ICD-10 and What the Ebola Virus Means for Healthcare Reimbursement

Public health officials are learning more every day about the procedures required to care for Ebola patients. But one thing that the Ebola crisis has revealed is that the health care system lacks the classification codes to track the disease and ultimately, to reimburse for care of patients who have the disease.

what the ebola virus means for healthcare reimbursementICD-9 has no specific code for Ebola. Under the classification system, the hemorrhagic fever would currently fall under 078.89 – the code for “other specified diseases due to viruses.” That means Ebola shares a code with many other viruses that have not yet been assigned a specific code. The next iteration of the classification system, ICD-10, gives Ebola the code A98.4. But the U.S. Congress in the spring delayed implementation of the new classification system. The fact that the United States still uses ICD-9 will make it more more difficult to share information about the disease and its movement with other countries, HIT Consultant reported. All of the world’s industrialized nations use ICD-10 and use the codes in the newer system to report health information to the World Health Organization.

Besides disease tracking, health officials are starting to learn what the Ebola virus means for healthcare reimbursement. The classification codes are also important for reimbursing the cost of care. When health claims are submitted to payers, the claim must include a code to indicate a particular disease or procedure. If any more Ebola cases arise in the United States, ICD-9 allows no way for a health care provider to submit a claim specifically for Ebola. Thomas Eric Duncan, the Liberian man who was treated at Texas Health Presbyterian Hospital in Dallas, had health care costs estimated at $1,000 an hour, Bloomberg News reported. That cost takes into account not only the care provided to Duncan, but also the expense of isolation procedures for an Ebola patient. The Texas hospital is not expected to recover any of the costs associated with the care of Duncan, who was uninsured.

The Texas hospital has offered to pay the health care costs of Nina Pham, one of the nurses who treated Duncan and was later diagnosed with Ebola, while she was in the hospital’s care. Pham was recently declared Ebola free after being treated at the the National Institutes of Health; that bill will likely be picked up by the federal government.

ICD-10 offers a way to submit health care claims for Ebola and also file for reimbursement for treating patients with the disease. But its implementation did not come in time for Ebola’s arrival in the United States. Much is still being learned about the procedures hospitals need to use to care for Ebola patients and it’s unclear whether new codes will be needed. But what is now clear is that the health system has a classification code for Ebola but for now, it has no way to use it. To learn more, contact us.

How to Reduce Prescription Errors in 21st Century Pharmacies

It may seem like a contradiction but the pharmacy of the 21st century will feature both robotic automation and greater interaction between pharmacists and patients.

prescription pharmacyPharmacy automation has been steadily making its way into many pharmacies throughout the country. Robotic systems from companies like Aesynt, Parata Systems and RxMedic sort and dispense pills, which spares pharmacists from work that takes a lot of time and can lead to human error. It’s hard to put a firm number on presciption errors but the Food and Drug Administration says it has received close to 30,000 reports of medication errors since 1992. With many pills looking alike and many drug names sounding similar, automated systems offer a better way of checking and verifying that patients receive only drug they were prescribed.

Another technology development that will change the pharmacy of the 21st century is the adoption of electronic prescribing, which gives doctors the ability to send prescriptions electronically to a pharmacy. E-prescribing reduces the chances for error that can come from misreading a doctor’s handwriting.

As for the pharmacists themselves, the evolution of pharmacist training is changing the profession. Compared to decades ago, today’s pharmacists can be more specialized and they enter the field with more specialized training, pharmacy consultant Ernest Gates tells Drug Topics. Some of these pharmacists will work in specialty pharmacies in areas such as oncology, geriatrics and diabetes among other areas of specialization.

Pharmacists who aren’t specialists can still expect to take on more responsibilities as a consequence of the Affordable Care Act. With the law’s expansion of Medicaid, Daniel Brown, a pharmacist and professor at the pharmacy school at Palm Beach Atlantic University, tells Medscape that he expects community pharmacies to see more Medicaid prescriptions. He also sees the increase in this patient traffic presenting additional opportunities for pharmacists to talk to patients about preventive services. Here’s where pharmacy automation is important. Automation doesn’t replace pharmacists. Instead, it provides a remedy to busy pharmacists – these systems free pharmacists to spend more of their time counseling patients instead of sorting pills. If the expected increase in patient traffic to pharmacies holds true, time savings found with automation will become very valuable.

For more information about emerging pharmacy trends, please contact us.

What Physicians Can Do To Fight The Rising Cost of Healthcare and Support Medical Necessity

Everyone’s trying to tighten their belts lately, and the medical field is no exception. One way to fight the rising cost of healthcare and support medical necessity is with smart diagnoses, fewer unwarranted procedures, and a more open dialogue between doctor and patient. Here are some steps the physician can use to determine if a treatment is medically necessary:

  • Collect a complete medical history. Every medical exam has a portion of medical history Q&A to it, but patients sometimes forget a detail here or there. If you think that a few more facts about their past can change whether a procedure is done or not, then ask. Asking a few more questions to flush out the whole story can rising cost of healthcare and medical necessityenlighten you on what may really be going on.
  • Double check diagnosis. The human body reacts similarly to various problem, so symptoms can be present in a lot of differ diseases. Double checking your diagnosis for similar diseases and matching it up with your patient’s medical history can mean the difference between right diagnosis and misdiagnosis.
  • Ask if the procedures are necessary. Certain procedures are necessary, and others are just a precaution. An article Laurie Tarken released in Fitness Magazine noted in 2009, $325 billion of the nation’s $2.7 trillion annual health care bill went to unnecessary medical procedures. This explains why speciality physicians groups are calling on their members to stop reflexively calling for some 200 tests and procedures to be done. Instead, these physicians are being asked to consider the efficiency of the test, and look for more efficient methods to get a correct diagnosis or treatment.

To be fair, it’s not always possible to avoid asking for tests and procedures to be done, especially in specialities with a risk of high litigation. In that case, it may be possible to simply cut back on preventative measures, such as the annual physical exam to get our health checked out. For some people it may be necessary to get their health checked regularly, while others can go for years between exams without harm.

For example, Laura Esserman, M.D., a professor of surgery and radiology at the University of California, San Francisco and the U.S. Preventative Services Task Force say that you can get a blood test for total cholesterol and HDL every 5 years as long as the findings are normal, but blood pressure testing should be done every other year unless it’s higher than the recommended levels for the patient’s age and fitness level.

Gaining the confidence necessary to diagnosis and call for the correct procedures comes with great training and lots of practice. This could help physicians fight the rising costs of healthcare and medical necessity over time. If you’d like to talk about this, or anything else, please contact us.