With the October 1, 2014, ICD-10 deadline approaching, you may be wondering how you will code a claim that you are submitting in October 2014 for a service that your practice provided in September 2014.
Even if you submit your claim on or after the ICD-10 deadline, if the date of service was before the October 1, 2014, deadline, you will use ICD-9 to code the diagnosis.
For dates of service on or after the October 1, 2014, deadline, you will use ICD-10. You may not be able to use ICD-9 and ICD-10 codes on the same claim based on your payers' instructions. This may mean splitting services that would typically be captured on one claim into two claims: one claim with ICD-9 diagnosis codes for services provided before October 1, 2014, and another claim with ICD-10 diagnosis codes for services provided on or after October 1, 2014.
Some trading partners may request that ICD-9 and ICD-10 codes be submitted on the same claim when dates of service span the compliance date. Trading partner agreements will determine the need for split claims.
Here's an example of a split claim:
A patient has an appointment on September 27, 2014, and is diagnosed with bronchitis. He returns for a follow-up appointment on October 3, 2014. In this case, a practice will submit a claim with an ICD-9 diagnosis code for the first visit and another claim with an ICD-10 diagnosis code for the follow-up visit.
Make sure that your systems, third-party vendors, billing services, and clearinghouses can handle both ICD-9 and ICD-10 codes depending on the dates of service in the months following October 1, 2014.
Please note that future ICD-10 Email Updates will explore how Medicare will handle dates of service for inpatient settings (e.g., a hospital inpatient stay that begins before the transition date and ends after the transition date will be coded on a single claim with ICD-10). Stay tuned for details.
Keep Up to Date on ICD-10
Visit the CMS ICD-10 website for the latest news and resources and the ICD-10 continuing medical education modules developed by CMS in partnership with Medscape to help you prepare for the October 1, 2014, deadline.
Home Care Software Solutions, Inc. provides integrated home health software solutions with CareSmart AMS software.
Looking for software or billing solutions for your home health or hospice agency?
Check out CareSmart AMS, EDI Smart Reader, Data Smart Online Backup and CareSmart Billing.
Copyright © 2011 Home Care Software Solutions. All rights reserved.
|
 April 2013 Quarterly System Release - Claim Hold
CMS Article PE201304-01
The Centers for Medicare & Medicaid Services (CMS) has identified technical issues with certain parts of the April 2013 quarterly systems release.
For claims with dates of service or "Through Dates" on or after April 1, 2013, the issues affect
(1) all home health final claims
(2) outpatient critical access hospital (CAH) and rural health clinic (RHC) claims where dollars have been applied to the beneficiary deductible, and
(3) the remittance advice summary payment amount for Medicare Advantage inpatient prospective payment system (IPPS) claims with indirect medical education (IME).
Actual payments and the claim-level payment amounts on the remittance advice are correct for these Medicare Advantage IPPS IME claims. Final home health, outpatient CAH and RHC, and Medicare Advantage IPPS IME claims with dates of service or "Through Dates" prior to April 1, 2013, are unaffected.
In addition, for claims pending with or received by the Medicare claims administration contractors on or after April 1, 2013, the issues affect
(1) all claims for assistant-at-surgery services, and
(2) all ambulatory surgical center claims.
As a result of these issues, CMS has instructed its Medicare claims administration contractors to hold all of these specific claim types until April 14, 2013, when system fixes are expected to be implemented. These claims will be released into processing on April 15, 2013. The claim hold should have minimal impact on provider cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 for paper claims) after the date of receipt.
CMS regrets any inconvenience and is working to resolve these issues as quickly as possible.
|
Copyright © 2011 Home Care Software Solutions. All rights reserved.
CMS is hosting an Elder Maltreatment Symposium.
The purpose of this symposium is to solicit input from stakeholders to assist CMS in further development of Measure #181: Elder Maltreatment Screen and Follow-Up Plan, as part of the Physician Quality Reporting System.
Interested parties are invited to participate, either on-site at CMS headquarters in Baltimore or via Webinar. The meeting is open to the public; however attendance is limited for both on site and Webinar participation. Please register for this event early as registration will close when attendance capacity has been met.
The symposium will be held on March 8 from 9am until 1pm ET in the main auditorium of CMS, 7500 Security Boulevard, Baltimore, MD 21244–1850.
Meeting Registration and Request for Special Accommodations Deadline:
Registration is now open. Anyone interested in attending the meeting or participating by Webinar must register by completing the online registration. For security reasons, registration and requests for special accommodations must be completed no later than 5pm ET on Friday, February 22.
CMS will post an audio download and/or transcript of the symposium on the CMS website and the US Quality Measures website following the meeting.
Home Care Software Solutions, Inc. provides integrated home health software solutions with CareSmart AMS software.
Looking for software or billing solutions for your home health or hospice agency?
Check out CareSmart AMS, EDI Smart Reader, Data Smart Online Backup and CareSmart Billing.
Copyright © 2011 Home Care Software Solutions. All rights reserved.
The next Home Health, Hospice & Durable Medical Equipment (DME) Open Door Forum is scheduled for
Wednesday, February 20, 2013
2:00pm – 3:00pm, ET.
If you wish to participate, dial
1-800-837-1935
Conference ID: 78869441.
Please see the Downloads section below for the full announcement including agenda. Thank you for your continued interest in the CMS Open Door Forums.
Home Health, Hospice, and Durable Medical Equipment Open Door Forum (ODF) Overview:
The Home Health, Hospice & Durable Medical Equipment ODF addresses the concerns of three unique health care areas within the Medicare & Medicaid programs. Issues related to Home Health PPS, the newly proposed competitive bidding for DME, and the Medicare Hospice benefit are all topics the forum has covered. Many of the issues covered bridge concerns within all three settings, and the combination of the topics under one Forum has been useful to many participants. We continue to hold Special ODFs when individual policy issues require special attention. Timely announcements and clarifications regarding important rulemaking, agency program initiatives, and other related areas are also included in the forums.
Copyright © 2011 Home Care Software Solutions. All rights reserved.
Medscape Modules Available on ICD-10 [↑]
CMS, through Medscape Education, has released two ICD-10 video lectures and an expert article providing practical guidance for the ICD-10 transition. The video lectures are specifically for physicians, while the article covers more general topics for all health care providers. Continuing medical education (CME) credits are available to physicians who complete the modules, and anyone who completes them can receive a certificate of completion.
The modules are free. You can use the links below to access them. If you are not a member of Medscape, you will first be prompted to fill out a brief registration form.
The videos, ICD-10: A Guide for Small and Medium Practices and ICD-10: A Guide for Large Practices, feature Daniel J. Duvall, MD, MBA, medical officer with the Hospital and Ambulatory Policy Group at CMS, describe:
- Global differences between ICD-9 and ICD-10
- How ICD-10 will have different impacts on practices of different sizes
- Basic transition planning steps and resources
In the article Transition to ICD-10: Getting Started, Joseph Nichols, MD, of Health Data Consulting covers documentation improvements, the coder-clinician relationship, training, working with vendors and payers, search tools, and resources.
For questions or technical assistance with the CME modules, please contact Medscape at CME@medscape.net.
Keep Up to Date on ICD-10
Please visit the ICD-10 website for the latest news and resources to help you prepare!
Home Care Software Solutions, Inc. provides integrated home health software solutions with CareSmart AMS software.
Looking for software or billing solutions for your home health or hospice agency?
Check out CareSmart AMS, EDI Smart Reader, Data Smart Online Backup and CareSmart Billing.
Copyright © 2011 Home Care Software Solutions. All rights reserved.
CMS Medicare FFS Provider e-News
Develop Your ICD-10 Communication and Awareness Plan
Although the final rule on the proposed ICD-10 deadline change has not yet been published, it's important to continue planning for the transition to ICD-10. A critical step in planning is to build organizational awareness and to develop a communication plan.
A communication and awareness plan ensures that all your employees and other internal departments as well as external business partners understand their roles and responsibilities for ICD-10 implementation. Think of this communication plan as a formal roadmap for communicating about ICD-10 throughout the transition. A plan is particularly important in larger organizations where you work with many different people and departments that may affect your successful transition to ICD-10. But it can be just as important in a small practice that everyone knows what, why, and how the transition will happen.
Your communication plan should identify:
- Project purpose – Provide ICD-10 background information and clearly describe the current state of ICD-10 progress in your organization, identify goals for the communication and awareness plan, and explain the purpose and expected outcomes of the transition.
- Partners – Identify all parties involved in your ICD-10 transition. For internal staff, you will need to establish a process to communicate governance issues to leaders and assess staff training needs. Coordinate with external groups such as vendors, clearinghouses, and state agencies about implementation updates and changes required in your systems and business processes.
- Messages – Be clear and consistent about what you say, focusing on specific steps and actions that need to happen for the ICD-10 transition.
- Issues – Outline your organization's protocol for identifying potential implementation issues and provide a plan for correcting them.
- Roles and responsibilities – Assign and clearly define communication roles and responsibilities to everyone involved in the transition.
- Timelines – Identify project milestones, secondary tasks, and deadlines. Be certain all project teams know what they will need to do. Develop back-up plans for each milestone to help you handle potential problems.
- Communication methods – Think about how to best communicate within your organization. Emails, in-person meetings, and conference calls may all be effective, but some might work better for different staff and divisions.
While the size of your organization will determine how much planning and documentation will be necessary for the ICD-10 transition, it is always important to keep the lines of communication open. This will help to foster trust among staff members and show that your organization is taking steps to implement ICD-10.
Keep Up to Date on ICD-10:
Please visit the ICD-10 website for the latest news and resources to help you prepare.
Home Care Software Solutions, Inc. provides integrated home health software solutions with CareSmart AMS software.
Looking for software or billing solutions for your home health or hospice agency?
Check out CareSmart AMS, EDI Smart Reader, Data Smart Online Backup and CareSmart Billing.
Copyright © 2011 Home Care Software Solutions. All rights reserved.
Major Improvements to the Internet-based PECOS System
Over the last year, we have listened to your feedback about Internet-based PECOS. We have made improvements to increase access to more information. PECOS is easier to use than ever with the following upgrades that are now available:
- The electronic signature emails to the Authorized Officials have been updated. The new emails will include the Provider/Supplier’s name as well as “1 of 2 emails” or “2 of 2 emails” in the subject line. Email 1 of 2 will contain the Web Tracking ID to be entered on the PECOS E-Signature page and email 2 of 2 will contain the PIN for the PECOS E-Signature page. The body of the email also contains additional information about the application, including:
- LBN or First Name/Last Name
- Provider/Supplier Specialty
- State
- Form Type
- Practice Location
- NPI
- SSN/EIN (Last 4 Digits Unmasked)
- Providers/Suppliers are now able to see all of their Medicare IDs in Internet-based PECOS, including Medicare IDs (Provider Transaction Access Numbers (PTANs)) associated with reassignment of benefits, practice locations, and Other Medicare IDs. Other Medicare IDs are Medicare ID(s) that are associated with the specific enrollment record for claims payment purposes, but are not yet directly linked to a Practice Location or a Reassignment of Benefits within PECOS.
When there are Medicare IDs listed in the enrollment, PECOS will display the “View Medicare ID Report” hyperlink on the “My Enrollments” page. The “View Medicare ID Report” is also available in the Topic View tab within a specific enrollment record.
- Providers will now have access to an Advance Diagnostic Imaging (ADI) Accreditation Report. This report is accessible from the “My Enrollments” page by selecting the “View” button for a specific enrollment. This report will display the modalities that the provider is accredited for, the effective and end dates and the Accrediting Organization. This report is also available if performing a Change of Information (COI) under the Physical Location and Special Payments section.
The ADI Accreditation Report displays up to 50 records on the screen. If more than 50 records exist, the provider will be prompted to download the report into an Excel spreadsheet by clicking the “Generate Report” button at the bottom of the screen.
- Individual providers that are currently enrolled in Medicare solely to order, but wish to enroll to be reimbursed by Medicare for services furnished can convert their existing CMS 855O enrollment application into a CMS 855I enrollment application. Please refer to the “Converting Existing CMS 855O enrollment to CMS 855I” on the CMS website.
- Providers and Suppliers completing a CMS 855B enrollment will now be able to designate their practice location type as a Critical Access Hospital (CAH) or a Skilled Nursing Facility (SNF).
- Federally Qualified Health Center (FQHC) applications will now be routed to the correct Medicare Administrative Contractor (MAC). A new question has been added asking if the provider is a Tribal Owned FQHC. Based on the provider’s selection the Internet-based PECOS application will be routed to the correct MAC.
To access internet-based PECOS, go to the PECOS website.
Home Care Software Solutions, Inc. provides integrated home health software solutions with CareSmart AMS software.
Looking for software or billing solutions for your home health or hospice agency?
Check out CareSmart AMS, EDI Smart Reader, Data Smart Online Backup and CareSmart Billing.
Copyright © 2011 Home Care Software Solutions. All rights reserved.
National Provider Call: Preparing Physicians for ICD-10 Implementation — Register Now
Thursday, October 25; 1:30-3pm ET
HHS has announced the final rule that delays the ICD-10 compliance date from October 1, 2013 to October 1, 2014. Now is the time to prepare.
During this ICD-10 National Provider Call, Dr. Ginger Boyle, a practicing family physician who has developed a coding education program for Spartanburg Regional Healthcare System (SRHS) and its family practice residency program, will share her success and some practical advice about the SRHS transition to ICD-10. CMS subject matter experts will also present the latest information and updates from their areas, followed by a question and answer session.
Agenda:
- Transitioning to ICD-10: practical pointers for providers
- Overview of ICD-10 implementation requirements
- Plans for Local Coverage Determination (LCD) and National Coverage Determination (NCD) ICD-10 conversions
- National implementation issues and plans
- Question and answer session
Target Audience: Medical coders, physicians, physician office staff, nurses and other non-physician practitioners, provider billing staff, health records staff, vendors, educators, system maintainers, laboratories, and all Medicare FFS providers
Registration Information: In order to receive call-in information, you must register for the call on the CMS Upcoming National Provider Calls registration website. Registration will close at 12pm on the day of the call or when available space has been filled; no exceptions will be made, so please register early.
Meeting with Your ICD-10 Project Team
To make sure your organization successfully makes the switch from ICD-9 to ICD-10 by the October 1, 2014, compliance deadline, it will be important to meet with your ICD-10 Project Team regularly to discuss transition activities, challenges, and needs.
Preparing for Your ICD-10 Check-in Meeting
As you hold in-person check-in meetings or conference calls, it is helpful to establish a day and time when the meeting will occur each month (e.g., 1 pm on the first Tuesday of the month), so that all team members know that ICD-10 is a priority for your practice. As the transition date approaches, you should switch to more frequent meetings, weekly or bi-weekly.
To make sure the check-in meetings are productive, consider the following tips for holding an effective meeting:
- Create an agenda. Developing and disseminating a brief agenda prior to the meeting will help keep the conversation on track and will allow team members to prepare their updates.
- Reserve time for questions. Remember to set aside time at the end of the meeting for questions from project team members.
- Take notes and draft action items. Following each meeting, distribute key takeaways and action items to the team to keep everyone informed about any important decisions made and individual responsibilities.
During meetings, team members should plan to discuss:
- Progress on ICD-10 transition activities. This will help to keep the team up to date on each individual's assigned tasks. It may also be helpful to use this time to set deadlines and goals for completing task activities.
- Upcoming education opportunities. Share information about local events or online trainings on ICD-10 that may benefit the team. Also, feel free to distribute ICD-10-related articles to keep the team informed about the latest ICD-10 news.
- Best practices. Have you done or did you hear about a novel way to address part of your transition to ICD-10? Take this time to share that information, and discuss how it can be applied in your group's implementation plan.
- Challenges encountered. Use this time to discuss any challenges the team has encountered, and brainstorm ways to successfully overcome these obstacles.
Keep Up to Date on ICD-10.
Please visit the ICD-10 website for the latest news and resources to help you prepare.
Every business needs a structured disaster recovery plan. With Data Smart Online Backup from Home Care Software, you can have tailored backup services to fit your home health or hospice agency. With server backup and recovery, remote office protection, laptop and desktop protection, and file archiving, your agency will be prepared for the worst.
Get more information at www.hcssolutions.com/datasmart or call 866-355-3164 today.
Copyright © 2011 Home Care Software Solutions. All rights reserved.
From HelpingYouCare.com:
HHS Agrees to End Practice of Denying Medicare Coverage for Skilled Care & Related Home Health & Therapy Due to Lack of Patient Improvement
By Editor, on October 24th, 2012
The U.S. Department of Health and Human Services (HHS) has entered into a proposed settlement of a lawsuit in which HHS agreed to revise portions of the Medicare Benefit Policy Manual to stop the long-standing practice of denying Medicare Skilled Care and related home health and therapy benefits on the basis of a lack of improvement of the patient.
The proposed Settlement Agreement, filed October 16, 2012 in a lawsuit pending in the U.S. District Court in Vermont, may result in a significant increase in future Medicare benefits to cover “Skilled Care” (delivered by a nurse or doctor) along with related home health and therapy services for Medicare patients who suffer from chronic conditions.
The proposed Settlement Agreement must be approved by the Court before it would go into affect. According to reporting by the New York Times, the parties have indicated that Court approval is expected.
According to the Center for Medicare Advocacy, which is plaintiffs’ counsel in the pending lawsuit, “Nearly half (46%) of all Medicare beneficiaries have three or more chronic conditions, the majority of which need therapeutic care.”
However, patients with chronic conditions (such as paralysis, Multiple Sclerosis, Alzheimer’s Disease, Parkinson’s Disease, or Lou Gehrig’s disease) often are unable to demonstrate that they would improve as a result of the Skilled Care and related home health care and therapy services they may need in order to avoid deterioration of their conditions and further hospitalizations. Therefore, up to now they frequently have been denied Medicare coverage of such care under the so-called “Improvement Standard” that has long been applied by Medicare providers and suppliers.
Continue Reading
Home Care Software Solutions, Inc. provides integrated home health software solutions with CareSmart AMS software.
Looking for software or billing solutions for your home health or hospice agency?
Check out CareSmart AMS, EDI Smart Reader, Data Smart Online Backup and CareSmart Billing.
Copyright © 2011 Home Care Software Solutions. All rights reserved.
Medicare Part B Outpatient Therapy Cap and Exceptions Process Extended Through December 31, 2012 [↑]
The Middle Class Tax Relief and Job Creation Act of 2012 (H.R.3630) was signed into law on February 22, 2012; extending the Medicare Part B Outpatient Therapy Cap Exceptions Process through December 31, 2012.
The statutory Medicare Part B outpatient therapy cap for Occupational Therapy (OT) is $1,880 for 2012, and the combined cap for Physical Therapy (PT) and Speech-Language Pathology Services (SLP) is also $1,880 for 2012. This is the annual per beneficiary therapy cap amount determined for each calendar year. Similar to the therapy cap, Congress established a threshold of $3,700 for PT and SLP services combined and another threshold of $3,700 for OT services. All therapy services rendered above the $3,700 are subject to manual medical review and certain providers will be required to submit a request for an exception.
The therapy cap applies to all Part B outpatient therapy settings and providers including:
- Private practices
- Part B skilled nursing facilities
- Home health agencies (TOB 34X)
- Outpatient rehabilitation facilities (ORFs)
- Rehabilitation agencies (Comprehensive Outpatient Rehabilitation Facilities-CORFs)
- Hospital outpatient departments (HOPDs) – beginning October 1, 2012 until December 31, 2012
The law requires an exceptions process to the therapy cap that allows providers to receive payment from Medicare for medically necessary therapy services above the therapy cap amount. Beginning on October 1, 2012 some therapy providers will be required to submit requests for exceptions (pre-approval for up to 20 therapy treatment days for beneficiaries at or above the $3,700 threshold). The $3,700 figure is the defined threshold which triggers the requirement for an exception request. This requirement will not be imposed on all therapy providers at one time, it will be phased in, and therapy providers will be assigned to three groups or phases. The requirement to submit an exception request will be imposed on them on the dates listed below depending on which of the three groups or phases to which they are assigned.
- Phase I October 1 to December 31, 2012
- Phase II November 1 to December 31, 2012
- Phase III December 1 to December 31, 2012
If you are a provider of physical therapy, speech-language pathology services, or occupational therapy services, you may receive a letter titled “Notification of Request for Exception Requirements for Therapy”, indicating your assigned phase.
You can find your assigned phase here. If you do not find your NPI number on the list, then you are in Phase III.
If you have questions, please contact your local Medicare Administrative Contractor’s (MAC’s) Customer Service Department. You can find your local MAC on the Provider Compliance Interactive map.
For more information on the Medicare Part B outpatient therapy cap and exceptions process visit the Medical Review and Education website.
Home Care Software Solutions, Inc. provides integrated home health software solutions with CareSmart AMS software.
Looking for software or billing solutions for your home health or hospice agency?
Check out CareSmart AMS, EDI Smart Reader, Data Smart Online Backup and CareSmart Billing.
Copyright © 2011 Home Care Software Solutions. All rights reserved.