ICD-10: Quick Reminders!

When to Start Using ICD-10

Use ICD-10 codes on all dates of service 10/1/15 and later. Dates of service prior to 10/1/15 should be submitted with ICD-9 codes no matter the claim submission date.

In short: date of service dictates the code set used, not date of submission.

Can You Dual Submit?

Dual processing is when a company will accept either code set or both to give leeway to providers that may be a bit behind in readiness. Medicare is however not allowing this, and most private payers are not allowing this either.

In short: adherence to the 10/1/15 transition date is the safest way to ensure no delay in reimbursements to your practice. Dual code submission will not be time saving or beneficial.

Are There Exceptions?

Workers Compensation and Personal Injury carriers are not federally mandated to switch to ICD-10. In California it appears that all or most all WC carriers are honoring the 10/1/15 transition, however we are still checking with each company prior to submitting first claims. We are also checking with all Personal Injury carriers (Medpay, etc.) to be sure.

In short: Most are honoring the 10/1/15 transition date, but you may want to check with WC and PI carriers to be certain.


Happy Coding! If you are an In Charge Office Solutions client, call or email with any specific questions you may have. We are here to help and make the transition as smooth as possible, and can set up training meetings if you are in the Bay Area.


Are you happy with our services? Would you like to save some money as the Holidays approach? Tell a friend about In Charge Office Solutions and receive triple referral credit if they sign with us by the end of the year! That’s an extra $300 in your pocket, and who couldn’t use that?

Do you have a colleague unhappy with their current service or looking to save over in-house billing? Maybe you know someone who feels they are not prepared for ICD-10? Let us help by spreading the word!

doctor with dollar sign


BREAKING: Anthem Announces Intent to Acquire Cigna

Whenever I hear the notification of an email to my business account after 8pm on a Friday, I know it’ll be something juicy. Nice PR move: release something slightly controversial (or very controversial) on a Friday, hoping it will be forgotten by next Monday’s news cycle.

WELL, I received one such notification last night and to my surprise, the Subject Line says, “Cigna Anthem Announcement.” Cigna Anthem Announcement? But those are two different things? Well, apparently not for long if everything goes as they plan, with a merger deal on the table.  The announcement says they expect finalization of the merger in the second half of 2016. They state that the “combined company” will expand networks for patients and make care more accessible. Anthem already has a strong medicaid network which has become increasingly important with the Affordable Care Act. Cigna will be able to utilize this, while those covered by Anthem will now have access to Cigna’s broad network of specialty care.

Why does this matter and how will things change?

Cigna Anthem Merger

Cigna Anthem Merger

Well, for us here at In Charge Office Solutions and most people who deal with insurance companies daily, you get to know each insurance company and their medical policies, procedures, and authorization processes. Cigna and Anthem have been quite
different companies to deal with to this point, and should the acquisition go through it will be interesting to see how/if those things change.

Beyond this, the insurance industry is already a relatively narrow one with large, recognizable companies covering the majority of people. Small insurance companies are few and far between, and often cannot compete with the larger companies. When a person is offered insurance coverage through their employer, there are usually only two or three options. Does the industry really need to narrow the field even more, taking a major player out? It is doubtful another will rise in its place.

This brings me to the most important point: this is definitely not a done deal.

It faces scrutiny by the Department of Justice and the Federal Trade Commission who have to review the agreement for antitrust issues. It also was not well received in the business world, with shares falling for both companies.

Whether or not it does go through, the agreement is a sign of the changing times in the industry. With such rapid changes in regulations, it is inevitable that insurance companies will restructure and adapt. Adaptation has always been a necessity in our business, so we will continue to do just that.


Happy With Our Service?

Spread the Word, and Save Some Money!OLYMPUS DIGITAL CAMERA

If you are a current client of ours and are happy with our services, tell a friend! If a referred provider signs with In Charge Office Solutions for billing services, receive $100 off your next invoice as our thank you.


2015 Brings Changes to Modifier 59

Modifier -59 is one of the most well known and used modifiers, because it has the potential to have a large impact on your reimbursement from health insurance companies. Because of its popularity (and often misuse), CMS has rolled out 4 new modifiers that essentially replace modifier 59.

What is Modifier 59?

It is defined in the CPT manual as a “Distinct Procedural Service.” It allows the provider to indicate that a procedure or service should be considered separate from another during the same encounter. This is only necessary on codes that are usually considered bundled services. For example:

CPT code 97140 (manual therapy) is usually bundled with CPT code 98940 (CMT, spinal).  When the manual therapy is performed as a separate service for a separate issue (diagnosis), then it can be shown by appending modifier -59 to the CPT code 97140.

This makes both codes payable rather than just the one. This also, of course, needs to be supported by the medical record.

What are the Changes?

CMS has created 4 new modifiers as subsets to modifier -59 that are intended to ultimately take the place of modifier -59. They are more specific, and allow the provider to more specifically indicate why the service is separately identifiable from another.

  1. XE – Separate Encounter
  2. XS – Separate Organ/Structure
  3. XP – Separate Practitioner
  4. XU – Unusual Non-Overlapping Service

How to Implement

The modifiers became effective January 1, 2015, and CMS is encouraging immediate use but is also still accepting modifier -59. It is also important to note that private insurance carriers may not yet be accepting them. Anthem Blue Cross has stated they will accept them for dates of service 1/1/15 and later, but they will not be accepted until the system update in February. It is important to check with your contracted carriers before making the switch, but equally as important to ensure a plan is in place.

Exciting Company News!

In Charge Office Solutions is growing, and along with that comes an exciting move!


We’ve moved!

Please make note of our new phone number and address:

PHONE: (925)398-8635

ADDRESS: 5510 Sunol Blvd, Suite 5

Pleasanton, Ca 94566


Our fax number and email addresses remain the same.

We realize that it may be a minor inconvenience, but I assure you the move is a positive one for our company and will allow us to serve our existing & new customers more efficiently. We moved in the month of August, and my hope is that none of our current clients even noticed the transition. It is business as usual at In Charge Office Solutions, where our focus is always getting you paid!

If you have any questions about this, please feel free to contact me directly.

Emma Calkins, President



BREAKING: Senate Passes Bill Delaying ICD-10

stopsignOn 3/31/14, the Senate passed a bill that includes delay of ICD-10 implementation to October 1, 2015 – an entire year extension. It states “The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD–10 code sets as the standard for code sets under section 1173(c) of the Social Security Act (42 U.S.C. 1320d–2(c)) and section 162.1002of title 45, Code of Federal Regulations.”

This puts many feet in mouths, including my own.

While on the surface this may seem like a relief, the amount of time, money, and energy spent to transition on October 1st of this year is immeasurable. To delay another year puts the brakes on something that all of us in the healthcare industry have prepared for. Software vendors have upgraded their systems, clearinghouses have begun ICD-10 testing, and coding educational institutions have begun teaching the new code set.

Delay also does not help to convince people that ICD-10 is a good thing, which is the point of the whole transition. More effective reporting, advanced specificity, and accuracy in claims reporting; these are all good things.

Our current plan is to continue with preparation as we were. Our clearinghouse is also moving forward with ICD-10 testing, even with the delay. Sign up for our newsletter to receive updates, or email if you have any specific questions: info@inchargeoffice.com .


ICD-10 for the Chiropractic Office

Chiropractic Symbol - GoldWith so much anticipation of looming ICD-10 transition, I’m getting more and more calls from Healthcare Professionals wondering what they should be doing to prepare. Luckily, there are a lot of resources out there and I am happy to be one of them.

There is an abundance of information for medical practices, but it is more difficult to find resources for the chiropractic office. The following link is a quick PDF file that was created in order to address some commonly used ICD-9 codes and what they will look like as ICD-10 codes:  ICD-10 for the Chiropractic Office

I hope that you find it helpful, and expect more resources to be posted as we get closer to the transition (October 1, 2014).

2014 ACA Implementation: One Month In

Happy New Year!

With 2014 came the roll out of the “ACA compliant” health insurance plans. The Covered Ca website is up and running with enrollment far exceeding projections; the most recent figures released  show enrollment of 500,108 in 2013.

The new plans’ high deductibles and co-payments have been the focus of much discussion, but it looks as if the real issue may be low enrollment rate of Healthcare Providers in the networks. The combination of low provider enrollment with no out-of-network benefits leaves little option for the 500,000+ enrollees when it comes to their healthcare.

Why Not Join?

Providers are reluctant to join the networks for many reasons. When insurance plans shift more out of pocket responsibility to the patient, it becomes more difficult to recoup payment for services. Patients may not understand their benefits and why they have to pay out of pocket, and resistance is met. This is already common in the business of healthcare, but higher deductibles and co-payments will only exacerbate the issue. Putting too much focus on payment with the patient can make some providers feel the focus shift too far from care to business. It is a delicate balance.

In the same vein, many providers are reluctant to join because fee schedules are either unclear or unacceptable. Typically, PPO fee schedules hover near and slightly above Medicare, but many Covered California plans reimburse slightly above Medi-Cal rates. Medi-Cal rates are unsustainable for many practices in California, and many providers have opted out of Medi-Cal participation for years. Why then, would those same providers join networks reimbursing near the same? Without a large enough Provider Network, many patients will find themselves having to switch providers or wait long hours for care.

Affordable Care Act: It’s Here, Now What?

Lately it seems difficult for people to discuss the Affordable Care Act (ACA) without things turning political, but that is what we are going to try to do here. Like it or not, changes are coming and some have already taken place

Insurance companies have had to create new plans that align with the provisions of the ACA, and with those new plans come new provider networks. These networks are generally EPOs – Exclusive Provider Organizations – which carry no out-of-network benefits.  Blue Shield of California recently sent out a “Q&A” about their ACA compliant EPO highlighting the fact that any services provided by a non EPO provider will receive no benefit. If the percentage of EPO plans increases greatly, it will be more important than ever to check a patient’s benefits before they are seen and make sure your practice is a part of their network. Get new patient insurance information over the phone at the time the initial appointment is made, and make it a routine part of your office processes.

Since  many practices are also small businesses, the reform will affect them in multiple ways.  Many of my clients have already received notice that their employee’s health plans will need to be changed to comply with the ACA, and with those new plans come higher premiums. A higher bill is the last thing any business wants, BUT, if there are truly more insured patients (and that is the plan), the increase in patient flow may make up for the increase in cost to your business.

With so much information thrown at those of us in the healthcare industry, it is important to sift through it and stay informed. There will be parts of the ACA that necessitate a change in how your practice is run. Only time will tell how many of these changes will ultimately effect business, and more importantly, patient care.