The New Language of Healthcare

 

In just under a year we are scheduled to Implement ICD-10 for all HIPAA covered transactions.  This is a significant change in how healthcare business is conducted – but it is not an insurmountable change.  With a bit of forethought, planning and education we can make the transition to ICD-10 less painful.  In the coming months you’ll find tips and tasks to keep you focused on the transition.  After all, you can only eat an elephant one bite at a time!

 

Learning a New Language

 

On October 1, 2015 the language of healthcare is changing.  This new “language” allows providers, payers and others to get a better picture of the patient and far more detail regarding the reason(s) for their visit.

 

Learning a new language takes time.  Communication between doctor and patient isn’t impacted by the change.  You’ll still take care of your patients with the same processes, procedures and care that you do today.  The change comes in communicating with third-party payors.  ICD-10 allows providers to paint a more thorough picture of the patient, allowing the insurance companies to “see” things that they can’t with ICD-9.  This change in communication impacts the inside of healthcare; insurance companies, software vendors, hospitals and doctors.  These new codes provide a more accurate description of the conditions encountered. 

 

Over the next 11 months we’ll work to keep the information we provide simple, clear and useful.  We’ll work to walk you thru how to prepare for the transition, how to speak this new language and how to find the information you need to keep your practice strong.

 

Your task this month is to purchase an ICD-10 book and read the introduction.  It’s important that you have access to this information.  We’ll explore the transition together over the coming months.

BCBS Medically Unnecessary Services

Effective July 14, 2014 BCBS IL has a change in policy for services deemed to be medically unnecessary or medically unproven (experimental and/or investigational). These services will no longer be considered patient responsibility upon denial.  These services will be denied with a message specifying that the patient is not financially responsible for the charges.

What items are considered medically unproven?  Interferential current stimulation, pneumatic traction and spinal uploading devices in any setting, many types of allergy testing, traction devices for use in the home, kinesiology, spray and stretch technique for myofascial pain, intermittent motorized traction, intersegmental traction, methods of mechanical massage, craniosacral therapy, hydrotherapy beds, kinesio taping, and low level laser are among the many elements that are not covered by BCBS. 

In order to charge the patient for these non-covered services, the patient must sign and date an authorization form that states the member has been informed prior to the services being rendered, that the services are no covered.  It must include the total cost of the services and a confirmation that the member accepts all financial responsibility.  

BCBS IL Medically Unnecessary

 

Effective July 14, 2014 claims submitted to BCBSIL for services deemed to be medical unnecessary, medical unproven, experimental or investigational will be denied with a message state the member will not be financially responsible for the charges.  If you are aware that a proposed service will meet the above criteria, you must obtain a written discloser/authorization from the member informing them that the services are not covered by BCBSIL and the patient is financially responsible for the services.  This must be done PRIOR to the services being rendered, must include the total cost and confirmation that the member accepts the financial responsibility.

 

Medically unnecessary services include intersegmental traction, interferential e-stim, kinesiology, hydrotherapy, knesio taping and some forms of massage therapy. 

 

 

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