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Mar 16 2016

ACA and Cancer: Not Necessarily a Match Made In Heaven

According to a recent study by Treato, cancer was the most widely discussed topic as related to the Affordable Care Act (ACA).

Treato helps patients and caregivers make more informed healthcare decisions by analyzing online conversations about medications and health conditions and sharing what others like you are experiencing and sharing online

To gather these facts on cancer and the ACA, Treato analyzed 32,000 online discussions related to the ACA across a total of 92 forums.

Plenty of Criticism

The general sentiment towards the ACA veered toward the negative, with 48% of posts in cancer forums contained criticism of the ACA.

Some of the most frequent complaints were:

  • Paying more for less. People feel like they are paying more out-of-pocket expenses and receiving less coverage.
  • Cumbersome rules. The rules related to subsidies, exclusions, inclusions and co-pays are complicated and hard for people to decipher.
  • Less options. Insurance providers are dropping out of the market, meaning there are less options to choose from.

But It’s Not All Bad…

While it’s true the majority of conversations skewed negatively towards the ACA, there were some positive notes, most notably gratitude. People were grateful for:

  • Affordability. This is a slight contradiction to the complaint that you’re getting less for more with the ACA, however, this could depend largely on what plan someone is on and how much of a subsidy they are receiving.
  • Accessibility. People with pre-existing conditions were grateful for having the option to purchase insurance.
  • Preventive screening. Inclusion of preventive screening in ACA plans allows people to head off major conditions, such as cancer, before it’s too late and people were happy for this benefit.
  • No lifetime limits. Finally, the prohibition of lifetime limits on coverage was received warmly by the public.

Love it or hate it, it’s here to stay (for now)

Regardless of your personal feelings towards the ACA, it’s here to stay, at least for now. Patients can take control of their care by staying involved with their physicians (and other care providers) and being proactive in finding financial assistance to ease the burden.

ACA and Cancer: Not Necessarily a Match Made In Heaven

Written by sara@sarachandlee.com · Categorized: ACA

Feb 09 2016

Faster Payments With ICD-10-CM?

Last October, the industry switched from the old ICD-9-CM coding system to a new system classified as ICD-10-CM. This updated system is used to code and classify symptoms, diagnosis, and procedures performed on patients. And, just maybe, for right now, payments have sped up a bit under the new coding system.

So Far A Faster Payment Process

ICD-10 Faster Payments?

90-day data points seem to suggest payment is faster under ICD-10. According to onPoint Principal (and coding guru) Bobbi Buell:

Well, I need to say that the switch to ICD-10-CM has sped up the payment process--or so it seems. Our company has a database of cancer drug claims/EOBS from about 262,000 lives in 2015. We looked at days to file ("DTF") and days to pay ("DTP") for 2015 ICD-9 claims versus ICD-10 claims from October  to date. These are the top 10 WORST Days to Pay insurance companies (with more than 10 paid claims) in terms of DTF and DTP---notice that many have IMPROVED under ICD-10 data so far. Weird, but again, this can be due to the smaller data set. I prefer to think of it as good work, offices!

Name ICD 9 DTF ICD 10 DTF ICD 9 DTP ICD 10 DTP
CAREMORE IPA 9 6 83 49
PEOPLES HEALTH NETWORK 14 7 57 49
WELLMED 9 4 102 48
BASIC HEALTH 40 21 35 47
HEALTHSCOPE BENEFITS, INC. 6 8 52 46
ST. JOSEPH HERITAGE HEALTHCARE 5 5 25 45
VETERANS ADMINISTRATION FEE BASIS PROGRAMS 47 6 50 45
UNITED MEDICAL RESOURCES 22 8 51 45
MANAGED HEALTH SERVICES - INDIANA 23 35 36 43
BROWN AND TOLAND MEDICAL GROUP 11 10 49 41
CALIFORNIA MEDI-CAL 13 24 112 40

 

We are seeing the same thing with drugs. You control Days to File and these have gotten better--the Days to File are actually improved over ICD-9-CM. Here are some examples of cancer drugs that have had some delays in terms of Days to File. Some of these drugs have new J-codes, so you would expect improvement, but most of our data is from 2015...Again, there is less time for bad accounts to accumulate--but, still good job getting those claims in!

Brand Name ICD 9 DTF ICD 10 DTF
Keytruda 16 9
Cyramza 19 8
Opdivo 17 8
Zevalin 13 9
Yervoy 11 8
Provenge 20 10
Xofigo 25 8
Ixempra 10 10
Jevtana 9 6
Arzerra 10 8

 

ICD-10-CM: What’s New

The ‘improvements’ each group sees from ICD-9-CM vary by specialty and patient mix.  Overall ICD-10-CM now consists of over 68,000 codes as opposed to ICD-9-CM, which only contained 13,000 codes.

Some of the other features that have been implemented in this new classification system include: the ability to easier describe a patient’s condition through combination symptom and diagnosis codes as well as injury codes and codes that are helpful for ambulance and managed care encounters.  Again, if we are talking about Oncology, there are not a super, duper number of improvements

Another important addition with ICD-10-CM is the ability to code which side of the body, right or left, has been evaluated or treated.  Some payers will require that the side of the body is specified for say, lung cancer or breast cancer.

 

Keep Track with focalPoint

With the help of our product focalPoint, you can keep track of all of your data to see the difference that ICD-10-CM has made to your business.  Some of these benefits might include decreased Days To File and Days To Pay resulting in a quicker process for patients.  Some of the the drawbacks may include the requirement for right and/or left specificity on the claim.  This may increase the denial rate for your product or service.

Our clear presentation of data and metrics will allow you to have the best picture and recognize opportunities and challenges that occur with the new system.  If you would like to learn more, contact our team today!

Written by sara@sarachandlee.com · Categorized: Coding · Tagged: coding, focalPoint, ICD-10

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