The ICD-10 Transition – Get the Facts

The United States’ upcoming transition to ICD-10-CM and ICD-10-PCS has been met with mixed reactions. The transition has many proponents and many detractors. A substantial portion of those who have voiced resistance to the idea of this transition is the physician provider community.

A large concern among physicians is the financial impact, on a small independent practice, that comes with the cost of converting software and computer systems to collect and report the new code set data. Additional concerns include the investment of time and resources necessary to educate internal staff to handle a sizeable expansion in the number of reportable codes as well as worries surrounding rejected claims secondary to not only coding errors, but technical errors and inability to update systems in time for the transition.

The Center for Medicare and Medicaid Services (CMS) has mandated the transition to ICD-10. In response to provider concerns, CMS has provided 10 facts about ICD-10 that address many of the fears that physicians have in face of ICD-10 implementation. The Healthcare IT News & Healthcare Finance’s ICD10Watch website included this list on their site on May 2, 2015.

Here are our favorites from their top 10 list:

You don’t have to use 68,000 codes.
Your practice does not use all 13,000 diagnosis codes available in ICD-9, nor will it be required to use the 68,000 codes that ICD-10 offers. As you do now, your practice will use a very small subset of the codes.

All Medicare Fee-For-Service providers have the opportunity to conduct testing with CMS before the ICD-10 transition.
Your practice or clearinghouse can conduct acknowledgement testing at any time with your Medicare Administrative Contractor (MAC). Testing will ensure that you can submit claims with ICD-10 codes. During a special acknowledgement testing week to be held in June 2015, you will have access to real-time help desk support. Contact your MAC for details about testing plans and opportunities.

If you cannot submit ICD-10 claims electronically, Medicare offers several options.
CMS encourages you to prepare for the transition and be ready to submit ICD-10 claims electronically for all services provided on or after October 1, 2015. But if you are not ready, Medicare has several options for providers who are unable to submit claims with ICD-10 diagnosis codes due to problems with the provider’s system. Each of these requires that the provider be able to code in ICD-10:

• Free billing software that can be downloaded at any time from every Medicare Administrative Contractor (MAC)
• In about half of the MAC jurisdictions, Part B claims submission functionality on the MAC’s provider internet portal
• Submitting paper claims, if the Administrative Simplification Compliance Act waiver provisions are met
• If you take this route, be sure to allot time for you or your staff to prepare and complete training on free billing software or portals before the compliance date.

These facts specifically address concerns that have been raised by the physician community in regard to size of the code set and claims rejection due to technical errors or system insufficiencies.

Visit the Healthcare IT News & Healthcare Finance’s ICD10Watch website to read more about CMS’ ICD-10 Facts.

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