October, 2009

I've been erratic, I know, but that's life on the road (another broken hard drive!) and at home with two H1N1 kids.  Here's the latest:

•  Can't avoid swine flu issues. Did folks know that to add to all the confusion, it looks like the big clearinghouses weren't paying attention either. At least three of the biggest fish in the pond (Availity, Capario, Emdeon) were erroneously rejecting H1N1 claims last week.  How can this not be a float conspiracy?

Anyway, one of the big clearinghouses re-submitted all the claims - good work.  The others?  How's this for customer service?

Apparently, we discussed it [reprocessing affected claims], but since we cannot identify the procedure codes rejected in error, we have to [sic] requested the clients resubmit the claims."

Quote straight to our EDI guys from a clearinghouse.  Insane.

•  Greg @ OP has an interesting live blog from the experience his wife's office had with their flu clinic last weekend.  A must-read for those in the pediatric EHR biz.
•  More Swine follies.  From a client in NJ, his experiences with the NJ imms registry:
  

  The biggest problem is that it will accept the data only for those children already in the registry, predominantly those born in state in the last 7-10 years or however long this has been running. Anyone older or from out of state who was not entered subsequently will have to entered manually now. I didn't check but I'd bet that's the majority unless you are limiting the vaccine to the younger ages right now.

• Finally, I bet this ICD-9 to ICD-10 tool will come in handy.

Really, I mean it - interesting data ASAP.  I have a ton of it!

If I boycott the swine flu, is that as good as a vaccination?

You see, I really want to talk about something else, but I can't hold off forever.

• For example, I should be talking about our next AAP endorsed Pediatric Coding and Practice Management Conference.  Woohoo!  Miami, on January 29!  Also sponsored by the Masters in Pediatrics program, which is part of the University of Miami.  I am particularly excited to see Dr. Tuck do his "Coding: A Day In The Life of a Pediatrician."  I don't know if it will be his first run, but it's close.
• How cool is this ICD-9 2010 Coding Cube Template?  I don't know whose idea it was here at PCC, but I love it.  If you're more of a 2 dimensional thinker, you may prefer our ICD-9 2010 Cheatsheet.  All for pediatricians, of course.  Sometimes, PCC amazes even me.
• I am so disappointed in the voting results from the AAP election that I can't even talk about it.  
• All it takes is one person to ask me "Pretty, please?" and I will post some fascinating provider productivity data (read: real $$ info!) Igor gathered.
• OK, I can't avoid the swine flu.  PCC, as usual, is helping the world by gathering H1N1 information from a practice management perspective.  The first of a series of articles.

Buried, which seems to be my status since August.  Some interesting items:

•  An official study indicating that the use of an EHR can improve primary care and supports the Medical Home model.  This is something our clients have known for 25 years.
•  Again, the MGMA tells us that "Medical practice revenues fall."  At first, I was ready to write a long diatribe about how the MGMA is getting wrong, but I see that pediatricians had by far the biggest increase in revenue after costs from 2007 -> 2008 (9%!).  This is much more in line with the data we see at PCC.  Whew.
• Oxford has sent out the scary "you can't be a boutique practice and contract with us" message.  It's too bad that my conversations with "boutique" (such a bad word) practices involving Oxford always concludes with, "...and we can finally stop dealing with Oxford and United!" [The Verden Group alerted me to this one.]
  

Finally, here's the big one today.  What is the purpose of the new Swine Flu admin code?  It makes no sense to me.  Pediatricians are finally getting their heads around admin codes vs. product codes and the AMA races in to create a new product-specific admin code? 

It used to be important to distinguish how the vaccine was given - oral/intranasal vs. injection.  Now, all that is tossed out just for this one strain of the flu.  What's going to happen when some avian strain hits?  Or Swine Flu II?  Keep adding new admin codes?

I am upset about this because we have two new sets of codes, admin and product, to record the swine flu, doubling the number of codes that will be rejected by the payers when the time comes.  Note that I said, "will."  But we gain nothing, as far as I can tell, in terms of data tracking...I can't tell how the immunization is given (fat luck comparing efficacies).  I don't know if counseling was given or if the recipient us under 9yo. 

Someone smarter than I am, and that's most of you, tell me what I'm missing.

Yes, I took a long break.  Sorry about that.  When I don't blog, one of two things is happening - I'm either on vacation (but still blog then most of the time anyway) or I am so overwhelmed with things to discuss that I can't figure out where to start.  I don't like just throwing up lists of links without proper support or commentary.  But I need to get this backlog broken somehere, so here it goes:

•  First, we have our chief health executive officer telling folks that pediatricians should be waiving their admin fees for swine flu. How about the radiologists and anaesthesiologists kicking in instead? I'm trying to figure out why having the least capable folks make the sacrifice is the way to go here.
•  Evan Steele runs his most persuasive piece about the real costs of EHR. What is your time worth?  More than you think.
•  Dave Tayloe tries to draw his line in the sand about swine flu reimbursement.
•  The coding for swine flu admin is going to be really, really gross.
•  Oh, hey, PCC has a new AAP-endorsed coding and practice management even.  Miami, late January. Details to follow.
•  I am fascinated by the return on preventive care, as many of you know. This article confirms that much of the reluctance to cover, say, obesity care is related to the insurance company opinion that the problem will be someone else's to pay for in a few years.
•  Siouxse keeps me up to date on the AAP's federal effort.
•  Last, but not least...the new AAP president is announced today.  Cross your fingers - good luck, Anne!