December 2013
Welcome to Synergistic Update. This
newsletter is our vehicle to provide information about SOS Software,
events in the healthcare industry, links to important regulatory
information, and notes about recent blog posts. Please let us know what
issues you would like to hear about. And remember, your feedback is
welcome at any time!
In
this issue:
Editor's Note:
We have been surprised to learn that many of you did not receive
or did not read the article on the ICD-10 in our last newsletter. In an
attempt to be sure all of our customers have the necessary information,
we have broken that article into smaller portions so you can
more
quickly consume what we consider to be very important information.
What
Makes the Move to ICD-10 a Big Deal?
DSM-5
and the ICD-10
SOS Products
and the ICD-10
Important
Links for ICD-10 Learning
Recovery
from Catastrophe: 'I have my daysheets!'
Reminder: CMS
Requires New Forms by April 1
Don't Forget:
Support for Windows XP is ending
SOS
Staff Profile: Manon Faucher, Chief Technical Support Representative
Customer Spotlight:
Psych & Psych Services
Recent blog
articles available:
Telehealth: Is this a legitimate way to
provide treatment?, September
26, 2013
HIPAA Omnibus Final Rule Now in Effect,
October 8, 2013
Medical Identity Theft: Fastest growing type
of fraud, October 11, 2013
Healthcare.gov Struggles in First Weeks,
October 24, 2013
Do You Own Your Patient Records?, November
5, 2013
Two Quick Notes: On Parity and HIPAA for
Business Associates, November 12, 2013
CMS Notices on ICD-10 Transition Become More
Concerned, November 19, 2013
A Model to Follow, December
2, 2013
What
Makes the Move to ICD-10 a Big Deal?
You all know about the
proverbial elephant in the room, right? Healthcare has its very own! On
October 1, 2014, all health care providers will be required to utilize
ICD-10
codes (International Statistical Classification of Diseases and Related
Health Problems) on claims in order to receive payment. Hospitals
will need to use the new codes for both diagnoses and procedures.
Mental health providers will use only the new diagnostic codes;
procedure codes will continue to be those from the Current Procedural Terminology® of
the AMA (CPT) or Healthcare Common Procedure Coding System
(HCPCS). These changes affect everyone in the healthcare system:
individual providers, clinics, hospitals, insurance carriers,
clearinghouses...........in short, YOU!
The
transition from ICD-9 to ICD-10 is a very big deal:
- The
new codes are much more specific than the old ones,
so there are many
more of them (approximately nine times as many) from which to choose,
and most often there is not a one-to-one correspondence between the
codes in the old and new systems. Providers or
Coders will need training in the new system.
- The
coding system itself is different. For example, the first character of
every ICD-10 diagnosis code is a letter instead of a number, and the
code itself could be as many as seven characters compared to ICD-9's
maximum length of 5. The only really familiar thing is that there is
still a period/decimal point after the third character. The new codes
require changes in any software that currently uses ICD-9 codes.
- The
change in codes means that insurance payers have to either re-program
their payment systems based on the new codes, or, at least in the short
run, use software mapping to translate the new codes back to an old
code that the payment system will recognize for proper claim
processing. The needed changes on the payer end are very extensive. As
a result, most
industry insiders expect the transition to be extremely
disruptive for all concerned
- How
did your payers manage with the last changes required? Were your
payments delayed? Remember the move to the NPI? The switch to ICD-10 is
the largest change in healthcare payment processing that anyone can
remember. Smart
providers will be setting aside funds, or negotiating lines of credit,
so that business operations can continue normally in spite of expected
insurance payment delays next fall.
DSM-5 and the ICD-10
The Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition
(DSM-5) was released on May 18, 2013. While continuing to be controversial
in its own right, the DSM-5 promises to add confusion to payment
processing for behavioral health and chemical dependency providers. As
we move toward the October 2014 implementation deadline for the ICD-10,
providers find themselves presented with conflicting information. On
the one hand is the new diagnostic manual with its new codes and
criteria; on the other hand is the requirement to move to the ICD-10
for payment processing. We hear the following question often:
Q. I use DSM codes instead of
ICD-9. Does any of this ICD-10 business pertain to me?
A. Actually, ALL
of it pertains to you.
Most DSM-IV codes match ICD-9 codes. In some cases a claim will be
rejected by a payer because you have not used a specific enough code.
This usually happens when you have used a generic DSM code with no
decimal characters; the payer wants the additional one or two
characters that the ICD codes include. Except, for some small,
niche
managed-care administrators, the health insurance industry is
standardized on ICD coding. In fact, ICD-9 diagnostic codes are one of
the standardized code sets required by
the HIPAA legislation
since at least 2004. Currently, and happily, for those of you who are
using DSM
documentation to determine your patients' diagnoses, the DSM codes
overlap with ICD-9 codes almost completely. As a result, when your
DSM-coded claim reaches the payer, it has been processed in accordance
with adjudication rules that are actually based on ICD-9 codes. With
ICD-10, that concordance between codes disappears! Please download American Psychiatric
Association's document on DSM5, ICD-9 and ICD-10 for a fuller
understanding.
This is what the American Psychiatric Association says in the document
linked above:
"On October 1, 2014, the United
States adopts ICD-10-CM as its standard coding system. How will
diagnoses be coded then?
DSM-5 contains both ICD-9-CM
codes for immediate use and ICD-10-CM codes in parentheses. The
inclusion of ICD-10-CM codes
facilitates a cross-walk to the new coding system that will be
implement-
ed on October 1, 2014 for all
U.S. health care providers and systems, as recommended by the Centers
for Disease Control and
Prevention’s National Center for Health Statistics (CDC-NCHS) and the
Centers
for Medicare and Medicaid
Services (CMS). This feature will eliminate the need for
separate training on
ICD-10-CM codes for mental disorders that is now being offered for all
other diseases/disorders by
other medical societies and
vendors to prepare for the 2014 implementation."
We
are not so sure about elimination of the "need for separate training."
Since many providers do not buy their own copy of the DSM, choosing to
work from a list of codes rather than the manual, they will not be in
possession of the cross-walk to ICD-10 codes. The
transition to ICD-10 codes removes the overlap between DSM and
ICD
completely. The older DSM-IV code books do not match up with ICD-10
codes, so you will have
to change from the codes you are currently using to the appropriate
ICD-10 codes starting on October 1, 2014 in order to receive insurance
payment. The recently released DSM-5 code books sold by American
Psychiatric Association include appropriate ICD-10 codes, in
parentheses, next to each diagnosis description, so purchase of those
resources may be of some assistance to you in selecting the correct
codes to put on your claims starting in October, 2014. That said, your
best resources for ICD-10 diagnosis coding to assure rapid insurance
payment will be ICD-10 code books, not DSM-5 books.
SOS Products
and the ICD-10
[The
Questions and Answers below often make reference to an SOS update that
includes ICD-10 features. In this discussion, that update is a set of
enhancements to the current generation of SOS software, not our
next-generation SOS product. The new product will, of course,
include the same range of features, but the release date of that
product is still uncertain, so we have decided to make all those
features available in the current generation of software as well.
Again, the discussion below refers to an update of the current
generation SOS software.]
In
the coming months your claim processors and perhaps even your insurance
payers may ask you details about your readiness to start submitting the
new ICD-10 codes on your claims when the transition date of October 1,
2014
arrives. Your readiness depends in part on the readiness of your
software. For those of you with current SOS Support/Update Agreements,
the answers are simple. Here are some of the questions you might want
to ask SOS and
our responses:
Q. Will SOS
automatically map or
somehow convert the current codes in my SOS claim setups to ICD-10-CM
codes?
A.
There is no way for software to automatically convert every ICD-9-CM
code
to an equivalent ICD-10-CM code with accuracy. In many cases the old
ICD-9 code has
been replaced by a multitude of new ICD-10-CM codes. SOS has no way to
know which of the new codes would be the right one for a particular
patient; only the provider or expert coder can determine that. Instead,
in late September 2013, SOS released a software update that includes
what we have called the "SOS ICD-10
Prep
Utility". The utility is available on the Tools menu in SOS Office
Manager and will allow you to gradually work your way
through your
patients' current diagnoses to set appropriate ICD-10 diagnoses to be
used starting in October 2014.
As it happens,
many mental/behavioral health ICD-9 codes have only one ICD-10 match in
the CMS General Equivalency Mapping (GEMs) table.
When you open a
patient in the Prep utility, it will automatically insert
the ICD-10 codes wherever there is an unambiguous match
of this sort. When there is not an obvious match, clicking a button on
screen will show you all the likely matches for the current codes,
based on CMS's GEMs table, so you can select the best match for this
patient without having to sift through all 90,000 ICD-10
codes.
We
are providing this utility now so that you have a full year to prepare
your patient data, rather than putting you in the position of waiting
nervously for SOS to release new software that accepts the new codes.
The ICD-10 selections you make using the Prep Utility will, of course,
be saved in your database. When SOS's ICD-10 compatible software is
released in 2014, your chosen ICD-10 codes will automatically be
imported and will appear in SOS, ready for insertion into your claims
when you need them. Your current ICD-9 codes will appear in the new
software as well, and will be used on your claims until the changeover
date you specify for your payers.
Q: What is your timeline for system
modifications and what do those modifications include?
A:
The ICD-10 Prep Utility is currently available for those with current
Support Agreements. No later
than June 1, 2014, SOS will release a version of the SOS software that
accepts both ICD-9 and ICD-10 diagnoses, also available for those with
current agreements. If you need to arrange for Support renewal, please
email Trish Merchant
to get a quote. A new System Option will
provide a field for you to specify the default date for SOS to start
using ICD-10 Dx codes in place of the old ICD-9 codes. This date will
be preset to October 1, 2014, but, in the unlikely event that CMS
delays implementation, you will be able to change that date. In
addition, each insurance payer configuration will have a new field
where you can specify a payer-specific ICD-10 changeover date, if
different than the system default date. The SOS update will also
include new ICD-10 compatible paper claim formats, and the necessary
adjustments to the 5010 electronic claim generation.
Q: Is there a cost for SOS users to
update to the ICD-10 compatible software?
A:
This ICD-10
update of the current generation of SOS will be available to all SOS
customers with current
support contracts at no additional cost. Those who do not have a current
support contract will have to renew their contracts to obtain the
update.
Q: Will you continue to support the
old software, or are you discontinuing some products in the wake of the
ICD-10 transition?
A:
SOS will continue to provide support to all customers with a current
support contract. For example, if a customer does not file insurance
claims and does
not require ICD-10 capability, that customer will continue to receive
support for their older version of SOS after the ICD-10 update is
released if the customer has a current support contract.
Q: Are there any new hardware
requirements associated with ICD-10-related software changes?
A:
The SOS software discussed above is an update of the current generation
of SOS products that first appeared in 2007. If you are currently using
a version between SOS 2007 and SOS 2013, no hardware changes will be
required to run the ICD-10 update.
Q: Will training be provided for
any new ICD-10-related functionality, and is there a charge?
A:
Articles detailing the use of the new features will be provided at no
charge on the SOS web site for both the ICD-10 Prep Utility and the
ICD-10 capable update to the software. The software changes should not
require any special training beyond that. Providers
and billers should, however, take advantage of any available training
on ICD-10 coding itself, particularly in their own specialty areas.
Neither your SOS software nor SOS Support Techs will teach you
to
correctly code your claims. Correct coding is your responsibility.
Q: Is
the update you describe the same as the "next generation"
software that I have seen mentioned on the SOS User Group?
A:
No. Our next generation software does contain the full range of ICD-10
features, but its
release date is still uncertain. For this reason, SOS has decided to
provide an update to the current generation of software in the
meantime.
Important
Links for ICD-10 Learning 
Information
about the ICD-10 and training materials to prepare yourself, your
colleagues and your employees are available extensively. Below are some
links that will give you a start on finding useful information that is
free or inexpensive. Be sure to check with your local and national
professional associations for information they may provide. If you have
a large organization and need a certified coder, please be sure to
search for educational opportunities for professional certified coders.
Recovery
from Catastrophe: 'I have my daysheets!'
All
too frequently, we have a call from a customer who has had a
computer crash. Usually, they have tried to access their SOS data to no
avail. We then go through a process of questioning them about their
backup system and whether they have gone through the process of
restoring their data from backup.
This past week, we had such a
call from Dr. K, a customer who had once before lost data because of a
computer crash. As a result of that loss, he had put a regular backup
program in place. This time, his sad story included a change in that
backup system; somehow, he had accidentally changed his backup from an
external drive to his local drive. His last good backup was from early
September, just before he had made the change in his backup
routine.
Reconstructing three or four months of data is not
impossible for a solo provider; however, it is usually the last thing
someone wants to do. With a calendar and the intake forms of new
clients, data can be reconstructed. Always, the provider must cross
their fingers and hope nothing was missed.
This story had a
happy ending. Dr. K had his printed daysheets from September through
the computer crash! He first restored his September backup to his new
computer. Once he was sure that was working properly, he entered one
daysheet at a time into SOS
Office Manager. He went through and added all the
information for his new clients and his task was complete....in hours
rather than days.
We
know that many people print daysheets but do not keep them. Or, they
save the daysheet to a .pdf file on the same computer. The moral of
this story is: keep
the daysheets....or at least, save them to
a different hard drive! You never know when they will save
you days or even weeks of reconstructive work.
Reminder:
CMS Requires New Forms by April 1
| If
you use a special or custom HCFA form (such as NY Medicaid), please
contact SOS. Updating any such forms will require custom
programming
and will not be done as RUSH orders. Please contact SOS NOW
if you use
such a claim form. |
Implementation of the ICD-10 has
made a new HCFA form necessary. CMS
has announced deadline dates for use of the new HCFA form that will be
ICD-10 compatible. CMS will begin accepting the new paper form (for
those who have a special exemption to send paper Medicare claims) on
January 6, 2014. Starting April 1, 2014, Medicare will accept only the
new form. The information and links below are from an email
notification we received on September 5, 2013.
As you
know,
private insurers will follow CMS' lead on use of the new form. SOS
users with current
support agreements
will be able to obtain an update containing the new format before the
Medicare deadline.
SOS Staff
Profile
Manon
Faucher, Lead Technical Support Representative
We
decided that it
might be fun for you, our customers, to know a bit more about those of
us
who
work here at SOS. After all, you talk to us often, but many of you have
never
met any of us. Manon Faucher is someone you have talked to if
you
have ever called for support assistance. As our Lead Technical
Support Representative, she spends much of her time on
the telephone or answering emails solving technical problems
for
you or answering
your questions about how to accomplish certain tasks. These are Manon’s
answers to our standard questions.
How
long have you worked at SOS?
I
have been
with SOS since March of 1993.
How
would you describe your role at SOS?
My main duty at SOS is to provide technical support to our customers.
My other functions include but are not limited to: personalized
training/consultation, document writing, testing, assisting our
programming staff in the development process by relaying the customers'
viewpoint, and assisting SOS staff with issues and questions.
How
do you prefer to spend your time when you are not
working?
As a new grandma, I prefer to spend time with my granddaughter Roxie (2
years old) and grandson Sebastien (3 months old). They reside in South
Carolina so I do a lot of traveling in the area, and also in Quebec,
Canada where all my family resides. I enjoy traveling and especially
cruising. My favorite hobbies are quilting, sewing and reading.
What
else would you like our customers to know about
you?
I
hate bugs/insects... so if you hear someone scream when you are on the
phone with SOS, just imagine that some sort of giant 'non-human thing'
just crawled on me or on my desk. I have been known to get out of a
moving car for a frog and a spider. Also, I am in the process of
learning Spanish; I hope someday I will be able to say that I
am
trilingual.
SOS Customer
Spotlight
Psych
& Psych Services
750 South Abbe Road
Elyria, Ohio, about 20 minutes west of Cleveland
Psych
& Psych Services has used SOS software since
December 1991. Below are our
questions and the answers provided by Dave Zachau, co-owner of the
practice.
For how long have you been
providing services to your community?
Our
director, Diana Santantonio, Ed.S. began the Practice in 1980.
How
many staff members are involved in your organization? What are their
credentials?
Currently,
we employ 21 therapists. Our professional staff includes a
psychologist, licensed social workers, and licensed counselors. We have
a clerical staff of nine.
What
areas of specialization do you provide to your community?
At
Psych & Psych Services, we have both a Mental Health and
Chemical
Dependency Treatment Program. Our Chemical Dependency Treatment Program
is state certified and includes the Intensive Outpatient level of care.
Along with standard mental health services, our treatment team includes
therapists with a diverse set of specializations that include:
performing forensic evaluations; custody and parenting evaluations; sex
offender assessment and treatment services; anger management group
treatment; eating disorders; sexual dysfunction; and bariatric
assessment. Our Sex Offender Treatment Program is also state certified
and includes a contract with a large County Probation Department to
provide assessment and treatment services.
Rounding off our
specialized services, Mr. Zachau offers new-hire and fitness for duty
evaluations to local Police and Fire Departments.
What is your
mission statement? How do you want your community to see you?
On
our web site home page you will find the
following statement:
Addressing
Mental Health Issues
Through
Understanding, Nurturing, and Guidance
When
someone you love needs help, or you are simply seeking ways to enhance
your
life, trust Psych and Psych Services for exceptional care and
counseling. Since
1980, Diana Santantonio and her staff of Professional Associates have
been
dedicated to providing the most effective and considerate mental health
care
available. Clients receive confidential, professional counseling,
psychotherapy and
treatment in the most caring and comfortable manner possible.
What
would you like to share with the SOS community of professionals who use
our software? Please include any unique things about your organization,
any interesting ways you use our software, what your special place
within your community is, how you are like/different from other
practices/organizations, or anything else you would like to share.
Diana
began the practice after working for several years at our county's
local community mental health center. While working in community mental
health, Diana developed a strong interest in providing mental health
and chemical dependency services for clients having a lower income as
well as clients with private insurance. At Psych & Psych
Services
we have accepted state Medicaid for all services and offer clients a
sliding fee schedule to help make treatment affordable.
Unlike
other practices in our area, several of our therapists interface and
work with attorneys and the Courts. As a result we work closely with
local Judges, probation officers, and police departments.
We
have been users of the SOS suite of products since the days of DOS. One
of the most helpful features of the software suite we found in the
Scheduler program. Having the outstanding balance owed by the client on
the Daily Log sheet helps keep our therapists on top of what their
clients owe without having to interrupt the support staff. Also, we
recently added computers to all therapist offices and enough licenses
for Scheduler to allow therapists to do their own scheduling. This has
reduced the line at the check-in/check-out window at the top of the
hour and has reduced the burden on the front-window receptionist. The
Scheduler program, along with the First Contact module, has allowed us
to use our clerical staff resources more wisely on a daily basis.
From all of us at
Synergistic Office
Solutions...
we hope you have
a
wonderful holiday season
as well as a
healthy, peaceful and prosperous 2014!
