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This is the second in a series of articles written by Karen Popa, RN; Director of Patient Financial Services, to help physician offices prepare for coding in ICD-10. Look for “Outpatient Orders Compliance” in September.Medicare and other payers frequently require a medically necessary diagnosis code to pay for outpatient services. In preparation for ICD-10, Michigan’s Medicare contractor (WPS) suspended many of the

local coverage determinations for services like chest x-ray and ECGs. It is unknown when the contractors will be reinitiating them, but it is expected that that they will do so within the next year.CMS has maintained all of the national coverage determina-tions for lab and other services. These are available in draft form for ICD-10 on the CMS website. Here are some FAQs on medical necessity and how your office can prepare.

What is medical necessity?• Medicare says “no payment shall be made… for items or

services not reasonable and necessary for the diagnosis and treatment of illness or injury or to improve the functioning of a malformed body member.” (Section 1862(a)(1)(A) of the Social Security Act)

• CMS defines Medical Necessity is a benefit system, NOT medical standards.o Medicare states “a test may be considered medically appro-

priate, but nonetheless excluded from Medicare Coverage.” (Fed Register 11/25/01 p.58810)

• Medical necessity answers the question: “Is this procedure a ‘benefit’ (reimbursable) for a patient with this diagnosis?”o Medical necessity, in this context, simply means the

patient has a diagnosis (ICD-9 or ICD-10 code) that sup-ports the service (CPT/HCPCS code).

How do I know what Medicare and other payers consider medically necessary?Medicare publishes coverage policies that outline what CPT

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munsonhealthcare.org/ForPhysicians

For the past four years, Lee Elston, BSN, MHL and I have been visiting physician practices to promote patient privacy best practices, which we affectionately refer to as our “HIPAA Road Trip.”

Over the course of our HIPAA Road Trip, we have discussed patient privacy with more than 1,000 physician practice staff in the Grand Traverse region. Both Lee and I have really enjoyed meeting with you and your staff to talk about what you do each and every day to protect patient privacy as well as opportunities for improvement.

You’ve asked great questions, which we have turned into articles and FAQs (frequently asked questions) so that we all learn and grow together.

To give you, as practice managers, even more patient privacy tools, we also developed a HIPAA Toolkit. The HIPAA toolkit includes helpful resources on staff education, compliance, and how to handle privacy complaints. The HIPAA toolkit is available at munsonhealthcare.org/HIPAA or there’s also a printed version.

If you would like to schedule HIPAA training for your practice, or if you’d like a printed HIPAA Toolkit, please contact Deb Kimball at (231) 935-3388 or dkimball@mhc.net.

WILL YOU BE THE NEXT STOP ON OUR HIPAA ROAD TRIP?

Deb Kimball

MEDICAL NECESSITY AND ICD-10

Karen Popa, RN

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MEDICAL NECESSITY AND ICD-10 Continued from page 1

codes require what diagnoses to qualify for payment. They are called National Coverage Determinations (country-wide) and Local Coverage Determinations (region-wide).Other payers have medical necessity policies and they generally differ from Medicare guidelines. They are called Individual Payer Policy Coverage. Usually they can be found on the payer website.It is best practice to know what payer medical policies are, so as to not delay care while the patient waits for clarification on a diagnosis.How will ICD-10 impact medical necessity?Initially, there will be few changes to the Medicare policies; however we don’t know how or when the commercial insurers will revise their policies. It is expected that Medicare will begin to require more specific diagnoses after the first year of implementation.What can my office do to prepare?• Identify the Top 10 Diagnosis Codes (by frequency) you use for OP orders.

o Convert these diagnoses to ICD-10.o Add specificity where required.

• When ordering tests and treatment, provide a diagnosis that supports medical necessity.Remember that:

o Orders to “rule out [X]" are not sufficient.o Orders must include information about the signs, symptoms, history, and other clinical

indications for the service or procedure. ICD-10 will be upon us in two months. Are you ready? Don’t forget to update your outpatient physician order forms, both electronic and paper, ASAP (see sidebar). It is not too early. After October 1, Munson Healthcare will require ICD-10 compliant orders for all outpatient testing and treatment.

Update Order FormsA reminder that all outpatient physician order forms, both electronic and paper, must be updated to the ICD-10 compliant version prior to October 1, 2015.

To update forms, order necessary forms through the Forms Order requisition process, update your EMR with revised form(s), and/or contact your Information Systems technical analyst if your EMR is hosted by Munson. Electronic forms are also available online at munsonhealthcare.org/physicianforms.

To ensure patient safety and consistent documentation, please discard all previous versions of these forms. Joint Commission surveyors check for use of current forms when they are on site.

Providers have been ramping up their documentation, completing specialized training, and preparing themselves and their staff for ICD-10. For all providers, the transition on October 1, 2015 will have a significant and lasting impact.

Based on a review of outpatient services at Munson Medical Center over the last 18 months, here are 10 of the top 25 most common ordering diagnoses affected by ICD-10. Coding for all diagnoses will change under ICD-10, some more than others, so complete and accurate documentation is critical.

Providers are encouraged to use the list as a starting point to begin translating the codes to their new ICD-10 equivalents. To see the rest of the top 25 or to access other online resources to assist you and your practice with the transition to ICD-10, visit the ICD-10 Resource Center at munsonhealthcare.org/icd-10.

Friday, September 18 | Lunch: 12:00 – 12:30 pm; Friday Medical Conference: 12:30 – 1:30 pm Munson Medical Center Conference CenterThe Sept. 18 Friday Medical Conference – less than two weeks before the Oct. 1 implementation of ICD-10 – will discuss the impact on physicians and practices and provide some last-minute steps that you can take to prepare for ICD-10.

Please encourage your physicians to attend. This conference has been approved for AMA PRA Category 1 Credits™. Practice managers are also welcome to attend. No need to RSVP if attending in person.

To attend via GoToWebinar, go to munsonhealthcare.org/cme to register after September 1.

ICD-10 Launches Oct. 1: Are You Ready?

TOP TEN 10 MOST COMMON ORDERING DIAGNOSES AFFECTED BY ICD-10

1. 42731 - Atrial fibrillation2. 41400 - Coronary atherosclerosis of unspecified type of vessel, native or graft3. 462 - Acute pharyngitis4. 4271 - Paroxysmal ventricular tachycardia5. 78900 - Abdominal pain, unspecified site6. 7140 - Rheumatoid arthritis7. 7295 - Pain in limb8. 7881 - Dysuria9. 79380 - Abnormal mammogram, unspecified

10. 71946 - Pain in joint, lower leg

Saturday, October 10 | Registration and Breakfast: 7:00 am – 8:00 am; Program: 8:00 am – 4:30 pm Grand Traverse Resort

The 3rd Annual Cardiovascular Update for Primary Care Providers will provide practical tools and resources for primary care, emergency medi-cine, hospital medicine physicians, PA/NPs, and nurses, including the most current developments in the diagnosis, treatment, and manage-ment of cardiovascular disease.

There is no cost to attend. Lunch will be provided. This workshop has been approved for 5.75 AMA PRA Category 1 Credits™.

For more seminar details and CME information, go to munsonhealthcare.org/cardiovascularupdate2015.

To register, go to munsonhealthcare.org/cardiovascularupdate2015 or call Munson HealthLink at (231) 935-5886.

Cardiovascular Update for Primary Care Providers

Please share with your physicians

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ACS REVERIFIES HOSPITAL’S LEVEL II TRAUMA STATUS

Munson Medical Center once again has received verification as a Level II Trauma Center by the American College of Surgeons (ACS). The hospital is the only Level II facility in Michigan’s northern Lower Peninsula.

The verification process confirms that Munson Medical Center is functioning as a Trauma Center and meets the criteria set forth by the ACS. Examiners look at the entire trauma process from EMS care through rehabilitation.

“We provide care to a region where many people live, work, and play and many more people come to vacation. So, we often are called on to help when tragedy strikes,” said Al Pilong, president of Munson Medical Center. “This reverification by the ACS should affirm for residents and visitors that our staff and physicians are ready to respond with high-quality specialized trauma care.”

Efforts to obtain ACS Level II verification involved several areas of the hospital including the Emergency Department, radiology, lab, nursing, operating room, physician leaders, hospital administration, and EMS management.

The hospital’s trauma team responded to 928 trauma incidents in 2014. The team is led by general surgeon David Kam, MD, MS, FACS, a surgical critical care fellowship trained surgeon, and Trauma Acute Care Surgery Manager Shamarie Regenold, MSN, FNP-BC.

There are a total of 10 general surgeons who rotate call 24/7 for trauma cases. Also available to the team when needed are three fellowship trained orthopedic traumatologists: Andrew Boyce, DO; B. Scott Groseclose II, MD; and Brent Wiersema, DO. The leaders and surgeons of the trauma team are supported by a group of seven advanced practice providers made up of nurse practitioners and physician assistants, as

well as Emergency Department physicians, nurses, and other support staff.

Regenold said the reverification shows the hospital’s commitment to the region.

“It is a true pleasure to be part of an organization that cares so much for its community members and the region,” she said. “The trauma team is one of the most dedicated groups of professionals I have ever worked with. Their commitment to trauma care should be commended.”

The hospital was first verified as a Level II Trauma Center in 2006.

Please note that the hours for the Kalkaska Memorial Health Center (KMHC) Lab are now 7 am – 11 pm, seven days a week (including holidays).

Kalkaska Memorial Health Center Lab419 S. Coral St., Kalkaska Hours: Seven days a week including holidays, 7 am - 11 pm (231) 258-7508

NEW HOURS AT KMHC LAB

Keeping the electronic health record up and running at 54 dif-ferent physician clinics associated with Munson Medical Center sometimes becomes more than a full-time job.

Days can stretch into nights when hardware and software fail to play nice together.

Information Systems Ambulatory Applications 10-member team is responsible for ensuring patient information flows from the physi-cian clinic’s exam room to the electronic health record, allowing it to be accessed by a specialist at the hospital or in another clinic.

“I think it’s great that we are able to support applications that actually help providers in the area have the right information to provide better patient care,” said Renee Gerrie, systems architect and a team lead for Ambulatory Applications. “They are able to get results interfaced into the EHR, they can e-prescribe from their laptops, and they can look at Radiology images or informa-tion sent from the hospital to their clinic.”

The team works closely with a four-member IS interface team to ensure that the three programs used in ambulatory clinics – eClinicalWorks, NextGen, and

ARIA – can communicate with hospital programs.

Over the past six years, the team has systematically gone from project to project, linking offices to components of the EHR which prepares them for Meaningful Use recognition and the reim-bursement that CMS has tied to that designation.

“Renee and her team do a great job and I see them as the glue that keeps our ambulatory EMR going,” said Donald Caraccio, MD, Munson Medical Center chief medical services officer, who practices at Thirlby Clinic. “I can honestly say that at Thirlby we would be lost without their sup-port. I suspect that is true at other

practices as well.”

When glitches and downtime oc-cur, the Ambulatory Applications team works closely with the Help Desk to communicate with of-fices, track the problem, and fix it.

Gerrie said users should always first call the Help Desk, because it generates a work ticket and puts it into the team’s queue. Downtime issues rise to the top of the list.

“We communicate a lot when there is a downtime,” she said. “We are communicating as much as we can and as soon as we can.”

Ambulatory Services knows their clients well. The team serves as

trainers for eClinicalWorks, and work closely with vendors of the other two programs during train-ing to ensure they can diagnose and fix issues that arise.

Gerrie said the team is committed to ensuring ambulatory patient information continues to flow electronically between all the various applications important for the EMR.

“If we have a major upgrade and then a slowness issue develops, having a small team like this hits us,” she said. “But the team pulls together and gets it done.”

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AMBULATORY APPS: THE TEAM BEHIND PHYSICIAN OFFICES’ EHR

Renee Gerrie and her colleagues work closely with physician offices to maintain their EHRs. She is systems architect and a team lead for Information System’s Ambulatory Applications.

Ambulatory Applications team members include: Renee Gerrie (Team Lead) Kelly Bator Deb Chmielewski (Team Lead) Russell Gauthier John Rokos Barb Slagel Linda Thornton Matthew Weaver Jim Whall Mia York

Interface team members include: Josh Adams Michael Beckwith Kirby Knight James Russell (Team Lead)

Ambulatory Apps., Interface Teams

BATCH SCANNING INTO POWERCHARTMunson Healthcare has launched a new project to batch scan the entire paper medical record post discharge into PowerChart. This project broadens the scope of scanned medical records to promote timely access to the patient’s clinical documentation.

When the paper record is scanned it can be viewed in Results Review, Documentation, or Clinical Notes. The information will post for the discharge date and time and will flow to the appropriate section of the electronic chart.

Read Sept. Practice Pro for more information.

IT’S CRITICAL TO REMOVE STAFF’S COMPUTER ACCESS UPON TERMINATIONIf a former employee accesses PowerChart, Physician Web Scheduler, etc. after leaving your practice, it is a serious HIPAA breach requiring investigation. Prevent privacy and security breaches by promptly reporting an employee’s termination to the Munson Help Desk by contacting (231) 935-6053 or helpdesk@mhc.net. You can also complete a Computer System Access Request Form, available at munsonhealthcare.org/ physicianforms, and fax to (231) 935-3215.

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NEW HOURS FOR CLINICIAN IS HELP DESK: 7 AM – 5 PMIn January, the Munson Information Systems Help Desk added a special line for physicians, clinicians, and practice staff calling for urgent IT issues affecting patient care, e.g. PowerChart, iPATH, paging, etc. After reviewing usage of the Clinician IS Help Desk for the past 7 months, its hours have changed to 7 am – 5 pm. However, the Help Desk is always staffed and can assist with any needs on the Technical Help Line 24/7.

The Clinician IS Help Desk is available Monday – Friday, 7 am – 5 pm, by calling 935-6053 then pressing #1. The wait times for the Clinician Help Line are shorter than for non-clinical issues. The Munson Help Desk is available 24/7

A New Face in Ambulatory Applications

Barb Slagel has joined the Ambulatory Applications team as our new First Level Support Analyst, replacing Dave Penne. Barb will start visiting practices over the next few months, and callers will start hearing her friendly voice once she has settled in.

For more on our Ambulatory Applications teams, read “Ambulatory Apps: The Team Behind Physician Offices’ EHR” on page 4.

NextGen User Group

All NextGen practices, whether hosted or not, are encouraged to attend the monthly NextGen User Group meetings. These meetings help NextGen practices prepare for future upgrades as well as provide best practices, tips, and tricks. Please contact John Rokos (jrokos1@mhc.net) to be added to the invite list.

PWS SCHEDULING REMINDERS• Patient Type = PRT: In PWS, a reminder to ALWAYS select “PRT”

for Patient Type. PRT stands for “pre-registration testing” and creates an account for the patient in our registration system.

• Confirm Location with Patient: As some tests are available at multiple locations, please make sure the patient knows at which location a test has been scheduled, e.g. Munson Medical Center vs. Munson Community Health Center.

• Confirm Time of Day with Patient: When scheduling a patient for a procedure in PWS, please make sure the patient is aware of the specific time including “am” versus “pm.” For example, if you schedule a patient for a mammogram at 9 pm…please point out that the appointment is at 9 in the evening and NOT 9 in the morning.

• Complete PWS Questionnaires: To help us keep your patients safe when performing a test and to confirm that the test ordered will provide the results your physicians needs to support patient care, it’s important to answer ALL questions completely and accurately.

PC Users Cautioned Against Windows 10 UpgradeMicrosoft is offering a free upgrade to Windows 10 for Windows 7 and Windows 8/8.1 computers.

We’d like to caution physician practices that you may want to wait to upgrade your computers’ operating system as many software programs, including eClinicalWorks, NextGen, Physician Web Scheduler, and programs that run on Citrix such as PowerChart, may not work properly in Windows 10.

Please consult with your software vendors and your practice’s tech support so that your systems aren’t automatically updated to Windows 10 without your approval.

Saturday, October 17 | 8 am – 5:30 pm | Grand Traverse ResortCome to a free, one-day interactive workshop for primary care providers to learn how to identify patients at high hereditary cancer risk, refer the right patients to the right providers, interpret genetic testing results, and apply genetic information to clinical management.

Michigan Dept. of Health and Human Services (MDHHS) is working with Munson Healthcare to provide this seminar followed by a year of additional cancer genetics resources for primary care providers. Munson Healthcare was specifically selected because the incidence of early onset breast cancer (diagnosis < 50 years), a risk factor for HBOC, is about 20% higher in the five counties served by Munson Healthcare than the average incidence in the state, according to Michigan Cancer Surveillance Program data.

This workshop has been approved for AMA PRA Category 1 Credits™. There is no cost to attend. Breakfast and lunch are provided.

For more information and to register visit: www.jaxge.org/workshops

Cancer Genetics Management in the Primary Care Setting

Please share with your physicians

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Each month in Practice Pro we’ll feature a member of MMC’s Physician Services, which includes Medical Staff Services, Physician Recruitment, Physician Liaison Program, and Continuing Medical Education.

Robin has spent the last eight years in Medical Staff Services and Physician Recruitment. Originally from the southwest Detroit suburbs, Robin has been a Suttons Bay resident for the past 35 years and raised her family there. Robin has four children: Elizabeth, Allison, Adam, and Ana, as well as a beloved dog named Boomer.

What is your role in Physician Services?I’m the friendly face that greets physicians and visitors stopping by Physician Services.

For Physician Recruitment, I support the physician recruiters from the initial sourcing of potential physician candidates to coordinating their site visits at Munson Medical Center (MMC) to ultimately coordinating each new physician’s orientation upon hire.

For Medical Staff Services, I organize physician leadership meetings including support materials, update medical staff policies, provide credentialing support, and, as always, willing to accept other duties as assigned. I also support Dr. Donald Caraccio in his new role as Chief Medical Services Officer.

What are the challenges for physicians and how can you help?Physicians have extremely busy schedules ranging from patient care to administrative responsibilities. When coordinating physician leadership meetings, site visits, and new physician orientations, it’s very helpful to work directly with the practice manager/office assistant to minimize emails, phone calls, and pages to physicians. Networking and establishing solid relationships with support staff is key.

What is the most rewarding aspect of your job?I love my job, and I really enjoy the diverse group of people with whom I am fortunate to work.

Life is a series of human interactions from which we can learn. One experience builds on another. We all have a role in our mission of improving the health of our patients and community, and it’s very rewarding to play a part.

What are you passionate about outside of work?

I enjoy piano lessons and am fascinated by music theory.

I love to travel and enjoy doing just about anything with my children. I recently came across this quote: “Hanging out with your grown-up kids is like visiting the best parts of yourself.” So true.

I’m dedicated to caregiving and work part-time as a caregiver for Share Care of Leelanau County.

I also volunteer through my local Elks Club. This summer we received a $10,000 grant from the National Elks Foundation to provide food baskets during the summer months to families whose children benefit from the school-subsidized lunch program.

What would we be surprised to learn about you?I’m very passionate about charitable giving, which is why I started a virtual giving circle “tentwentyfive” to support families in need. Members of tentwentyfive donate $10.25 each month, and then three to four times a year, we select a family who would benefit from a little extra help. For the cost of two specialty coffees, a lunch at a restaurant, or 100 recycled pop cans each month, we combine our monthly contributions to help hard-working families living paycheck to paycheck who, by one unexpected event – a medical emergency, loss of a part-time job, etc. – would struggle even more to pay their bills, buy groceries, or put gas in their car. The date of 10/25 was a special life-changing event in my life and coincidentally is a reference to Luke 10:25-37, The Parable of the Good Samaritan – “Love your neighbor as yourself.”

What one word best describes you?Grateful. I am very thankful for all the blessings in my life.

What is the best way to contact you?Stop by Physician Services on D6 at MMC or I can also be reached at (231) 935-5892 or rwodek@mhc.net.

Getting to Know...Robin Wodek

Robin WodekPhysician Services

Physician Welcome ReceptionMeet our new medical staff and honor our retirees. Hors d’oeuvres and refreshments will be served; prize drawings will be held throughout the reception.

For more information, please contact Robin Wodek at (231) 935-5892 or rwodek@mhc.net.

Thursday, October 1, 2015 | 6 - 8:30 pmHagerty Conference CenterGreat Lakes Campus715 East Front Street, Traverse City

S A V E T H E D A T EPlease share with your physicians

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Providers Who Are No Longer PracticingKeary O’Connor, DO; family practice, has left the area.

A reminder that the following providers have recently retired or left the area:• Thomas Crosby, MD, FACC• Peg Dunn, CNM• Richard Hartwell, DO• Harry Ko, DO• Margaret Moen, MD• Peter Shireman, MD• David Steffey, MD• Rochak Varma, MD• David Wilcox, MDFor those practices with an EMR, please update your records.

New faces will join the Rehabilitation Services team to enhance inpatient and outpatient rehabilitative care at Munson Medical Center.Munson Medical Center and Mary Free Bed Rehabilitation Hospital recently signed an agreement that brings Munson Medical Center into the Mary Free Bed Rehabilitation Network. The network is an innovative alliance of hospitals and providers throughout Michigan.Mary Free Bed will now collaborate with Munson Medical Center to manage day-to-day operations of the hospital’s inpatient and outpatient rehabilitation services.The agreement does not change ownership of Munson Medical Center’s inpatient or outpatient rehabilitation services or locations. Rehabilitation services operated by other hospitals in the Munson Healthcare system are not affected.Mary Free Bed will employ two program directors, one for inpatient and another for outpatient services, as well as two nurse liaisons who will facilitate admissions to the inpatient unit. Physical Medicine & Rehabilitation physicians on the hospital’s medical staff, and current Munson Medical Center therapists and nursing staff, will continue to deliver care for patients.Collaboration with Mary Free Bed Rehabilitation Network will help the medical center improve care coordination and transitions of care for patients as well as the ability to care for more patients closer to home.

Munson Medical Center Joins Mary Free Bed Rehabilitation Network

Munson Neurosurgery Program ExpandsThomas C. Schermerhorn, MD and J. Eric Zimmerman, MD to practice togetherAs of Sept. 1, Neurosurgeon J. Eric Zimmerman, MD, will join Munson Neurosurgery at 1221 Sixth St., Ste. 100, Traverse City. Dr. Zimmerman will practice with Thomas C. Schermerhorn, MD, to provide state-of-the-art neurosurgery to patients throughout northern Michigan. Both physicians are accepting new patients. For appointments call (231) 392-0640.

100 YEARS OF CARING CELEBRATIONTuesday, Sept. 155 - 7 pmMunson Medical Center front lawn(Along Elmwood Street near Medical Campus Drive)

Please join us as we celebrate “100 Years of Caring” at Munson Medical Center. One act of generosity by James Decker Munson, MD, in 1915 led to today’s high-quality regional medical center that benefits all of northern Michigan.Brief remarks at 5:30 pm by Munson Healthcare President and CEO Ed Ness and Munson Medical Center President Al Pilong will be followed by a tree planting ceremony in honor of Dr. Munson and placing of a time capsule. Enjoy cake, iced tea, and coffee and view a “100 Years of Caring” timeline while listening to the music of Jeff Haas.Free parking is available in the parking structure along Medical Campus Drive.

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1105 Sixth StreetTraverse City, MI 49684-2386

munsonhealthcare.org/ForPhysicians

Michael J. Howe, MD

Michael J. Howe, MD, has joined the staff of Munson Healthcare as specialist in cardiology and interventional cardiology. Dr. Howe practices at Traverse Heart & Vascular, and is board certified in internal medicine and cardiology.

Traverse Heart & Vascular1200 Sixth St., Ste. 200Traverse City, MI 49684(231) 935-5800 phone(231) 935-5799 fax

For additional information, call HealthLink at (231) 935-5886 or 1-800-533-5520.For additional information, call HealthLink at (231) 935-5886 or 1-800-533-5520.

Anthony H. Livorine, MD

Anthony H. Livorine, MD, has joined the staff of Munson Healthcare as specialist in diagnostic radiology and neuroradiology. Dr. Livorine practices at Grand Traverse Radiologists.

Grand Traverse Radiologists1105 Sixth St.Traverse City, MI 49684(231) 935-6400 phone(231) 935-0498 fax

Yelena E. Kier, DO

Yelena E. Kier, DO, has joined the staff of Munson Healthcare as specialist in hematology/oncology. Dr. Kier practices at Munson Oncology, and is board certified in internal medicine.

Munson Oncology5041 N. Royal Dr., Ste. 2Traverse City, MI 49684(231) 392-8400 phone(231) 935-0704 fax