ICD-10, Health Plan Identifiers (HPIDs), and CMS

Medicare (CMS/HHS) Bulletin: On September 5, 2012, HHS published a final rule delaying the ICD-10 compliance date to October 1, 2014 (and now 2015). In that same rule, HHS adopted a standard for a unique health plan identifier (HPID) requiring health plans to obtain an HPID by November 5, 2012. Small health plans had until November 5, 2012, to comply. Confused about all the new rules? Well, here are more (lots of acronyms so we decoded them for you). In line with the anticipated changes to the ICD-10 Coding System, other related imperatives have been officially announced, complete with their compliance dates. All of the new rules are important for medical providers and their billing, coding, and practice managers. HPID (Health Plan Identifier) Currently, health plans and other entities that perform health plan functions, such as third party administrators and clearinghouses, are identified in Health Insurance Portability and Affordability Act of 1996 (HIPAA) standard transactions with multiple identifiers that differ in length and format. Covered health care providers are frustrated by various problems associated with the lack of a standard identifier, such as: improper routing of transactions; rejected transactions due to insurance identification errors; difficulty in determining patient eligibility; and challenges resulting from errors in identifying the correct health plan during claims processing. The adoption of the HPID and the OEID (Other Entity Identifier) will increase standardization within HIPAA standard transactions and provide a platform for other regulatory and industry initiatives. Their adoption will allow for a higher level of automation for health care provider offices, particularly for provider processing of billing and insurance related tasks, eligibility responses from...

Version 5010 From Centers for Medicare and Medicaid Services

As of January 1, 2012 all HIPAA covered entities must be compliant with Version 5010. Any electronic transaction for which a standard has been adopted must be submitted using Version 5010. Electronic transactions that do not use Version 5010 are not compliant with HIPAA and will be rejected. HHS authorized an enforcement discretion period through June 30, 2012. During this time, CMS did not initiate enforcement action against any covered entity that was not compliant with the updated Version 5010/D.0 standards. Med-Certification encourages providers to stay abreast of these important developments and to use the online information and resources to accomplish that. Industry Collaboration WEDI, CMS, many industry organizations, and stakeholders collaborated on a series of three webinars to help the entire health care industry become fully complaint in ASC X12 5010 implementation. A multi-tiered campaign was launched to gather feedback, track challenges, and identify and provide guidance to correcting ASC X12 5010 implementation-related issues, especially among commercial payers. The last webinar was held on June 25, 2012. View the WEDI_CMS Power Point and audio recording from the webinar to learn more. The online issues reporting tool is available to help address ongoing issues. Covered entities may continue to submit issues associated with implementing ASC X12 5010, and search through a database documented problems. Version 5010 Resources CMS has developed fact sheets to help you prepare for the transition to Version 5010. Visit CMS.gof for up to date information and recommendations. FAQs: Versions 5010 and D.0 Transition Basics Versions 5010, D.0, and 3.0 Overview Version 5010: Testing Readiness, What You Need to Know Talking to Your Vendors About ICD-10...

Normal Laboratory Values

In the medical field, terminology is the first step to tackle patient care.  Medical transcriptionists require a thorough knowledge of medical terminology, including anatomy, physiology, and pathology.  Coders must also know enough about the body and how it works to be able to code successfully.  In the process of evaluating a patient, laboratory tests are commonly undertaken.  Understanding the “normals” and “abnormals” is sometimes critical to ensure accuracy, particularly in transcription.  It is also useful to know for personal health reasons, for oneself and the related family members.  Here is a list of the “normal” laboratory values. Normal Lab Values HEMATOLOGY Red Blood Cells RBC (Male) 4.2 – 5.6 M/µL RBC (Female) 3.8 – 5.1 M/µL RBC (Child) 3.5 – 5.0 M/µL White Blood Cells WBC (Male) 3.8 – 11.0 K / mm cubed WBC (Female) 3.8 – 11.0 K / mm cubed WBC (Child) 5.0 – 10.0 K / mm cubed Hemoglobin Hgb (Male) 14 – 18 g/dL Hgb (Female) 11 – 16 g/dL Hgb (child) 10 – 14 g/dL Hgb (Newborn) 15 – 25 g/dL Hematocrit Hct (Male) 39 – 54% Hct (Female) 34 – 47% Hct (Child) 30 – 42% MCV 78 – 98 fL MCH 27 – 35 pg MCHC 31 – 37% neutrophils 50 – 81% bands 1 – 5% lymphocytes 14 – 44% monocytes 2 – 6% eosinophils 1 – 5% basophils 0 – 1% CARDIAC MARKERS troponin I 0 – 0.1 ng/ml (onset: 4-6 hrs, peak: 12-24 hrs, return to normal: 4-7 days) troponin T 0 – 0.2 ng/ml (onset: 3-4 hrs, peak: 10-24 hrs, return to normal: 10-14 days) myoglobin (Male)...