HIPAA Electronic Transaction Standards with ICD-10

HIPAA Electronic Transaction Standards with ICD-10

(Do You Need to Maintain Both Code Sets in Your Practice – Yes)

Even though everyone will be using ICD-10 codes after Oct. 1, 2014 if they want to get paid, clinicians won’t quite be finished with ICD-9. Patient records prior to ICD-10 implementation must be transitioned to the new coding system. There will be coding, form and procedural changes and there are sure to be glitches along the way. With forethought, planning and understanding, the changeover can proceed easier than many might anticipate.

Clinicians and billers will have new codes to use and new standards they must implement to adhere to HIPAA regulations. Multiple changes will take place over a very short time that will be stressful.  There are strategies that can be used to accomplish all the target goals that don’t require an inordinate amount of effort, excessive overtime, and maintains HIPAA compliance.

For the smoothest transition, clinicians will need patient demographic information and the means to access it at will as they make the change from their old methods to the new EMR systems capable of handling all the new codes. To maintain HIPAA compliance, sensitive data can be stored on-site or in the cloud, providing that necessary security measures are in place.

All new patient information will be coded using ICD-10. Importing ICD-9 into the data into the new coding format for existing patients will take some time, but clinicians will find that as information is transferred and existing patients continue their care, overlaps will become apparent. Practice owners will need to maintain both coding systems for a time to ensure the complete transfer of patient data.

To facilitate the initiation of ICD-10, some EMRs have automatic crosswalks that will convert the coding. To ensure compliance, it’s essential that clinicians contact the clearinghouses and payers they work with and run sufficient testing to make sure all systems can communicate with each other. Each practice should make an effort to practice with converting ICD-9 to ICD-10 to familiarize themselves with its nuances before the official implementation date.

HIPAA version 5010 is the new standard for conducting electronic transactions to ensure patient privacy is maintained. It provides a platform for the use of ICD-10 coding. Practices and billers must implement the new HIPAA 5010 standards before ICD-10 codes can be utilized.

The upgrade to version 5010 was essential, as the old systems couldn’t use or accommodate the greatly expanded code set. HIPPA 5010 applies to “covered entities” that includes payers, providers, clearinghouses and health plan carriers. They all must upgrade to the new standards if they submit claims for reimbursement, transmit patient information, track claim status and verify coverage eligibility.

Clinicians should be aware that there are a couple of potential exceptions when the use of ICD-9 codes may still apply. Those are Workers Compensation and personal injury claims. The Affordable Health Care Act regulations continue to evolve and future legislation may change to encompass those two entities under ICD-10 coding.

The use of both coding systems allows practices to test and troubleshoot any intercommunication problems with payers and providers within its network. The testing process can identify areas where clinicians may need more training in appropriate documentation and provides valuable coding practice for clinicians and billers.

Practitioners aren’t alone – there are numerous sources of online assistance. Free training and resources are available on websites that include Medicare, the American Health Information Management Association (AHIMA), and the American Academy of Professional Coders (AAPC). The Find-A-Code application is also available that offers crosswalks, lookups and tools to simplify coding.

The 10 Advantages of ICD-10 Over ICD-9

The 10 Advantages of ICD-10 Over ICD-9

With the transition from the International Classification of Diseases (ICD)-9 to ICD-10 set to take effect on Oct. 1, 2014, it’s time to look at the advantages of ICDE-10 compared to the old system. ICD-10 provides 68,000 diagnostic codes and creates a new alpha-numeric system of 3-7 digits.

ICD-10 allows for different diagnosis coding according to the venue in which the patient is seen. ICD-10-C will be used by primary physicians and therapists, while ICD-10-PCS is for inpatient hospital procedures. Despite reticence and trepidation on the part of many clinicians, ICD-10 will provide some distinct advantages that will benefit practices in a variety of ways.

    1. The most important advantage to the new codes will be the ability to provide a more in-depth diagnosis for each patient and condition, ultimately leading to fewer claim rejections. Every practitioner has felt the frustration of having a reimbursement claim denied or sent back for more information. The new codes are designed to include a variety of expanded information to facilitate the claims process.
    2. The new coding system employs a new alpha-numeric sequence that allows for easy changes and updates as technology advances.
    3. ICD-10 codes are very specific about each incident in terms of when, where and how an injury took place, along with symptoms and any measures the patient may have taken on their own to gain relief. They provide numerous sub-categories for enhanced scope of reporting.
    4. The ICD-10 system provides clinicians with an updated listing that takes into account changes in technology and practices that have evolved since the implementation of ICD-9 over 30 years ago. New diseases, conditions and terminology allows for a better and broader scope of reporting ranging from animal attacks to conditions arising from space age technology.

  1. The enhanced coding provides detailed data for statistics gathering, analysis and research.
  2. ICD-10 codes allows for better monitoring to assess quality of care.
  3. The new codes should provide greater insight into each patient case and reduce the need for volumes of client records to be transmitted. Electronic transmission of data reduces the need for paper records, offering an environmentally-friendly solution. Practitioners can share standardized information electronically with other caregivers for better patient outcomes.
  4. The greater specificity of ICD-10 has the potential for yielding better reimbursement levels for clinicians. Practitioners can discover which procedures generate the best revenues and bill accordingly when it’s appropriate.
  5. The new coding is designed to increase efficiency within practices, allowing clinicians to better manage their available resources to reduce overall healthcare costs.
  6. The U.S. is the only country that hasn’t already transitions to the ICD-10 codes. A universally accepted standard of coding allows information to flow freely between healthcare professionals any country in the world. This is especially important in the control of contagious diseases and potential epidemics, but has other applications, too. It allows for better monitoring to assess quality of care.

The transition to ICD-10 codes will require clinicians to capture data in new ways, but will provide practitioners with an improved means of documenting the complaints and diseases of each patient. That ability has the potential to generate a significant increase in revenues.

How to Automate Patient Follow Up

How to Automate Patient Follow Up

One of the most important things a clinician can do is to keep his/her name in front of patients. That can be done with automated patient follow up. When patients provide their information, the practice should obtain the client’s mail, email, home phone and cellphone number, along with their permission to communicate with them in those ways.

An automated system should be able to contact patients by all four of those mechanisms. The In Touch EMR™ has the ability to accommodate those who utilize mobile devices and older patients who may not be comfortable with modern technology. Patient follow up encompasses more than appointment reminders.

Traditional Mail

In Touch EMR™ has the ability to generate personalized greeting cards with a variety of user defined messages. The feature is an effective means of connecting with new and established patients. Cards are computer generated, but have the look and feel of a personal note.

Cards are effective in welcoming new patients after their first visit or thank established patients for their continuing patronage. Cards can be sent on client birthday or on their anniversary with the practice. Cards tend to make a more lasting impression and are perceived as requiring more effort on the part of the practitioner.


An email message can be generated for the same purposes as a card and many individuals prefer being contacted by email rather than other means of communication. Messages can be used to notify clients about special deals, coupons and referral programs. When applicable and appropriate, congratulatory messages can be sent for an upcoming marriage, birth of a baby or workplace promotion.

Every practice should produce a newsletter and email is a convenient means of delivering it. In Touch EMR™ has the ability to generate newsletters with new, educational and engaging content that requires little effort on the part of the clinician.


In Touch EMR™ can send personalized voice messages to a variety of mobile devices. Studies have shown that individuals typically respond to a text or voice mail within five minutes of its receipt, making it ideal for patient communication. Clinicians can connect with a variety of messages, from appointment reminders to extending holiday greetings.

Home Phones

There are still some individuals who resist the use of smartphones and computers. These are typically older patients. They may not have a computer or mobile device, but they will most likely have an answering machine. In Touch EMR™ can generate any type of message desired to keep in touch with patients that may be resistant to newer types of technology.

Automated patient follow up is an essential part of operating a successful clinic. Automation simplifies the process for staff, while building goodwill with patients who are then more likely to refer the practice to others. It’s customer service at its best, facilitated through the automatic abilities of the In Touch EMR™.


The Revised CMS-1500 Claim Form

The Revised CMS-1500 Claim Form

The transition to ICD-10 codes comes with a revised CMS form to facilitate reporting. The National Uniform Claim Committee (NUCC) approved the use of the revised CMS- 1500 Claim Form in February 2012. The new CMS-1500 form will be printed with 02/12 in the lower right hand corner to indicate it’s the replacement for the 08/05 version.

The CMS-1500 must be used when billing Medicare and other federal payers for services. Clinicians must indicate when submitting claims on CMS-1500 if they’re using ICD-9 codes or if they’ve already made the transition to ICD-10. It’s essential that clinicians maintain communication with their payers and clearinghouses and conduct testing to ensure submissions are being transmitted and received correctly.

Medicare began accepting the revised version of claim form CMS-1500 on Jan. 6, 2014 and all submissions after March 31, 2014 must be done with the revised CMS-1500.

For those who have received a waiver for electronic transmission, Medicare will continue to accept paper claims, but only on the revised form. Medicare will deny any claim submitted on the old CMS form on and after April 1, 2014.

The new CMS-1500 was required to correctly report and document the thousands of new ICD-10 codes and the alpha-numeric system that will be used. Use of the new form is mandatory when billing any federal payer. Many of the line-by-line item changes were relatively small, such as changes in wording. For example, TRICARE CHAMPUS has been shortened to TRICARE and the Social Security number is now referred to as an ID number.


Other line items with which clinicians were familiar were eliminated entirely, since the information will now be reported elsewhere on the form or not at all. A number of lines now read “Reserved For NUCC Use” and data that includes employer’s name, school and balance due that wasn’t reported on 837P weren’t deemed necessary and aren’t required on CMS-1500.

An enhancement on the form allows clinicians to list up to 12 diagnosis codes per patient. CMS-1500 has a number of open fields, but they can’t be utilized to report additional data. Practitioners now have qualifiers to identify them as a referring, ordering or supervising provider and diagnosis codes that were labeled 1-4 now have an A-L designation.

The ICD-10 codes are more specific and the CMS-1500 reflects that. The new form has a QR Code that can be scanned with a smartphone. The QR Code takes users to the NUCC website. The revised CMS-1500 also underwent changes that would provide practitioners with the ability to add extra qualifiers when needed.

Any reimbursement claims filed prior to implementation of the revised CMS-1500 that must be resubmitted for any reason should be transmitted utilizing the revised form. This is true even if the previous claim was submitted on the earlier form.

A copy of the form can be downloaded for examination purposes, but it can’t be utilized to submit claims. CMS-1500 uses exact red ink match technology and much of the embedded information will remain invisible when it’s scanned with an Optical Character Recognition (OCR) device. Clinicians should be aware that payers can opt not to process claims that are submitted in black ink and doesn’t use the red ink match technology.

It will take some time for clinicians to familiarize themselves with the revised CMS-1500 form and the new ICD-10 codes, but the form is now an accomplished fact. The new codes and forms are a reality of the healthcare environment and clinicians must use them or risk not receiving reimbursements.