There are two types of patient statements.

  1. Standard Statement: This type of statement will show all charges that have a balance on them. The balance shown on this statement is the Patient Reference Balance. If you print or send standard statements, your patients will get statements showing a balance that may not reflect the amount the patient will need to pay. For this reason, we recommend that you do not use standard statements for patient billing purposes.
  2. Remainder Statement: Patient remainder statements will show the charges that make up the patient remainder balance. This means that charges that have not yet been paid by responsible insurance carriers will not appear on these statements. We recommend that you use remainder statements for patient billing purposes.
  3. Missed Co-pay Remainder Statement: The only difference between this and the Remainder Statements is that this statement will include missed copays in the total amount due. In order for this statement to work properly you must turn this function on in Program Options by checking the Add Copays to Remainder Statements field in the Billing tab. This statement function is only available using Statement Management.
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As you prepare for your transition to the new ICD-10 diagnosis codes, you will need to work closely with different partners.  In today’s blog post, we are going to look at the role of working with your clearinghouse and how they can help you prepare for the new diagnosis code implementation.  At the bottom of the blog post are some questions you should ask your clearinghouse.

Planning for ICD-10: Working with Clearinghouses


As we move towards the ICD-10 transition, CMS reminds practices that clearinghouses can be a valuable resource for testing ICD-10 preparedness. For instance, clearinghouses can help providers look at the reasons for rejection and analyze their claim problems during the transition. However, providers should not expect clearinghouses to offer the same level of assistance for ICD-10 transition as they did when HIPAA Version 5010 was implemented, since ICD-10 is based on provider data and clinical documentation.

The Role of Clearinghouses in the ICD-10 Transition
Practices preparing for the October 1, 2014, ICD-10 deadline are looking for resources and organizations that can help them make a smooth transition. It is important to know that while clearinghouses can help, they cannot provide the same level of support for the ICD-10 transition as they did for the Version 5010 upgrade. ICD-10 describes a medical diagnosis or hospital inpatient procedure and must be selected by the provider or a resource designated by the provider as their coder, and is based on clinical documentation.

During the change from Version 4010 to Version 5010, clearinghouses provided support to many providers by converting claims from Version 4010 to Version 5010 format. For ICD-10, clearinghouses can help by:

  • Identifying problems that lead to claims being rejected
  • Providing guidance about how to fix a rejected claim (e.g., the provider needs to include more or different data)

Clearinghouses cannot, however, help you identify which ICD-10 codes to use unless they offer coding services. Because ICD-10 codes are more specific, and one ICD-9 code may have several corresponding ICD-10 codes, selecting the appropriate ICD-10 code requires medical knowledge and familiarity with the specific clinical event.

While some clearinghouses may offer third-party billing/coding services, many do not. And even third-party billers cannot translate ICD-9 to ICD-10 codes unless they also have the detailed clinical documentation required to select the correct ICD-10 code.

As you reach out to your clearinghouse or billing service, you may want to ask:

  • Are you prepared to meet the ICD-10 deadline of October 1, 2014? Where is your organization in the transition process?
  • Can you verify that you have updated your system to Version 5010 standards for electronic transactions? (Only systems with Version 5010 can accept ICD-10 codes; systems with the older, Version 4010 standards cannot accommodate ICD-10.)
  • Who will be my primary contact at your organization for the ICD-10 transition?
  • Can we set up regular check-in meetings to keep progress on track?
  • What are your plans for testing claims containing ICD-10 codes? How will you involve your clients, such as my practice, in that process?
  • Can my practice send testclaims with ICD-10 codes to see if they are accepted? If so, when will you begin accepting test claims?
  • Can you provide guidance or training on how my clinical documentation will have to change to support ICD-10 coding?
  • Do you anticipate any pricing changes for your services due to the switch to ICD-10?

As you prepare for the October 1, 2014, ICD-10 deadline, clearinghouses are a good resource for testing that your ICD-10 claims can be processed—and for identifying and helping to remedy any problems with your test ICD-10 claims.

Keep Up to Date on ICD-10:
Visit the CMS ICD-10 website for the latest news and resources to help you prepare for the October 1, 2014, deadline.

Article Resource:
The Role of Clearinghouses in the ICD-10 Transition” located on the CMS website.
Planning for ICD-10: Working with Clearinghouses and Billing Services” located on the CMS website.

For more resources or information on Medisoft ICD-10 readiness, please visit www.medicalbillingsoftware.com/medisoft-icd-10.htm

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