Comments on: Mental Health Billing and the ICD-10 http://www.sosoft.com/blog/2008/10/31/mental-health-billing-and-the-icd-10/ Mon, 06 Feb 2012 16:08:40 +0000 hourly 1 http://wordpress.org/?v=3.3.1 By: Kim http://www.sosoft.com/blog/2008/10/31/mental-health-billing-and-the-icd-10/comment-page-1/#comment-253 Kim Thu, 20 Nov 2008 17:24:42 +0000 http://www.sosoft.com/blog/?p=50#comment-253 I am thankful I paid my support agreement. This is just another way to try to cause trouble getting paid. We will manage like we did with the NPI. I will put Noe on speed dial now. I am thankful I paid my support agreement. This is just another way to try to cause trouble getting paid. We will manage like we did with the NPI. I will put Noe on speed dial now.

]]> By: Ann Aukamp http://www.sosoft.com/blog/2008/10/31/mental-health-billing-and-the-icd-10/comment-page-1/#comment-21 Ann Aukamp Thu, 06 Nov 2008 15:05:44 +0000 http://www.sosoft.com/blog/?p=50#comment-21 This whole diagnosis code situation is difficult, even now. I have a terrible time keeping track of which codes require 5 digits, and which 4. I think insurance companies are delighted to find some wrinkle by which they can avoid payment to clinicians. My wish would be that we could be provided with a file that we could choose to use, overwriting what we had already had, or not. This is my wish, with or w/out the swap to ICD 10. That said, sounds like ICD 10 will be complex. I heartily second the notion of long and flexible implementation, with no company allowed to reject claims until all - or at least all major ones - are ready to use the new set- up. Best - Ann Aukamp This whole diagnosis code situation is difficult, even now. I have a terrible time keeping track of which codes require 5 digits, and which 4. I think insurance companies are delighted to find some wrinkle by which they can avoid payment to clinicians. My wish would be that we could be provided with a file that we could choose to use, overwriting what we had already had, or not. This is my wish, with or w/out the swap to ICD 10.
That said, sounds like ICD 10 will be complex. I heartily second the notion of long and flexible implementation, with no company allowed to reject claims until all – or at least all major ones – are ready to use the new set- up.
Best – Ann Aukamp

]]> By: Seth http://www.sosoft.com/blog/2008/10/31/mental-health-billing-and-the-icd-10/comment-page-1/#comment-20 Seth Tue, 04 Nov 2008 20:47:22 +0000 http://www.sosoft.com/blog/?p=50#comment-20 There will be no additional software cost for SOS customers who maintain support contracts. (If there is no public domain source for the ICD-10 codes and descriptions, SOS would probably create an import utility and tell you where you could purchase a suitable file containing the data.) The adjustment of field lengths, and even adding a new Dx category, with the ICD-10 codes pre-loaded, is no big deal technically. As Kathy points out, however, the implementation hurdles are likely to be tied up with payor implementation schedules. Consider, for example, that you have a patient with primary coverage with Payor One and secondary coverage with Payor Two. Let's say that Payor One mandates use of ICD-10 starting on June 1, but Payor Two won't be ready until September 1 and requires the ICD-9 codes until then. Somehow you would have to maintain TWO sets of diagnoses for your patient and designate the set that should be used for which payor when. Lordy, what a headache! I would hope that there will be a fairly long transition period during which either diagnosis will be accepted, and a firm deadline for ICD-10 only. In practice, what that will mean is that nobody will use the ICD-10 until the deadline to avoid problems with payors that are not ready. This situation is the NPI all over again, and after seeing the chaos resulting from THAT change, I am not expecting an easy changeover. There will be no additional software cost for SOS customers who maintain support contracts. (If there is no public domain source for the ICD-10 codes and descriptions, SOS would probably create an import utility and tell you where you could purchase a suitable file containing the data.) The adjustment of field lengths, and even adding a new Dx category, with the ICD-10 codes pre-loaded, is no big deal technically. As Kathy points out, however, the implementation hurdles are likely to be tied up with payor implementation schedules. Consider, for example, that you have a patient with primary coverage with Payor One and secondary coverage with Payor Two. Let’s say that Payor One mandates use of ICD-10 starting on June 1, but Payor Two won’t be ready until September 1 and requires the ICD-9 codes until then. Somehow you would have to maintain TWO sets of diagnoses for your patient and designate the set that should be used for which payor when. Lordy, what a headache! I would hope that there will be a fairly long transition period during which either diagnosis will be accepted, and a firm deadline for ICD-10 only. In practice, what that will mean is that nobody will use the ICD-10 until the deadline to avoid problems with payors that are not ready. This situation is the NPI all over again, and after seeing the chaos resulting from THAT change, I am not expecting an easy changeover.

]]> By: Debra http://www.sosoft.com/blog/2008/10/31/mental-health-billing-and-the-icd-10/comment-page-1/#comment-19 Debra Tue, 04 Nov 2008 12:42:24 +0000 http://www.sosoft.com/blog/?p=50#comment-19 Small practices will be hard hit unless there is some sort of online training available. With HIPAA everything went smoothly until May 23 when Medicare decided to crosswalk NPI to tax id in their records. Since most MD's signed up right out of residency, they put their SS# and over the next 20 or so years forgot that fact. With ICD-10, we should be able to learn next year the changes (hopefully) if the information is put out there to learn. Small practices will be hard hit unless there is some sort of online training available. With HIPAA everything went smoothly until May 23 when Medicare decided to crosswalk NPI to tax id in their records. Since most MD’s signed up right out of residency, they put their SS# and over the next 20 or so years forgot that fact. With ICD-10, we should be able to learn next year the changes (hopefully) if the information is put out there to learn.

]]> By: Kent Eichenauer http://www.sosoft.com/blog/2008/10/31/mental-health-billing-and-the-icd-10/comment-page-1/#comment-18 Kent Eichenauer Tue, 04 Nov 2008 00:07:15 +0000 http://www.sosoft.com/blog/?p=50#comment-18 I know that ours is a small practice of only 4 providers, but it seems to me that, especially if the AHA is behind this, there's not a whole lot of choice. I know SOS has always made things as user-friendly as it can. Maybe I'm just in denial, and I understand this can be more complicated than the NPI, but at least we don't have all the codes that a family practice MD would have. I know that ours is a small practice of only 4 providers, but it seems to me that, especially if the AHA is behind this, there’s not a whole lot of choice. I know SOS has always made things as user-friendly as it can. Maybe I’m just in denial, and I understand this can be more complicated than the NPI, but at least we don’t have all the codes that a family practice MD would have.

]]> By: Keith Myers http://www.sosoft.com/blog/2008/10/31/mental-health-billing-and-the-icd-10/comment-page-1/#comment-17 Keith Myers Mon, 03 Nov 2008 23:50:58 +0000 http://www.sosoft.com/blog/?p=50#comment-17 I think there are two issues here. The first, the more simple one from our standpoint, is the entering of the ICD-10 code into the billing system. That should be relatively simple assuming that SOS has upgraded its software to accommodate the new codes. The harder part is that ICD-10 is completely different from ICD-9. Different numbering system, some possible different names for diagnoses, etc. The training all of us will need to understand ICD-10 is the greater problem. If SOS will upgrade, at a reasonable cost (I've heard of estimates from HHS of between $85,000 to $250,000 per provider), then it will be up to us to find or develop the training in how to use ICD-10. I think there are two issues here. The first, the more simple one from our standpoint, is the entering of the ICD-10 code into the billing system. That should be relatively simple assuming that SOS has upgraded its software to accommodate the new codes. The harder part is that ICD-10 is completely different from ICD-9. Different numbering system, some possible different names for diagnoses, etc. The training all of us will need to understand ICD-10 is the greater problem. If SOS will upgrade, at a reasonable cost (I’ve heard of estimates from HHS of between $85,000 to $250,000 per provider), then it will be up to us to find or develop the training in how to use ICD-10.

]]> By: Kathy http://www.sosoft.com/blog/2008/10/31/mental-health-billing-and-the-icd-10/comment-page-1/#comment-16 Kathy Mon, 03 Nov 2008 18:50:05 +0000 http://www.sosoft.com/blog/?p=50#comment-16 That's how it should work, but consider the following: 1. The ICD-10 has an additional character and many software products do not have enough spaces in the diagnosis and procedure code fields to handle it. While the SOS database can accomodate to the change, many billing programs will not be able to do so. Some providers will need to buy new software or pay for upgrades. 2. Many payer adjudication systems are much more rigid than billing software. Consider the complications of a huge payer who must completely revamp their system to accept the new codes. 3. Some of our users struggle with the crosswalk from the DSM-IV to the ICD-9 where most of the codes are identical. The new codes will not look like the old ones. 4. SOS for one has avoided changing diagnostic codes because many providers customize their lists. Any changes the software vendor makes overwrite user customizations. 5. Even if the software vendor were to create a crosswalk, there will always be details that the user must handle. Providers will need to educate themselves about the new system, use the new codes, and make the fine decisions among competing choices. 6. This is much more complicated than the NPI. That’s how it should work, but consider the following:

1. The ICD-10 has an additional character and many software products do not have enough spaces in the diagnosis and procedure code fields to handle it. While the SOS database can accomodate to the change, many billing programs will not be able to do so. Some providers will need to buy new software or pay for upgrades.

2. Many payer adjudication systems are much more rigid than billing software. Consider the complications of a huge payer who must completely revamp their system to accept the new codes.

3. Some of our users struggle with the crosswalk from the DSM-IV to the ICD-9 where most of the codes are identical. The new codes will not look like the old ones.

4. SOS for one has avoided changing diagnostic codes because many providers customize their lists. Any changes the software vendor makes overwrite user customizations.

5. Even if the software vendor were to create a crosswalk, there will always be details that the user must handle. Providers will need to educate themselves about the new system, use the new codes, and make the fine decisions among competing choices.

6. This is much more complicated than the NPI.

]]> By: Paula http://www.sosoft.com/blog/2008/10/31/mental-health-billing-and-the-icd-10/comment-page-1/#comment-15 Paula Mon, 03 Nov 2008 18:06:27 +0000 http://www.sosoft.com/blog/?p=50#comment-15 I agree, how hard can this be - give MD's the ICD-10 sheet, and enter the ICD code into the program. Am I missing something also? I agree, how hard can this be – give MD’s the ICD-10 sheet, and enter the ICD code into the program. Am I missing something also?

]]> By: Diane http://www.sosoft.com/blog/2008/10/31/mental-health-billing-and-the-icd-10/comment-page-1/#comment-14 Diane Mon, 03 Nov 2008 17:47:23 +0000 http://www.sosoft.com/blog/?p=50#comment-14 How hard could this be? Won't most of the codes be similar to what they are now? Will SOS be able to distinguish what is what and update accordingly or will this have to be a patient by patient change? Or am I completely not understanding what the ICD-10 is all about? How hard could this be? Won’t most of the codes be similar to what they are now? Will SOS be able to distinguish what is what and update accordingly or will this have to be a patient by patient change? Or am I completely not understanding what the ICD-10 is all about?

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