But delay doesn’t mean abandon, and industry experts are urging facilities to continue preparations for switching to the new code set.

So make the most of the reprieve.

To put things in perspective, it took attendees at a recent coding boot camp four hours to code 20 cases in ICD-10 – and that was with the help of the instructor.

It’s estimated that coding will take twice as long under ICD-10 – at least initially – resulting in a 10% to 25% loss in coding productivity.

An update on ICD-10 is expected from HHS soon. Until then, this four-step plan can help you make the most of the extended prep time:

1. Plan a strategy. Create a plan for dealing with reduced coding productivity. Consider how you’ll tweak the workload to offset the loss (offer overtime pay, hire more coders, outsource some of the work, etc) and how that will affect your practice financially.
2. Review all written procedures and policies concerning coding. Look for any documents that will need to be updated to reflect ICD-10 changes. Note: The Centers for Medicare & Medicaid Services (CMS) has some helpful resources at www.cms.gov/ICD10.
3. Review payor contracts. Since contracts are based on the current ICD-9 codes, your practice will need to work with carriers to update them for ICD-10. Don’t assume they’ll do it for you.
4. Establish a line of credit. The switch to ICD-10 will certainly affect cash flow, and most lines of credit need to be in place for six months to a full year before funds become available.

Think of it this way: If you use this time now to get up to speed on ICD-10, the switch to ICD-11, which is coming in 2015, won’t seem so bad.

Is your facility ready for ICD-10? Share your preparation plans for the future in the comments area below.

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Orthopedic surgeons, plastic surgeons and neurosurgeons are the specialists whose bills are most likely to generate surprises for their patients. In fact, 50% of mega-bills insurers receive from out-of-network doctors come from one of those three types of doctors.

Those are the findings of a new report by the New York Department of Financial Services. According to the report, too many patients are left holding the bag for surprisingly large bills because of how little coverage insurers offer for services provided by out-of-network doctors.

The report also looked at more than 2,000 consumer complaints regarding large bills for non-emergency, pre-approved treatments. Because medical providers don’t have to disclose whether or not they’re in-network before they provide the treatment, patients may not understand that they could be facing much larger out-of-pocket costs. For example, in one of the complaints a patient went to an in-network hospital for routine gallbladder surgery with an in-network surgeon. But the anesthesiologist was out-of-network, which left the patient on the hook for an unexpected $1,800 bill.

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•  57% of people in low-income families (earnings of less than $29,726 for a family of four) were uninsured for some time in the past year; 35% had been uninsured for two years or more
• 36% of adults in moderate-income families (earnings between $29,726 and $55,875 for a family of four) were uninsured during the year, and 18% had been uninsured for two years or more
• 12% of adults in families with earnings at or above $89,400 for a family of four were uninsured during the year, and only 3% were uninsured for two years or more.

Not surprisingly, lower income respondents were also less likely to report that they had a regular health care provider or that they had received common preventive care and screenings such as mammograms.

According to the report’s authors, while the current health care reform efforts such as The Affordable Care Act will help narrow the access divide, it won’t solve the problem.

To see the full report, visit The Commonwealth Fund.

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A new report by federal analysts found that the reduced spending in 2010 (the last year for which data is available) was due to a combination of high unemployment, lower household income, a reduction in the number of people with private insurance and some folks opting to skip needed care (or choose cheaper options) because they simply couldn’t afford the preferred treatment.

According to the report by CMS, in 2010, health spending grew just 3.9%, only 0.1 percentage point faster than 2009. Total health spending in 2010 was $2.6 trillion, about $8,402 per person. To date, 2009-2010 had the slowest rate of growth of any two-year period in the 51 years this data has been tracked.

More troubling, although this rate is “slowing,” health spending still grew exceptionally faster than the rest of the economy. About 45% of the spending was shouldered by government agencies at all levels — up from 41% in 2009. That increase is largely the result of growing Medicaid enrollment and enhanced federal matching rates from the American Recovery and Reinvestment Act.

At the household level, spending was up 2.8% in 2010. One-third of such spending was employee contributions to private health insurance. People weren’t necessarily getting more for their money though. A significant portion of the increased spending was due to higher cost-sharing requirements for some employees, a trend toward plans with higher deductibles and/or co-payments, and many people having to pay out-of-pocket for health care after losing their health insurance coverage.

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The report, State Trends in Premiums and Deductibles, 2003-2010, found that 62% of people live in states where health insurance premiums are equal to 20% or more of earnings for a middle income worker under 65.

On average, premiums for an employer-sponsored family plan increased by 50% between 2003 and 2010, to $13,871 annually. Even in the five “lowest-cost” states, premiums ranged between $11,379 and $12,409.

And employers aren’t picking up as much of the cost anymore. Since 2003, the employee-paid portion of health insurance has increased by 63% — far more than incomes have risen, and a higher proportion of the total cost.

But workers aren’t getting more for their money — they’re getting less. According to the report, only 52% of employees had a deductible in 2003; by 2010, it was 74%. And the size of the average per-person deductible has increased by a whopping 98% over the same time period.

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That’s the message from a recent study from Medical Liability Monitor. The study of rates from 40 insurance companies found that 55% of rates stayed flat compared to last year.

Among those that did change, however, most went down for the sixth year in a row, with 90% decreasing between 0.1% and 9.9%.

Changes varied based on geography, ranging from a 3% increase in New Hampshire to an 11.4% drop in Mississippi.

The actual rates paid may have decreased even more as more insurance companies have started offering schedule credits — 11% of companies introduced new credits this year, and 20% did so last year. Overall, 30% of companies increased the amount of credits they offered this year, and none reported a decrease.

What’s behind the drops in rates? The report attributes the trend largely to more doctors joining Accountable Care Organizations, more doctors becoming employees of larger hospitals and practices, and other initiatives promoted by the Patient Protection and Affordable Care Act.

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That’s the conclusion drawn from a recent report by the General Accounting Office (GAO).

A number of factors, play a role, including the variety of insurance benefit plans, inability of physicians to know in advance if certain tests or additional procedures will be likely, how much of a deductible a specific patient has already met, as well as the secrecy that surrounds the negotiated rates of payment between insurers and providers.

The lack of transparency is more than an annoyance.  It makes it harder for patients — whether insured or not — to make decisions about which non-critical tests and procedures are worth performing.

To see the full report, click here.

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The AMA’s findings include:

• 83% of metropolitan markets were  “highly concentrated,” based on the newly revised Horizontal Merger Guidelines issued last year by the U.S. Department of Justice and Federal Trade Commission
• In about half of metropolitan markets, at least one health insurer had a commercial market share of 50% or more, and
• In half of the states reviewed in the study, the two largest health insurers had a combined commercial market share of 70% or more.

The 10 states with the least competitive commercial health insurance markets, are:

1. Alabama
2. Alaska
3. Delaware
4. Michigan
5. Hawaii
6. District of Columbia
7. Nebraska
8. North Carolina
9. Indiana
10. Maine.

The 2011 edition of the study, Competition in Health Insurance: A Comprehensive Study of U.S. Markets,  reports commercial health insurance market shares and federal concentration measures for 368 metropolitan markets and 48 states.

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Farah Maria Perez pleaded guilty  to one count of conspiracy to commit health care fraud, according to a joint announcement by the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Perez worked for Florida Home Health Care Providers Inc., a home health care agency. The agency was supposed to provide home health and therapy services to Medicare patients. In truth, the company existed primarily to bill Medicare for physical therapy and other services that either weren’t needed and/or were never provided.

According to prosecutors, between January 2006 and March 2009, Perez and her co-defendants falsified patient files for Medicare beneficiaries to make it appear that they qualified for home health care and therapy services.  Perez admitted she knew the beneficiaries didn’t qualify for and didn’t receive the services and that the files were being changed so that the Medicare program could be billed for medically unnecessary therapy and home health related services.

Perez also admitted recruiting Medicare beneficiaries who agreed to let the agency bill Medicare for services that were unnecessary or never provided.

Four of her co-conspirators who were charged in the February 2011 indictment, Jose Nunez, M.D.; Lisandra Alonso; Luisa Morciego; and Vicente Guerra, have also pleaded guilty.

Perez’s sentencing is scheduled for November of this year. She faces a maximum prison sentence of 10 years in addition to fines, supervised release, and forfeiture of any property or proceeds derived from her criminal activities.

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According to the report, the company would offer a variety of plans, at different cost levels, through a health insurance exchange. The move would be allowed under health reform changes that take effect in 2014.

Walgreens wouldn’t confirm or deny the report, saying only that it was “looking into a number of options” to serve customers in the health system.

A number of companies — with or without prior experience in the health care industry — are expected to enter the market that’ll open up as more of the health reform provisions take effect.

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