Insurance Billing Made Easy, Update News


Yes, you may have thought I dropped off the face of the earth while in fact, I've been hard at work managing a busy practice, 2 kids and a mother with dementia, ha! I've also been hard at work updating Insurance Billing Made Easy for ICD-10, but unfortunately the fates have aligned against me and I have some bad news.

Insurance Billing Made Easy v2 will not be out this year. 

I am so close to having the edits completed, but my mother's health has been declining this year and, after a stroke just a few weeks ago, it is clear that I cannot make the necessary time to complete my book update.

So, on October 1st the price of the book will drop by 50% to reflect the non-ICD-10 ready nature of the guide.

The process and information in my book is still relevant and viable, however, so its still a good and worthwhile read if you want to understand insurance! I will be working on the update as early as I can in 2016 and publishing through Amazon with both a print and e-book version thereafter.

Where Do I Get ICD-10 Codes and Conversion Services EASILY??!

The GOOD news is that ICD-10 really does NOT have to be hard at all. Even if you've hardly prepared, you're in for a treat because there are great services for code conversion available and I'm going to tell you where to find them!

My favorite by far is the integrated ClientTracker Code Converter because I literally have to do nothing! If you use ClientTracker and you're in the cloud (recommended!) this is provided to you for free. You enter a diagnosis by name, or by the ICD-9 code and it automatically shows you the ICD-10 options. You pick, the system codes your SOAP note and invoice and voila! Coding is done.

Office Ally also has a free ICD-10 code search tool. You can choose to look up ICD-9 or ICD-10 codes by number or by description. It doesn't convert codes for you, but it will show them to you with a very simple search such as "pain" or "shoulder." Very handy.

Last recommend ICD-10 conversion tool is the AAC Network AcuCode Digital Coding Tool. For an annual fee, you have access to the website where you can enter a description or an ICD-9 diagnosis code and it will list all the ICD-10 codes for you. Efficient and accurate!

I'm afraid that is all the news for now. I have some very helpful updates planned for IBME - tables to help compare digital practice management systems, summary recaps of each chapter to highlight important points, an expanded section on charting, a print version and more! I'm very excited and very close to completion, but due to my mother's health and needs it just has to be on the back burner for a while.

I appreciate all of your patience and patronage! Please don't hesitate to stay in touch and submit questions. Since I am still editing, if there are specific things YOU want to see more of in my next version, let me know! I'll do my best to accommodate your requests.

Until next time, here's to you business success,

~Rebecca Hurwood, LAc

Thanks JR, for sharing this link - had to repost at large! I wish the news was better, but not really a surprise that rates will be increasing.  Be ready to review plans when they come out later this year to advise patients about their best options for 2016:


2016 health insurance rates have been sent to the Oregon Insurance Commissioner. It looks like small group rates shouldn't increase too much. But individual rate increases may be more substantial. http://goo.gl/8eU4ib

The world of insurance reimbursement for CAM providers has become increasingly difficult over the past two years.  In particular the new CareCore authorization required for Regence BCBS OR, WA, ID, UT plans to access care is extremely limiting.  For Physical Therapists in particular they have to complete so much paperwork (sometimes 45 minutes between charting, completing the forms and submission) in combination with the restricted number of visits per illness, that patients truly cannot get better.  The Oregon Physical Therapy Association is currently collecting statewide data about how Oregon PT's are able or unable to adequately provide care now, and we can certainly speculate where that is going...

But I digress - despite all the new challenges being born out of insurance company fear around insuring the previously uninsured, there are still some reasonable interventions we can take to maximize our reimbursements.

Here's a little step by step guide towards auditing your services and reimbursement rates towards making the most of your fee schedule and your billing practices:

1. Collect Reimbursement Data - the first step is to survey your Explanation's of Benefits and make a list of what different insurers reimburse for the codes you use most.  If you haven't done this in the past year, I highly recommend you do so - the results can be rather eye opening.
2. Audit Services, Coding and Fee Schedule - now take a look at how you treat and what you do.  Do you do any cupping, gua sha, tuina or other bodywork? Do you provide regular nutritional counseling? Use a heat lamp?  All of these things have individual codes - are you using them? List all the codes that would accurately reflect what you do in a typical new patient, return patient, or other type of regular treatment and compare how you are actually coding with how you could be coding.
3. Compare Services and Reimbursement Data - now that you have both your reimbursement per code list, and an audit of what you do compared to what you code, it is time to line them up.  Can you spread your fees out over more codes to more accurately reflect what you do, and would this result in increased reimbursement?  If so, you should!
4. Be Consistent and Fair - remember that you should never bill an insurance company more than you would be willing to charge a patient - there is always a chance the claim will be denied and will become patient responsibility.  A time of service discount should also be no more than 30%, better to be 20% or less.  You should bill consistent code sets to ensure that your billing practices are fair.
5. Adjust Fee Schedule - using the information gathered above, you can now do the math, make decisions and adjust your fee schedule accordingly.  Your fee schedule and your code sets or bundles for new patients, return patients etc. should accurately reflect what you do, match your chart notes, and result in you getting paid fairly for service!

If you're new to insurance billing and need a step by step guide from the ground up, you should consider purchasing my book Insurance Billing Made Easy - it is designed to help you plan a fee schedule and bill consistently and easily to maximize your profits.

Until next time, happy billing!!

~Rebecca

As I work on updating my book I'm also looking at an online CEU course to accompany the update.  

If there's anything particular about insurance billing you really want to know/have included in my book or the CEU course, let me know!  You can email me or post in the comments below and I will take all suggestions under consideration!

Anyone who has purchased my ebook within a year of the update will receive an extra special super duper cheap upgrade offer for the new ebook update when it comes out (like seriously ridiculously less than a starbucks mocha cheap) so don't hesitate to pick it up!

I also do consulting for insurance billing set up and execution locally and remotely, in case you didn't know. ;)

~Rebecca 

It's that time again - for me to renew my NCCAOM certification - and I just had to renew my CPR certificate.  Something (we all) do every two years to stay up to date.  I had a great experience with the American Healthcare Academy just now AND they gave me a referral code that gets you 5% if you have to renew your CPR too!  Thought the least I could do was share!  Here's the deal:

1. Go to http://cpraedcourse.com
2. Select your course from the menu - TIP you can "demo" a course with them which actually allows you to go through the whole thing FOR FREE.  Then you just have to pay if you decide to take the quiz.
3. Complete course
4. Enter Code at checkout - RH3652795
5. Save 5%

And here's the other cool thing - for an extra $20 you get a lifetime recertification.  That's right, every 2 years when you CPR is about to expire they email you, you take the course again FOR FREE and are recertified.  How awesome is that?

Anyway, just had to share.  Hope you're having a wonderful day!

Well its confirmed, ICD-10 is now delayed until October 2015 as Obama passed into law the Sustainable Growth Rate (SGR) "doc fix" temporary legislation.

In a move surprising even the Centers for Medicare and Medicaid, the Senate approved a bill on March 31st that would delay ICD-10 implementation until October 1, 2015 pushing back the current transition deadline by an entire year.

Bill HR 4302, the Protecting Access to Medicare Bill of 2014 mainly creates a temporary fix to the sustainable growth rate, or SGR, section of the bill which deals with reimbursement for Medicare physicians.  Without a fix of some sort, Medicare physicians are facing an immediate 24% reimbursement rate cut.  The revised bill controls this down to 0.5% initially and eases into transition.

Apparently on Monday Senator Ron Wyden (go Oregon!) proposed SGR Bill S 2157 that similarly corrected the SGR calculation problem but did not include the ICD-10 delay and also included wider reform for ICD-10 implementation, but this bill was opposed by yet another from Alabama Republican Senator Jeff Sessions and ultimately did not move ahead.

For a more complete report, see this excellent article from the Journal of the AHIMA.

The bill is now headed to the President who is expected to sign it into law, but until that happens all we can do is wait.  Beyond all the physicians, hospitals, clinics and private practices who have been preparing in good faith, most affected are the newly graduated medical coding professionals who have been trained ONLY in ICD-10 and now face education that could be frankly worthless for a whole additional year.  Hopefully, some provisions for suitable employment will be made for them, and if nothing else there may be a flood in the market of coding professionals ready and willing to help those who are less prepared get ready for the (inevitable if delayed) transition.

The new CMS 1500 form version 02/12 is required for use starting April 1st - are you ready?

The changes are relatively minor but a couple missteps could result in your claims no longer being paid.

To help us along, Ginkgo Software put together a great video outlining all the changes.  You can view it HERE, its quite comprehensive.

In addition, here is a shorter list of the most noticeable changes that could result in you not getting paid if you don't select the right options:

Box 14 requires a qualifier for any date listed there (only used in auto accidents, worker’s comp, and pregnancy).  Use 431 for “Onset of Current Symptoms (i.e. accident) or 484 for Date of Last Menstrual Period

Box 15 also requires a qualifier for the date.  Use the following as/if applicable:

• 454 Initial Treatment
• 304 Latest Visit or Consultation
• 453 Acute Manifestation of a Chronic Condition 439 Accident
• 455 Last X-ray
• 471 Prescription
• 090  Report Start (Assumed Care Date) 
• 091  Report End (Relinquished Care Date) 
• 444 First Visit or Consultation

Box 21 is now numbered instead of lettered.  Be sure to translate the LETTERS corresponding to your diagnosis codes to Box 24e the Diagnosis Pointer instead of numbers as before.  THIS IS THE MOST CRITICAL CHANGE TO SUCCESSFULLY FILING OUT AND FILING THE 02-12 VERSION FORM.  Box 21 also includes an “ICD Indicator”  Enter a 9 here if you are using ICD-9 codes or a 10 here if you are using ICD-10 codes.

Box 24c Instead of a number indicator, now enter simply “Y” for Yes, this treatment is related to an emergency or “N” for No, this treatment is not related to an emergency.

Box 24e Enter letters corresponding to the diagnosis code lines in Box 21 instead of numbers as before.  I.e. if you have one diagnosis, enter “A” on each procedure code line in this box, two diagnoses, enter “AB” and so on.

You can also link to a complete guide from the NUCC by clicking HERE.


Good luck everyone, and stay on your toes!  If you have trouble with the new form feel free to ask questions in the comments section below and I'll do my best to answer them.

Here's to your Insurance Billing Success,
~Rebecca

Blue Cross Blue Shield is now funneling all of their Acupuncture, Physical Therapy, Occupational Therapy, Speech Therapy, Chiropractic, Massage and Spinal Therapies.  

I just completed a training course with CoreCare National, the third party provider who will be managing this process and let me tell you - it isn't going to be fun.  It isn't difficult and one of the benefits of CoreCare is that they guarantee that if your case needs to be reviewed for any reason, your request for authorization will be reviewed by a peer in your field AND if you need to talk to to someone about next steps you will talk to a peer as well, but this is a big barrier to treatment that we are all just going to have to deal with.

Here are some highlights of the training to help you navigate these new waters.

Right of the bat, on your first visit with a patient IF you are the first Acupuncturist (or other provider listed above) they have seen for the calendar year, you can go online, submit a request and get 4 treatments covered for most musculo-skeletal conditions.  It literally takes 5 minutes, requires no doctor's referral or authorization - you just have to have an account on the CareCore National Website which also takes just a few moments to set up.

Beyond that, you must submit a Treatment Request that documents medical necessity for additional treatments.  That means you need the following:

1. Valid Diagnosis Code (there are guidelines and lists on the CoreCare Website, but choose something that includes PAIN and you're more likely to be approved)
2. Documentation of Measurable Improvement - i.e. orthopedic tests, ROM percentages, disability scores, pain scale notation
3. Proof via Measurable Data (above) that the patient is improving but still requires treatment
4. NOTE that NEW CONDITIONS are validation for additional treatment so if you're treating 5 things for a patient, you might consider billing for only one, and then adding additional ones as new conditions over the course of the year.

CareCore also really emphasizes home care so be sure you are giving your patients homework to improve and that you are charting what you are giving them and how you are counseling them on continuing home care activities.

From the webinar I just attended, one of the best codes you can use for female patients is Dysmenorrhea - because it is expected that the patient is going to have this pain every month, and if Acupuncture is sufficient to help relieve it without pursuing additional expensive western therapies (such as laparoscopy for endometriosis) they are going to count that as a bonus and a good reason to continue covering Acupuncture treatment.

Most pregnancy related issues such as induction and breach baby presentation are not covered, and if you're treating anxiety and depression you better find a physical manifestation of pain associated with the condition or they most likely are not going to fund it.

FEP or Federal Employee Program members are exempt from the new CareCore National program (phew!) so no changes there, and no changes have been made in treatment codes covered, so any treatment code that was paid previously on any given plan will still be paid now through this system.

Well… there isn't much of it here, but in the webinar today CareCore did say they wanted to hear about new research validating Acupuncture treatment for additional conditions, so if you want a diagnosis to be covered or a certain duration of treatment to be covered that isn't, find some research backing up your claim or request and submit it.  They realize that they are learning and are willing to review scientific evidence supporting expansion of their guidelines.

If you work with Health Net or American Specialty Health, this process will be relatively old hat - it is much the same.  They made mention of a "tier status" much like ASH uses, but there were so many basic questions in the webinar they couldn't get to explaining it.  Presumably, it will be much like ASH - the longer you are connected to CareCore, the higher your tier status and the more treatments will be approved with any given request.

At any rate, we don't have a choice - working with CareCore for authorization is required for all of starting in just two weeks time so buck up, get registered and run a few test patients through the system this week to make sure you're up to speed and can add this into your workflow without too much difficulty sooner rather than later.

CareCore's provider relations team is very friendly too, so don't hesitate to call.  And good luck!!

Until Next Time,
~Rebecca

I blogged before about the changes to Regence BlueCross BlueShield's Acupuncture reimbursement - namely that they are contracting with a company called "Core Care" to administer CAM benefits.  This means starting next year, all CAM treatments require pre-approval through this administrator.

There has definitely been a lot of backlash, but no change in policy which is unsurprising.

Still, they are offering free webinars this month and next for Acupuncturists specifically to help illuminate how this process works.  You can go online to the Regence site HERE to sign up.

The times available are:

• Wednesday, December 18, 12 p.m. – 1 p.m. (PT) / Meeting Number: 734 116 661
• Wednesday, January 15, 9 a.m. – 10 a.m. (PT) / Meeting Number: 738 323 531
• Thursday, January 16, 12 p.m. – 1 p.m. (PT) / Meeting Number: 737 701 693

Check it out and sign up if you want all the details!

Best of luck with your insurance billing practices in the coming year!
~Rebecca