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Finally ICD-10 is Coming!

July 16, 2015

ICD-10benefitsIt is as official as it can be. Despite efforts by the American Medical Association (AMA) to push back the ICD-10 implementation date for a fourth time, any further postponement is highly unlikely. All medical providers need to begin using the new codes on October 1, 2015. Those who are not ready yet need to pull out all the stops to get ready.If this means upgrading software to accommodate ICD-10, then upgrading must be done. There will be some accommodations for erring when submitting the wrong ICD-10 codes, but there will be no allowances for submitting claims with ICD-9 codes.

Although the AMA’s official policy is to oppose the October 1 implementation date, it has negotiated with the Centers for Medicare & Medicaid Services (CMS) to make some policy changes that will ease the transition. In a recent joint announcement issued by the AMA and CMS, it was made clear that the implementation date will not change. AMA and CMS will work together to assist providers to get ready for the big transition.

Prior to the joint announcement, providers were told their claims would be rejected outright if the wrong ICD-10 codes were submitted. To assist physicians who face a major loss of revenue if they are not yet up to speed on the new codes, CMS has eased its policies, essentially providing a grace period for the first year.

  • Claims that have unintentionally used the wrong ICD-10 code will not be denied or audited if the code is from the correct family of new codes.
  • Meaningful Use penalties will not be levied for the use of the wrong code if the code is from the correct family of the new codes.
  • If the Medicare claim cannot be processed due to inaccurate codes, advance payments to providers may be authorized.
  • CMS will provide an ombudsman through a Coordination Center who will be available to help providers with ICD-10 issues. The ombudsmen will “triage and answer questions about the submission of claims.”

According to American Health Information Management Association Senior Director of Coding Policy and Compliance Sue Bowman, the grace period provides the flexibility providers need during the transition time while also requiring at least a “basic level of accuracy.” She notes that it accommodates the need of the medical community to not have “too much rigidity during the learning curve period.”

The AMA and CMS will work together to provide training across the country to help assist those providers who are still unprepared for the transition. Both will be offering, either jointly or parallel, educational seminars and articles, webinars and even on-site training. CMS has provider training videos that can be accessed online.

Do you know if your practice is ready for ICD-10?

Although CMS will not reject claims with incorrect ICD-10 codes, the Medicare claims processing systems will not be able to process any claims with ICD-9 codes for services provided after September 30. The systems will also not be able to process any claims that are submitted with both ICD-9 and ICD-10 codes.

In the joint statement, the AMA and CMS noted that, in the U.S., the ICD codes have not changed in 35 years. Many terms are outdated and some are even obsolete. The change is necessary for the advancement of research and can no longer be delayed. The new coding will make it easier to detect “disease outbreaks and adverse drug events.”

Have your billing company ask payers some relevant questions

The president of the AMA pledges to continue working with CMS “to make sure the transition is as smooth as possible.” For further assistance in getting ready for the big October 1, 2015, implementation date, The CMS offers, for free, a “Road to 10” plan for use by smaller physician practices who may be having problems getting ready and need last minute assistance. All providers can find current information and assistance for ICD-10 implementation at the AMA Wire.

Please click the link below to join our free webinar to learn more about how you can implement ICD-10 action plan for your own practice. Please note only first 100 registrations are free after that its $299 per participant!


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