were exemptions that specialty practices could qualify for in Stage 1, the initial confusion surrounding the guidance created challenges for many providers. CMS has now provided guidance on Core, Menu and Clinical Quality Measures (CQM) exclusions. CMS has been very clear that potential exclusions are not based on a particular specialty, but rather on the specific data that a practice does not collect because it is not relevant to their practice. They note that there are no “blanket” exclusions for any type of provider and that the physician is responsible for “evaluating whether they meet the exclusion criteria for each applicable objective.” After receiving numerous comments from medical societies, industry associations and other stakeholders, it seems that CMS is listening to the concerns that have been raised by specialty providers. With MU2, providers have more clarity regarding the process for reporting Core, Menu and Clinical Quality Measures. For example, CMS has published a Meaningful Use for Specialists Tipsheet.

Nextech has been committed to supporting our clients through the challenges of attesting for Meaningful Use Stage 1, and we’re now prepared and dedicated to assist with Stage 2. We have been hard at work to ensure that our solutions, including Nextech with NexERx version 11.0, Nextech with NewCropRx 11.0, Nextech 11.1, and Nextech 11.2, are compliant with the ONC 2014 Edition criteria, and we’re pleased to announce that they have been certified as Modular EHRs by the Certification Commission for Health Information Technology (CCHIT®). For the past 17 years, Nextech has been the leader in technology for specialty practices and has supported more than 7,000 surgeons and physicians and more than 40,000 staff members. Our clients trust us to provide technology that increases the efficiency of their practices and allows them to stay in regulatory compliance.

Healthcare professionals are bracing for a big change in 2014. Beginning October 1, providers across the nation will make the switch from ICD-9 to ICD-10 diagnostic code sets, a move that hasn’t been made since 1979. With no grace period allotted by the federal government, physicians are charged with coming up with a plan of attack for implementing ICD-10 and getting their staff fully functional by the Oct. 1 deadline. Integrating ICD-10 into daily practice operations will need to start with a complete understanding of the major differences between ICD-9 and ICD-10. The most obvious change buzzing throughout the industry is the vast difference between the number of codes provided by ICD-10. Under the new system, codes will increase from 18,000 to more than 140,000. Federal healthcare regulators say the upsurge of codes will allow for more specific documentation during patient visits. For example, physicians documenting a patient who broke their arm will be asked to specify whether the right or left arm was broken, a detail not provided with the basic ICD-9 code sets. Another difference providers will notice immediately: code structure. As opposed to ICD-9 codes, the ICD-10 code sets will include numbers as well as letters. The length of the code will also change. ICD-10 diagnostic codes will range from 3-7 characters while procedure codes will include 7 alpha-numeric characters.

It’s a new day in the medical industry. As of Sept. 23, new changes to Health Insurance Portability and Accountability Act (HIPAA) regulations have been sweeping the healthcare field, forcing physicians to keep a closer eye on the security of protected health information (PHI). The new revisions, also referred to as the “Omnibus Final Rules,” place added pressure on doctors to protect medical records with the threat of stiff fines for violators. Stemming from the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, the new HIPAA regulations were announced Jan. 17, 2013, by the U.S. Department of Health and Human Services (HHS). The revamping of HIPAA’s rules comes as the federal government continues its push for early adoption of electronic medical records (EHRs). With billions of dollars in incentive payments going toward early EHR adopters, federal legislatures are working to clamp down on security breaches when it comes to PHI. Operating as the enforcers of new HIPAA sanctions, the Office of Civil Rights (OCR) will work to ensure compliance through investigating complaints and conducting audits of businesses and organizations covered by the rules. Doctors found to be outside of compliance could face hefty fines ranging from $100 to $50,000 per violation with a maximum fine of up to $1.5 million in 12 month period.