NewsLine - May 2011 - (Page 12)

continued from previous page and administrative records, information technology, health plan relations, and contracts. In addition, learned patterns and relationships among codes would have to be relearned because of the changed structure and organization of the code set.2 It is estimated that to understand the coding differences, approximately eight hours of training will be needed for coding and clinical staff.3 Hospices will need to determine the number of people to send to these training sessions. Both in-person and web-based training are available through CMS, the American Academy of Professional Coders, and other organizations. Software Revisions: The Version 5010 Protocol Effective January 1, 2012 Healthcare providers also need to start planning for another change: Implementation of the new 5010 protocol for submitting electronic claims that will become effective on January 1, 2012. During a June 2010 conference call, Christine Stahlecker, director of the Medicare billing procedures division of CMS, said that electronic claims submitted to Medicare on or after that date must use the new protocol or they will not be accepted.7 Thus, providers, claims clearinghouses, and anyone else who will be using the new protocol should begin internal testing immediately if they have not done so already, followed by external testing as soon as possible. Stahlecker also noted that the new protocol is needed because the current one, known as 4010, is outdated. She said that almost 500 change requests were received and addressed in the new version. If you think about it, your current billing software for submitting UB04s does not contain the fields necessary for using ICD-10 for claims submission while version 5010 does. There are other technical changes as well that may require the revision of intake forms to capture primary language spoken, etc. Electronic remittance advices and all other electronic protocols must be updated to the 5010 protocol as well. What It Means for the Healthcare Industry • Staff will need to be trained. • Physicians will need to be trained. • Software, and possibly hardware, will need to be updated or purchased. • Revisions to forms will be required. • Mapping of old and new codes must be completed. • Your clearinghouse for claims transmission must be ready. • Increased denials during the learning curve and some glitches are to be expected. • There will be a need for both ICD-9 and ICD-10 for at least two years. • There will be process and policy changes for both providers and payers. • LCDs with diagnosis codes will need to be revised. If you haven’t spoken to your software vendor about these changes, you must do so immediately. Within the next six months (depending on when you’re reading this article), your present software performing billing and collecting functions will be obsolete. Be certain to ask your vendor four key questions: When will your system be upgraded? When will testing begin? Will you require a hardware upgrade too? How much will all of this cost? 12 NewsLine

Table of Contents for the Digital Edition of NewsLine - May 2011

POLST: An Evidence-based Tool for Advance Care Planning
A Message From Don
ICD-10: It’s Time to Begin Preparing
26th MLC Supporters (display ad)
Experience the ACHC Difference (display ad)
LifeBeat at Southern Tier Hospice and Palliative Care
Introducing NHPCO’s Custom Print Marketplace (display ad)
Voice of NCHPP: Spiritual Care: A Physician’s Perspective
NCHPP: Getting Involved
Recruiting Problems? HMR (display ad)
New - Hospice MDP Summer School (display ad)
CMS Clarifies Aspects of the Face-to-Face Encounter
Harvest: A New Film That Will Resonate With Members
Member News and Notes
Upcoming Educational Offerings
Cover 2

NewsLine - May 2011