Telehealth Expansion, Billing, and Testing for COVID-19

As the landscape around us is rapidly changing due to the Novel Coronavirus (COVID-19) Pandemic, we have had a slew of calls regarding Telehealth.

Last Updated May 11,2020 Please note that this information was current at time of publication, however rules around Telehealth during the COVID-19 Public Health Emergency are changing daily; we will continue to update this post as information changes but we encourage you to check sources cited frequently for updates. This is not a substitute for legal advice; check with your attorney and other billing advisors. Most of the information reflects the federal government’s stance; you are directed to your private payers and Medicaid plans for their policies about coding and reimbursement, which may vary from the federal government’s.

AZCOMP is prepared to assist you with actual implementation of Telehealth services, however, many of the questions go beyond getting a solution in place. Therefore, we thought it would be beneficial to provide a timeline of what has transpired during the COVID-19 public health emergency as well as a summary of key points to understand regarding different types of telemedicine services, COVID-19 testing, and billing guidelines.

Current Events:

March 5, 2020 – America’s Health Insurance Plans issues a statement regarding action they are taking to address prevention, testing, and treatment of the corona Virus.

March 6, 2020 – Congress passed the Coronavirus Preparedness and Response Supplemental AppropriationsAct (  This new legislation will allow physicians and other health care professionals to bill Medicare fee-for-service for patient care delivered by telehealth during the current coronavirus public health emergency.

March 17, 2020 – The Trump Administration announced further expansion of Telehealth coverage for Medicare beneficiaries during the COVID-19 outbreak.

March 17, 2020 – After meeting with the Trump Administration many insurance issuers announced that they are also expanding efforts by waiving copays, waiving prior authorizations, covering the cost of the COVID-19 test, and allowing reimbursement for telehealth. (For details see Health Insurance Providers Respond to COVID-19

March 18, 2020 – CDC Announces new ICD-10-CM code for COVID-19 will be effective April 1, 2020

March 18, 2020 The Families First Coronavirus Response Act becomes law, which among other things includes health provisions that require private health insurance to cover testing for COVID-19 without cost-sharing (deductibles, co-payments or co-insurance), and requires Medicare to cover, without cost-sharing, visits to health care providers that relate to COVID-19 testing during the public emergency.

March 30, 2020 CMS Announces Additional Waivers and New Rules to Address COVID-19 Patient Surge

March 31, 2020 CMS released an interim final rule, “Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency.” This rule further expands telehealth including additional covered services and new/modified billing instructions during the COVID-19 pandemic.

April 30, 2020 Trump Administration Issues Second Round of Sweeping Changes to Support U.S. Healthcare System During COVID-19 Pandemic

To get more details on the most recent announcements we encourage you to review the following:

Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19 (published 4/29/2020)

CMS Dear Clinician Letter (published April 6, 2020)

Medicare Telemedicine Provider Fact Sheet (published March 17, 2020)

Medicare Telehealth Frequently Asked Questions (published March 17, 2020)

The following instructional video was published by CMS on May 8, 2020 and replaces the previous video:

Types of Telemedicine Visits

It is important to understand the types of telemedicine services as each type of visit will have varying requirements regarding how the service is initiated, administered and billed. All of the services listed below can now be performed for new or established patients during the public health emergency.

  • Telehealth Visits: The provider must use an interactive audio and video telecommunications system that permits real-time communication between the distant site and the patient at home.
    • Effective for services starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to patients in broader circumstances.
    • Limitations have been removed during the emergency allowing telehealth services to be provided in all settings including a patient’s home.
    • Medicare beneficiaries will be able to receive a specific set of services through telehealth including evaluation and management visits (common office visits), mental health counseling and preventive health screenings. *New: The list of covered telehealth services was expanded to include over 80 additional services on March 30, 2020 under the interim rule- for a full list click here.
    • Telehealth services are NOT limited to services related to COVID-19. In order to support social distancing strategies and reduce the risk of COVID-19 transmission the statutory provision broadens telehealth flexibility without regard to the diagnosis of the patient as long as the service billed is reasonable and necessary.
    • Telehealth visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits.
    • The HHS secretary has been given the authority to waive the originating site requirement ( for telehealth services provided by a qualified provider to Medicare beneficiaries ( in any identified emergency area during emergency periods.
    • Telehealth services may be provided to Medicare beneficiaries by phone, but only if the phone allows for audio-video interaction between the qualified provider and the beneficiary.
    • The Medicare coinsurance and deductible would generally apply to these services. However, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.
  • Virtual Check-ins: Brief communication service with practitioners via a number of communication technology modalities including synchronous discussion over a telephone or exchange of information through video or image.
    • The patient must verbally consent to receive virtual check-in services.
    • Practitioners may educate beneficiaries on the availability of the service prior to patient agreement. 
    • Virtual check-ins can be conducted with a broader range of communication methods, unlike Medicare telehealth visits, which require audio and visual capabilities for real-time communication.
    • Medicare coinsurance and deductible would generally apply to these services.
  • E-Visits: Patient initiated communication through an online patient portal.
    • Individual services need to be initiated by the patient; however, practitioners may educate beneficiaries on the availability of the service prior to patient initiation. 
    • The patient must consent to receive virtual check-in services.
    • The Medicare coinsurance and deductible would generally apply to these services.
  • Telephone Visits: Audio only visits. *NEW as of March 30, 2020 per the Interim Rule and further expanded on April 30, 2020 under the Second Round of Changes
    • When real-time audio visual equipment is not available to conduct an E/M visit remotely, practitioners may now conduct a visit over the phone for both new and established patients. These services were previously non-covered.
    • Medicare payment for telephone E&M visits is equivalent to the Medicare payment for office/outpatient visits with established patients effective March 1, 2020. (*New as of April 30, 2020 under the Second Round of Changes)
    • CMS is also allowing many behavioral health and education services to be furnished via telehealth using audio-only communications. The full list of telehealth services notes which services are eligible to be furnished via audio-only technology, including the telephone evaluation and management visits can be found here. (*New as of April 30, 2020 under the Second Round of Changes)
  • Remote Patient Monitoring: Allows patients to use mobile medical devices and technology to gather patient-generated health data and send it to healthcare professionals.
    • These services can be provided for both acute and chronic conditions and can now be provided for patients with only one disease. For example, remote patient monitoring can be used to monitor a patient’s oxygen saturation levels using pulse oximetry.
    • For purposes of treating suspected COVID-19 infections, Medicare will allow the service to be reported for shorter periods of time than 16 days (the normal requirement) as long as the other code requirements are met.

Eligible Providers

CMS is allowing all providers that are eligible to bill Medicare for their professional services to bill for Medicare telehealth services, including physical therapists, occupational therapists, speech language pathologists, and others who were previously ineligible, to receive payment for Medicare telehealth services. (*New as of April 30, 2020 under the Second Round of Changes and retroactive to March 1, 2020)


In this section we will provide information for Medicare Billing guidelines during the Public Health Emergency. Many of the private payers are following suit, but you will need to verify rules with individual payers as they may vary. One of the best guides we have seen for Medicare billing is Special Coding Advice presented by the American Medical Association. (Updated May 4, 2020) We highly recommend reviewing their guide as it includes a variety of scenarios that cover COVID-19 Telehealth billing, COVID-19 Laboratory Billing, Non-COVID-19 Telehealth Billing, and more. A great resource for checking billing guidelines for private payers can be found by clicking here.

CPT Codes

The CPT Code will depend on the type of Telemedicine Service performed. Here is a summary from CMS of the CPT codes that pertain to the type of service:

Summary of Telehealth CPT Codes Covid-19
COVID-19 CPT Billing

Payment for Phone Calls (*NEW as of March 30, 2020 see the Interim Rule)

CMS will now pay for phone calls using codes 99441-99443, and 98966-98968. These are time-based codes.

  • Physicians, nurse practitioners, and physician assistants should use codes 99441—99443
  • Other qualified health care professionals who may bill Medicare for their services, such as registered dieticians, social workers, speech language pathologists and physical and occupational therapists should use codes 98966—98968 with applicable GN, CO, or GP modifiers.

CMS previously announced that Medicare would pay for certain services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians. Now, CMS is broadening that list to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020. (*New as of April 30, 2020 see Second Round of Changes)

Remote Patient Monitoring

Use CPT Codes 99091, 99457-99458, 99473-99474, 99493-99494

Place of Service (POS) Codes and Modifiers

The following information was updated April 6, 2020 after a correction was released by CMS on April 3, 2020

When billing professional claims to Medicare for all telehealth services with dates of services on or after March 1, 2020, and for the duration of the Public Health Emergency (PHE), bill with:

  • Place of Service (POS) equal to what it would have been had the service been furnished in-person
  • 95 Modifier, indicating that the service rendered was actually performed via telehealth

As a reminder, CMS is not requiring the CR modifier on telehealth services. However, consistent with current rules for telehealth services, there are two scenarios where modifiers are required on Medicare telehealth professional claims:

  • GQ Modifier– Service was furnished as part of a federal telemedicine demonstration project in Alaska and Hawaii using asynchronous (store and forward) technology.
  • GT Modifier– Service was furnished for diagnosis and treatment of an acute stroke.

There are no billing changes for institutional claims; critical access hospital method II claims should continue to bill with modifier GT.

(The following information was added on April 9, 2020 to include information provided by CMS in a Special Edition Newsletter from the Medicare Learning Network dated April 7, 2020)

Providers are to apply Modifier CS on applicable claim lines to identify COVID-19 testing-related services that are not subject to cost sharing under the Families First Coronavirus Response Act. Covered services include medical visits that that result in an order for or administration of a COVID-19 test; are related to furnishing or administering such a test or to the evaluation of an individual for purposes of determining the need for such a test. The effective date for modifier CS is for services performed between March 18, 2020 through the end of the Public Health Emergency.

For professional claims, physicians and practitioners who did not initially submit claims with the CS modifier must notify their Medicare Administrative Contractor (MAC) and request to resubmit applicable claims with dates of service on or after 3/18/2020 with the CS modifier to get 100% payment. 

For institutional claims, providers, including hospitals, CAHs, RHCs, and FQHCs, who did not initially submit claims with the CS modifier must resubmit applicable claims submitted on or after 3/18/2020, with the CS modifier to visit lines to get 100% payment.

Revenue Codes *for institutional claims only

Revenue code 780 is used as the revenue code for telemedicine institutional claims (See Revenue Codes)

Diagnosis Codes (see CDC Official ICD-10 COVID-19 Coding Guidance)

  • Diagnosis of COVID-19: Effective April 1, 2020, for confirmed diagnosis of COVID-19 only, use U07.1 (For visits prior to April 1, 2020, report the code for the patient condition that is related to the COVID-19 (e.g., J12.89, “Other viral pneumonia”) and B97.29, “Other coronavirus as the cause of diseases classified elsewhere.” see New CDC Coronavirus Code Announcement for details)
  • Known Exposure to COVID-19 Without Confirmed Diagnosis of COVID-19: For cases where there is an actual exposure to someone who is confirmed or suspected (not ruled out) to have COVID-19, and the exposed individual either tests negative or the test results are unknown, report Z20.828, “Contact with and (suspected) exposure to other viral communicable diseases.”
  • Possible Exposure to COVID-19 Without Confirmed Diagnosis of COVID-19: For cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation, assign code Z03.818, “Encounter for observation for suspected exposure to other biological agents ruled out.”
  • Screening for COVID-19: For asymptomatic individuals who are being screened for COVID-19 and have no known exposure to the virus, and the test results are either unknown or negative, assign code Z11.59, Encounter for screening for other viral diseases.
  • Suspected COVID-19: For patients presenting with any signs/symptoms associated with COVID-19 (such as fever, etc.) but a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as: R05 Cough, R06.02 Shortness of breath, R50.9 Fever, unspecified
    If a patient with signs/symptoms associated with COVID-19 also has an actual or suspected contact with or exposure to someone who has COVID-19, assign Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, as an additional code. This is an exception to guideline I.C.21.c.1, Contact/Exposure.

We recommend checking with the CDC for ongoing announcements regarding ICD-10 Coding at:

Testing (COVID-19 FAQ Sheet)

Medicare Part B will cover a test to determine if beneficiaries have coronavirus for dates of service on or after Feb. 4, 2020. However, providers of the test will have to wait until after April 1, 2020, to submit a claim to Medicare for the test.

Many health plans have publicly announced that COVID-19 diagnostic tests are covered benefits and will be waiving any cost-sharing that would otherwise apply to the test.

CMS will pay hospitals and practitioners to assess beneficiaries and collect laboratory samples for COVID-19 testing, and make separate payment when that is the only service the patient receives. (*New as of April 30, 2020 see Second Round of Changes)

Medicare and Medicaid are covering certain serology (antibody) tests, which may aid in determining whether a person may have developed an immune response and may not be at immediate risk for COVID-19 reinfection. Medicare and Medicaid will cover laboratory processing of certain FDA-authorized tests that beneficiaries self-collect at home. (*New as of April 30, 2020 see Second Round of Changes)

Laboratory Billing

*New: The following information was added after the April 30, 2020 Second Round of Changes

During the COVID-19 Public Health Emergency, CMS is relaxing billing requirements for laboratory tests (PDF) required for a COVID-19 diagnosis. Any health care professional authorized under state law may order tests. Medicare will pay for tests without a written order from the treating physician or other practitioner:

  • If an order is not written, an ordering or referring National Provider Identifier (NPI) is not required on the claim
  • If an order is written, include the NPI of the ordering or referring professional, consistent with current billing guidelines

For a full list of Laboratory Tests that do not require a practitioner order during the Public Health Emergency visit

Additional/Cited Resources:

Although AZCOMP Technologies makes every effort to ensure that information regarding billing guidelines are checked and accurate in both our documentation and training, it should be understood that our expertise is in the software itself and not in billing practices. Therefore, it is the sole responsibility of the user to study, interpret and remain abreast of billing requirements and deadlines, contacting authoritative sources directly as needed. Any claims documentation and training provided by AZCOMP Technologies is based on our interpretation of the rules published by and and are subject to change. Information and training provided is “as is” and without any express or implied warranties. AZCOMP Technologies assumes no responsibility for any inaccuracies, errors, or omissions, expressly disclaiming liability for damages of any kind arising out of the use of, reference to or reliance on any content provided.

AZCOMP Technologies – the #1 eMDs reseller since 2005.

We are the ultimate source for all things Medisoft & Lytec. Whatever your question or problem or need with Medisoft & Lytec, we can help you. AZCOMP can help with sales, training, coaching, installation, support, EHR, add-on tools such as preferred clearinghouses, or patient statements, patient payments, appointment reminders and more.

For more Medisoft information, visit our website here:

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Be sure to call us at (877) 959-8292 for all your network and healthcare technology needs.

ICD-10 Grace Period FAQ

ICD-10 Launch Button Cartoon

CMS Releases FAQ Sheet Regarding ICD-10 Grace Period

In July we wrote an article about the ICD-10 Grace Period (remember, this is not an extension!). CMS has been fielding questions ever since then about what this really means. So recently they posted a FAQ sheet to help providers better understand the grace period.

Check out the CMS grace period FAQ sheet by clicking here.

Today Is The Last Day Before The ICD-10 Transition!

Do you have all of your ducks in a row? Have you upgraded your software to Medisoft v20 or Lytec 2015? Do you have all of the training you need?

If you haven’t upgraded your software, do it today by calling us at (888) 799-4777.

If you need any ICD-10 training, check out our ICD-10 resource page at

We have a lot of other ICD-10 videos on our YouTube channel to help you get the education you need. Watch as many of these videos as many times as you want.

If you need one-on-one training, or tech support or any additional help, please call us at (888) 799-4777.

Notice Regarding Print-Image Files and ICD-10

Are you still submitting claims to your clearinghouse using “Print-Image” files?

If you are still using the print image method for submitting claims, you need to start submitting using the new CMS 1500 02/12 claim form or your cash flow will be negatively impacted.

As October 1, 2015 approaches, the primary concern for all providers is whether or not they will continue to receive revenue as the entire industry makes the biggest transition in healthcare in 35 years! While many practices are finishing off the tail end of their ICD-10 Action Plans, and are well on their way to a smooth transition, we have recently seen a surge in calls from practices that have not yet completed ICD-10 testing with their clearinghouse and payers.

As we are assisting practices with their testing, we are finding a higher than expected number of practices that are sending print image files to their clearinghouses. Most clearinghouses cut off the use of print image files when the industry shifted to the new CMS 1500 02/12 form back on April 1, 2014. However, there are still a few outliers that continued to allow users to submit print image files.

Keep in mind that HIPAA required all electronic transactions to be submitted in the ANSI 5010 format as of January 1, 2012.

In order to comply with this new standard, Medisoft built the capability to submit claims in the 5010 format directly from the program through the Revenue Management module. If you are not using Revenue Management then you are submitting claims in a print image format to your clearinghouse. Then the clearinghouse is converting the print image file for you to the ANSI 5010 format and forwarding it on to the payers.

How You Can Find Out If You Are Sending “Print Image” Text Files

Typically the print image format comes from a file that is formatted based on the HCFA claim form fields. In Medisoft and Lytec the most common method of producing the print image file was by setting up an EDI receiver to launch an executable file called CMS11.exe. Here is a sample of what you may see when you are sending claims that notifies you that you are sending a “print image” text file.

medisoft cms11 text file print image

Or you can watch this short video where we show you in Medisoft how you can find out if you are sending “print image” files.

Don’t Let Your Claims Get DENIED

As of Medisoft v19 and Lytec 2014, Medisoft and Lytec discontinued support of the cms11.exe file. It was never updated to match the new claim form or to handle ICD-10 codes. Therefore, if you are still relying on this method to submit claims there is a very high likelihood that your ICD-10 claims will be DENIED starting October 1, 2015.

While some clearinghouses may continue to support print image file submissions, our understanding is that they will require you to use a print image file that produces a print image of the CMS 1500 02/12 claim form. Please take note that the CMS11.exe file produces the old 08/05 claim format and that print image submission is not supported in Medisoft or Lytec.

Get On Board With Revenue Management

The good news is Medisoft v19 (and Medisoft v20) and Lytec 2014 (and Lytec 2015) are both equipped with not only the new 02/12 claim forms, but also with Revenue Management. The Revenue Management module in Medisoft and Lytec can be configured to send claims to any clearinghouse or even directly to the payers in the 5010 format.

In addition, Revenue Management has features such as claim scrubbing and ERA posting that your practice can take advantage of to streamline billing processes.

revenue management claim check screen shot

While the Revenue Management application is included with the ICD-10 compatible versions of Medisoft and Lytec, it does require setup and configuration to successfully utilize it. If you need to get setup on Revenue Management please call us at (888) 799-4777 to schedule the configuration with an EDI Professional!

If You Need Revenue Management Configured, Don’t Wait!

Please do not wait to contact us as the backlog of practices that need configuration and training is growing and our availability is based on first come first serve.

We also highly recommend contacting your clearinghouse as soon as possible to discuss this change, and to coordinate the switch from the print image file to the ANSI 5010 format.

Here Is A Clip From A Recent Webinar Explaining The Problem And What You Can Do About It

video play - no print image support

Join Us For Our ICD-10 Conference

ANNOUNCING: ICD-10 Prep Conference

Find Out What Every Practice Needs To Know To Effectively Prepare for ICD-10

icd10 prep event banner 3

Now is a good time to panic about the ICD-10 deadline.

If you’ve been ignoring every piece of ICD-10 advice and guidance for the past three years, and you are not prepared for the deadline, you should be panicking.

But instead of a panic attack, let’s just get started on preparing for ICD-10. It is time to get way beyond serious and make ICD-10 happen by October 1.

Join Us For Our FREE ICD-10 Training Conference, Live at Our Office in Gilbert, AZ

Get critical ICD-10 information specific to your software. ICD-10 is literally right around the corner. Make sure you’re ready & have all the critical information you need to get your software and your staff ready.

Even if you feel that you are already prepared, join us at the training so you can shore up what you’ve already learned, maybe learn a few more tips & tricks, and learn from your colleagues.

Don’t miss our FREE ICD-10 Prep where we’ll show you how to:

  • Convert your Existing ICD-9 Codes to ICD-10
  • Easily Do a Mass Import of ICD-10 Codes
  • Effectively Handle Giant Superbills
  • Correctly Setup Your Software for Testing Claims
  • Quickly Search for Codes (Without a bulky code book)

This will be critical for your practice to know how to do…and we’ll teach it to you for FREE!

Who Should Attend?

This conference is for anyone who uses Medisoft or Lytec for billing and claims. This includes any version of Medisoft, any version of Lytec, Medisoft Clinical, and Lytec MD users.

Due to the nature of the ICD-10 regulations it is HIGHLY RECOMMENDED that the Doctor, Office Manager, and Biller attend.

The Conference is FREE, but registration is REQUIRED for each person who wants to attend.

Click Here To Register.

icd-10 prep register here


One Year “Grace Period” For ICD-10

ICD-10 Launch Button Cartoon

The ICD-10 implementation date has not been extended, but there is now a one-year “grace period”.

Although the impending date for ICD-10 has not been delayed, CMS announced this month that they will be extending a one-year “grace period” to help protect provider’s income and ease the transition to ICD-10. As we have worked with practices to put the proper tools in place to prepare for ICD-10 there seems to be a common concern regarding whether or not reimbursements for claims will be disrupted, or claims denied as they learn how to properly code in ICD-10.

This announcement from CMS should be welcome news for providers that share this concern.

Here are some of the highlights of the announcement:

  • Claims with Non-Specific codes will still be paid.

    • The primary reason the code set has expanded so drastically under ICD-10 is because of the level of specificity it provides. During the one-year grace period Medicare will not be denying claims for non-specific codes as long as the code submitted is in the same code family.
  • Use of Non-Specific codes for Quality Reporting will be acceptable.

    • Physicians will not be penalized based on the specificity of the code as long as the code used is from the same family of codes. This rule applies to PQRS, the EHR Incentive Program (Meaningful Use), and the value-based payment modifier.
  • Reimbursement for Medicare claims will not be withheld due to claims processing issues on their end.

    • CMS will authorize a payment advance if a Medicare contractor is unable to process a claim due to issues related to ICD-10.
  • Resources will be made available to help monitor and resolve ICD-10 related issues quickly.

    • CMS will establish a communication center that will included an ICD-10 ombudsman devoted to training physician issues.

CMS made a point of noting in the announcement that the Medicare claims processing system will not have the capability of accepting ICD-9 codes for dates of service after September 30, 2015. Providers need to continue to prepare for the impending October 1, 2015 transition deadline.

If you have not upgraded to an ICD-10 supported version of Medisoft or Lytec yet, please call ASAP so we can help you out. Contact us at (888) 799-4777.

For more information, please click here to visit the CMS website. Or you can read this post by AMA Wire.

ICD-10 Code Training

Are You Looking For ICD-10 Code Training?

icd-10 (01)

Lately we have been getting a lot of questions about code training for ICD-10.

While we are experts for Medisoft and Lytec in the software and the tools available in the software, we admittedly are not experts in coding, nor do we give billing training or advice. We can educate you on the features inside the program and help you learn to use them, those looking for code training and billing training need to be getting that sort of training from an accredited resource.

When it comes to code training and billing training, multiple resources exist but the most well known and respected resources are the AAPC (American Academy of Professional Coders) and AHIMA (American Health Information Management Association). Both of these entities provide courses covering a wide range of specialties and staff roles.

For coding training, click either of these links:



There may also be associations that are specific to your specialty that you should research for educational information and training.

ICD-10 Features Training for Medisoft or Lytec

If you are looking for information on how to use the ICD-10 features that are found in the latest versions of Medisoft and Lytec, we have ICD-10 training webinar recordings that you can access for free by clicking here.

Five More Facts about ICD-10 from CMS

are you allergic to anything cartoonThe other week, the Centers for Medicare & Medicaid Services (CMS) shared five facts dispelling misperceptions about the transition to ICD-10.  We posted about that and added some comments.  In case you missed it, you can read that one here.

Here are five more facts addressing common questions and concerns CMS has heard about ICD-10:

Five More Facts about ICD-10 & comments about them

1. If you cannot submit ICD-10 claims electronically, Medicare offers several options.

CMS encourages you to prepare for the transition and be ready to submit ICD-10 claims electronically for all services provided on or after October 1, 2015. But if you are not ready, Medicare has several options for providers who are unable to submit claims with ICD-10 diagnosis codes due to problems with the provider’s system. Each of these requires that the provider be able to code in ICD-10:

  • Free billing software that can be downloaded at any time from every Medicare Administrative Contractor (MAC)
  • In about ½ of the MAC jurisdictions, Part B claims submission functionality on the MAC’s provider internet portal
  • Submitting paper claims, if the Administrative Simplification Compliance Act waiver provisions are met

If you take this route, be sure to allot time for you or your staff to prepare and complete training on free billing software or portals before the compliance date.

2. Practices that do not prepare for ICD-10 will not be able to submit claims for services performed on or after October 1, 2015.

Unless your practice is able to submit ICD-10 claims, whether using the alternate methods described above or electronically, your claims will not be accepted. Only claims coded with ICD-10 can be accepted for services provided on or after October 1, 2015.

3. Reimbursement for outpatient and physician office procedures will not be determined by ICD-10 codes.

Outpatient and physician office claims are not paid based on ICD-10 diagnosis codes but on CPT and HCPCS procedure codes, which are not changing. However, ICD-10-PCS codes will be used for hospital inpatient procedures, just as ICD-9 codes are used for such procedures today. Also, ICD diagnosis codes are sometimes used to determine medical necessity, regardless of care setting.

4. Costs could be substantially lower than projected earlier.

Recent studies by 3M and the Professional Association of Health Care Office Management have found many EHR vendors are including ICD-10 in their systems or upgrades—at little or no cost to their customers. As a result, software and systems costs for ICD-10 could be minimal for many providers.

5. It’s time to transition to ICD-10.

ICD-10 is foundational to modernizing health care and improving quality. ICD-10 serves as a building block that allows for greater specificity and standardized data that can:

  • Improve coordination of a patient’s care across providers over time
  • Advance public health research, public health surveillance, and emergency response through detection of disease outbreaks and adverse drug events
  • Support innovative payment models that drive quality of care
  • Enhance fraud detection efforts

What this means for smaller independent practices (from our perspective)

First – Don’t put yourself in a position where you are scrambling to try and figure out a work-around at the 11th hour.

It is very nice that Medicare offers some options for you in the event that you haven’t gotten your act together in time.  The problem with this is that you will still be scrambling to figure things out, to learn a new system, to learn what crazy hoops you have to jump through just to get by.  This will still cripple your operation.

Don’t rely on some duct tape patch job free software program provided by MAC.  The software may be free but your time is not.  Remember this is free software for sending a claim – period.  It is not a Practice Management software and it will not integrate with Medisoft or Lytec.

In the free program, you won’t be able to post payments, send statements, run reports, track aging, etc.  This means you will still need to log all of the information into your Practice Management software (Medisoft or Lytec), and then rekey it into the “free software” so that you can submit the claim.

If you are already using Medisoft or using Lytec for your billing, your best bet is to continue managing all aspects of your billing from one place in a program that you are already familiar with.

We also recommend getting the ICD-10 ready version early.  Get it early so you can practice and be prepared.  Get it early so you don’t get caught in a tidal wave of other practices who are waiting till the last minute.


Second – if you are using the Medisoft or Lytec EMR systems, the ICD-10 billing components are included.

When you use McKesson Practice Choice EMR that is integrated with either Lytec or Medisoft, your ICD-10 ready version of Lytec or Medisoft is included with the EMR subscription.  Same with Lytec MD or Medisoft Clinical EMR systems.  If you have already been using these systems then the ICD-10 features you need are already available to you.

If you are one of the hold-outs for implementing EMR, and if you have not upgraded your PM software, then maybe now is the time to consider implementing an EMR.  Aside from all the regular advantages of implementing EHR (which are many), and also aside from the fact that when you implement a Medisoft or Lytec EHR you will get the ICD-10 features for free, there are many aspects of our EHR systems that will make your life easier with the transition to ICD-10.

Do you want to learn how to make the transition to ICD-10 easier on you?

Click here to opt-in to our ICD-10 webinar recordings.


Start Practicing Using Your ICD-10 Codes As Soon As…Now!

Even if you have all of the tools that you need, if you wait until October 1 to start using everything, then it will be a rough transition.  If you haven’t worked out your own kinks, then you could see significant delays in getting your claims paid and you will be frustrated with the process.  Don’t do that to yourself.  You can start practicing today!

Here are a couple tips to help you start practicing.

Our second webinar recording shows you how to put your software (either Lytec or Medisoft) into “testing mode” so that you can submit test claims.  In our third webinar, we outline how you can test your ICD-10 claims with your clearinghouse.  We provide specific information from Relay Health because that is our preferred clearinghouse, but we give you the info you need so you can enquire with your own.

There is also a feature in your ICD-10 version of the program that allows you to just start coding everything in ICD-10 right now, but your claims will still be submitted in ICD-9 right up until September 30th!  In the program, you can set a date for when to start submitting your ICD-10 claims.  Set that date right now so you don’t need to worry about making any changes on the morning of October 1.  Learn how to do this by watching the webinars.

Doing all this will allow you to practice coding in ICD-10 now and so that you and your staff can get comfortable with the changes, but without the added stress of potentially delayed payments.

Good luck!  Please comment below if you have any questions, need any help, or have any success / failure stories to share with the community.


Disclaimer: AZCOMP Technologies, Inc, (AZCOMP) is providing this material as an informational reference for practices who currently submit claims using ICD-9 codes. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of posting, the Health Care industry is constantly changing, and it is the responsibility of each provider to keep themselves up to date of industry requirements.

Five Facts about ICD-10 from CMS

quick fix icd-10 conversion team cartoon

The Centers for Medicare & Medicaid Services (CMS) recently talked with providers to identify common misperceptions about the transition to ICD-10 in order to help dispel some of the myths surrounding ICD-10.  Some of the most common questions and concerns about ICD-10 are covered in these five facts written by CMS.

The Five Facts about ICD-10 & CMS comments about them

1. The ICD-10 transition date is October 1, 2015.

The government, payers, and large providers alike have made a substantial investment in ICD-10.  This cost will rise if the transition is delayed, and further ICD-10 delays will lead to an unnecessary rise in health care costs.  Get ready now for ICD-10.

2. You don’t have to use 68,000 codes.

Your practice does not use all 13,000 diagnosis codes available in ICD-9.  Nor will it be required to use the 68,000 codes that ICD-10 offers.  As you do now, your practice will use a very small subset of the codes.

3. You will use a similar process to look up ICD-10 codes that you use with ICD-9.

Increasing the number of diagnosis codes does not necessarily make ICD-10 harder to use.  As with ICD-9, an alphabetic index and electronic tools are available to help you with code selection.

4. Outpatient and office procedure codes aren’t changing.

The transition to ICD-10 for diagnosis coding and inpatient procedure coding does not affect the use of CPT for outpatient and office coding.  Your practice will continue to use CPT.

5. All Medicare fee-for-service providers have the opportunity to conduct testing with CMS before the ICD-10 transition.

Your practice or clearinghouse can conduct acknowledgement testing at any time with your Medicare Administrative Contractor (MAC).  Testing will ensure you can submit claims with ICD-10 codes.  During a special “acknowledgment testing” week to be held on June 2015, you will have access to real-time help desk support.  Contact your MAC for details about testing plans and opportunities.

What this means for smaller independent practices (from our perspective)

First – if you feel you aren’t prepared, there is no time like today to get started.

What do you need to do to get prepared?  That answer is different for each different practice, but we have some resources available for you.  Use the ones that fit best with where you are at.

ICD-10 Planning Tools

ICD-10 Webinar Series – A few months back we hosted a series of ICD-10 webinars.  You can access the recordings now by clicking here.  In these 4 short webinars (each recording is between 30 to 45 minutes) we provide a lot of information to help with planning, to help you learn how to use the ICD-10 tools that are built into Medisoft v20/v19 and Lytec 2015/2014, how to conduct testing with your clearinghouse, and give other tips on how to become ICD-10 ready.

Quick ICD-10 Planning Checklist – This 1 page (front and back) checklist summarizes in simple terms what you need to consider for your practice to get ICD-10 ready.

ICD-10 Impact Summary – This 1 page (front side only) info sheet summarizes how ICD-10 might impact different aspects of your practice to help you understand what changes you might need to make. – They have some videos you can watch, a “Build Your Action Plan” tool you can use and many other articles and other resources.

Second – you need to upgrade to the ICD-10 ready version of your software.

Your software is not ICD-10 ready if you are not on Medisoft v20/v19, or Lytec 2015/2014.  Medisoft v18 or any other earlier model is not ICD-10 ready.  Lytec 2013 or any other earlier model is not ICD-10 ready.

Call us today at (888) 799-4777 to get your ICD-10 ready software.

Third – consider additional software solutions to help make the transition easier.

In addition to upgrading to Medisoft v20 or Lytec 2015, there are additional tools that can help make things easier.  Fact number 3 above provided by CMS states that electronic tools are available to help you with code selection.  Here are the tools that we have to offer.

Codes on Disk

If your time is valuable then you are going to truly appreciate this simple tool.  Import the latest CPT-4, ICD-10, and HCPCS codes for your specialty into Medisoft or Lytec to assist you with implementing the standard code set requirement for HIPAA.  Save yourself hours of manual labor entering all those procedure and diagnosis codes.  This tool can be used by existing Lytec and Medisoft users alike.  It will not erase your existing codes.

Encoder Pro

Encoder pro enables users to simultaneously search across ICD-10, CPT, and HCPCS codes to get integrated search results, code details, and descriptions.  This will save so much time compared to searching a physical code book by hand.  If you have Google or Bing at your fingertips, would you ever go pick up a phone book or encyclopedia or dictionary?  Take advantage of Encoder Pro the way you use Google to find things out.


Has your practice implemented an EMR yet?  If you are not using EMR yet, let ICD-10 be another reason to consider it.

How can EMR help with ICD-10?  The short answer is that we cover 5 ways an EMR can help make the transition to ICD-10 easier in our webinar series mentioned above.  Feel free to watch the webinar recordings.

Still not really a direct answer, but here are two questions to consider to get you started thinking about it.

Question 1: What is your paper superbill going to look like with the expanded list of codes you will use in your practice?

Question 2: With an increased need for documentation, how are you going to retrain yourself or your staff to be better at documentation?

With the transition to ICD-10, even though you won’t need to use all 68,000 codes, you will definitely see an increase in the number of codes you are using on a regular basis.  This could significantly increase the size of your superbill.  If you are seeing patients with a four or eight page superbill, how fun will that be to manage?

By implementing an EMR, you will make the switch to an electronic superbill which will be so much better for managing all those codes.  Additionally, the documentation needed with your ICD-10 claims will be taken care of for you while using the EMR program.

There are several other ways an EMR can help with ICD-10, which are covered in our webinar replay you can watch.  And of course EMR helps in many other aspects with amazing tools like e-prescribing, lab-interfaces, eliminating paper charts and helping to improve patient care to name just a few.  To learn more about our Medisoft and Lytec EMR options or to schedule a demo, just give us a call!

Lastly – practice using ICD-10 codes starting ASAP!

Practice!  Practice!  Practice!

Even if you have all of the tools that you need, if you wait until October 1 to start using everything, then it will be a rough transition.  If you haven’t worked out your own kinks, then you could see significant delays in getting your claims paid and you will be frustrated with the process.  Don’t do that to yourself.  You can start practicing today!

Here are a couple tips to help you start practicing.

Our second webinar recording shows you how to put your software (either Lytec or Medisoft) into “testing mode” so that you can submit test claims.  In our third webinar, we outline how you can test your ICD-10 claims with your clearinghouse.  We provide specific information from Relay Health because that is our preferred clearinghouse, but we give you the info you need so you can enquire with your own.

There is also a feature in your ICD-10 version of the program that allows you to just start coding everything in ICD-10 right now, but your claims will still be submitted in ICD-9 right up until September 30th!  In the program, you can set a date for when to start submitting your ICD-10 claims.  Set that date right now so you don’t need to worry about making any changes on the morning of October 1.  

Doing all this will allow you to practice coding in ICD-10 now and so that you and your staff can get comfortable with the changes, but without the added stress of potentially delayed payments.

That’s it for now.

If you’ve been working on getting ICD-10 ready at your practice – feel free to share your successes or your failures with the community so we can learn from each other.  Share with us in the comments below!

Congress Passes Historic Medicare Reform

Bipartisan Bill Headed to President’s Desk for Signature

(The content of this post is from a letter received from McKesson on April 15, 2015 as a McKesson Public Affairs ALERT.)

congress passes historic medicare reform HR2

Yesterday, the U.S. Senate overwhelmingly passed H.R. 2 which reforms the Medicare physician payment system, helps slow healthcare cost growth, and extends healthcare coverage for children. The measure also passed the House by a bipartisan vote of 392 to 37. The President plans to sign the bill.

The passage of these critical reforms is both substantively and politically important.  The measure avoids the threat of draconian cuts to Medicare providers. Politically, the bipartisan negotiating process and the overwhelmingly bipartisan vote show that in the newly controlled Republican Congress both parties can work together to get things done.

McKesson has advocated for these Medicare reforms in recent years and strongly supports this measure as it will have a positive impact on our physician customers and business partners.

What is the Sustainable Growth Rate (SGR)?

Medicare payments to physicians are determined under a formula, commonly referred to as the “Sustainable Growth Rate” (SGR).  SGR was first passed into law in 1997 and intended to control physician spending by linking it to the nation’s economic growth.  The formula has called for reductions in physician payment rates since 2002, but Congress has spent nearly $150 billion in 17 short term patches to avoid the cuts.  The most recent patch was to expire on March 31st.  If Congress hadn’t acted, providers would have received a 21% reimbursement rate cut in April.

For several years, a bipartisan group of legislators had been working to permanently reform the SGR formula, but an agreement had proved politically elusive.  However, a few weeks ago, Speaker Boehner and Democratic Leader Pelosi announced they had reached a deal.

What Does the Bill Do?

The Medicare Access and CHIP Reauthorization Act (H.R. 2) returns certainty to Medicare reimbursement, incentivizes quality and value, slows the growth of health care spending, and extends health coverage for children.  Specifically, the bill:

  • Reforms the Medicare physician payment system by providing a 0.5% annual increase for Medicare providers for the next four years;
  • Transitions to an incentive-based payment system in 2019 with potential for increased payment rates for providers participating in alternative payment models based on patient outcomes;
  • Requires Electronic Health Records (EHRs) to be interoperable by 2018 and prohibits providers from deliberately blocking information sharing with other EHR vendor products;
  • Extends funding for the Children’s Health Insurance Program (CHIP) and Community Health Centers for an additional two years, and
  • Extends for six months a moratorium on enforcement of the “two-midnight” rule for short inpatient hospital stays.

What Does This Mean for McKesson Customers?

The guaranteed payment increase over the next four years will introduce mid-term stability and predictability for Medicare providers before they are transitioned to a new value-based system. The bill also supports providers as they navigate participation in alternative payment models, with the potential for increased reimbursement rates.

Though hospitals, nursing homes and rehabilitation centers will only see a base pay increase of 1% in 2018, about half of the increase without passage of the legislation, they largely backed the bill. In a letter, the American Hospital Association commended Congress for delaying cuts to the Medicaid Disproportionate Share Hospital program an additional year, until 2018, and extending the partial enforcement delay on Medicare’s “two-midnight” policy for an additional 6 months.

This bill is also good news for hospitals, clinics, and providers who treat children enrolled in the CHIP program; without the two year extension, approximately two million children would lose access to healthcare, and more than eight million children could lose access to specialty care.

Finally, the bill requires EHRs to be interoperable by 2018 and prohibits providers from deliberately blocking information sharing with other EHR vendor products.  It also leverages EHRs for quality reporting and requires the exchange of healthcare information to manage patient care across care settings.

For More Information

To read more about this legislation, see the official House Energy and Commerce Committee detailed summary here.

Relay Health ICD-10 Testing Information

Learn Here How To Test Your ICD-10 Claims With Relay Health


Relay Health is an electronic claims clearinghouse that is integrated with the Revenue Management feature of Medisoft and Lytec.  Relay Health’s seamless integration is awesome for you because it allows you to manage the entire claims process from within the program (Medisoft or Lytec), it provides you with real-time information about claim rejections or approvals, it speeds up the payment process, and reduces the time you spend on the claims process.

If you are not using the Relay Health clearinghouse, give AZCOMP a call to find out more about how Relay Health can save you time and get you paid quicker.

ICD-10 Testing

Earlier this year, AZCOMP produced and hosted 4 webinars designed to help small practices get ready for ICD-10.  In these webinars we discussed things like:

  • The ICD-10 billing challenges and the solutions that are available to you in Medisoft version 20 (or 19) and Lytec 2015 (or 2014)
  • How to put Medisoft or Lytec into “testing mode” so that you can test sending claims
  • How to set the date for the ICD-10 transition so that you can start using ICD-10 codes today and still be submitting your claims using ICD-9 codes
  • How to begin testing with your clearinghouse (including how to do this with Relay Health)
  • Problems your practice will face switching to ICD-10 outside of submitting claims and the solutions to these problems.

There was a lot more discussed in the 4-part webinar series but those are the highlights.

Click Here To Get Access To The Webinar Recordings!

Relay Health’s ICD-10 Testing Update

AZCOMP is a partner with Relay Health and they recently sent us this information about conducting ICD-10 testing with them.  Everything that you read below here is the information that we received from them.

ICD-10 Testing – It’s Easier Than You Think!

By now you’ve heard the warnings. If you’re not already conducting ICD-10 testing, you’re late. So why are you waiting? It’s easier than you think!

There are three types of testing available to RelayHealth customers:  End-to-End Testing, Validation Testing, and Self-Supported Payer Testing. 

Here’s how to get started:

1. End-to-End Payer Testing (Available Through July 31, 2015)
RelayHealth customers can send ICD-10 test claims to the 300+ core payers that are part of the RelayHealth testing program. Test claims will be processed through RelayHealth and sent to payers following the same process as ICD-9 claims.

  • Determine if you have been selected by your payers to conduct ICD-10 testing. Most payers are indicating they will test with a limited number of providers. 
  • View the training course for the RelayHealth ICD-10 testing program. This training course should be viewed prior to attempting any ICD-10 testing with your payers.
  • Review the “RelayHealth Reports – Test” section of the RelayHealth Reference Guide for information on RelayHealth generated test reports returned for test claims.  
  • Access the Payer Testing Readiness Dashboard from ConnectCenter or Collaboration Compass to determine if your payers are ready to conduct end-to-end ICD-10 testing.

Hundreds of RelayHealth customers have used our end-to-end ICD-10 testing platform to submit thousands of ICD-10 test claims to their payers and receive test claim remittances back from their payers. 

This end-to-end testing platform is only available until July 31, 2015. This aligns with the Centers for Medicare and Medicaid Services’ (CMS) recommendation to complete all ICD-10 testing by July 31 – to focus on final go-live preparations and mitigations (if any) during the last 60 days before the compliance deadline.  

2. Validation Testing (Available throughout the ICD-10 transition)
Validation testing allows customers to verify that their ICD-10 test claims have been successfully transmitted to RelayHealth – but it does not include the transmission to the payer component of end-to-end testing. 

Customers can send ICD-10 test claims to RelayHealth for code set validation of ICD-10-CM (Clinical Modification) for diagnosis and ICD-10-PCS (Procedure Coding System) for inpatient hospital procedures.

3. Self-Supported Payer Testing (Available throughout the ICD-10 transition)
If you were not selected by your payers to participate in end-to-end testing, you should ask your payers if they will enable you to submit passive ICD-10 test transactions. RelayHealth provides the means to conduct passive testing by enabling you to deliver an 837 test file to providers. This allows you to test directly with any of your payers, whether you’ve been selected to test or not.


If your organization is not ready for the ICD-10 transition, you may experience significant backlogs, claim denials, and negative impacts on revenue. 

Read One Customer’s ICD-10 Testing Success Story
From the start, Tampa General Hospital understood the importance of payer-provider collaboration in ICD-10 readiness – particularly when it came to testing. They knew that this testing would be different than anything the industry had done before and in order for it to be meaningful, there had to be open and transparent collaboration between providers and payers. Learn how Tampa General validated its ICD-10 readiness and also helped identify some potentially problematic claim issues.

Action Required: If you haven’t started ICD-10 testing yet, we recommend you choose one – or more – of the testing options offered through RelayHealth and get started as soon as possible.

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