SDCMS Medical Office Manager Bulletin Board (2011.01)
ASK YOUR OFFICE MANAGER ADVOCATE
Question: Can you please provide me with ICD-10 information and let me know what we need to be doing now?
Answer: It is important to prepare now for the ICD-10 and Version 5010 transition. The following are steps you can take to get started:
- Providers: Develop an implementation strategy that includes an assessment of the impact on your organization, a detailed timeline, and a budget. Check with your billing service, clearinghouse, or practice management software vendor about their compliance plans. Providers who handle billing and software development internally should plan for medical records/coding, clinical, IT, and finance staff to coordinate on ICD-10 and Version 5010 transition efforts.
- Payers: Review payment policies since the transition to ICD-10 will involve new coding rules. Ask your software vendors about their readiness plans and timelines for product development, testing, availability, and training for Version 5010 and ICD-10. You should have an implementation plan and transition budget in place.
- Software Vendors, Clearinghouses, and Third-party Billing Services: You should have products and services in development that will allow payers and providers to fully implement Version 5010 on Jan. 1, 2012, and ICD-10 on Oct. 1, 2013. Begin talking to your customers now about preparing for the transition. Your products and services will be obsolete if you do not take steps now to get ready.
The Centers for Medicare and Medicaid Services (CMS) website has official CMS resources to help you prepare for Version 5010 and ICD-10. CMS will continue to add new tools and information to the site throughout the course of the transition, so check the site frequently for updated resources.
ICD-10 diagnosis codes must be used for all healthcare services provided in the United States on or after Oct. 1, 2013. ICD-10 procedure codes must be used for all hospital inpatient procedures performed on or after Oct. 1, 2013. Claims with ICD-9 codes for services provided on or after Oct. 1, 2013, cannot be paid.
SAVE THE DATES FOR THESE, THE BEST MEDICAL OFFICE MANAGER SEMINARS AND EVENTS!
- JAN 20: Palmetto GBA/Medicare “Provider Enrollment”
- JAN 26/27: “Simple Approaches to Informed Consent and Informed Refusal”
- FEB 3: “Treating Patients Right”
- FEB 4/11/18/25 (Four Fridays): Certified Medical Insurance Specialist Course
- FEB 10: “Contract Negotiations”
- MAR 3: “Legalities of Hiring”
CODING CORNER … BY MICHELLE PENA, CPC, CHMB (CAHEALTH.COM)
Question: I heard that in 2011 Medicare will cover beneficiaries’ annual exams with no coinsurance. Is this true?
Answer: Yes. As health reform continues to get under way, there have been some preventive care benefit changes for employer-based health plans and Medicare for 2011. The Patient Protection and Affordable Care Act mandates that group coverage plans provide coverage for preventive services without cost sharing (deductibles, copayments, etc.). It further instructs Medicare to provide “annual wellness visits resulting in a personalized prevention plan.” For Medicare beneficiaries, there will be two types of wellness exams covered with no deductible or coinsurance. The first is the “Welcome to Medicare” physical exam. This exam is covered within the first 12 months of the patient’s Part B effective date, and HCPCS code G0402 is used to identify this service. The second exam effective Jan. 1, 2011, is the “Annual Wellness Visit.” This exam is covered annually to develop or update a personalized prevention plan based on the patient’s health and risk factors. There is some speculation about the HCPCS code assigned, but, to date, nothing has been officially published by Medicare, so be on the lookout for Medlearns.
References:
SPECIAL FOCUS: BECOME A CERTIFIED MEDICAL INSURANCE SPECIALIST IN FEBRUARY 2011
Key Course Objectives*:
- Compliance
- Basics of Health Insurance
- Managed Care Plans
- Medicare
- Medicaid and Other State Programs
- Workers’ Compensation
*For a detailed description of key course objectives, visit the August issue of San Diego Physician at SDCMS.org/publications.
LIMIT: 30 REGISTRANTS — SIGN UP EARLY!
Register now for the CMIS course presented by Practice Management Institute (PMI) (www.pmimd.com):
- Four Fridays in February: 4, 11, 18, 25
- 8 a.m.–4 p.m.
- Held at the SDCMS Meeting Room, 5575 Ruffin Rd., Ste. 250, San Diego, CA 92123
- Cost for SDCMS Members and Their Staff: $499 (includes breaks, lunch, and instructional materials)
- Cost for Nonmembers/Staff: $999
Questions or to Register: Contact Sonia Gonzales, your SDCMS office manager advocate, at (858) 300-2782 or at Sonia.Gonzales@SDCMS.org.
WIN AN iPOD TOUCH!
SDCMS Office Managers: Here’s your chance to win an iPod Touch! Please send your questions, comments, pictures, ideas — anything that you would like to see on your SDCMS Medical Office Manager Bulletin Board — to me, Sonia, at Sonia.Gonzales@SDCMS.org or call me at (858) 300-2782. The first five ideas received will be entered into a drawing to receive an iPod Touch. The winner will be announced in our February issue.