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Here's where you can find out about what CHS is up to, what's coming in the future and events. Keep up to date with CHS happenings and find out what's on our calendar.

SIIA NATIONAL EDUCATION CONFERENCE AND EXPO

It is time for the 35th Annual SIIA National Educational Conference and Expo. Similar to previous years, Complete Health Systems will be exhibiting at the show, which will be held on October 18 - 20, 2015 in Washington, D.C.

Be sure to stop by booth #500, so we can show you how CHS can help improve how you manage self-insured programs.

RBS (REGULATORY BUDGET SENTINEL)

ICD-10 IMPLEMENTATION: WHAT TO EXPECT ON OCTOBER 1

By: Nicola Heredia, CHS Marketing Coordinator

After numerous delays to the implementation date, tomorrow is the official deadline for ICD-10 to become the coding system utilized nationwide by everyone from providers to medical coders.

The new coding method has been a planned upgrade to the existing ICD-9 system for several years, but software updates and training will be put to the test on October 1. Although many predicted that the deadline would be delayed again, the government has kept this date, still knowing that obstacles will arise during the transition.

“ICD-10 has the potential to create many improvements in our public health system,” said Andy Slavitt, acting administrator for the Centers for Medicare and Medicaid Services, CMS, in an AP article. “There will be bumps and challenges – our job is to plan for them, too.”

Exceptions Established to Make Transition Smooth

Although October 1 is the implementation date, CMS has set grace periods and put other exceptions in place to make the transition as smooth as possible.

After tomorrow, all claims must be coded in ICD-10 only. Leading up to this, coders were allowed to use both ICD-9 and ICD-10 codes as a way of practicing. CMS realizes that there is a processing lag when it comes to claims, so any that were created and submitted on or before September 30 that have ICD-9 codes will still be accepted and processed.

Delayed reimbursement due to incorrect coding has led physicians to be particularly concerned about the ICD-10 change. In July, CMS announced that there will be a grace period for Medicare claims to account for coders adjusting to the new system.

“While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims,” wrote the CMS in a published article. 

What Happens After Oct. 1

A survey published in Health Care Finance News and conducted by Navicure/Porter Research in August demonstrated that there were 94 percent of participants that anticipate an automatic increase in claims being denied due to ICD-10 implementation. Over half of respondents feared that revenue would be impacted after October 1.

So what changes can be expected once ICD-10 is in place?

Experts within the industry do not anticipate that there will be any major effects noticed within the first few weeks. However, after claims start to be submitted and processed with the new coding system that is likely when obstacles will arise.

In the near future, however, software glitches and coding errors appear to be the most likely issues to be expected when ICD-10 first takes over. Thursday may be a very long day for those who will directly work with the new codes. All of the end-to-end testing and training that has taken place over the last few years will make the transition easier.

“Following years of training, testing and collaboration, October 1 will be a momentous day for the healthcare industry and the patients we serve when the ICD-10 code set makes its long-awaited debut,” said AHIMA CEO Lyne Thomas Gordon, MBA, RHIA, CAE, FACHE, FAHIMA, in a public statement published in Health IT Analytics.

If you believe that you are not prepared for ICD-10 implementation, the preparation process must begin now. CMS has created an ICD-10 Coordination Center that is offering preparation help. Go to roadto10.org for more information.

HRAs NO LONGER REQUIRE INDIVIDUAL IRS REPORT

By: Nicola Heredia, CHS Marketing Coordinator

The IRS has released their official instructions on the procedure to report Health Reimbursement Accounts, or HRAs. On September 16, the agency announced that HRAs would not have to be reported separately if it is being offered as a part of a major medical plan.

This decision came as somewhat of a surprise since the IRS published a draft that originally indicated something very different. In the draft 2015 instructions, HRAs were not considered to be an additional part of the health plan. Instead, the reporting policy considered it separate and would require additional reporting.

The reason for this separation was that the IRS changed how they categorized the self-funded HRAs. Instead of including it as part of the larger health plan, the draft 2015 instructions said that coverage was not provided by the same plan so separate reports were necessary.

The IRS explained that the carrier would be responsible for the fully insured health plan component, while the employer would be required to report the self-insured, HRA benefit.

The standard of reporting insurance benefits is the result of the Affordable Care Act. The health care law requires insurers and self-insurers to provide a minimum essential coverage, or MEC, to be submitted annually to the IRS.

Submitting the MEC is a way for the IRS to track that individuals are in fact enrolled in a plan and the length of time that they have been covered. Insurance providers are required to submit the MEC for fully insured plans, while employers submit the report for self-insured plans.

The question that the IRS has had to decide on is whether or not HRAs require separate reporting, and if so, who is responsible to report the reimbursement accounts.

Although the draft 2015 instructions indicated that the agency was leaning towards requiring additional reports to be filed, the final determination seems to make more sense and allows reporting relief for insurance providers.

Employers that offer an HRA integrated with either a self-funded or insured health care plan will not be required to submit an additional report for separate reimbursement accounts. Instead, it will be considered a benefit of the insurance coverage. Reports will only be required for the major medical coverage plans.

There is an exception to this decision, which requires two specific types of HRAs to be reported separately. The Stand-Alone HRA and a HRA that is integrated with a plan from another employer would require individual reports to be filed.

Insurance providers appear to be pleased with the IRS’ decision to simplify the reporting process that is required by the ACA. Not creating additional reporting requirements makes sense for both the IRS and insurers.

For more information on the IRS’ latest decision, please visit http://www.irs.gov/pub/irs-pdf/i109495b.pdf.

Sources: PrimePay.com, WSandCo.com and Benefit Advisors Network

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