CODING CORNER…FOCUS ON ICD-10 – AUGUST 2015

 By Lisa Kropp, Coding and Credentialing Manager
Practicefirst’s Implementation Assistance Plan

  • On or around June 1, 2015, your practice should have received a report containing the 20+ most commonly billed ICD-9’s by your practice in 2014.  We included the ICD-10 mappings that may be applicable.  The purpose of this is to assist you in identifying the impact to your practice.  In many cases, there are direct mappings (ICD-9 to ICD-10).  In other cases, where more complex conditions & manifestations are present, there are NOT direct mappings and you will have to investigate these further.
  • If you did not receive a report, please contact Lisa Kropp 716.348.3904 or lisak@pracfirst.com

What to Expect in August:

  • Coding Clients: Scheduling of telephone or on site session to provide specialty specific ICD-10 information.
  • Billing Clients: Contact by a member of the billing team to discuss your practice’s readiness.

New VIDEO ICD-10 resources: https://www.youtube.com/watch?v=_pLwSh09sGo&list=PLw4-yeXdND_pd1Jp_TZmjJb_Wm-ncFQtG
Available Articles:

  1. Road to 10
  2. Introduction to ICD-10 Coding
  3. ICD-10 Coding and Diabetes
  4. ICD-10 Coding Basics & More
  5. ICD-10 and Clinical Documentation

ICD-10 Resource List

  1. http://www.cms.gov/Medicare/Coding/ICD10/
    1. Contains videos for small practices, resource flyers as well as a clinical documentation video.
  2. https://www.aapc.com/icd-10/
    1. Robust resources for practices of all sizes including options to purchase physician training, ICD-10 manuals
  3. https://www.aapc.com/icd-10/crosswalks/
    A.  Laminated ICD-10 crosswalk cards available for purchase ($24.95-specialty
    specific)

Below are suggested links you should begin using now as ICD-10 nears:

If you would like more information about how we can tailor our services to meet your needs, please contact Lisa Kropp; Coding & Credentialing Manager at 716.348.3904 or lisak@pracfirst.com<

BILLING UPDATES – AUGUST 2015

By Sarah Howarth, Billing Manager

Univera Community Health

Effective August 1, 2015 Univera Community Health will be changed to YourCare Health Plan.  Univera IPA will be changed to YourCare IPA.  Existing provider agreements under Univera Community Health remain effective.

Effective August 1, 2015, a new product is added to Exhibit A of provider contracts with Univera Community Health/YourCare Health Plan.  Basic Health Plan a/k/a Essential Program Plan is offered through Univera Community Health/YourCare Health Plan through the New York State Department of Health.  This product will be made available to low income individuals that do not qualify for Medicaid, but also do not make enough to purchase coverage off the exchange or through their employer.

Reimbursement for this plan is consistent with the current Univera Community Health fee schedule.  Providers may opt out of participation in the Basic Health Plan a/k/a Essential Program Plan by providing written notice within sixty days of Univera’s notification dated June 29, 2015.  Providers who do not provide written notice will be considered par.

MEDICARE/MEDICAID DUALLY ELIGIBLE INDIVIDUALS

CHANGE TO PROVIDER REIMBURSEMENT METHODOLOGY

As a result of changes to New York State Social Services Law, Effective July 1, 2015 Medicaid is no longer reimbursing partial Medicare Part B coinsurance amounts (20% of the Part B coinsurance).  The total payment to the provider from Medicare and Medicaid combined will not exceed the amount that the provider would have received for a Medicaid-only patient.  If the Medicare payment is greater than the Medicaid fee, no additional payment will be made.  Per State regulation, a provider of Medicare Part B benefit cannot seek to recover any Medicare Part B deductible or coinsurance amounts from Medicare/Medicaid Dually Eligible Individuals.

For Billing questions, please contact Sarah Howarth at 716-348-3923 or sarahh@pracfirst.com