Gearing up for ICD-10

Apr 07, 2015 at 04:16 pm by Staff

CMS confirms Oct. 1 switch; healthcare consultant offers cautionary notes

Successful completion of a full week of end-to-end testing of the new ICD-10 coding shows the healthcare industry is ready for the next step toward total conversion from ICD-9 coding, Marilyn Tavenner, former administrator of the Centers for Medicare and Medicaid Services (CMS) said before her departure from the federal agency earlier this year.

To promote the healthcare industry’s smooth transition from ICD-9 to ICD-10, CMS is conducting a comprehensive program of testing. In the first full week of testing -- from Jan. 26 to Feb. 3 – CMS received nearly 15,000 test claims from 660 providers.

“Testing allows us to identify areas of improvement, and we’ll work with outside entities and stakeholders to improve those very small deficiencies identified,” she said at the time. “And we’ll continue to do testing, especially in those areas we identify as needing improvement.” Tavenner added, “Because ICD codes are required on medical bills, we want healthcare providers to be confident they can submit Medicare claims and get paid as the nation switches to ICD-10.”

CMS also identified a point that’s prompted some confusion among the healthcare community. Acting Administrator Andy Slavic has reiterated ICD-9 coding is to be used for services provided before the Oct. 1 deadline; ICD-10 coding will be used for services provided on or after Oct. 1. Prior to Oct. 1, ICD-10 can be used only for test purposes. However, once we hit Oct. 1, 2015 only ICD-10 can be used for services rendered on or after that date. But claims submitted after Oct. 1, 2015, for services provided before that date, must still use ICD-9 codes.

Margie Maley, BSN, MS, coding educator and consultant with KarenZupko & Associates Inc., a national consulting firm based in Chicago, said she’s strongly advising clients that bill directly to Medicare to apply for end-to-end testing.

“If you don’t get accepted for end-to-end testing, at the very least conduct acknowledgement testing,” she said, noting that applications for the next available end-to-end testing (mid-July) became available on all carrier websites (MACs) on March 13.

“Medicare is only accepting up to 850 providers per testing week, so act fast,” urged Maley. “Even our orthopedic clients who must deal with the greatest increase in ICD-10 codes and reorganization have jumped onto the testing bandwagon successfully.”

Maley pointed out that claims testing highlights more than ICD-10 issues. 

“Medicare says that 6 percent of testing errors were due to ICD-10,” she emphasized. “Yet more than twice that – 13 percent – were due to provider-preventable errors, such as incorrect NPI or submitter ID, or invalid place of service or HCPCS codes.” 

Carrier software bugs are also being caught in the testing phase.

“A lot of this is just the nature of software development … not necessarily a coding issue,” Maley said. “Everyone is creating new features to deal with ICD-10 and they need to be tested so bugs are caught and fixed before the deadline. So make sure your practice is part of the testing process. You never know what you might learn about your own processes.”

CMS is clearly ready for ICD-10, emphasized federal officials.

“And thanks to our many partners — spanning providers, health plans, coders, clearinghouses, professional associations and vendor groups — the healthcare community at large will be ready for ICD-10 on Oct. 1,” Tavenner promised before stepping down. “I appreciate the tremendous efforts and achievements of health professionals as we work together to realize the benefits of ICD-10 and other advances toward the ultimate goal of improving the quality and affordability of healthcare for all Americans.”

For healthcare providers unable to complete the necessary systems changes to submit claims with ICD-10 codes by Oct. 1, CMS has provided free billing software via MAC websites.

This billing software has been updated to support ICD-10 codes to offer submitters an ICD-10 compliant claims submission form; coding assistance isn’t provided. Alternatively, all MACs websites provide internet portals; a subset of those portals offer claims submission.


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