Archive for October, 2015

ICD10 Frequently Asked Questions

Monday, October 19th, 2015
Frequently Asked Questions
Q: What is ICD-10-CM and ICD-10-PCS?
A:  ICD-10-CM (International Classification of Diseases -10th Revision-Clinical Modification) is a US clinical modification of the WHO’s ICD-10, developed to support US health information needs. ICD-10-CM is designed for classifying and reporting diseases in all US healthcare settings. ICD-10-PCS (Procedure Classification System) was developed by CMS and is not based on an international coding system. ICD-10-PCS replaces the ICD-9-CM procedure coding system and will only be required for facilities reporting procedures on hospital inpatient services. When speaking of both these new classifications, the term “ICD-10″ is often used.
Q: Who has to comply with ICD-10?
A: ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability and Accountability Act (HIPAA), not just those who submit Medicare or Medicaid claims.
Q: Why is it important not to further delay the implementation of ICD-10?
A: ICD-10-CM and ICD-10-PCS must be adopted as soon as possible to reverse the trend of deteriorating health data. Never in US history have we used the same version of ICD for 35 years. In addition, many countries have already moved to ICD-10.
Q: Will ICD-10-PCS procedure codes be used for both inpatient and outpatient hospital services?
A: No. ICD-10-PCS procedure codes are designed only for hospital reporting of inpatient services. Current Procedural Terminology (CPT) codes will continue to be used for physician and outpatient services.
Q: ICD-10 seems so complicated. Do physicians really need to use all the codes in ICD-10?
A: No. Healthcare providers will not use all the codes in the classification system; rather they will use a subset of codes based on their practice. Physicians will only use the ICD-10-CM code set for diagnosis coding. The ICD-10-CM code set is like a dictionary that has thousands of words, but individuals use some words very commonly while other words are never used.
Q: Does ICD-10 compete with other healthcare initiatives that require time and resources to implement?
A: Healthcare organizations and providers have known for 14 years that ICD-10 implementation would occur and that they should prepare for the implementation, and the industry began to officially move toward implementation in 2008. While there are always competing priorities, the US healthcare system has already waited too long to realize the benefits of ICD-10. In addition, many healthcare initiatives are tied to ICD-10 implementation, so they work hand in hand.
Q: What are the benefits of ICD-10?
A: ICD-10 will improve national healthcare initiatives such as Meaningful Use, value-based purchasing, payment reform and quality reporting. Without ICD-10 data, there will be serious gaps in the ability to extract important patient health information needed to support research and public health reporting, and move to a payment system based on quality and outcomes.
Q: What is the value of ICD-10?
A: The improved clinical detail, better capture of medical technology, up-to-date terminology, and more flexible structure will result in:
  • Higher quality information for measuring healthcare service quality, safety, and efficiency
  • Greater coding accuracy and specificity
  • Recognition of advances in clinical practice and technology
  • Improved ability to measure outcomes, efficacy, and costs of new medical technology
  • Enhanced review of medical necessity and fewer claims denials
  • Improved ability to determine disease severity for risk and severity adjustment
  • Global healthcare data comparability
  • Improved ability to track and respond to public health threats
  • Reduced need for manual review of health records to perform research and data mining and adjudicate reimbursement claims
  • Reduced need for supporting documentations to support information reported on claims
  • Reduced opportunities for fraud and improved fraud detection capabilities
  • Development of expanded computer-assisted coding technologies that will facilitate more accurate and efficient coding and alleviate the coder shortage
  • Space to accommodate future code expansion
Q: What will happen if I submit a claim with a DATE OF SERVICE of Oct. 1, 2015 and later with an ICD-9 code?
A: All claims that are received with a DATE OF SERVICE of Oct. 1, 2015 and later with an ICD-9 code will be denied.
Q: What should I do if my claim is rejected? Will I know whether it was rejected because it is not a valid code versus denied due to a lack of specificity required for a National Coverage Determination (NCD) or Local Coverage Determination (LCD) or other claim edit?
A: Yes, submitters will know that it was rejected because it was not a valid code versus a denial for lack of specificity required for a NCD or LCD or other claim edit. Submitters should follow existing procedures for correcting and resubmitting rejected claims and issues related to denied claims.
Q: What are the “established time limits” to process claims?
A: Guam Public Law 25-189, Section § 9902. Prompt Payment for Health Care and Health Insurance Benefits, “(b) Health Plan Administrators shall reimburse a Clean Claim, or any portion thereof, submitted by a patient or Health Care Provider that is eligible for payment and not contested or denied not more than 45 calendar days after receiving the Clean Claim filed in writing.”
Q: How will the transition from ICD-9 to ICD-10 work with Referral/Authorization transactions and subsequent episode of care?
A . Authorization requests will require the provider to supply the diagnosis using the correct ICD format depending on the requested start date. For requested dates of service or date of admission prior to October 1, 2015, the ICD-9 codes will be utilized.
For requested dates of service or date of admission start from October 1, 2015 and beyond, the appropriate ICD-10 codes will be utilized.
Q: If providers have questions about the testing, who can they contact?
 
A. For questions related to ICD-10 testing, providers can call the EDI Help Desk at 649-6956, extension 7229 or via email to editeam@takecareasia.com
Q: Specify whether you system can accommodate both ICD-10-CM/PCS and ICD-9-CM code sets in dual testing strategy?
A. During the testing phase, providers will be able to submit claims with both ICD-9 and ICD-10 codes to test dual use in the TakeCare testing environment.

Notice of Change to ICD-10

Monday, October 19th, 2015

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Notice of Change to ICD-10

Monday, October 19th, 2015

The transition to ICD-10 is required by October 1, 2015, for health care providers, health plans, and clearinghouses by the Center of Medicare and Medicaid services.

In accordance with the federal mandate, TakeCare Insurance, inc. will no longer accept claims submitted with ICD-9 codes for dates of service on or after October 1, 2015. Electronic claims will be rejected by the online system, and paper claims will be returned to providers for correction.

Claims with dates of service prior to October 1, 2015 will be processed with ICD-9 codes, regardless of claim submission method.

Please utilize the following links for more information regarding ICD-10: 

If you have any questions regarding this notice, please contact our Customer Service team at 646-3526.


PROMO: Guam Community College Foundation 2k/5k

Monday, October 19th, 2015

aTCsponsoredEvent

 

 

TakeCare Insurance is offering members complimentary bibs for the John K. Lee Jr. Scholarship 2k/5k Run/Walk.

To reserve a bib, please click on the link below and complete the form. Information about picking up the bib will be emailed to recipients on October 30, 2015. Deadline to enter is October 29, 2015.

Click here to request a bib

Quantities are limited. While supplies last.


TakeCare launches Balanced Lifestyle initiative with Women’s Soccer Festival

Friday, October 16th, 2015

**FOR IMMEDIATE RELEASE**

 

October 16, 2015 1:35pm

TakeCare sponsors Achieve Your Goal’s Women’s Recreational Soccer Festival

As part of TakeCare’s “Balanced Lifestyle” initiative, TakeCare is proud to partner with the Guam Football Association in presenting TakeCare’s Achieve Your Goals Women’s Recreational Soccer Festival, the first known soccer festival for women’s recreational teams in Asia.

“TakeCare has been an active part of this community for almost 45 years. As a company, TakeCare has always understood the importance of getting fit and being active. Now, we’ve taken that a step further with the Balanced Lifestyle initiative,” says Jeff Larsen, President of TakeCare Insurance, Inc.

The Balanced Lifestyle initiative is a TakeCare program that promotes physical activity, healthy eating, relaxation and maintaining a positive social life while focusing on key aspects of maintaining good overall health.

“The TakeCare Achieve Your Goals Festival will provide women an opportunity to play in a fun and recreational soccer festival, which will include multiple short scrimmages with other teams,” explains Grace Martinez, Festival Coordinator.

“We’re excited to see this historical event, that not only promotes getting fit, but achieve your goal to obtain good overall health,” Larsen shares.

The festival will take place on Sunday, October 25, 2015 at the Guam Football Association’s Harmon Training Facility. TakeCare’s Wellness Team will also be present to share information about the importance of Breast Cancer Awareness.

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Federal Program Renews with TakeCare in 2016

Wednesday, October 14th, 2015

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Federal Program Renews with TakeCare in 2016

Tuesday, October 13th, 2015

(Tamuning, GU) — The United States Office of Personnel Management (OPM), has renewed the Federal Employee Health Benefit (FEHB) Program with TakeCare for the upcoming 2016 benefit year.

“This marks a successful longstanding, thirty-plus year relationship between OPM and TakeCare Insurance,” said Jeff Larsen, TakeCare President. “Over the years, we continue our commitment to provide our valued Federal members with the best possible coverage options, offer optimal health care delivery options by providing exclusive access to the FHP Health Centers on Guam and Saipan, and a comprehensive suite of wellness and health education classes and incentives. We are happy to continue the assurance that all federal employees and their family members covered under this program receive the utmost value for their premium contributions,” continued Larsen.

As a health insurance provider covering over 8,300 Federal civilian employees, retirees and family members through the FEHB program on Guam and the CNMI, TakeCare is held to high regulatory standards required by the Office of the Inspector General (OIG) and the OPM.

TakeCare Insurance Company offers optimal choice and easy access to the providers consumers want.  TakeCare’s health plans provide expansive coverage to its 33,000 plus members at a reasonable price with exceptional, member-patient focused services.  A seasoned and enduring health insurance company, with over 40 years in the industry, TakeCare upholds the highest standards of excellence for accredited provider networks, patient management expertise, and end-to-end quality control processes.

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