Wound Care Clinic Reimbursement in 2013


Wound Care Clinic Reimbursement

Diving so far into outpatient Wound Care reimbursement today, I may drown in MediHoney!  Corny joke aside (sorry), very interesting area of healthcare right now. Wound Care Clinics are a huge asset to any community, help lower E.R. visits and hospital admissions, and are profitable. Policy changes everywhere; continuing education a must! Vegas isn’t a bad location for a conference either.

Palmetto to Noridian: What is the Difference?

If you are a Medicare participating provider in California, Nevada, or the other territories formerly known as Jurisdiction-1B, your Medicare Administrative Contractor (MAC) has changed. Effective September 16th, 2013, Noridian Healthcare LLC Jurisdiction E has taken over the contract for the areas formerly known as Jurisdiction-1B under Palmetto GBA.

What Changes

    • Payer ID  and Claims Address. This is a simple one time update in your system and shouldn’t have an impact on reimbursement.
      Payer ID: 01112 for Northern CA.
      Claims Address:
      Medicare Part B Claims
      P.O. Box 6774
      Fargo, ND 58108-6774
    • How paper claims are edited. Most claims are not billed on paper these days, but all offices have HCFAs on hand for when it is necessary. The edits of paper claims by Noridian differ slightly from Palmetto’s, but enough that they may deny your paper claims and ultimately delay reimbursement.  Noridian has provided a handy guide here, but at the moment of this blog post their website is down and has been for some time. The transition must have been a bit hard on their website’s servers! It gives box by box instruction, so it is worth a visit back when the site is up.
    • New Provider Portal. Obviously, you’ll no longer go to Palmetto’s provider portal unless you’re accessing information for claims submitted prior to the transition. Noridian will use the Endeavor portal, and if you were registered with Palmetto you were automatically enrolled with Endeavor. An email was sent to the email address associated with your account.

What Remains the Same

      • Local Coverage Determinations (LCD). From a claims reimbursement perspective, the fact that the LCDs are unchanged from Palmetto’s is huge. Most of us know the applicable ones for our practice(s) like the back of our hand, or at least where we can find them. Your LCD# will change, but the contents will not.
      • Your EFT, ERA, submitter number. If you are already set up to receive electronic remittances and to submit electronic claims with Palmetto you will not need to reapply with Noridian. You’ll only need to change their claims payor ID (mentioned above).
      • Your status with Medicare. No Re-Validation required!

Questions or comments? Leave them below, or give us a call any time (925)583-5328.



Windows XP Losing HIPAA Compliance

PHI FolderSince its implementation in 1996, HIPAA has shaped much of how medical care is given, recorded, and how those records are protected. Because so much personal health information (PHI) is stored on desktop or laptop computers, the operating system (OS) must be secure to meet HIPAA standards. This means receiving security updates and patches when they are released, and if you’re running Windows, Microsoft takes care of that for you.

Bad News for XP Users

Beginning April 8, 2014 Microsoft will no longer support their Windows XP Operating System. This means they will no longer release those security updates and patches necessary to keep the OS in HIPAA compliance.  Although ending support is a normal part of the operating system “life cycle,” the fact is that Windows XP was a popular OS and is still used on an estimated 37.74% of active PCs, second only to Windows 7.  Healthcare providers and their businesses are sure to be a part of that statistic, and April 2014 will be here before you know it.

What to Do?

Bite the bullet and upgrade. Windows 7 is a good option and is a relatively easy transition for most users. Microsoft will  be supporting  Windows 7 through 2020, keeping the OS HIPAA compliant for the next 7 years. It may seem like a large undertaking, especially if your office uses multiple PCs and licenses, but the security and compliance justify the switch. If you are an In Charge Office Solutions client, we can assist with the transition (ask us how).

Dual Coding & ICD-10 Transition

ICD-10 implementation is looming, and the industry is scrambling to prepare for the transition. Our post in May gives a broad overview of ICD-10 and how to prepare, but let’s talk now more specifically about “Dual Coding.”

ICD-10 Chalk


What is “Dual Coding?”

Dual Coding is the term that describes claims that have both ICD-9 and ICD-10 diagnosis codes. When a major change occurs, there is usually some leeway in the first few months that would allow for this type of claim to squeak through. This gives time for all players to get acclimated to the new requirements and how to implement them. Dual Coding has been a hot topic of sorts in our industry, with many wondering if it would be allowed.  With this release from Medicare, that question has been largely answered with a resounding “NO.” All claims after October 1, 2014 will be denied if they contain ICD-9 diagnosis codes. Private insurers are sure to follow suit.

What Can You Do?

Prepare! Medicare shows no indication of delaying the transition, and is pushing for quick and relatively painless transition. Rather than allowing for acclimation in the first few months, your practice will need to be prepared PRIOR to the transition date. October 1, 2014 may seem like a long way off, but this transition will require a complete overhaul of many office processes. Do not let your practice’s cash flow be affected by needless denials!

Quality Data Code (QDC) Registry Open Now.

All Ambulatory Surgical Centers (ASCs) are asked by Medicare to participate in Quality Data Code (QDC) reporting. Reporting for the measures is handled in two parts, the second of which is now open after a brief delay. More on this below.

 Part 1: “G” codes

As of October 1, 2012, ALL Medicare ASC claims were to be reported along with “G” codes. The codes are used to report any adverse events that occur, hospital admissions/transfers, and whether any IV antibiotics were ordered/used. These “G” codes carry no Relative Value Units (RVUs), which means they are not reimbursable. The use of the codes on your claims indicates your participation in the QDC reporting program, and no additional registration is required.

Part 2: Registry Reporting

The second part is the reporting via registry (www.qualitynet.org) on measures ASC-6 and ASC-7, and covers data from January 1, 2012 through December 31, 2012.

  • ASC-6: Safe Surgery Checklist Use. Simple yes or no to the question, “Does/did your facility use a safe surgery checklist based on accepted standards of practice during the designated period?”
  • ASC-7: ASC Facility Volume Data on Selected ASC Surgical Procedures. For a specific set of CPT codes, report the total number of times they were performed during the reporting period.

This information was to be reported during the time period of July 1, 2013 through August 15, 2013. That window was changed near July 1 due to technical issues with QualityNet, and they opened the registry for reporting on July 9. They only extended the deadline to August 18, despite the delay. If you haven’t logged in to the Quality Net portal, do not wait until August 18 to allow for any potential technical issues to be worked out.

No RVU – Why Participate?

If an ASC does not participate in the QDC program, they face a 2% reduction in Medicare fee schedule. This reduction begins in 2014, and is significant when put in line with the 2% sequestration cut. If time is money and you are spending time without any additional return, it can become frustrating to maintain. In Charge Office Solutions is set up to easily report these measures for our clients, ensuring they receive the highest reimbursement possible without additional burden to your facility.

ICD-10 Transition – Coming Up!

The United States is one of the last developed countries that still uses ICD-9 for diagnosis coding. ICD-10 has actually been around since 1994, and has been used in Australia, Canada, and many countries in Europe since the early 2000s.  Advances in diagnostic technology allows for more specificity, and ICD-10 offers a way to report to that level. Some main differences are:

  • Available codes jump from 13,000 with ICD-9 to 68,000 with ICD-10.
  • ICD-9 codes are mainly numeric (unless a “V” or an “E” code) and are 3-5 characters in length. ICD-10 are alpha-numberic, and 3-7 characters.
  • The additional characters in ICD-10 format specify the etiology, the anatomic site, and severity.

When new healthcare regulations and are set to roll out, the industry knows the deadline will likely be pushed back (sometimes multiple times). It is looking more certain that ICD-10 transition will be the exception to that rule, and October 1, 2014 will be the implementation date.

Will You Be Ready?

CMS has released suggested timelines , but each practice should really tailor their transition plan to fit their needs. Healthcare claims billing and reimbursement is a true collaboration between many players.  Here are a few of those players and how things may change due to ICD-10:

  • Clearinghouse and Software: Software programs will need to be updated to recognize and accept the new codesets, and your clearinghouse will also need to update their edits. Your clearinghouse should also be keeping you updated on payer readiness as it gets closer to implementation. In Charge Office Solutions takes care of this for their clients.
  • Office Staff: All office documentation that currently uses ICD-9 codes will need to be updated to accommodate for the new codeset. This may include superbills, lab orders,etc.
  • Healthcare Providers: Because each diagnosis must be coded to the highest level of specificity, Providers will need to become familiar with the level expected and document their encounters accordingly.
    EX:  Open wound of left cheek:
    ICD-9 “873.51” which specifies open wound of cheek, complicated.
    ICD-10  “S01.402A” specifies the first encounter for an open wound of left cheek and temporomandibular area.

In Charge Office Solutions will be working with each client to help ease the transition for their practice, and make it as seamless as possible. Rather than a burden, ICD-10 is a means to advance the accuracy of claims reporting and documentation.

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