Tiptastic Tuesday: ICD-10 Acknowledgement Testing Week Is This Week!

We would like to remind trading partners, billing services, software vendors, and clearinghouses that ICD-10 Acknowledgement Testing Week is this week, March 2-6, 2015. This testing week allows CMS to analyze testing data. Registration is not required for Acknowledgement Testing Week.

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AMA Wants to Delay ICD-10 Implementation

The American Medical Association (AMA) recently reinforced its position that ICD-10 implementation should be delayed by two years. The AMA was instrumental in helping delay the ICD-10 implementation from October 1, 2013 to October 1, 2014. However, some experts say that this delay is only hurting physicians by giving them the idea that the AMA will be able to delay ICD-10 implementation once again.

So, how can we make physicians start taking ICD-10 implementation seriously? We can start by reminding them that ICD-10 will not change the way they practice medicine, it will only change the way they document it. In fact, ICD-10 is written more in clinical terms and less in coder speak so this may be important to physicians who already document necessary information about their patients. It is crucial that physicians are reminded not what they need to document, but what they are not documenting.

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Medicare Will Not Conduct End-to-End Testing for ICD-10, MGMA Concerned

As you know, CMS will be switching to ICD-10 but they won’t be testing the system, potentially putting your revenue at risk.  Officials from the Medical Group Management Association (MGMA) state that they are “extremely concerned” and that failure to conduct testing could end in cash flow disruption and “serious access to care issues for Medicare patients.”  Industry pressure could eventually convince CMS to reverse its decision and do some testing.

CMS officials are surprised that anyone expected ICD-10 testing, although they are requiring Medicaid agencies to test the system with providers.  According to CMS, it’s up to health systems, hospitals, and physician practices to ensure they can send data in the correct format.

Some experts recommend that healthcare providers start to perform their own testing with payers to make sure their revenue stays afloat after the switch.

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Preparing For ICD-10: Non-Covered Entities

Non-covered entities are not required to transition to Version 5010 and ICD-10. However, for many organizations, the bene­fits of adoption far outweigh the challenges. ICD-10 coding will benefit non-covered entities in several ways, including:

  • Expanded detail in injury codes, which will help automobile insurance and worker’s compensation programs.
  • ICD-9 codes will no longer be maintained once ICD-10 has been implemented; the ICD-9 codes will become less useful and resources will be continually harder to obtain.
  • Use of Version 5010 and ICD-10 facilitates claim ­ling for coordination of bene­fits.
  • Implementation of Version 5010 and ICD-10 is consistent with industry standards.

Preparing For ICD-10: The Role Of Clearinghouses

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 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.

Preparing For ICD-10: Payer Basics

The transition to ICD-10 is mandatory for all payers, providers, and other organizations covered by the Health Insurance Portability and Accountability Act (HIPAA). It is important to keep your ICD-10 transition efforts on track. Allow adequate time for testing, which is estimated to take payers up to 23 months. Payers must plan to be ready to process claims with ICD-10 codes for medical diagnoses and inpatient procedures. The following are steps to take now to prepare for the ICD-10 transition:

  • Review: Review payment policies. The transition to ICD-10 will involve new coding rules.
  • Investigate: Investigate General Equivalence Mappings (GEMs) and reimbursement crosswalks. This will help assess the impact of ICD-10.
  • Check: Check with software vendors, billing services, clearinghouses, and providers. Ask software vendors, billing services, and clearinghouses, as well as providers to find out what they are doing to prepare and what their timelines are for testing and implementation.
  • Communicate: Communicate with colleagues about the ICD-10 transition. Meet with professional and support staff to discuss the new codes and where they are used to help assess the impact. Assign roles and responsibilities for addressing the transition.
  • Identify: Identify needs and resources. Consider the changes that will be required and develop a budget, timeline, and an implementation plan that take into account speci­fic workflow needs, vendor readiness and training.
  • Plan: Plan strategies that will minimize provider reimbursement and operational interruptions.

Tiptastic Tuesday: Processing Split Claims

Last week, the Centers for Medicare & Medicaid Services (CMS) clarified the policy for processing split claims for certain institutional encounters spanning the ICD-10 implementation date; when ICD-9 codes are effective for the portion of the services rendered on September 30, 2014 and earlier, and when ICD-10 codes are effective for the portion of the services rendered on October 1, 2014, and later.

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