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.
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.
From CMS Medicare FFS Provider e-News
The compliance deadline for ICD-10 is now October 1, 2014. With two years to complete ICD-10 implementation, providers and payers will need to communicate regularly to help ensure a smooth transition. To keep transition activities on track, providers and payers should:
Engage in an Open Dialogue:
Once you have established an ICD-10 Project Team or designated a representative to oversee transition activities, reach out to the organizations you coordinate with to inform them of your implementation plans. Regardless of your organization's size or resources, it is important to make sure you are regularly communicating with external partners about transition plans. If you have not already done so, make sure to:
- Communicate the current status of your organization's ICD-10 implementation efforts. As payers and providers may be at different stages of implementation, it is important to reach out to one another to share your organization's current focus.
- Share contact information for all key personnel at your organization involved in ICD-10 implementation activities. This will help ensure that information and updates are sent to the appropriate person(s) working on ICD-10 implementation, as well as reduce instances of miscommunication between organizations.
- Establish regular check-in meetings. Whether you choose to set up formal conference calls, in-person check-ins, or send updates via email, it is important to establish regular meetings to review transition progress and address challenges.
-
- Revise and Share Implementation Timelines :
Since the ICD-10 compliance deadline is now October 1, 2014, organizations will need to revisit their existing timelines or develop new ICD-10 implementation timelines. The timelines developed by CMS outline the steps you will need to take moving forward as well as the timing for each activity.
Following the revision of your organization's implementation timeline, share it with the providers or payers you are coordinating with on the ICD-10 transition. Providers and payers will need to work together on testing, so it will be important to make sure your timelines are in sync.
Please note: Current CMS timelines are based on the October 1, 2013, compliance deadline. CMS plans to update all materials to reflect the new October 1, 2014, compliance deadline. Continue to check the CMS website for updated materials.
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.
Assembling an ICD-10 Project Team
Assembling an ICD-10 Project Team to oversee your organization's shift to ICD-10 is instrumental to a successful transition. This team will be responsible for overseeing the ICD-10 planning and implementation process.
Select Your Team
Since ICD-10 will affect nearly all areas of your practice, project teams should consist of representatives from key areas of your organization, including:
- Senior Management
- Health Information Management/Coding
- Billing/Finance
- Compliance
- Revenue Cycle Management
- Information Systems and Technology
This multi-disciplinary team provides the cooperative environment necessary to address your organization's needs. If you run a small business or practice, several of these functional areas may rest with the same individuals, making your transition team smaller.
Appoint a Project Manager
Once members of the project team have been selected, appoint one team member to serve as the project manager. As the manager, he or she will be responsible for establishing accountability across the ICD-10 implementation team and making business, policy, and technical decisions.
Your Team's Initial Tasks
With an established project team and a designated project lead, you'll be ready to begin planning for ICD-10 implementation. Project teams should:
- Establish regular check-in meetings to discuss progress and address any issues.
- Conduct an ICD-10 impact assessment to help you determine how the transition to ICD-10 will affect your organization, and allow you to schedule and budget for all ICD-10 activities.
- Plan a comprehensive and realistic budget. This should include costs such as software upgrades and training needs.
- Identify and ensure involvement and commitment of all internal and external stakeholders. Contact vendors, physicians, affiliated hospitals, clearinghouses, and others to determine their plans for ICD-10 transition.
- Develop and adhere to a well-defined implementation timeline that makes sense for your organization.
Communicate Regularly
Remember to communicate regularly with your entire ICD-10 project team. Keeping the lines of communication open will help make sure everyone is kept up to date on the implementation progress. It may be helpful to establish and circulate a calendar of internal tasks, milestones, and deadlines to help keep day-to-day activities running smoothly and on schedule.
Tips for Home Health and Hospice Agencies to Plan for the ICD-10 Transition
Although the final rule on the proposed ICD-10 deadline change has yet to be published, it is important to continue planning for the transition to ICD-10. The switch to the new code set will affect every aspect of how your organization provides care, but with adequate planning and preparation, you can ensure a smooth transition for your practice.
You should consider the following checklist to help keep your efforts on track with your transition:
- Educate staff and leadership about ICD-10
- Appoint an ICD-10 coordination manager and delegate a steering committee to manage the transition
- Train staff on changes in documentation requirements from health plans and how this will affect work flow
- Perform an impact assessment
- Examine existing uses of ICD-9 codes in order determine aspects of work flow and business practices that ICD-10 will potentially change. Be sure to evaluate planned and ongoing projects as well
- Create a list of staff members who need ICD-10 resources and training, such as billing and coding staff, clinicians, management, and IT staff
- Plan a realistic and comprehensive budget
- Estimate a budget that includes costs such as software, hardware, staff training, and any initial change in patient volume
- Coordinate with external partners
- Contact system vendors, clearinghouses, and billing services to assess their readiness and evaluate current contracts
- Ask your vendors how they will support you in the transition to ICD-10 and request a timeline and cost estimate
- Analyze existing health plan trading partner agreements
- Get ready for testing
- Request a testing plan to schedule from your vendor
- Conduct internal testing within your clinical practice as well external testing with payers and other external business partners after you have completed the planning stages
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 provides integrated home health software solutions with CareSmart AMS software.
Looking for software or billing solutions for your home health agency?
Check out CareSmart AMS and CareSmart Billing.
Copyright © 2011 Home Care Software Solutions. All rights reserved.
Although the final rule on the proposed ICD-10 deadline change has yet to be published, it is important for home health and hospice agencies to continue planning for the transition to ICD-10. The switch to the new code set will affect every aspect of how your organization provides care, from registration and referrals, to software/hardware upgrades and clinical documentation.
A critical step in planning for the transition is to conduct an impact assessment of how the new code sets will affect your organization. Your impact assessment should include:
- Documentation Changes: You will need to consider the increased specificity of ICD-10 codes compared to ICD-9 codes, and ensure that patient encounters are documented with appropriately comprehensive clinical descriptions. You should:
- Train staff to accommodate the substantial increase and specificity in code sets
- Consider physician workflow and patient volume changes
- Revise forms, documents, and encounter forms to reflect ICD-10 codes
- Evaluate processes for ordering and reporting lab/diagnostic services to health plans
- Reimbursement Structures: You should coordinate with payers on contract negotiations and new policies that reflect the expanded code sets, since they can affect reimbursement schedules.
- Systems and Vendor Contracts: Ensure your vendors can accommodate your ICD-10 needs. Find out how and when your vendor plans to update your existing systems. You will need to review existing and new vendor contracts and to evaluate vendor offerings and capabilities against your organization's expectations. Work with your vendors to draft a schedule for needed tasks.
- Business Practices: Once you have implemented ICD-10, you will need to determine how the new codes affect your processes for referrals, authorizations/pre-certifications, patient intake, physician orders, and patient encounters.
- Testing: Work with your vendors to determine the amount of time needed for testing and schedule accordingly.
ICD-10 will affect nearly all areas of your agency, but with a thorough impact assessment, you can keep your day-to-day activities running smoothly while you transition to ICD-10.
Keep Up to Date
Please visit the ICD-10 website for the latest news and resources to help you prepare.
Home Care Software provides integrated home health software solutions with CareSmart AMS software.
Looking for software or billing solutions for your home health agency?
Check out CareSmart AMS and CareSmart Billing.
Copyright © 2011 Home Care Software Solutions. All rights reserved.
Post-Acute Care
Study highlights cost-effectiveness of home healthcare as post-acute setting
When home healthcare is used as the first post-acute care setting after a hospital stay, it was found to be the most cost-effective care setting, new research suggests.
For the study, conducted by Dobson DaVanzo and Associates, investigators studied Medicare claims data for 24,239,080 total post-acute episodes and a total of $472.8 billion in Medicare payments. Post-acute settings included skilled nursing facilities, inpatient rehab facilities and long-term care hospitals.
According to the executive summary, Home Healthcare Is A Cost Effective Setting for Post-Acute Care. Of the episodes that are admitted to a formal post-acute care setting upon discharge from the index acute care hospitalization
(HHA, SNF, IRF, LTCH), home health first setting episodes are the least costly: representing 38.7 percent
of episodes, but only 27.8 percent of first setting episode Medicare payments. Read the summary HERE.
ICD-10 delay should be one year, says HHS
WASHINGTON – The loose contingent of health professionals railing against the ICD-10 delay will likely consider this welcome news: There is a document circulating the Web right now – with a stamp at the top suggesting it will be published in the Federal Register on April 17, 2012 – in which HHS proposes that the new compliance date for ICD-10 be October 1, 2014. Read more HERE.
Caregiving as a ‘Roller-Coaster Ride From Hell’
In her book, Dr. Denholm discusses a series of coping strategies that she developed with her husband during his long illness. The most important of these is to adopt communication tools that avoid red flags, accusations and self-pity, and instead “create expectations, agreements and understandings, including some that may involve agreeing to disagree,” she said. Continue Reading . . .
April 16th, 2012
National Healthcare Decisions Day exists to inspire, educate & empower the public & providers about the importance of advance care planning. National Healthcare Decisions Day is an initiative to encourage patients to express their wishes regarding healthcare and for providers and facilities to respect those wishes, whatever they may be.
Management
Change the Game, Transform Your Company
The strategic conversation in most companies has shifted from cost-cutting to growth and expansion. But how do companies get out of the "survival mode," identify the right new products and services, and motivate employees to create real competitive advantage? Read more HERE.
10 Requirements of the Perfect Manager
If you could hire your next boss, what selection criteria would you use? Alan Norton shares a make-believe want ad aimed at finding the ideal manager. Read more
Copyright © 2011 Home Care Software Solutions. All rights reserved.
ICD-10: It’s Closer Than It Seems – Steps to Take to Refine your Version 5010 Upgrade
The Version 5010 upgrade deadline was Sun Jan 1. CMS initiated an enforcement discretion period for 90 days, which ends on Sat Mar 31. You should be finalizing your upgrade to Version 5010 if you have not yet done so.
Once you have finished your upgrade to Version 5010, you'll need to ensure your system continues to run properly. Providers should look for the following indicators to make sure there are no problems with their system upgrade:
- An Increase in Rejections or Denials of Claims – An increase in rejections or denials of claims may be an indication that there is not sufficient or correct data provided to meet Version 5010 standards. Partners, such as payers, also have a part in correcting this issue, since forwarding, converting, or formatting data can result in rejections or denials. Monitor your claims closely to determine the reasons for rejection or denial of claims and coordinate with payers to ensure that data is properly processed to avoid claim delays.
- Issues with Non-Electronic Funds Transfer (non-EFT) Payments – Version 5010 includes changes to claims formatting, including a full nine-digit zipcode and inclusion of provider billing address. Submitting claims with only a five-digit zipcode will result in rejection. If your practice has not submitted the correct billing or mailing address as part of your Version 5010 claim, your non-EFT payments or Explanation of Benefits (EOBs) information may be mailed to the wrong physical location. Make sure to coordinate with your payers to verify how they use enrollment information and process claims data, as this will also be affected by the mailing address on file. Being diligent in tracking your claims and remittances (EOBs) will help identify and address any issues that may arise.
- Formatting Discrepancies with Partners – Your trading partners should also have upgraded to Version 5010; however, your organization may interpret the new standards differently than your external partners, which can result in rejected claims. You should coordinate with your payers and/or clearinghouse to determine any gaps or discrepancies in claims submissions. You and your partners should monitor claims that are automatically transferred between payers and address new response formats or data as claims are processed.
Make sure to take a look at the Version 5010 section of the ICD-10 website to find helpful factsheets on the upgrade to Version 5010 and previous listserv messages discussing the Version 5010 upgrade.
Keep Up to Date on Version 5010 and ICD-10. Please visit the ICD-10 website for the latest news and resources to help you prepare, and to download and share the implementation widget today!
Important Update – “HIPAA Version 5010/D.0 Implementation” Document has been Updated
Updates have been made to the recently-posted document titled “Important Update Regarding HIPAA Version 5010/D.0 Implementation” – specifically, CMS has modified information related to the Diagnosis Related Group (DRG) code. The document can be found at the top of the HIPAA Versions 5010 & D.0 Overview webpage, at http://www.CMS.gov/versions5010andd0/01_overview.asp.
Copyright © 2011 Home Care Software Solutions. All rights reserved.
In a little over 18 months from now medical providers including home health and hospice agencies will be transitioning to ICD-10. How is your agency preparing for the transition?
During the next 18 months, Home Care Software is committed to providing you and your home health and hopice agency with the tools and resources that you need to be fully prepared. To start, CMS launched ICD-10 National Provider Calls last year. These calls can be reviewed in their entirety on the CMS YouTube channel.
From CMS:
Is your organization preparing for a smooth transition to ICD-10 on Tuesday, October 1, 2013? ICD-10 National Provider Calls, hosted by the CMS Provider Communications Group, can help you prepare for the US healthcare industry's change from ICD-9 to ICD-10 for diagnosis and inpatient procedure coding.
Video slideshow presentations from the following National Provider Calls are available on the CMS YouTube Channel. These video slideshows include the call slide presentation and audio with captions; each call includes presentations by CMS subject matter experts, followed by a question and answer session.
The ICD-9-CM and ICD-10 Cooperating Parties – CMS, the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), and the Centers for Disease Control and Prevention (CDC) – discuss ICD-10 implementation strategies and planning, and the CMS Provider Billing Group discuss the Medicare FFS claims processing guidance issued in August 2011.
CMS subject matter experts discuss how physician offices can prepare for the change to ICD-10 for medical diagnosis and inpatient procedure coding and provide updates on national ICD-10 implementation issues affecting all providers.
CMS subject matter experts discuss the ICD-10 conversion process currently taking place within CMS, including a case study from the Coverage and Analysis Group on their transition to ICD-10 for the lab national coverage determinations (NCDs).
Podcasts, complete audio files, and complete written transcripts for these ICD-10 National Provider Calls are also available on the CMS ICD-10 webpage at http://www.CMS.gov/ICD10/Tel10/list.asp.
Available 24/7, YouTube video presentations and podcasts make learning about the ICD-10 transition easy and convenient. Check them out today.
Copyright © 2011 Home Care Software Solutions. All rights reserved.
Clarification Concerning HIPAA 5010 and NCPDP D.0 Cut-Over and Impacts on Crossover Claims
Wed 1/18/2012 3:03 PM
On Monday, December 5, 2011, CMS issued a Special Edition MLN Matters Article (SE1137) entitled “Additional Health Insurance Portability and Accountability Act (HIPAA) 837 5010 Transitional Changes and Further Modifications to the Coordination of Benefits Agreement (COBA) National Crossover Process.” CMS issued this guidance for the benefit of physicians/practitioners, providers, and suppliers to help them understand why they were seeing greater instances of Medicare correspondence letters that made reference to error N22226 as the basis for why their patients’ claims could not be crossed over.
CMS has since learned that concern exists in the provider community concerning whether billing of hardcopy CMS 1500 or UB04 claims or HIPAA version 4010A1 or National Council for Prescription Drug Programs (NCPDP) version 5.1 batch claims will result in Medicare being unable to cross those claims over to COBA supplemental payers that have cut-over to exclusive receipt of crossover claims in the version 5010 837 claim formats or NCPDP D.0 batch claim formats. This is not true.
During the 90-day Version 5010 non-enforcement period (Sunday, January 1, 2012 through Saturday, March 31, 2012), Medicare will have the systematic capability to perform up- or down-version conversion of incoming claim formats (ie. convert incoming hardcopy formats to HIPAA equivalent claim formats and convert incoming version 4010A1 claim formats to 5010 formats and vice-a-versa), in accordance with external supplemental payer specifications concerning production claims format. This practice will discontinue, however, at the conclusion of the 90-day non-enforcement period, with the exception below. (This action is controlled by information that the Common Working File receives concerning individual supplemental payers’ ability to accept HIPAA 5010 or NCPDP D.0 claim formats in “production” mode.)
Note that physicians/practitioners, providers, and suppliers that have authorization under the Administrative Simplification Compliance Act (ASCA) to submit claims using a hardcopy format should know that Medicare has the systematic capability to convert keyed claims into outbound-compliant HIPAA 837 claim formats for crossover claim transmission purposes. This is true at all times, not just during the 90-day non-enforcement period.
Flu Season is Here! While seasonal flu outbreaks can happen as early as October, flu activity usually peaks in January. Remind your patients that annual vaccination is recommended for optimal protection. Medicare pays for the seasonal flu vaccine and its administration for seniors and others with Medicare with no co-pay or deductible. Healthcare workers, who may spread the flu to high risk patients, should get vaccinated too. Don’t forget to immunize yourself and your staff. Protect your patients. Protect your family. Protect yourself. Get the Flu Vaccine—Not the Flu.
Remember – The flu vaccine plus its administration are covered Part B benefits. CMS has posted the 2011-2012 seasonal flu vaccine payment limits at http://www.CMS.gov/McrPartBDrugAvgSalesPrice/10_VaccinesPricing.asp. Note that the flu vaccine is NOT a Part D-covered drug.
For more information on coverage and billing of the flu vaccine and its administration, as well as related educational provider resources, visit http://www.CMS.gov/MLNProducts/35_PreventiveServices.asp and http://www.cms.gov/immunizations.
Copyright © 2011 Home Care Software Solutions. All rights reserved.