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March 2014

BREAKING NEWS: Congress Delays Implementation of ICD-10 until 2015 or later.

Congress has ordered CMS not to implement the ICD-10 this year. As of this time, they can do it no sooner than October 1, 2015. The long term effects of this new legislation, signed on April 2 by President Obama, are at present unknown. We do know that you still must begin using the new CMS claim form, so you must still do the update announced below if you file any claims on paper.

In this issue:

New SOS Release Available for Download
Antivirus Products Sometimes Cause SOS Installation Issues
Remember: CMS Requires New Forms by April 1
SOS Update and the ICD-10
Important Links for ICD-10 Learning
DSM-5 and the ICD-10: Continuing Customer Inquiries
Don't Forget: Support for Windows XP is ending
SOS Staff Profile: Linda Crosby, Senior Customer Service Representative
Customer Spotlight: Boston Institute for Psychotherapy

Recent blog articles available:

ICD-10 Challenges Behavioral Health Providers, February 5, 2014
Information Explosion, February 12, 2014
Smartphone Apps for Behavioral Health: Are you connected, February 19, 2014
Sharing Mental Health Information: HIPAA Privacy Rule Guidance, February 26, 2014
Government Entities are not sheltered from HIPAA requirements, March 11, 2014
Performance-based Compensation: What is your plan?, March 19, 2014
Simply Put: Simplify, March 25, 2014





 New SOS Release Available for Download

The new release of SOS software that includes the new paper claim format, as well as full support for the ICD-10 Diagnosis codes, is now available on the Download Files page of the SOS website. Please note that you should not download this update if you do not have a current support agreement. Doing so will overwrite your current version and may make it impossible for you to use your software. Please call us if you would like to have and use this update but do not have a current contract.
There are two things you need to know about this update before you get started:

  • First. We strongly recommend that you continue to do your ICD-10 coding using the ICD-10 Prep Utility on the Tools menu instead of directly in the Claim Setup form.That way, you can take advantage of the automatic Dx matching features we provide in the utility. When you are done adding the new Dx's in the utility, you can import them to the patient Claim Setup screens using the Import item on the Tools menu. After the changeover on October 1, you will just enter the ICD-10 codes directly in the Claim Setup, as you do now for the ICD-9 codes.
SOS Tools Menu
  • Second: The new paper claim formats appear in your "Create CMS 1500..." menu and can be identified by the "(0212)" characters at the end of the description. (If you look at the lower right corner of the new paper forms, you will see "(02-12)" indicating that the redesign was actually done two years ago. We left out the dash to save a little space. You will find a (0212) version of each of the stock CMS 1500 formats.)

Claim form list




Anti-virus Products Sometimes Cause SOS Installation Issues

Recently, some SOS customers have experienced a few problems while trying to install their updates. Their Anti-Virus software (usually McAfee, Norton, Avast, and TrendMicro) excludes SOS files from getting installed. What seems to happen is that during the update process, the Anti-Virus program mistakes the updated files for malicious software. As a result, not all of our files get installed and the customer ends up with a botched installation. Disabling the Anti-Virus program for 15 minutes is enough to prevent this problem.

Be sure to re-enable the Anti-Virus program once the SOS software is successfully installed!



Remember!

Remember!
: CMS Requires New Forms by April 1

CMS 1500 02/12
Implementation of the ICD-10 has made a new HCFA form necessary. The deadline to begin using this new form for any claims you send to CMS is April 1. CMS began accepting the new paper form on January 6, 2014. Starting April 1, 2014, Medicare will accept only the new form.  As you know, private insurers usually follow CMS' lead on use of the new form. SOS users with current support agreements may download the update containing the new format. 




SOS Update and the ICD-10

Last quarter's newsletter contained a Question and Answer article about SOS and the ICD-10. We have now released our update which will allow you to send the new CMS claim form right away and use the ICD-10 codes in your claims starting on October 1, 2014. Please take a look at that article for comprehensive answers to your questions. We continue to get questions about the ICD-10 on our SOS User Group. If you are not a member of that group, you really should join. This is a great way to stay on top of all the changes in our industry and use of our software, and to participate in discussion and get answers to your questions.

A recent question about the update and Seth's response follow.



Question:

We now have the new update installed. I see the fields for both ICD-9 and ICD-10 (in the Claim Setup). Can we populate both at this time for new clients, or do we have to wait until October 1 and then strip the ICD-9 and add ICD-10? If we can now enter both, how does the software know what Diagnosis to send to Emdeon on the claims?

Answer:

Yes, you certainly can fill in both ICD-9 and ICD-10 fields now, if you like. If you know the appropriate ICD-10 codes, that would certainly be appropriate.

If you need help selecting the appropriate ICD-10 codes, however, then we suggest that you just enter your ICD-9 codes in the Claim Setup for now. As we get closer to October 1, use the ICD-10 Prep
CMS 1500 (02/12) Utility on the Tools menu to review each claim setup. The utility will suggest appropriate ICD-10 codes wherever possible. In many cases, you will just open the screen, confirm that appropriate codes have been displayed by the utility, mark the coding "Complete" and go on to the next one.


SOS Office Manager
will automatically use the ICD-10 codes for services on or after October 1, the default date for switchover set in the software, or any other date you specify as the change-over date in Setup > System Options > Billing tab > last field.


SOS Insurance Carriers Additional tab









If you find that a certain payer is not ready to handle ICD-10's on October 1, then you can set a payer-specific cutover date on the Additional tab of the Insurance Carriers/Plans form:


Payer exception cutover date





In all probability, all payers will be accepting the ICD-10 codes on October 1, but have this payer-specific option in the unlikely event that you should need it.

Bottom line is that all you have to do is make sure that your ICD-10 codes are in those Claim Setups by October 1, whether you put them in manually or you import them using the ICD-10 Prep Utility. SOS Office Manager will take care of choosing the appropriate type of code for you, based on the service dates you are billing. It will even generate separate claims if you have some services in the batch that are before the cut-over date and some that are after.





Important Links for ICD-10 Learning  

We know that some of you have not yet begun to prepare for the ICD-10 transition, so we thought we would share these links again in this newsletter. 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 are part of a large organization and need a certified coder, please be sure to search for educational opportunities for professional certified coders.

WHO ICD-10 Tool





DSM-5 and the ICD-10: Continuing Customer Inquiries

We know that most behavioral health providers utilize the Diagnostic and Statistical Manual of Mental Disorders to diagnose their patients. We also are aware that many of you believe that you use DSM diagnoses for billing. It is very important that you begin to understand that you actually use ICD codes to get paid for the services you render. Most of the time, the DSM and ICD-9 codes are identical. Sometimes, they are not the same and your claim is rejected.

DSM-5 and ICD-10 change everything.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) was released on May 18, 2013. While it is controversial in its own right based on some of its content, 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 diagnoses and criteria; on the other hand is the requirement to move to the ICD-10 for payment processing. We hear the following question often:

Question:

When will SOS include the DSM-5 in products? 
DSM-5

Answer:

We will not license the DSM-5 from American Psychiatric Association (APA) for use in our products. The codes associated with the DSM-5 are ICD-9 codes through September, and ICD-10 codes thereafter. If you purchase the DSM-5 manual, you will see that each disgnosis has the two ICD codes next to it. You use the DSM descriptive information to make your diagnosis, but what you enter as the diagnosis code to go out in your claims will be an ICD code. THERE ARE NO DSM-5 CODES APART FROM THE ICD CODES REFERENCED FOR EACH DIAGNOSIS IN THE DSM-5.

We have provided a pick list for DSM-5 in our latest update, as well as retaining the DSM-IV Axis I and II codes, but we are not populating the DSM-5 list because the needed codes are already available in the ICD lists. If it makes you feel better to add the codes you use to the provided DSM-5 list, please do so. In fact, we strongly suggest that you completely ignore all three DSM lookups in SOS. Note that if you enter many DSM-5 diagnoses in the list, using ICD-9 codes now, you will have to go through and replace the codes with the APA-specified ICD-10 code on October 1. We do not see much purpose in that. APA expects you to develolp your diagnosis based on the description and criteria in the DSM-5 manual, then use the ICD code the DSM-5 tells you to use for that diagnosis when billing and when communicating information to other providers.

SOS Diagnosis Code screen 
As we have said previously, 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 part of 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)."


ICD-10 ManualSince 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. In fact, the DSM-5 has no codes of its own. 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.





Don't Forget! On April 8, 2014 Microsoft discontinues all support and updates for Windows XP. 

Microsoft publishes a Support Lifecycle Policy that allows you to know when they will no longer support and produce security updates for all of their products. Please attend to these dates. 

HIPAA compliance requires that computers on which PHI are stored must be secure. Current versions of Windows and the software you use are most helpful to guarantee that security.

Don't forget




SOS Staff Profile

Linda Crosby, Senior Customer Service 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.  

Linda Crosby photoHow long have you worked at SOS?

In May, it will be 15 years.

How would you describe your role at SOS?

I provide customer service, process the billing for Emdeon electronic transactions and support renewals, and answer general questions regarding use of our software. In addition, I process the enrollments for Emdeon electronic transactions for our customers.

How do you prefer to spend your time when you are not working?

I am a huge Disney fan, so I like to spend free time on the weekends visiting the Disney World theme parks. I also enjoy cross stitch, and find that a great way to relax in the evenings.

What else would you like our customers to know about you?

I appreciate the challenges our customers face working in busy offices. I worked for a private practice mental health group with 6 providers for 9 years using SOS Office Manager to handle all of their billing. 



SOS Customer Spotlight             Spotlight image

Boston Institute for Psychotherapy
1415 Beacon Street
Brookline, MA
bostoninstitute.org


For how long have you been providing services to your community?

We have been providing services for 43 years.

How many staff members are involved in your organization? What are their credentials?

We currently have 23 administrative, clerical, managerial staff and 108 clinicians. Many of the clinicians work part-time. We have psychiatrists, psychologists, social workers and licensed mental health counselors.

What areas of specialization do you provide to your community?

We are a licensed community mental health center providing outpatient services from birth through old age. We have an adult treatment center, The Rice Center for Young Children and Families that sees families with children age 5 and under, provide clinical services to students in the Boston Public Schools and to students at the School of the Museum of fine arts.

In addition to our treatment center, we provide pre and post-graduate training in psychodynamic psychotherapy.

We also offer continuing education to therapists and lay people around mental health issues.

What is your mission statement? How do you want your community to see you? 

Mission Statement
The mission of the Boston Institute for Psychotherapy is to contribute to human development, mental health, and the effectiveness of human organizations. This mission is to be accomplished by learning, developing, teaching and applying psychodynamic principles.





Thank you for being our customer. We appreciate your business.

Synergistic Office Solutions, Inc.  17445 East Apshawa Road   Clermont, FL 34715   352-242-9100