HCFA and ICD-10 Ready

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HCFA Facts

The acronym HCFA (commonly pronounced “HICK-fuh”) refers to an agency of the U.S. federal government called the Health Care Financing Administration. The organization is funded through the Social Security system and oversees the operations of the Medicaid, Medicare and Child Health programs. As of 2010, HCFA provided health insurance to more than 74 million Americans.

The acronym HCFA is somewhat outdated: in 2001, the agency’s name was changed to the Centers for Medicare and Medicaid Services (CMS) in an attempt to give the organization a fresh start and a new direction.

For more information, visit the CMS website www.cms.gov.

CMS 1500-02/12 Facts

According to CMS, only the revised, 02-12 version of the CMS 1500 Health Insurance Claim Form will be accepted as of April 1, 2014. Please click here for the most recent information from CMS.

ICD-10 Facts

On April 1, 2014, the Protecting Access to Medicare Act was enacted. The Protecting Access Act included a small section stating that the Department of Health and Human Services (HHS) could not adopt ICD-10 as the nation’s standard code set until October 1, 2015 at the earliest. An interim final rule is expected to be passed soon that will require the use of ICD-10 beginning October 1, 2015. The final rule is also slated to require that HIPAA-covered entities continue to use ICD-9-CM through September 30, 2015.

PracticeStudio is Ready

PracticeStudio supports the CMS 1500 (02/12) claim form and the ASC X12 Health Care Claim Professional (837P) Version 5010, which aligns with CMS 1500 (02/12) requirements for insurance claim processing. PracticeStudio also allows format changes by insurance carrier for most date items on the CMS 1500 (02/12) form, allowing for selection of either a 2- or 4-digit year or no output at all. For some of the fields that now allow qualifiers, the qualifiers can be either printed or suppressed. These template changes allow for the requirements of virtually any insurance carrier.

PracticeStudio supports ICD-10 and has been ICD-10 ready since 2011. In fact, the Medicaid programs in several states have required ICD-10 codes for the last couple of years. Part of the Dx browse in PracticeStudio includes a cross-map tool that helps you to filter down to possible ICD-10 codes from an existing ICD-9 code to make the transition easier.

Do you know how many different diagnosis codes you have used this year? The Dx Codes by Patient report shows all diagnosis codes that have been used for a given date range, showing the patients who have the diagnosis code as well as how many times the code was used for the patient. Knowing which diagnosis codes you currently use will help in transitioning to the ICD-10 codes. Rather than searching through the 69,000+ ICD-10 codes, you can concentrate on only the ICD-10 codes that correspond to the ICD-9 codes you currently use.