October 2002
Editorial
John W. McDaniel
Nearly 40 years ago, the venerable songster Bob Dylan noted, “the times they are
a-changin’.” While it’s safe to assume he wasn’t singing about physician
reimbursement, the sentiment accurately reflects the current coding climate.
Consider for example, that as of October 1, 2002, you have 146 ICD-9-CM coding
changes to ponder. More daunting, you can expect your Medicare reimbursements to
decline in 2003. The Centers for Medicare and Medicaid Services estimate that
physician fee schedule payments will slide by 5.1%
during the coming year. However, if a suggested modification of the formula for
configuring the Medicare Economic Index—a crucial factor in determining fee
schedule rates—is approved, payments will drop by a slightly smaller 4.4%.
That’s little comfort, to be sure.
Those in the know also say you can expect managed care companies to more closely
examine your coding utilization in the near future. In addition, private payers
and the Federal government will be sharing their findings from coding audits.
Increased scrutiny, coupled with frequent changes in guidelines and regulations,
make it imperative that medical practices begin to take these issues seriously.
Many physicians are moving too slowly—it’s believed that only 30% of practices
are ready to comply with the Health Insurance Portability and Accountability Act
(HIPAA). That’s a serious problem when you recognize that HIPAA-related security
and code sets will begin use this month, and privacy regulations will be
enforced starting in April 2003.
We can help you get up to speed. In this month’s issue, we detail how to best
use daily hospital visit codes and how to get everyone in your practice involved
in coding compliance. You can find answers to a pair of intriguing questions
posed by readers. If you’re looking for an extra opportunity to hone your coding
skills, participate in a teleconference entitled “How to Develop and Implement a
Coding Compliance Program” scheduled for Wednesday, October 23, 2002. This
60-minute presentation will focus on the steps necessary to ensure compliance.
As chief executive officer of a major physician practice advisory company, I
will weigh in, as will a physician coding compliance expert, and a retired
Federal Bureau of Investigation agent who took part in healthcare-related
investigations for many years. For more information on this event, visit our Web
site at www.Coding-Compliance.com.
John W. McDaniel
Editor-in-Chief
Toll-free phone: 1-800-764-2633
E-mail: jmcdaniel@premierhealthcare.com