The Problem North American Medical Management of Illinois, Inc. (NAMM-IL) was recently impacted by a retroactive fee schedule change that involved processing over 300,000 claims on top of their current workload! A project of this magnitude threatened to bring their normal day-to-day operations to a standstill as staff would’ve had
NCHS and CMS have published General Equivalency Mappings (GEMs) as a translation reference between I-10 and I-9 diagnosis and procedure codes. These “one-to-one” mappings translate one I-10 code to either one I-9 code or one cluster of up to six ICD-9 codes. This is why the mappings are referred to as both one-to-one and
While SymKey’s Batch Processing module allows you to create virtually limitless custom scenarios to modify or process claims, there are also several pre-programmed scenarios built into the SymKey® Professional and Hospital Claims modules. Denying Hard Duplicates with SymKey® for EZ-CAP® One of the most widely used SymKey® for EZ-CAP® scenarios
HCIM has just raised the bar in healthcare payer consulting services with a groundbreaking Performance Assurance pledge. We pledge to deliver professional, competent, and affordable consulting services to the agreed-upon specifications or fix it at no additional charge. This means that clients will never be charged more than the price
Don’t lose sight of the ICD-10 deadline! October 1, 2013 is closer than you think… Did you know? You should have already completed ICD-10 impact assessment, risk analysis, and mitigation planning. If you haven’t, you’re in good company – industry surveys indicate that the majority of healthcare payers are behind
Many people still believe that the new ICD-10 CM and PCS code set transition from ICD-9-CM will simply involve one-to-one mapping, but it will also require one-to-many general equivalency mappings (GEMs). This will require analysis, system reconfiguration, and thorough staff training. One-To-Many Example With the new ICD-10 coding, sports injuries
Over the span of my career, I have led or been involved in numerous system installations and conversions. It seems like each project involves an out of date or unsupported primary/legacy system that needs to be replaced, which means that a new and exciting system is waiting out there to
HCIM’s SymKey® Kwik Actions™ application increases the efficiency and productivity of Claims Operations staff by automating routine tasks within and around their health care benefit administration system. Kwik Actions are custom developed “hotkeys” that users may utilize on demand to perform a predetermined set of screen navigation steps (keystrokes, mouse
According to the RAND Science and Technology Policy Institute’s comprehensive technical report on The Costs and Benefits of Moving to the ICD-10 Code Sets, providers will incur costs for computer reprogramming, the training of coders, physicians, and code users, and for the initial and long-term loss of productivity among coders and physicians. The
Continuing economic pressures and recently enacted Health Care Reform mandates place additional pressure on all health plans and managed care/payers to improve their operational efficiencies and reduce associated costs. Future reductions in Medicare reimbursement rates and increased competition will also require everyone to “do more with less money.” Industry mandated changes
Yes, SymKey’s “Reprocess/Pend” standard scenario is a perfect automated solution for repricing paid claims and is very simple to use for EZ-CAP status 9 claims. Create a .txt file with a list of the paid claim numbers that need to be repriced Open the SymKey Professional Claims module Check the
CMS Progress in Implementing the New Standards CMS is well into the process of readying its FFS Medicare systems to handle the 5010/D.0 standards. All Medicare systems will be ready to handle the new standards by January 1, 2011. Medicare plans for its systems to handle the current 4010A standard