TCMS Alert

CMS will appoint an Ombudsman (an advocate) that will help triage and address your ICD-10 issues and concerns with representatives in CMS’s regional offices. You can email the ICD-10 Ombudsman at icd10_ombudsman@cms.hhs.gov

Please read through this CMS document for more information:

https://www.cms.gov/Medicare/Coding/ICD10/Downloads/ICD-10-guidance.pdf

09/17/2015

CLAIMS WITH DOS PERFORMED AFTER OCT 1ST WILL REQUIRE ICD-10 CODING

Are you prepared or making preparations? Most of our clients have.

Criterions or TCMS will only convert or select an ICD10 Codes set if you have downloaded the latest update and activated the date sensitive settings in your setup.

To enter claims using ICD-10 codes for services performed on or after October 1^st, 2015, there are a few things you will need to do on October 1^st, 2015.

#1 – Make certain that you are using TCMS version 4.8.9.4 or higher.

#2 – Enter the ICD10 start date (10/1/2015) located at the bottom of the Practice Information section of setup

#3 – Enable the “Use ICD-10 Codes” option in Practice Defaults (middle tab) from within Practice Setup

#4 – Insurance carriers will need a checkmark in the option “Use ICD10 Code” in order to send ICD-10 formatted coding.

a) To place the checkmark in all carriers at once, use the option (at the top of the Insurance Setup screen) labeled “Use ICD10 for all carriers”

b) To place the checkmark in carriers individually: Edit the Insurance Carrier(s) to place a checkmark in the option “Use ICD10 Code” at the bottom of each carrier’s edit screen

#5 – Enter the ICD-10 codes you will need in the Diagnosis Code Setup screen.

a) ICD-10 can be entered manually (FREE) or with Automated Diagnosis Code Assistance (FEE)

b) Manual code entry assumes you have access to ICD-10 coding resources to assist with proper coding

For more details related to Readiness, click here

09/03/2015

ICD-10 Readiness

Criterions EHR and TCMS solutions are currently ICD-10 ready and now offer automated functionality to assist practices as they transition to this new coding methodology. To learn more about the features and pricing of ICD-10 Automated Diagnosis Code Assistance, please consult the ICD-10 Readiness document. In addition, practices opting for our automated ICD-10 solutions can complete the online ICD-10 Agreement

3/29/2015

Emdeon and EmblemHeath Insurance have come to an agreement..

The threat of electronic claim process redirection or interruption has been avoided.

3/9/2015 -

Emblem Health stating they will no longer accept Emdeon claims

Emblem health is mailing letters to all clients stating “On April 1^st EmblemHealth will end its Electronic Data Exchange (EDI) with Emdeon to submit electronic claims”

This notice, from Criterions, is to make you aware that we are aware. This is a contractual argument between the largest clearinghouse in the US and an equally large Insurance Payor.

We expect to receive more details in the days to come as they feverishly work to resolve this issue. We will keep all clients posted through notices, such as these, as we get this information.

3/8/2015

ICD-10 is almost a reality.

There are two related items in this alert that will help prepare your office for its use in Criterion’s TCMS and Browser software.

One attachment is a written, detailed 14-page book… the other is an abbreviated movie that focuses on the software setup for ICD-10.

Below are the Documents for you to Download

ICD10 - The Movie ICD10 - Documentation

TCMS Version 4.8.8.2

February 9th, 2015

ALL TCMS CLIENTS (ONLY) WILL NEED TO UPDATE TO VERSION 4.8.8.2

A universal change to the URL used by all TCMS clients to create a claim file occurred this past Friday. As a result, our programming staff create a new version of TCMS (v. 4.8.8.2) with only one enhancement that addresses the change.
Any clients that are using the TCMS browser, or EHR, are not affected by this change at all; however, if you are using TCMS, you will not be able to create an electronic claims file until you perform the update to this new version.

PQRS Deadlines are approaching

February 28th, 2015 - If filed using our EHR the 2014 filing deadline. Please note the

enrollment with Quality Net (EHR Registry) can take significant time.

March 31st, 2015 - If filed using our recommended registry however registry may have cutoff

by March 15^th 2015

PQRS Measure filings are performed in one of 3 ways:

· Claim based filing for the entire year submitted along with routine claim entries (Free)

· Filing through a certified registry service using a small sample population (Service fee)

· Filing through our certified EHR (Free)

Since 2007 many providers filed PQRS measures allowing them to receive an annual incentive bonus for their participation.

In 2013 a penalty began when data was not filed.

In 2014 (Filing now) the number of required measures to avoid the penalty is 3 and if you file 9 you will get a .5% bonus

In 2015 you will be required to report 9 measures to avoid the payment penalty.

Criterions has two offerings for clients who did not do claims based reporting throughout the 2014 year.

1. Meaningful Use EHR Clients – For clients who are using the latest Criterions EHR in a meaningful way (collecting clinical data), Quality Net has said clients may export a file (QRDA file) from their EHR and import it into the Quality Net registry system*.

a. There is no charge from Criterions for the production this QRDA files.

b. This method for reporting is new, untried and agency verbiage is confusing or contradictory. All of our communications with the registry indicate a provider only need to submit one measure to qualify for the incentive. We do not make any warranty to this claim and are not responsible for any untoward outcome. Their description is below:

1. Using a direct EHR product that is Certified EHR Technology (CEHRT) or EHR data submission vendor that is CEHRT, report on at least 9 measures covering 3 National Quality Strategy (NQS) domains. If the EP’s CEHRT does not contain patient data for at least 9 measures covering at least 3 domains, then the EP must report the measures for which there is Medicare patient data. An EP must report on at least 1 measure for which there is Medicare patient data.

Please note:

Registration is done online at: https://www.qualitynet.org/portal/server.pt/community/pqri_home/212

We have found the registration process to be time consuming (18+ steps) so please begin immediately.

Also the Quality Net Site seems to work best in the Google Chrome browser.

EHR Version 3.0.1.10 or our EHR is required to produce this file. You version number can be found in the lower right portion of your browser’s Criterions login screen.

2. Registry based reporting – Criterions will produce a file for clients who did not use the certified Criterions EHR in a meaningful way which will contain data on measures pertaining to most specialties.

a. The cost, charged by the registry is $350 per doctor for file production and registry submission.

b. Depending on the data available in your system, providers may be required to manually enter or select some data into the files to be submitted to the registry.

TCMS Version 4.8.7.1

Released October 27^th, 2014

There is now a Debit button available when a Copay is received and posted for a Processed Credit card payment.

There was an issue with the Employee Productivity report in a prior version. It was not picking up records to display on the report. This has been corrected in this version.

There was an issue with the System Debit function. An error would occur when a specific series of steps were taken by the user. This problem has been corrected.

Previewing a batch of previously printed Workers Comp claims was not marking the ledger if the batch was reprinted in a prior version. This has been corrected.

An option to include claims that are flagged as “On Statement Hold” has been added to the Patient Claims Export screen.

An option has been added in the Anesthesia Minutes Report’s wizard screen to select by transaction date range.

Clicking on the Audit key for the Insurance Profiles was taking too long to open. It has been sped up in this version.

TCMS had an issue in a prior version in the Scheduler that caused an error in the Oracle Software database. The error would occur intermittently and was not associated with any specific action by the user. We have identified the specific source and resolved the issue in this version.