ICD-10 Effective Oct. 1st
After numerous false starts, it now appears that the International Classification of Diseases, 10th Revision (ICD-10) will be a reality come this Thurs., Oct. 1st. The Centers for Medicare and Medicaid Services (CMS) is issuing final guidance to providers. According to Dr. Bill Rogers, the CMS ICD-10 Ombudsman, CMS is fully prepared for the transition and to solve problems that may arise.
The most recent guidance from Dr. Rogers states:
The U.S. health care system will start using the International Classification of Diseases, 10th Revision. This is a huge moment because ICD-10 will help doctors and other health care providers better:
· Define patients’ clinical status and treat their complex medical conditions.
· Coordinate care among providers.
· Support new payment methods that drive quality of care.
As we come to October 1st, CMS wants to assure the medical community that we’ve tested and retested our systems, and we’re prepared to solve problems that may come up.
Because we know this is a major transition, we’ll be:
· Monitoring the transition in real time.
· Watching our systems.
· Addressing any issues that come to the ICD-10 Coordination Center.
We’ll also be supporting you in four ways:
1. If you need general ICD-10 information, we have many free resources at our Road to 10 webpage and on gov/ICD10 that can help, such as the ICD-10 quick start guide, customized ICD-10 action plans, videos, and Frequently Asked Questions.
2. Your first line for help for Medicare claims questions is to contact your Medicare Administrative Contractor. They’ll offer their regular customer service support and respond quickly. You can find MAC contact information here.
3. You can e-mail our ICD-10 Coordination Center, and we’ll respond to your questions.
4. You can contact me, the ICD-10 Ombudsman. I’ll be an impartial advocate for providers, focused on understanding and resolving your concerns.
We’ve been working to help you move to ICD-10 by offering resources and flexibility, but if you aren’t ready for the transition, you still have options that will enable you to continue to provide care and be paid for your services. We recommend that you check with other payers to learn about their available claims submission alternatives.
The Road to 10 countdown clock highlights how close we are to this important milestone. If you haven’t yet started to transition, it is doable, and we encourage you to start today.
Source: CMS email distribution.
In addition, LeadingAge New York is reminding members of the CMS Frequently Asked Questions (FAQ) document that clarifies how CMS intends to handle claims during the transition period. Included in the FAQs is the question: “What happens if I use the wrong ICD-10 code, will my claim be denied?” The CMS response is:
While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practioners claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practioners used a valid code from the right family. However, a valid ICD-10 code will be required on all claims starting on October 1, 2015.
Source: CMS FAQ
Contact: Patrick Cucinelli, pcucinelli@leadingageny.org, 518-867-8827