Monthly Archives: July 2015

Ask the Expert: ICD10 for Cash Practices and the Effect to Personal Injury and Workers’ Compensation

Q. I am a ‘cash only’ practice and do not contract with any payers. Do I still need to use ICD-10?
A. While technically you do not have to do so under the HIPAA federal regulations, it is still a good idea to include ICD-10 codes on the bill you provide to your patient. The reason for this is that some patients may submit claims to their insurance company on their own behalf and if the codes are not the current and correct ICD10 the patient will not receive any reimbursement.

Q. What benefits are there for Non-covered Entities (this includes workers’ compensation and personal injury claims) to transition to ICD-10?

A. According to AHIMA, there are several benefits for non-covered entities and notes that CMS plans to work with these organizations to encourage ICD-10 use.

Benefits: The increased detail in ICD-10 provides significant value to non-covered entities. For example, the expanded injury codes will be useful to automobile insurance and workers' compensation programs. Non-covered entities stand to achieve the same benefits of using more detailed, up-to-date code sets as covered entities, including better data for:

• Measuring the quality, safety, and efficacy of care
• Designing payment systems and processing claims for reimbursement
• Conducting research, epidemiological studies, and clinical trials
• Setting health policy
• Operational and strategic planning and designing healthcare delivery systems
• Monitoring resource utilization
• Improving clinical, financial, and administrative performance
• Preventing and detecting healthcare fraud and abuse
• Tracking public health and risks
In addition, ICD-9-CM will no longer be maintained once ICD-10 is implemented; meaning the usefulness of the ICD-9-CM code set will rapidly decline. ICD-9-CM products and resources also will become increasingly difficult to obtain. Those non-covered entities that continue to use ICD-9-CM after the ICD-10 compliance date will compromise their ability to compare data with covered entities.

Q. What will happen if our clinic does not switch to ICD-10?
A. Claims that are submitted by HIPAA covered entities (all claims except cash, PI and WC), without ICD-10 diagnosis after October 1, 2015 will not be processed.

Be Aware of Credit Card Fees

Many providers accept credit cards as a form of payment, but need to be aware of the associated fees when accepting virtual credit card payments from insurers for reimbursement purposes. Virtual credit cards are unique card numbers generated for a specific one-time transaction and linked to real accounts with card issuers. Clinics need to be aware that these transactions carry significant fees compared to traditional forms of payment--up to five percent of the transaction amount--and may include additional fees to offset fraud risk when card numbers are entered manually, which in effect reduces reimbursement to the clinic. It also effectively transfers the cost of the transaction from the payer to the clinic.

Acupuncture Timed Service Documentation Requirements

The 15 minute increment of time is defined as personal one-on-one contact with the patient. This means that the physician acupuncturist is in the room with the patient, is actively performing a medically necessary activity that is a component of acupuncture or electro acupuncture. The time that the needles are retained is specifically excluded for the purpose of determining time and consequently from reimbursement. 8 Minute Rule for Timed Codes – One Service

For services billed in 15-minute units, count the minutes of skilled treatment provided. Only direct, face-to-face time with the patient is considered for timed codes. 8 minute time rule for timed service

• 7 minutes or less of a single service is not billable.

• 8 minutes or more of a single service is billable as 1 unit or an additional unit if the prior units were each furnished for a full 15 minutes:

• 8 – 22 minutes = 1 unit

• 23 – 37 minutes = 2 units

• 38 – 52 minutes = 3 units

• 53 – 67 minutes = 4 units

The face-to-face time can be identified as pre-service work which includes greeting the patient and a brief interval history. Intra-service work for actions connected to the acupuncture procedure which may include pertinent evaluation and assessment of the patient (tongue, pulse, palpation, ROM etc.), hand washing, patient positioning, locating and cleaning the points, inserting and stimulating the needles, checking on the patient, removing the needles, and any discussion or counseling related to the acupuncture service. The face-to-face time does not include needle retention time where there is no need for direct patient monitoring or contact.

Acupuncture Medical Necessity

To demonstrate the effectiveness and medical necessity of acupuncture providers should have documentation that indicates some or similar factors as listed below.

1. Reduction in the use of pain medication

2. “Functional improvement” clinically significant improvement in activities of daily living, ROM, functional performance tests et al as measured during the history and physical exam.

3. Use of standardized outcome assessment forms such as Oswestry, Neck Disability Index, and General Pain Index et al.

4. Physical examination where quantified findings demonstrate significant and measured changes.

5. Ultimately of course pain reduction but with pain reduction there is always increased function and that is the more significant change to be noted.