Resistance is futile

Which of the following is true?

“Resistance is futile” is the motto of the Borg Collective warning you that assimilation is at hand.

“Resistance is futile” is the motto of CMS warning you that ICD-10 implementation is at hand.

Well, both are true.  (Apologies to colleagues at CMS: I am not comparing you with the Borg Collective, just making a joke.)  Captain Picard may have escaped the Borg Collective but medical practices are not going to escape the transition to ICD-10.  Honestly, I tried to resist ICD-10: let another consultant do the training, I thought.  Someone else can write the “ready, set, go” ICD-10 articles.  But, I’ve been dragged into the ICD-10 vortex, and assimilated. (And Scotty can’t muster enough power to beam me out.)

A recent MGMA article warned that physician practices are lagging behind in their preparations for ICD-10.  Hospitals and larger health systems are more prepared for the transition, but many small medical groups have dragged their feet.  Their reluctance is understandable.  The American Medical Association continues to ask CMS for a delay in the start date, and doctors may hope that the AMA will get its wish.  Practices are implementing e-Prescribing, adopting electronic medical records and trying to succeed in meaningful use, and struggling to report on PQRS measures.  Many physicians in private practice are reluctant to invest in the cost of training for their staff members.

But, 2014 is just around the corner and the time for resistance is passed.   Here are the key to-do’s for small practices.

  • Buy an ICD-10–CM book.  I know it says “draft version” but buy it anyway.  Changes to both ICD-9 and ICD-10 are limited between now and the implementation date.
  • Schedule staff members for a 1-3 day training in the first or second quarter of 2014.  At least two from each practice.
  • Print a list of your most frequently used codes.
  • Look at the documentation for services for common documentation codes.
  • Try to code the cases from the documentation.
  • Make a list of cases you couldn’t code, and what you would have needed in the documentation in order to code the case.  Educate clinicians.
  • Ask your software vendor, “When are you installing and testing the ICD-10 update?”

In the next few months, I’ll have articles published in the AAFP Journal of Practice Management and Medscape with more specific recommendations for ICD-10 implementation.  I am also doing two GatewayEDI webinars in January.  I’ll announce all of those here on my blog, or sign up for my newsletter at

In the meantime, live long and prosper.

There’s no place like home, but everyone likes to get out once in a while

In order to be eligible for Medicare covered home health services a patient must be considered home bound.  But what does that mean?  That the patient can never leave the house?  Doesn’t generally leave the house?  Is like a Vermonter in a snow storm, and doesn’t see the point of leaving the house?

 CMS recently clarified language in its manual about what constitutes “confined to the home” and thus eligible to receive home health services.  Since physicians must certify and order home health agency (HHA) services, this is relevant.  The policy is found in the Medicare Benefit Policy Manual, 100-02, Chapter 7, section 30.1.1.

 Here is the clarified description from the manual:

  For a patient to be eligible to receive covered home health services under both Part A and Part B, the law requires that a physician certify in all cases that the patient is confined to his/her home.  For purposes of the statute, an individual shall be considered “confined to the home” (homebound) if the following two criteria are met:

1.  Criteria-One:

 The patient must either:

  • Because of illness or injury, need the aid of supportive devices such as crutches, canes, wheelchairs, and walkers; the use of special transportation; or the assistance of another person in order to leave their place of residence


  • Have a condition such that leaving his or her home is medically contraindicated.

If the patient meets one of the Criteria-one conditions, then the patient must also meet two additional requirements defined in Criteria-two below.

2.  Criteria-two

  • There must exist a normal inability to leave home;


  • Leaving home must require a considerable and taxing effort.

 The policy goes on to say that the patient may leave home for medical appointments, dialysis, and for receipt of chemo or radiation therapy.