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March - April 2014 •
Volume 19, Issue 2

HBMA'S Vision and Mission
Message from the President
By Jeanne A Gilreath, CHBME, HBMA President
HBMA is faced with many challenges related to the evolution (some say revolution) of today's healthcare industry. These challenges are affecting all of the stakeholders that billing companies touch – either directly or indirectly – and include providers, facilities, payors, and patients. Additionally, competitive fee pressures have resulted in declining billing company revenues. These factors, among others, have resulted in HBMA's need to rethink its vision and mission. Click for more

HBMA Strategic Imperatives
By Ron Decker, CHBME
On December 24th around 9:00 PM, we experienced a 3.7 earthquake centered 1.3 miles from our Christmas Eve festivities. This followed a 4.5 only two weeks before. The conversations quickly shifted from Christmas traditions, family members, and what we put in the eggnog. Our guests wondered why – in an area experiencing catastrophic tornados, ice storms, droughts, and torrential Pacific Northwest rain – we were discussing earthquakes! Click for more

The Patient Centered Medical Home
An Opportunity for Improvement in Care and Revenue
By William Rollow, MD, MPH, Deborah Johnson-Ingram, and Julie Peskoe
Over the past decade, a new model of primary care called the "Patient Centered Medical Home" (PCMH) has gained increasing acceptance by payors, creating opportunities for increased revenue. We will review its history, requirements for transformation, associated revenue opportunities, and use of claims data. Click for more

Tools for Getting from ICD-9-CM to ICD-10-CM
The Real Deal, or Smoke and Mirrors?
By Holly Louie, RN, PCS, CHBME, and Melody Muliak, MSHS, CRA, FAHRA, RCC, CPC, CPC-H
With the fast-approaching ICD-10-CM implementation deadline of October 1, 2014, has come the proliferation of so-called translators, mapping programs, and crosswalks. Members of the billing and coding communities have been left asking, "Are these legitimate tools? Will they solve coding challenges by automating the coding process? Or will they just create new and additional challenges?" Click for more

Debunking ICD-10's Three Biggest Myths
Clarifying the Reality
By Jackie Griffin
Earlier this year, the Centers for Medicare & Medicaid Services (CMS) addressed several misunderstandings around ICD-10 in its "ICD-10-CM/PCS Myths and Facts" guide. While CMS debunked some of the most common ICD-10 myths, much of the industry is still confused about key topics, such as whether the ICD-10 deadline will once again be extended or which payors are required to transition to ICD-10. With less than a year until ICD-10 goes into effect, providers cannot waste time believing anything but the truth. Click for more

Participating in the Physician Quality Reporting System
Feature Article
By Daniel H. Green, MD, FACOG
The Physician Quality Reporting System (PQRS), run by the Centers for Medicare & Medicaid Services (CMS), encourages the reporting of quality information. PQRS gives participating eligible professionals the opportunity to assess the quality of care they are providing to their patients, helping to ensure that patients get the right care at the right time. Click for more

Reduce Hassles with AMA's Administrative Simplification Website
AMA Perspective
Published with permission of the American Medical Association (AMA)
If you are tired of calling to check the status of claims, searching payor websites for information, or figuring out why claims were denied, AMA's new administrative simplification website, available at, is the right tool for you. There, you will find free resources that can help you streamline your claims processes. Click for more

Myth-Busting Culture Change
Look at Your Organization's Culture
By Kevin Herring
Like the proverbial many ways to skin a cat, there are a number of ways to change the culture of an organization. There are also some principles that have proven their worth – along with more than a few myths that have crept into the popular literature on the topic. Here are a few of those myths that you should ignore in the vast sea of change mantras. Click for more

Using Smart Big Data to Transform the Collection Process
Feature Article
By Bill Marvin
As healthcare reform adds millions of new consumers to the U.S. healthcare system, and copays, deductibles, and coinsurances accelerate the rise in patient payments, billing services and their clients must operate more efficiently to keep administrative costs low and collect more from patients. Click for more

Dissecting the Balance Sheet
Feature Article
By Michael K. Farmer, CPA
Many business people only look at their profit and loss report when reviewing their financials. They may be missing some important information that is delineated on the balance sheet. Below is a sample balance sheet with items that should be reviewed to ensure the financial health of any company. It is also helpful to have a comparative balance sheet showing the current and last periods. This will help identify items that are growing or declining. Click for more

2014 Evaluation and Management Code Changes
Coding Corner
By Jackie Miller, RHIA, CCS-P, CPC
The 2014 CPT® code set includes a number of new and revised codes and coding guidelines for evaluation and management (E/M) services. In this column, we will review the changes related to interprofessional telephone/Internet consultation, complex chronic care coordination, and transitional care management. Click for more

Z Codes
By Valerie Fernandez, MBA, CPC, CPC-H, AHIMA ICD-10 Trainer
ICD-10-CM Z codes (categories Z00 – Z99) are used to report factors influencing health status and contact with health services. They are found in Chapter XXI in the ICD-10 book and may be used in any healthcare setting. They can be reported as a principal diagnosis in an inpatient setting, and may be listed either as a primary or secondary diagnosis in an outpatient setting, based on the type of encounter. Click for more

Flash Fill in Excel 2013
By Nate Moore, CPA, MBA, CMPE
If you have ever found some of Excel's complex functions and formulas intimidating or time-consuming to implement, this column is for you. One of the powerful new features in Excel 2013, Flash Fill, can recognize patterns in data and extract interesting information for you without writing any formulas. All you need to do is show Excel what you are looking for, and Flash Fill takes care of the rest. Click for more

Revenue Cycle Management and EHRs
EHR Issues
By Ron Sterling
Evolving payment mechanisms, such as Accountable Care Organizations and Shared Savings Models, are changing the Revenue Cycle Management (RCM) focus from encounter notes to a variety of other measures to justify billing and prove that quality measures are being met. Click for more

Issues Facing Medical Billing Companies in 2014
From the Road
By Dave Jakielo, CHBME
Are you ready for the most interesting year in the medical billing industry history? The rapidly changing environment and the challenges you will be facing mean that you will have to devote more time to strategic planning than ever before. Otherwise it will be difficult to remain in business. Click for more

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