Synergistic Update
December 2011
Welcome to Synergistic Update. It is our plan to use this new vehicle to provide information to you on a regular basis. We will share news 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.
In this issue:
What to expect with the new 5010 electronic claims format
Deadline_dates_5010_not_same_as_ICD10
Install_version_2010_of_your_SOS_software
New version of First Contact Module available
Recent blog articles:
Health
Insurance: How do you feel about yours? October 12,
2011
Motivation:
How do we generate it? October 28, 2011
Daemon:
Thought-provoking book by Daniel Suarez November
14, 2011
Thanksgiving:
Thanks to you! November 22, 2011
Change
in Healthcare is Upon Us…Law or not November 30,
2011
What to expect with the new 5010 electronic claims format
SOS has modified our electronic claims module to meet the 5010 standards. We have tested and passed muster with Emdeon, our clearinghouse partner. We are currently testing several other custom modules for sending claims to certain Medicaid and Medicare payers.
You will need to make very few changes to your SOS data to use the updated module. The standard moves toward use of 9-digit zip codes but only requires them for Facility and Supplier address. Additionally, the Supplier address must be a physical address, so we have added a ‘Mailing Address’ on the Supplier screen to accommodate our customers who receive their payments at a P. O. Box number. There has also been simplification of the list of “Relationship to Insured” categories.
If you use the SOS electronic claims module to send your claims to Emdeon and have not yet received any communication from SOS, please contact Kim@sosoft.com or call her at 352-242-9100, option 1. The deadline for implementation of 5010 transactions is January 1, 2012, but a 90 grace period has been instituted by CMS.
Deadline dates: 5010 is not the same as ICD-10
We have found that some of our customers are confused about the changes to the ANSI X12 5010 electronic claim format and the more massive move to the ICD-10. A couple of years ago, CMS realized that the ICD-10 change is so large that it is crucial to separate it from the simpler format change for electronic claims. Since the 5010 claim format is needed in order to use ICD-10 procedure and diagnosis codes, it was mandated that this switch should come first. Accordingly, January 1, 2012 is the deadline for implementation of the 5010 format. Be sure to look at CMS’ FAQ on the subject.
The deadline for use of the ICD-10 is October 1, 2013. This change will not affect behavioral health providers in the same way that it will affect medical practices and hospitals.
The ICD-10 contains both procedure codes and diagnostic codes. In the hospital realm, both diagnoses and procedures must utilize the longer, more detailed ICD-10 codes after October 1, 2013. In outpatient behavioral health, the change will not be so dramatic. If you use the DSM-IV, you will be able to continue to do so, or move to the DSM-V if it is available. If you utilize ICD-9 codes for diagnosis (as required by CMS for Medicare claims), you will move to the more detailed ICD-10 diagnostic codes. If you use HCPCS codes for your procedures, you will likely continue to use those. If you currently use CPT codes for inpatient procedures, you will switch to the ICD-10 procedure codes, but remain with CPT for outpatient procedures. You can find detailed resources at the CMS website.
The American Medical Association has recently announced its opposition to the implementation of the ICD-10 by the 2013 deadline based on the expected costs to providers. Stay tuned to learn whether CMS and HHS will reconsider the October 1, 2013 deadline.
Install version 2010 of your SOS software
If you have not already done so, now would be a good time to install version 2010 of your SOS software. If you cannot locate your last update CD but have a current Support/Update agreement, you can download the most recent update. Those of you who are filing claims electronically using our Emdeon module or one of our custom modules will require this update before you can add the update that will allow you to send 5010 compliant claims, so please get your install done as soon as possible. SOS is lightly staffed in the week between Christmas and New Year’s Day, so it will be very difficult for us to do any hand holding during updates. Please get them done earlier than the holidays so we can provide you with the best possible service.
SOS has implemented an online help system to facilitate your email requests for assistance. This system allows SOS to keep track of our email communications for technical support so that all of our support staff know just what has been done for you by email as well as by telephone. To use the system, just go to http://help.sosoft.com and click on either Submit a ticket or View existing ticket (if you need to follow up on something you previously initiated). On the main page, you will also find articles on issues with which people have requested assistance. Sometimes, these pieces are the quickest way for you to get assistance. Take a look at these and other Knowledgebase articles. You may just find a quick answer to some of your burning questions.
New version
of First Contact Module available
For
those of you who have First Contact
Module, there is an update available. At the SOS
website, click on Support > Download Files. Click on
SOS First Contact
build 202 Installer to get to the readme file for the First Contact
Module.
Scroll down to the bottom for the download link.
PLEASE
NOTE: You must have installed the 2010 version of the SOS software, the
most
recent release, to use this FCM update.