Moving forward with ICD‐10, Apps to check out and other updates for Speech Therapy, Physical Therapy

October 1st deadline has come and gone with a headaches and pain we're all still trying to fight through.

Let me be the first to say I know many people have been frustrated with getting claims to pay, figuring out how to change the codes, getting Medicaid and CMO authorizations to work, etc. Please be kind to any staff or billing assistants that help your office at this time during your frustration. It's taking more time, more steps to process claims with all the new changes at hand and frustration is high.

Georgia Medicaid changed prior authorizations as most of you know by now. Diagnosis code selection has to have a start date of 10/01/2015 to current to be able to work. Authorizations for CMOs have had a return time of 5 business days. If you do not hear from the CMO you are requesting within that time, fax the documents with proof of the Medicaid submission asap. Even if the provider is not linked to the CMO via Medicaid and you are given a warning, you still should be able to submit the authorization via the web portal. Submitting via the portal will help document that it has been submitted. You cannot make corrections if a tech denial is received for a CMO application, from my experience. Those corrections do not seem to be processing as requested.

Georgia Medicaid has also changed their standard applications to include the clinic's owner name, dob, ssn and percentage of ownership. The CMO applications must be performed under a Medicaid login online, needing same ownership information. I have been having difficulty with CMO applications if the provider is in network with one CMO, Medicaid will not allow us to enter the application online. Once I contact the CMO we wish to participate in, they state we can only apply via the Medicaid website. If anyone knows anything different for this issue, please let me know.

Unspecified/Other codes...the ultimate question. Medicaid has came out with a list of codes you can't use for their claims. You can find this list by going to their website: provider information, provider notices, ICD‐10 Unspecified Diagnosis Codes Set to Deny in GAMMIS_v1

There is also several other documents in this section that answer some of the ICD‐10 changes. A document states: If a claim lists both specified and unspecified diagnosis on the same line on a professional claim form, will they deny? Yes. I have seen this example with hearing loss unspecified recently. They also provide an email for ICD‐10 questions: icdproject@dch.ga.gov

Most commonly used diagnosis codes:

R62.0 = Delayed milestone in childhood

M62.81 = Muscle Weakness Generalized

Many providers asked me if new Rx and POCs were needed with the transition. The answer is no. It's the coding that is changing, not the actual type of diagnosis. However please remember if you ever let a POC lapse past 6 months from the physician's signature date, you must obtain an Rx before proceeding with any dos with the client. Remember that an Rx is good for only 30 days, expecting that a POC will be signed by the physician within that time.

Medicaid has scheduled their next Medicaid Fair date: December 1st, 2015 in Macon. This is a great chance to go meet representatives from around the state in both with DCH and CMOs. You can inquire face to face about applications and claims. Unfortunately this next scheduled date happens to be the next BCW deadline, but hope some of you can make it.

Amerigroup recently stopped faxing any responses to authorizations. After calling last week to check on a couple of authorizations, I was left disheartened to hear that they will no longer be faxing approved nor denied authorizations to providers. I was also informed that after the first week of December there will no longer be an authorization department to contact for questions, requests, or peer to peer reviews. Any requests will have to be contacted via email at gapeer2peer@anthem.com Let me say once again, frustration is high folks.

Peachstate has recently been processing some claims out of network. If you receive this denial, contact your provider rep with the information ﴾member id, dob, claim #﴿ on the claim that needs to be reprocessed.

Recently I have been asked about how to combine EMR with working in the homes and what software is best for this. Signing documents is never an easy thing when we are all always on the go. However, I did stumble upon researching different apps that seem to work well:

Tiny Scanner or Turbo Scan: These apps work by taking a photo of your document with your phone that needs to be scanned and turns it into a pdf to be able to email or text to someone. Tiny Scan's free version works well as one page document, but I believe to do several pages into one document you must use the paid version. I have found that Tin Scanner is much clearer than Turbo Scan. Tiny Fax: also works the same as above, but allows you to fax a pdf instead.

Dropbox or Google Drive: Both of these cloud storage apps allow you to take a photo and save automatically to your app. I don't find that they produce a clear image as other scan apps do, but it still works. Remember that Google Drive can also offer Google Docs, Google Sheets and Google Slides ﴾comparable doc editing software such as Microsoft Word, Microsoft Excel, and Microsoft Powerpoint﴿. Google Drive is also HIPAA compliant after you file a BAA agreement when creating an account.

Adobe Fill & Sign DC: This app allows you to take a photo or form already saved on your phone/tablet and sign the document according to size. Once you have created the document, the form can then be sent via email, saved to your cloud format, or text as a pdf.

*Note: I'm not stating that any of the above applications are HIPAA compliant. Please remember to follow your policies and procedures of HIPAA compliance within your own organization.

Once again, if you have any tips or corrections to share, please comment on my blog post on my website or email me to share with the rest of the class. And as always, feel free to pass this info onto anyone. Thank you to all our speech, occupational and physical therapists out there for all you do!

Hope everyone has a great holiday season!