Are you ready for them? With the passage of the Affordable Care Act, huge changes have happened in the world of Medicare, Medicaid and Commercial Insurances. This has made it extremely important that the medical billers and coders are particularly aware of the changes that will affect the way that they do their jobs. Now is the time to be learning and implementing as much as possible.
The physicians and other healthcare professionals are already facing huge changes in their offices as they transition to EHR systems. Whether good or bad, these changes have affected the way that healthcare is being done in our world. It is up to those of us who work in the healthcare professions to stay abreast of what is happening.
One of the biggest changes is the implementation of ICD-10. United States will be transitioning to the ICD-10 because we are the only country that still uses ICD-9 and it is creating confusion with the global healthcare insurance marketplace.
According to CMS, the implementation date is October 1, 2013. This chart from AAPC shows some of the challenges that coders will be facing.
| Issue |
ICD-9-CM
|
ICD-10-CM
|
|---|---|---|
Volume of codes
|
approximately 13,600
|
approximately 69,000
|
Composition of codes
|
Mostly numeric, with E and V codes alphanumeric. Valid codes of three, four, or five digits.
|
All codes are alphanumeric, beginning with a letter and with a mix of numbers and letters thereafter. Valid codes may have three, four, five, six or seven digits.
|
Duplication of code sets
|
Currently, only ICD-9-CM codes are required. No mapping is necessary.
|
For a period of two years or more, systems will need to access both ICD-9-CM codes and ICD-10-CM codes as the country transitions from ICD-9-CM to ICD-10-CM. Mapping will be necessary so that equivalent codes can be found for issues of disease tracking, medical necessity edits and outcomes studies.
|
In order to accommodate these changes and the others made recently in the healthcare system, the CMS-1500 Health Insurance Claim Form is being updated. Not only will coders have to learn a different system, but so will medical billers!
The new form will have a number of changes. And the implementation date is the same day as the ICD-10 implementation date. October 1, 2013! You can find those changes at: http://www.nucc.org/
Here is just a sampling of some of the changes.
- Item number 1-- Deleted "CHAMPUS" and changed (Sponsor's SSN) to (ID# DoD#).
- Item number 8-- Deleted "PATIENT STATUS" and content of field.
- Item Number 14-- Changed title to "DATE IF CURRENT ILLNESS, INJURY OR PREGNANCY (LMP), Removed the arrow and text in the right-hand side of the field. Added "QUAL." and a vertical, dotted line to accommodate a 3-byte qualifier.
The NUCC recommended timeline for transitioning to the 0212 version of the 1500 Claim Form is as follows:
June 1, 2013 – Health plans, clearinghouses, and other information support vendors are ready to handle and accept the revised (02/12) 1500 Claim Form.
June 1 – October 1, 2013 – Providers can use either the current (08/05) or the revised (02/12) 1500 Claim Form. Health plans, clearinghouses, and billing vendors are able to accept and process either version of the form.
October 1, 2013 – The current (08/05) 1500 Claim Form is discontinued; only the revised (02/12) 1500 Claim Form is to be used. All rebilling of claims will be on the revised (02/12) 1500 Claim Form from this date forward, even though earlier submissions may have been on the current (08/05) 1500 Claim Form.
There is still time to learn about these changes. The more informed you are, the easier the transition will take place in your office.
Here's hoping that all of the changes will go smoothly for you.
Thanks for reading.
Donna McHugh, CMRS
Resources:
http://www.newmedicalforms.com/revised-cms-1500-02-12-claim-form-1/
www.cms.gov
The Daily Buzz, April 16, 2013, Larry Weston, AMBA,
www,nucc.org
