The wild fires have made for some beautiful sunsets in the area. But they have also caused great devastation. Anthem Blue Cross has taken steps to help members effected by the wildfires. Insureds who live in Butte, El Dorado, Humboldt, Lake, Madera, Napa, Nevada, Sacramento, San Bernardino, San Diego, Shasta, Solano, Tulare, Tuolumne and Yolo counties will have enhanced benefits for out of network care. Anthem states these benefits are extended at least through 8/21/2015.
- Emergency and urgent care services provided by out-of-network doctors and hospitals will be paid at in-network coverage levels.
- waiving the notification penalty on utilization management (UM) review of in-hospital cases.
- If they on a prescription drug plan they can get refills at any pharmacy now.
- If they use a mail order pharmacy they can update their address information by calling Member Services
- They can get replacement medical equipment (also called Durable Medical Equipment or DME) if theirs was lost, damaged or can’t be accessed.
Claims filing deadlines will be extended. With the exception of refilling lost or damaged drugs, the insured must call Member Services number on their card to request any of these adjustments.
Why is the insurance company so intrusive?
We had one of our small groups in a little bit of a huff this week when the insurance carrier asked for the DE9 payroll tax return. This was required in order to process the Medicare Primary rate for one of their employees who is over age 65, but still actively at work.
If an employer has less than 20 employees, the employee is allowed to request that Medicare pay first (Medicare Primary) and then be given a discounted premium rate by the insurer. This makes sense for some, as Medicare is paying the bulk of the individual’s claims, so the carrier provides a discounted rate.
So why the DE9? The carrier must verify that in fact the group has less than 20 employees and is eligible for this option. The Affordable Care Act, also known as the ACA or Obamacare has increased compliance and audit of health insurance vendors, so they are now extra careful.
So how about a little fun on this Sunday. Do you know what ICD-10 is? Ask Jane White of CPR Medical Billing. Or ask your doctor’s billing department. An eye roll is the most tame response you will receive.
ICD-10 is the new coding system designed to provide the highest level of detail on claims. The intention is to provide the most detailed information and help to provide meaningful outcomes research on the efficacy of health treatments. The current system ICD-9 has about 15,000 codes. ICD-10 has 68,000.
The new system is to be live 10/1/2015. This new system will certainly have a learning curve for coders in provider offices. As an example there was one code for “Antepartum transient hypertension” (elevated blood pressure in pregnancy) under ICD-9. ICD-10 has 7 codes that provides specificity to each trimester of pregnancy as well as whether there was proteinuria (protein in the urine).
Here are a few you might enjoy.
W55.21 – Bitten by a Cow
W61.33 – Pecked by a Chicken
V00.01 – Pedestrian on Foot in Collision with Roller-Skater
Z63.1 – Problems in Relationship with In-Laws (is wine a valid Rx?)
Y92.253 – Hurt at the Opera
Y93.D1 – Accident While Knitting or Crocheting
W56.22 – Struck by Orca, initial encounter-(Is there a code for second encounter, or do they assume there will be only 1?)
And in the “when will this happen on Shasta Lake OSU weekend category”…
V91.07 Burn Due to Water-Skis on Fire
So be prepared for some billing and claims issues as the coders become accustomed to the new system.
