ICD-10 Readiness

The new ICD-10 standard for diagnosis codes will be required for all HIPAA-covered CMS claims on October 1, 2015. We encourage customers to develop a readiness plan, and we will continue to closely monitor developments to keep you informed.

The Brightree team has been closely following the announcements and has a robust solution planned for release prior to the CMS deadline. This release will be fully compliant with the ongoing use of ICD-10 codes. As Brightree is a SaaS platform, all customers in good financial standing will be upgraded at no additional cost.

There are approximately 18,000 ICD-9 diagnosis codes, and the transition to ICD-10 will expand the number to approximately 140,000 codes. Because of the increased number of codes, there are very few one-to-one matches. Moving your business forward will require not only compliant solutions, but staff education and training. Brightree is ready to support you with both.

FAQs for Brightree ICD-10 readiness

What is Brightree's view on ICD-10?

With regard to ICD-10, our view remains consistent: We are committed to improving healthcare data integrity and information exchange, and have made meaningful investments to prepare our solutions for ICD-10 in advance of the October 1, 2015 date. Our cloud-based approach means all of our customers receive these enhancements automatically, without “upgrade” costs that apply when modernizing outdated server-based systems. Based on our investments, we stand ready to help our customers transition to ICD-10.

What can my company do to prepare ourselves for the transition to ICD-10?

Since much of the change affects your processes, it is best if you create an overall transition plan, build a team and establish a budget to cover any training costs or cash flow shortages. One of your initial actions should be to assess overall impact to the code set change in areas like workflow, forms and reports. Another key action would be to determine your most frequently used ICD-9 codes and start becoming familiar with the equivalent code or codes in ICD-10. Once ready, you will be upgraded automatically to the ICD-10 compliant release of Brightree. Be sure to communicate your plans for the ICD-10 transition to all of your staff as well as any third parties such as referral sources. Be sure to provide adequate training for your staff to match their roles. Test your claims with direct payers and monitor Brightree’s testing with Medicare and other key payers.

My company requires all of our vendors to complete an ICD-10 compliance questionnaire to help with our planning. Who can I send this to for completion?

We are planning to respond to individual questionnaires. Please email support@brightree.com and we will respond as quickly as we possibly can.

Once the ICD-10 compliant releases are available, will they be available to all customers immediately, or will there be a waiting list?

We will follow our normal release process by testing with Beta customers first, then making the release Generally Available to all customers afterward.

Has Brightree participated in the testing period facilitated by CMS?

Yes. In, March 2014, Brightree submitted multiple test claims across all product lines – including the Brightree HME, Brightree Home Health, Brightree Hospice, Pacware and MedAct products – and has received 100 percent acceptance that the test claims have been acknowledged and accepted by CMS. In addition, we have also successfully completed end- to-end testing with CMS in January 2015. For more information please click here.

Will Brightree solutions be able to automatically convert all my ICD-9 codes to ICD-10 codes?

No, Brightree will not be able to automatically convert any ICD-9 codes to ICD-10 codes. Unlike the transition to 5010 format where vendors and clearinghouses were able to convert 4010 files to 5010 files, ICD-10 codes must be specific to the diagnosis of the patient as determined by the physician. Brightree is working on reports and other tools to assist our customers with the transition.

Will there be additional charges for the ICD-10 compliant releases of Brightree solutions?

No, there will be no additional charges for this functionality.

Will additional hardware be needed for the upgrades?

No, there are no additional changes in hardware that will need to be made.

How will Brightree solutions accommodate both ICD-9 and ICD-10 as we work with claims for services provided before and after the deadline, or for non-covered entities?

For both historical purposes and claims processing during the transition period, the display and usage of both ICD-9 and ICD-10 is expected to be needed on a payer by payer basis. The appropriate code (ICD-9 or ICD-10) will be available based on the payer and date combination.

Will ICD-9 remain available in Brightree solutions for use with exempt insurers (i.e. workers’ comp and auto)?

Yes, the Brightree solutions will still support ICD-9 codes as needed in the new releases.

What type of education and training will Brightree provide to customers?

Brightree will provide free online training and awareness sessions to prepare customers for the transition.

When will the training be for Brightree customers?

We will follow our normal release process and conduct training just prior to the release.

Does Brightree offer Consulting Services to help me with this transition?

Yes. For more information on what services are available, please contact info@brightree.com.

Does Brightree offer a Billing Service that I can use to help me?

Yes. For more information on what services are available, please contact info@brightree.com.

Who is the Brightree executive in charge of ICD-10?

Steve Rogers, Vice President Product Management. For questions email support@brightree.com or call 1-888-598-7797 x 5.

Brightree HME and Pharmacy customers

What specific changes are being made in the Brightree HME solution to support ICD-10?
  • With the ICD-10 compliance release of the Brightree HME solution, you will be able to populate a patient and their orders with both ICD-9 and ICD-10 codes.
  • Brightree HME will be able to create claims with either ICD-9 or ICD-10 codes based on the service date. This will allow you to update patients and orders in advance of the cutover date of 10/1/15 minimizing any billing delays. You will be able to set payer-specific cutover dates for any payers that will not be ready by the general cutover date.
  • Brightree HME will expand orders to allow up to twelve ICD-9 and twelve ICD-10 codes at a time to accommodate the new CMS 1500 form.
  • We are also updating our external API and other partner integrations (i.e. rehab anywhere) to accommodate entry of ICD-9 and ICD-10 codes.
  • Reports will be updated to show ICD-10 diagnosis codes. Existing customer extracts reporting on diagnosis codes will be updated to show both code sets.
  • We are updating pharmacy and NCPDP claims to accommodate ICD-10 codes.
When will you have a test environment ready for the Brightree HME solution?

We will make our test environment available early Summer 2015.

Brightree Home Health and Hospice customers

What specific changes are being made in the Brightree Home Health and Hospice solution to support ICD-10?
  • We are adding effective start and end dates to the diagnosis screen to control when diagnoses codes are active. This will also allow the system to support the transition period when ICD-9 and ICD-10 codes are both used for claim generation and provide historical information for reporting.
  • We improved the code and keyword search to use the auto-complete functionality and fully incorporated the ICD-10 coding structure in the Search by Category functionality.
  • To support Home Health agencies, we will create new OASIS templates to support OASIS C-1 as well as an improved process for file generation.
How will Brightree Home Health support episodes that will start prior to 10/1/2015 and end after 10/1/2015?

Adding effective start dates and end dates will allow you to have both ICD-9 and ICD-10 codes active for an episode. All ICD-9 codes can end on 9/30/2015 and ICD-10 codes started on 10/1/2015. The changes will be available well ahead of 10/1/2015 so date entry changes can be made as soon as needed. Changes to the billing system will use the episode start date to show the ICD-9 codes on RAP and episode end date to show ICD-10 codes on the final claim.

Which payers will the Brightree Home Health and Hospice solutions be tested with and when?

Brightree will participate in the national testing with CMS. We are also working with our clearinghouse partner for Brightree Home Health and Hospice, Zirmed, to conduct testing with key payers as they become ready for testing.

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