ICD10 Implementation – Possible Delays Pending

With just a few months to go until ICD10 implementation, there is still some chance that implementation might be delayed yet again.

On 4/30/15, Representative Ted Poe of Texas introduced a bill to ban the use of ICD10.

The bill is called the “Cutting Costly Codes Act of 2015”. It prohibits the federal government from requiring the use of ICD10 instead of ICD9. Poe claims that the implementation of the new code set will put unnecessary strain on the medical community.

Possible Delays Pending
Caution

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Stagnation in HIPAA Adoption Rates

A few weeks ago I wrote a short blog about the recently released statistics on the adoption rate of HIPAA transactions compiled by CAQH for the calendar year of 2013. This report is called the 2014 CAQH index and is available through the CAQH web site (http://www.caqh.org/) or directly through this link:

http://www.caqh.org/pdf/2014Index.pdf

This study is actually the second year in a row where they collected this data so in addition to providing adoption rates for 2013, the data for 2012 is available as well along with a measurement of change in the adoption rate of these transactions over a year.

Here are the adoption rates for the two years for the three most common standardized healthcare electronic transactions:

Claim Submission 2012 90.2% 2013 91.8% Change +1.46%
Eligibility 2012 64.7% 2013 65.3% Change +0.6%
Remittance Advice 2013 42.7% 2013 46.4% Change +3.7%

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Medicare Eligibility through HETS and the Hospice Notice of Election (NOE)

Medicare maintains a computer system dedicated to the processing of eligibility requests through the HIPAA ANSI 270/271 transactions designed for this purpose. The system is called HETS which stands for HIPAA Eligibility Transaction System. You can obtain more information about this system from their site:
http://cms.gov/Research-Statistics-Data-and-Systems/CMS-Information-Technology/HETSHelp/HowtoGetConnectedHETS270271.html

This system is updated daily with information from the Common Working File (CWF) and other CMS systems to include current eligibility data and billing history for all current Medicare patients. This system is supported by the MCARE help desk. As one of the National Service Vendors for this system, we work closely with this organization to monitor reported issues and suggest enhancements. So far, they have done a very good job in dealing with the issues reported and correcting them.

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CMS Report Card on ICD10 End-to-End Testing

Medicare held a conference call yesterday (2/26/15) regarding the status of testing between Medicare provider systems, clearinghouses, and the CMS adjudication systems that will be used for processing claims with ICD10 codes in October.

Medicare has been ready for ICD10 for several years. Each quarter, they have updated their systems to prepare for the transition. Early this year, they ran their first live test that involved the processing of test claims submitted by volunteers through the entire adjudication process, including providing remittances.

reportCard

This is referred to by CMS as “end-to-end” testing. This process allows the providers to test their processes including coding with ICD10, the validity of their claim files, and the payments and adjustments returned for the services. It also allows CMS to fine tune their systems to make sure they are ready in October.

There were 661 participating submitters that represented about 1400 NPIs. The tests were performed from 1/26 – 2/3. 14,929 claims were processed and about 81% were accepted. 6% had errors related to ICD9 or ICD10 codes, 13% had other errors not related to ICD10. Of these claims, 56% were professional, 38% institutional and the others suppliers, like DME. Continue reading

Moving from ICD9 to ICD10 – Dealing with the Transition and Learning from the Past

As the healthcare industry prepares for the October transition from ICD9 to ICD10, many organizations are dealing with the obvious issues.  Computer systems are being upgraded to handle the new codes, health plans are developing new business rules for reimbursement, coders and physicians are being retrained.  These are all necessary steps in the adoption of these codes, but some of the most difficult issues will not be in dealing with the new codes, but transitioning to them as these systems are implemented.

One of the strategies in dealing with these types of transitions is to look toward similar situations in the past.  How did this impact you last time?  What issues came up that you did not anticipate?  These transitions are never smooth, but they have to be dealt with.  Experience is the best teacher.

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Florida Medicare – Transitioning Dial-Up Users to a NSV.

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First Coast Medicare(FCSO) is terminating dial-up connectivity on March 2, 2015. If you are currently using a dial-up connection to send claims and download remits, it’s time to switch. FCSO has provided a list of their approved Network Service Vendors(NSV) that you can use for these services to prevent any interruption to your cash flow. Continue reading

Looking toward the future – 2015

For any non-seasonal business, the calendar year end is a time to look backward at the year and evaluate your performance and to look forward toward the upcoming year to evaluate your challenges and goals.  At MEDTranDirect, 2014 was a pretty good year as we responded well to industry changes and dramatically expanded our market share in the HIPAA transaction processing business technology sector.

Looking forward to 2015, we have a somewhat unique perspective.  The healthcare industry as a whole is bracing for the impact of ICD-10.  The 10/1/15 deadline will influence the planning for most healthcare business partners including provider organizations, vendors, payers, and government agencies.  This single issue impacts almost every organization that must deal with these codes and their influence on recording diagnoses, procedures and the processing of claims. Continue reading

Preserving Your HIPAA Transaction Files

A few days ago I had a call from a current customer.  They needed help with a project to find claim data that met a certain criteria for additional action.  In this case, a major commercial payer had paid claims late over an extended period of time to healthcare providers all over the country.  This particular hospital had learned at a conference that they could collect the substantial interest on these claims by simply creating a list of the claims that qualified and submitting this list and supporting documentation to the payer.  They had contacted a consultant that was going to assist them with this process.  All they needed was a way to identify these claims and create this list.

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One of our products (835Direct) is capable of loading electronic remittances (835s) into a database and mining the data back out in a variety of formats.  It could have been used to examine the remittance data from this payer and produce a spreadsheet of all claims where the difference in the bill date and the payment date was greater than x. However, the software they use to obtain their remittances imported the remittances into a proprietary product for printing EOBs, posting to AR and such, but did not provide the capability of producing this list.  Furthermore, this vendor does not forward the 835 remittances they receive on behalf of the customer on to the customer.  After they are imported, they are archived by the vendor and the customer must pay service fees to obtain their own information in the original 835 format.  This customer is exploring this option, but even if it is worth the expense, it will take additional time to obtain this information. Continue reading

CMS Creates New Process for Late NOE Appeals

If you are associated with a hospice, you are aware of the new rules regarding the timely filing of NOEs.  You can review these rules in my previous article or through this CMS announcement:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3032CP.pdf

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By now, you have made it through October claim processing and hopefully you experienced as few late NOEs as possible.  If you did have some late NOEs, you might still be able to recover this lost revenue.

In the original announcement, CMS gave the MACs the authority to process appeals for late NOEs and gave the circumstances where these appeals might be granted.  If an appeal is successful, uncovered charges could be reversed by the MACs.

On 11/6, CMS issued another announcement regarding the appeals process for late NOEs:

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3118CP.pdf

As described in the original announcement, whenever an NOE is filed late (entered in DDE over five days after the admission date), the hospice must report the late NOE on the first claim for the initial hospice benefit period.  This is done by reporting the non-covered days with occurrence span code 77, even if the hospice believes that the NOE is late for reasons eligible for an appeal. Continue reading

Hospices Brace for New CMS Five-Day Submission Requirement for the NOE

CMS announced the final rule for hospices regarding the timely filing of the NOE in transmittal 3032 sent out August 22.

In the document, CMS designates that a timely-filed NOE (Notice of Election) shall be filed within five calendar days after the hospice admission date.  This applies to the NOTR (Notice of Election Termination/Revocation) as well.  This regulation is effective for dates of services on or after October 1st.

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Previously, there were no regulations regarding the timing of submitting these transactions. The NOE and the NOTR are essentially claims submitted to CMS that do not represent any services being billed, but the execution or revocation of an agreement between the hospice and the beneficiary receiving their services. These agreements are normally executed in the field, away from the office, at the patient’s home or with representatives of their family. The NOE is used to notify CMS that the beneficiary has elected to change their relationship with Medicare and to accept all medical services related to a diagnosis through the hospice only from that point forward, until they elect to change this relationship. Continue reading