Thursday, July 21, 2011

CMS Full Encounter Updates

CMS is currently holding technical assistance meetings for health plans across the country.  SCAN representatives attended the July session in San Diego the week of July 11.

A lot of issues remain up in the air, but we do know a few things.

  • CMS is holding fast on the subject of the 13 month timely filing.  Plans are given an additional month over the 12 month FFS timely filing to account for the submission from provider to plan to CMS.   There is discussion of filing benchmarks and we hope to know more about this after the final session ending the first week of August.
  • Plans cannot make material corrections to claims/encounters, this must be done by the provider of service.  For example, diagnosis codes, procedure codes and other fields involved in pricing the claim (e.g., addresses, modifiers) must be corrected by the provider.
  • Full 9 digit ZIP codes will be required on claims/encounters.
  • CMS has clarified that the only dental claims that will be required are those that are covered by fee-for-service Medicare.  This includes jaw reconstruction after an accident, and examinations (no treatment) prior to kidney transplants and some heart valve implants.  If the services are performed by a hospital based dentist (rare) then the submission must be on the 837 I, and if performed by a dentist in private practice, on the 837P.  No 837D (dental) claims will be accepted by CMS.
  • \CMS has no projected date for a draft of the CMS-HCC model with ICD-10 codes.  There was also no update about a move to the new 87 disease CMS-HCC model.
As we learn more from CMS about full encounter data requirements, we'll post it here.

Please let us know if there are any specific issues you'd like to see in this space.  You can leave us a comment, or email us at

Monday, July 18, 2011

CMS Physician Conference Call for ICD-10 Implementation

Date:  08/03/2011

Time:  1:00 - 3:00 PM  EASTERN TIME

Subject:  ICD-10 Implementation Strategies for Physicians National Provider Call

Target Audience: Medical coders, physician office staff, provider billing staff, health records staff, vendors, educators, system maintainers, laboratories, and all Medicare fee-for-service (FFS) providers


The Centers for Medicare & Medicaid Services (CMS) will host a national provider call on "ICD-10 Implementation Strategies for Physicians." Is your office preparing for a smooth transition to ICD-10 on October 1, 2013? CMS subject matter experts will discuss ways that physician offices can prepare for the change to ICD-10 for medical diagnosis and inpatient procedure coding. A question and answer session will follow the presentations.

  • The following topics will be discussed:
  • ICD-10 requirements and resources overview
  • Implementation strategies for physician offices
  • Update on coverage conversion activities
  • National ICD-10 implementation issues
  • Update on bill processing, including claims that span the implementation date
  • Update on Home Health Agency Home Health Resource Grouper

How to Register:

In order to receive the call-in information, you must register for the call. It is important to note that if you are planning to sit in with a group, only one person needs to register to receive the call-in data. This registration is solely to reserve a phone line, NOT to allow participation.

Please note: If you plan to request continuing education credit from your professional organization and if this organization requires proof of registration, you will personally need to register so that you receive a confirmation e-mail.

Registration will close at 1:00 p.m. ET on August2, 2011, or when available space has been filled. No exceptions will be made, so please be sure to register prior to this time.

To register for the call participants need to go to:

Fill in all required data.

Verify that your time zone is displayed correctly in the drop down box.

Click "Register".

You will be taken to the "Thank you for registering" page and will receive a confirmation e-mail shortly thereafter. Note: Please print and save this page, in the event that your server blocks the confirmation e-mails. If you do not receive the confirmation e-mail, please check your spam/junk mail filter as it may have been directed there.

If assistance for hearing impaired services is needed the request must be sent to no later than 3 business days before the event.

On the day of the call, please dial in at least 15 minutes before call start time.

Presentation Materials:

Presentation materials for the August 3 call will be available on in the "Downloads" section no later than 24 hours before the conference call. Remember to download the presentation materials from the CMS site prior to the teleconference.

Continuing Education Credits

 Continuing education credits may be awarded by the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA) for participation in CMS National Provider Conference Calls.

Continuing Education Information for American Academy of Professional Coders (AAPC)

If you have attended or are planning to attend a CMS National Provider Conference Call, you should be aware that CMS does not provide certificates of attendance for these calls. Instead, the AAPC will accept your e-mailed confirmation and call description as proof of participation. Please retain a copy of your e-mailed confirmation for these calls as the AAPC will request them for any conference call you entered into your CEU Tracker if you are chosen for CEU verification. Members are awarded one (1) CEU per hour of participation.

Continuing Education Information for American Health Information Management Association (AHIMA)

AHIMA credential-holders may claim 1 CEU per 60 minutes of attendance at an educational program. Maintain documentation about the program for verification purposes in the event of an audit. A program does not need to be pre-approved by AHIMA, nor does a CEU certificate need to be provided, in order to claim AHIMA CEU credit. For detailed information about AHIMA's CEU requirements, see the Recertification Guide on AHIMA's web site.


Please note: The statements above are standard language provided to CMS by the AAPC and the AHIMA. If you have any questions concerning either statement, please contact the respective organization, not CMS.