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September 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:

Move to ICD-10 is on the way: SOS's ICD-10 Plans
New CMS-1500 Forms Required Soon: Do you use a special HCFA form?
Microsoft discontinues support for Windows XP in April 2014
NOTE: Emailing PHI is not HIPAA Compliant
HIPAA-secure online Backup...with a BAA
Filing Secondary Claims Electronically through Emdeon: New document available
SOS Staff Profile: Noe Gamez, Technical Support Representative
Customer Spotlight: Laura S. Morrison, Ph.D.

Recent blog articles available:

Brain 2013, January 10, 2013
Violence in our Lives: What to do?, January 17, 2013
P.S. on Gun Violence in our Lives, January 22, 2013
HIPAA Final Rule Finally Released, January 31, 2013
Caregiving Revisited, February 12, 2013
PQRS Intro, April 16, 2013
Thoughts on the Quality of Death and Dying: A personal reflection, June 18, 2013
ICD-10 Implementation
June 27, 2013
New Blog Strategy: Short, targeted posts....States prep for health information exchange in emergency, July 18, 2013
PHI Leaks: The Insider Threat, July 24, 2013
'Single Payer Healthcare Would Save US $Billions' Study Shows, August 1, 2013
Now Open for Enrollment: Health Insurance Marketplace, August 8, 2013
HIPAA Breach Fines Grow, August 19, 2013
Contractor vs. Employee: How does your organization decide?, August 29, 2013
HIPAA Omnibus Rule: How much time have you spent?, September 6, 2013
New CMS-1500 Forms Required Soon, September 13, 2013
HHS Releases Model Notice of Privacy Practices, September 20, 2013




Move to ICD-10 is on the way: SOS's ICD-10 Plans

On October 1, 2014, all health care providers will be required to utilize ICD-10 codes on claims in order to receive payment. The following is a detailed Q & A by Seth Krieger, President of Synergistic Office Solutions, to address the software issues involved in accomplishing this goal. Please do read it carefully.

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 known as "Silver". Silver 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.

The transition from ICD-9 to ICD-10 is a very big deal:
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 codes on your claims when the transition date of October 1, 2014 arrives. Your readiness depends in part on the readiness of your software. Here are some of the questions you might want to ask SOS and our responses:

Q. I use DSM codes instead of ICD-9. Does any of this pertain to me?
A. Actually, ALL of it pertains to you. Except, perhaps, 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 required standardized code sets required by the HIPAA legislation since at least 2004. 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. Please download American Psychiatric Association's document on DSMV, ICD-9 and ICD-10 if this matter concerns you.

The transition to ICD-10 codes, however, removes the overlap completely. 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.

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 accurately convert every ICD-9-CM code to an equivalent ICD-10-CM code. 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. That said, SOS will be releasing a software update in late September, 2013, that includes what we are calling the "SOS ICD-10 Prep Utility". The utility will be 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 next October (a year from now).

As it happens, many mental/behavioral health ICD-9 codes have only one ICD-10 match in the CMS General Equivalency Mapping (GEM) table. When you open a patient in the Prep utility, it will automatically insert the appropriate 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 GEM 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 will be available by October 1, 2013. No later than June 1, 2014, SOS will release a version of the SOS software that accepts both ICD-9 and ICD-10 diagnoses. 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's use of the software 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 "Silver" or "next generation" software that I have seen mentioned on the SOS User Group?
A: No. Silver 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.


New CMS-1500 Forms Required Soon: Do you use a special HCFA form?

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.  

CMS 1500 02/12    "CMS-1500 Claim Form Updates: Medicare to Accept Revised Form Starting January 2014

The CMS-1500 Claim Form has been recently revised with changes including those to more adequately support the use of the ICD-10 diagnosis code set. The revised CMS-1500 form (version 02/12) will replace version 08/05. The revised form will give providers the ability to indicate whether they are using ICD-9 or ICD-10 diagnosis codes, which is important as the October 1, 2014, transition approaches. ICD-9 codes must be used for services provided before October 1, 2014, while ICD-10 codes should be used for services provided on or after October 1, 2014. The revised form also allows for additional diagnosis codes, expanding from 4 possible codes to 12. 

Only providers who qualify for exemptions from electronic submission may submit the CMS-1500 Claim Form to Medicare. For those providers who use service vendors, CMS encourages them to check with their service vendors to determine when they will switch to the new form.

Medicare will begin accepting the revised form on January 6, 2014. Starting April 1, 2014, Medicare will accept only the revised version of the form."

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.

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.



Microsoft discontinues support for Windows XP in April 2014

Microsoft has announced that it will discontinue all support and updates for Windows XP on April 8, 2014. This has implications for you if you are still using Windows XP on any of your computers.

When Microsoft discontinues support for a product, they will no longer provide updates for that product. This makes yourPersonal computer operating system susceptible to attack by criminals wanting to hack into your computer. You see, as long as you have been doing automatic updates of Windows XP, each time someone finds one of the many vulnerabilities in this operating system, Microsoft creates a fix for that weakness that is automatically installed on your computer. This automatically keeps your system from being hacked by way of these vulnerabilities. 

With no more fixes comes exposure to every virus and trojan horse that thieves and hackers can come up with. Your credit card information, your patient's Protected Health Information, anything you thought was secure on your Internet-connected computer is no longer so. Such vulnerability means that your computer system is not compliant with the requirements of HIPAA....your PHI is at risk. If you keep customer information (like credit card info) on the machine, that also is at risk putting you out of compliance with your credit card vendor. 

If you have not already moved all of your computers from Windows XP to one of the newer versions of Windows, please begin your transition right away.        


Important Note to our Customers: Emailing PHI is not HIPAA compliant

SOS would like to remind you that email is not secure. Unless you use encrypted email, or you can document that the patient has approved it, you should never include Protected Health Information (PHI) of any kind in the subject or body of an email message. Any attached documents should be cleansed of PHI before being sent, or the document should be zipped with 256 bit AES encryption or better, prior to being attached to the email message. The password to open the document should be conveyed to the receiver by phone or fax.

If your email is going to SOS, you can fax the encryption password to SOS at 888-609-5514 or you can forward it to us by telephone at 352-242-9100, option 1. Never include the password in an email.
 email image

We take the protection of your PHI very seriously. Anytime we receive an email from you that contains PHI, we notify you of the potential breach of information and we enter it into our own Breach Log, as required by our HIPAA policies. Please carefully review anything you send to us by email before it is sent.
 
 



HIPAA-secure Online Backup...with a BAA

As you may be aware, we have recommended online backup through products like Mozy and Carbonite for quite some time as a supplement to local, first line backup strategies. We emphatically do NOT recommend any single backup strategy as your ONLY backup, but online backup is very slow relative to the other methods, which is why its best place in the system is as a supplemental, off-site backup and part of your HIPAA-mandated Business Continuity and Disaster Plans.

A couple of things about using online backup for your SOS data and other protected health information (PHI):

Here are the takeaways:
  1. You must do local backups under any circumstances, but supplementing with online backups is strongly recommended for disaster recovery and as a backup to your local backups.
  2. All backups, whether local or online, must be encrypted by turning on the encryption options in your backup software. If you are doing file copies as your backup, you must use something like WinZip or 7Zip to encrypt the files during the copy process.
  3. If you are using an online backup service, and you want to be sure that you are HIPAA compliant, then be sure to get a BAA from your backup vendor. If your backup vendor won't sign one, then switch to a vendor who will. Encrypt the backup before you send it to the online service. Once you have a backup saved on the new system, delete all your backups on the old system and uninstall the old vendor's software to avoid accidental use.

This past month, two more SOS customers experienced serious data loss because they did not have a working backup system. SOS guidance on what you should be doing for backup is readily available. Please use it!




Filing Secondary Claims Electronically through Emdeon: New document available

Manon recently noticed that many of our Emdeon customers were getting rejections for secondary claims. She updated our document on electronic filing of secondary insurance claims for your edification. Please let us know if it is helpful to you.



SOS Staff Profile

Noe Gamez,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. Noe Gamez is someone most of you have spoken to. As one of our Technical Support Representatives, he spends most of his time on the telephone solving technical support problems for you or answering your questions about how to accomplish certain tasks. Here are Noe’s answers to our standard questions.  

Photo of Noe

How long have you worked at SOS?

    I have been with SOS since January 2000.

How would you describe your role at SOS?

    I would describe my role as someone who makes sure things are working properly for our customers.

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

    It varies on the mood that I'm in. There are days when I would just curl up and read a book from beginning to end. Then there are other days when I like to go hiking or doing any activities that involve the outdoors.

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

    Two things:

                                                                  Yes, my real name is Noe, and 

                                                                  I'm really a nice guy in person!



SOS Customer Spotlight Spotlight graphic            

Laura S. Morrison, Ph.D.
Morrisons Psychotherapy
Graeagle, California

Dr. Laura S. Morrison has used SOS software since May 1991. Below are our questions and her answers.

For how long have you been providing services to your community?
28 years in Plumas County (which includes Graeagle); we were initially in Quincy. I've been in Graeagle 8 years.

How many staff members are involved in your organization? What are their credentials?
At this point there is just me. My husband and I were in practice together from 1990 to 2011; he was an LCSW. However, he passed away two years ago. At this point, our county is extremely short on private-practice psychotherapists and mental health services in general.

What areas of specialization do you provide to your community?
There are areas I especially like, but I see a real variety of clients since I'm the only psychologist and virtually the only licensed therapist in private practice in the county. I do a fair amount of psychological testing, for courts and county agencies for two different counties. I mostly see clients individually--no groups; it's much too small a community for anonymity. I work with a lot of clients with PTSD, anxiety disorders, and all the kinds of things that usually come up.

Since I work in a retirement community (and I'm getting closer to that age myself), I see quite a few retirees. That has turned out to be far more interesting and satisfying than I would have thought possible. Retirees, and older people in general, are working on some very tough issues. I also do a fair amount of marriage counseling with retirees--very interesting, since long-term married people and older people have much more motivation to stay together.

I have also become very interested in working with clients suffering from major depression. This, too, is not an area most therapists are interested in--it takes a lot of patience, and a much more directive approach than one would use working with other kinds of clients.

I consult with several other agencies in town, including ones working with abused children. However, I don't see children much anymore; I started out my career doing a lot of work with children, but I guess I'm beginning to feel a little too old to get down on the floor and do play therapy. I still very much enjoy testing children. I guess, in doing testing with both children and adults, I've never lost that fascination, wondering how the tests are going to come out, what I'm going to see that I didn't expect. In doing evaluations, I also enjoy pulling a great deal of information together from all the sources I can contact and trying to integrate that information into something that is really going to help the client/family/agency.

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

In a very small town like this, everyone talks about their experiences with their therapist with everyone else. And I think I'm respected, the "go to" person for mental health information and advice that others might not have. I've done quite a bit of clinical supervision with therapists (and have seen quite a number of them in therapy); I've consulted with agencies, attorneys, and nonprofits; sometimes people call me, just asking me what kinds of services they need, and I can help them figure that out (although our services are limited). I guess I'm saying that there is something satisfying about being older and more experienced in our profession; we don't "age out" as quickly as some professions do. It sounds silly, but I think I'm enjoying being seen as wise. If I lived in a tribal culture, I would enjoy being a wise woman. After spending all these years accumulating information, it feels good to be able to give back.

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.

We've been using SOS software since 1991, and I've seen so many changes and improvements in what you have to offer. I remember when the first Windows version came out (I'm dating myself), and thinking, "This is really complicated." But I've used almost every one of those features over the years. I guess what I use the most is the insurance tracking. Being able to immediately look at any client, see which sessions insurance has and has not paid, and how much, how long it took, and how many authorizations are left, and what's happening with the second insurance--that kind of information has been invaluable.

Because I live in a rather poor county, I have to accept insurance. I know a lot of therapists are cash-only these days, and the insurance companies are so nasty that I don't blame them. If I weren't using SOS, I wouldn't even attempt the insurance billing, but SOS makes the impossible possible. Insurance companies count on the fact that therapists are so overworked and not very good at billing that they probably won't follow up on a payment if the insurance company denies it. But with SOS, I'm usually on top of it, and I have a pretty good collection percentage. One of my therapist friends uses a billing service, but she still has to do all this work (by hand!) to get the paperwork ready for the billing service! Entering clients and transactions in OM is so easy that I can't imaging doing it any other way.

And when Medicare started expecting us to use all these exotic codes to document our compliance with their "good practice" standards, I could just incorporate those in as simple transactions (with a $0.01 charge). Frankly, Medicare is really very easy with OM...and with ECM.

But the electronic billing is astonishing; it has changed my life. When I was still struggling to get everything set up and working, one of my therapist friends in Reno said, "It's so easy." That gave me hope and kept me going. So I want to tell your readers this: It is really so easy, and it is SO worth it. The toughest snag I had during setup was that the program didn't seem to like the information I entered for referral sources (doctors), no matter what I did. But Manon helped with a workaround for that. The only problem that I've had recently is that the process is so easy (takes about 5 minutes, once I've entered everything and closed the daysheet) that I don't pay enough attention to insurance company denials. I recently discovered (with the help of Emdeon) that one particular insurance company was denying a lot of claims for really obscure and trivial reasons. So I will also say: Check your Emdeon claims information every month or after you send a billing batch. Emdeon also lets you print out documentation that you billed that session months ago, for those nasty insurance companies who deny claims and then won't pay for a claim more than three months old.

SOS is really incredibly useful, even (maybe especially) for small practices. So whether you're old or young, and whether or not you're comfortable with a computer, it's worth learning the program and using it. It makes it possible to do rather complex insurance billing, to bill agencies for multiple clients, and all without a secretary. In other words, the way our profession is going, you just about have to have something like this to survive.