Insurance news
Ready, Set, CODE!
Written by Edior   
Wednesday, September 09, 2015 05:05 PM
Excerpted from Ready, Set, CODE! ICD-10 Compliance Deadline Is Oct. 1, 2015 
By Jill Foote


It has been over 35 years since the International Classification of Diseases, Ninth Revision, Clinical Modification, called ICD-9-CM was introduced to the medical profession. According to the Centers for Disease Control (CDC), the original intent of the code set was for the “classification of morbidity and mortality information for statistical purposes.” Although the original intent was epidemiological, through the passing of time, payer reimbursement policies were developed, and the codes are now closely linked to claims processing and provider reimbursement.

As we approach the Oct. 1, 2015 deadline set by the U.S. Department of Health and Human Services' (HHS) transition to ICD-10, the 10th revision of the International Classification of Diseases, it is of utmost importance to consider your clinic’s revenue cycle management. Just as ICD-9-CM far exceeded its predecessors in the number of codes provided, ICD-10-CM has been expanded to seven possible digits, allowing for thousands of new codes that permit greater specificity. It is important to know how ICD-9 codes affect your current revenue so that you can be proactive in your transition to ICD-10. We have outlined a few steps every doctor of chiropractic (DC) should consider:

ICD-10:  Unspecified Codes
Written by Editor   
Monday, August 24, 2015 12:00 AM

The Journal of AHIMA warns about taking the easy road and reporting unspecified codes, stating, "Yes, there is an 'unspecified' code in ICD-10, and you can code it all you want. But in two to three years when you review your severity and risk scores you will be in bad shape, because you won't have the specificity in your codes that you need to justify higher levels and better reimbursement."

With this information in mind, if unspecified codes are available in ICD-10, how can a provider know when it is appropriate to use them?

Optum to Establish Per Diem Payments Rather than Fee-for-service
Written by Editor   
Thursday, July 16, 2015 02:25 PM

IMPORTANT – Quick Brief:  Texas will be among the first states in which Optum (UnitedHealthcare) will implement mandatory per diem reimbursement rather than fee-for-service. Watch for provider notification letters prior to the October 1, 2015, planned implementation date.

The per diem is basically a set fee for all services performed on a day.  So on the first day of service where you will typically see an exam, x-ray, treatment and therapy, instead of a payment for each service, it will be a single aggregate payment.  This per diem amount will be the same on the second and subsequent visits where the normal protocols may be only a spinal manipulation. “Select DME procedures reimbursed separately."


Payment reform for healthcare has been gaining momentum. From the Patient Protection and Affordable Care Act (PPACA) effort to advance payment away from fee-for-service reimbursement, to the Centers for Medicare and Medicaid Services (CMS) announcement that half of its Medicare payments would flow through alternative payment models by 2018, payment reform is coming whether providers are prepared or not.

Legal teams associated with the chiropractic industry have been meeting with Optum.  It is reported that beginning in October of this year, Optum will begin to transition chiropractic providers from a fee-for-service payment to a per diem model.  Texas is slated to be included in the first phase of implementation.  This change will be implemented in phases and letters will be sent to providers in advance of implementation.  

CMS Proposes 0.5% Doc Fee Hike
Written by Editor   
Thursday, July 16, 2015 02:19 PM
Quick Brief:  Medicare reimbursement for physicians will increase in 2016 by 0.5% the CMS reports.  PQRS modifications will also be announced.


Physicians will see a 0.5% overall increase in Medicare reimbursement in 2016 under the proposed physician fee schedule announced by the Centers for Medicare and Medicaid Services (CMS).

The proposed fee schedule, which will be finalized this fall, is the first to be issued since Congress repealed the much-abhorred sustainable growth rate (SGR) payment formula in April. The 0.5% update was specified in the SGR repeal bill.

Get Ready for ICD-10 Transition at August 1 Workshop Sponsored by TCA, ACA
Friday, July 10, 2015 09:00 PM

Are you concerned about the ICD-10 compliance deadline coming up October 1, 2015? Contrary to what you’ve heard, the transition from ICD-9 to ICD-10 likely won’t be delayed. If you’re not ready, it could be a disaster for your practice … costly delays or denials that could impact your clinic’s cash flow or cut down your reimbursements.

But you can avoid the headaches by signing up for an ICD-10 training workshop hosted by the Texas Chiropractic Association (TCA) in conjunction with the American Chiropractic Association (ACA).

The Basics to Billing Workshop: ICD-10 Training for the Chiropractic Office will take place at two venues:

Saturday, July 25, 9 a.m.-4 p.m.



Saturday, August 1, 9 a.m.-4 p.m.


Register online or complete and return the registration form by July 18.

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