INFORMATION BREACH NOTICE – MAJOR INSURERS IN WNY

Cyberattack affecting Excellus BlueCross BlueShield, Univera, Lifetime HealthCare Companies and Affiliates

On August 5, 2015 it was determined that a sophisticated cyberattack gaining unauthorized access to the information technology systems at Excellus BlueCross Blue Shield, Univera Healthcare and Lifetime Healthcare companies and their affiliates  on December 23, 2013!  The cyber attackers may have gained unauthorized access to individuals’ information which could include name, date of birth, Social Security number, mailing address, telephone number, member identification number, financial account information and claims information.    The current investigation has not determined that any data was removed from the IT systems and there has been no evidence to date that data has been used inappropriately.

The above carriers are working with Mandiant, a cybersecurity firm to conduct an investigation and have notified the FBI.  Notices will be sent to individuals impacted by this security breach by November 9, 2015.  Free credit monitoring and identity theft protection services are available for anyone affected by the attack.

The incident affects members, patients or other who have done business with the plans listed below:

  • Excellus BlueCross BlueShield
  • BlueCross BlueShield of Central New York
  • BlueCard Members – if services where received in the local Excellus service area
  • BlueCross BlueShield of the Rochester Area (Finger Lakes BlueCross BlueShield and BlueCross BlueShield of the Rochester Area)
  • BlueCross BlueShield of Utica-Watertown (BlueCross BlueShield of Greater Utica and Watertown BlueCross)
  • Univera Healthcare (HealthCare Plan, Prepaid Healthcare Plan, Univera Healthcare-CNY, Univera Community Health and Buffalo Community Health)
  • The MedAmerica Companies (Finger Lakes Long Term Care Insurance Company)
  • Lifetime Benefit Solutions (EBS Benefit Solutions, EBS-RMSCO and RMSCO)
  • Lifetime Care (Genesee Region Home Care Association and Genesee Region Home Care of Ontario County)
  • Lifetime Health Medical Group (HealthCare Plan Medical Centers, Health Services Medical Group and Lifetime Health Centers)

CODING CORNER REMINDER…ICD-10

By Lisa Kropp, Coding and Credentialing Manager

Last Call for ICD-10

  • It is predicted that the ICD-10 transition will make a significant impact on cash flow due to delayed payment and claims adjudication. Although testing occurs, the industry cannot be certain that claims will process as correct and timely as they do now.  Therefore, it is our recommendation that every practice ensure cash reserves and lines of credit are available to keep your practice operational for 3-4 months in the event there is a disruption in cash flow due to delayed payments and/or denials.
  • Billing Clients: Practicefirst will expect all dates of service 10/1/2015 forward to contain ICD10 diagnosis codes on your billing sheets.  Any claims submitted with ICD-9 codes will be returned to the office for correction.
  • Coding Clients: Practicefirst will continue to be a resource for questions. Training has occurred either in person or via telephone.  If you have not received your session, you must contact PF at 716.834.1191.

&nbs

CODING CORNER…FOCUS ON ICD-10 – SEPTEMBER 2015

By Lisa Kropp, Coding and Crredentialing Manager

What to Expect in September:

  • Coding Clients: PF will continue to be a resource for questions.  Training has occurred either in person or via telephone.  If you have not received your session, you must contact PF at 716.834.1191.
  • Billing Clients: PF will expect all dates of service 10/1/2015 forward to contain ICD10 diagnosis codes on your billing sheets.

The BEST Resource at this stage:

  1. CMS’s Road to 10
    1. http://www.roadto10.org/Aligning Clinical Documentation and ICD-10:

DIABETES MELLITUS, HYPOGLYCEMIA AND HYPERGLYCEMIA….Increased Specificity

The diabetes mellitus codes are combination codes that include the type of diabetes mellitus, the body system affected, and the complications affecting that body system.

When documenting diabetes, include the following:

TYPE: e.g. Type 1 or Type 2 disease, drug or chemical induced, due to underlying condition, gestational

  1. COMPLICATIONS: What (if any) other body systems are affected by the diabetes condition? e.g. Foot ulcer related to diabetes
  2. TREATMENT: Is the patient on insulin?
  • A second important change is the concept of “hypoglycemia” and “hyperglycemia.”
  • It is now possible to document and code for these conditions without using “diabetes mellitus.”
  • You can also specify if the condition is due to a procedure or other cause.
  • The final important change is that the concept of “secondary diabetes mellitus” is no longer used; instead, there are specific secondary options.

ICD-10 DIABETES CODE EXAMPLES:

E08.65            Diabetes mellitus due to underlying condition with hyperglycemia

E09.01             Drug or chemical induced diabetes mellitus with hyperosmolarity with coma

R73.9              Transient post-procedural hyperglycemia

R79.9              Hyperglycemia, unspecified

INJURIES….Increased Specificity

ICD-9 used separate “E codes” to record external causes of injury. ICD-10 better incorporates these codes and expands sections on poisonings and toxins.

When documenting INJURIES, include the following:

  • Episode of Care:                     Initial, subsequent, sequelae (late effect)
  • Injury Site:                              Be as specific as possible
  • Etiology:                                 How was the injury sustained?
  • Place of Occurrence:               e.g. School, work, etc.

Initial Encounters may also require, where appropriate:

  • Intent:                                     e.g. Unintentional or accidental, self-harm, etc.
  • Status                                     e.g. Civilian, military, etc.

Injury CODE EXAMPLE:

Example: A left knee strain injury that occurred on a private recreational playground when a child landed incorrectly from a trampoline:

  • Injury: S86.812A, Strain of other muscle(s) and tendon(s) at lower leg level, left leg, initial encounter
  • External cause: W09.8xxA, Fall on or from other playground equipment, initial encounter
  • Place of Occurrence: Y92.838, Other recreation area as the place of occurrence of the external cause
  • Activity: Y93.44, Activities involving rhythmic movement, trampoline jumping   

For additional examples, by specialty, please visit: https://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.htm

If you would like more information about how we can tailor our services to meet your needs, please contact Practicefirst at 716.834.1191 or tom@pracfirst.com<