Prepare Now for ICD-10 Implementation

The Centers for Medicare and Medicaid Services (“CMS”) issued confirmation last week that the compliance date for ICD-10 is October 1, 2015.   CMS has posted ICD-10 timelines and is directing providers to begin or continue implementation efforts now.  Health care providers, payers, clearinghouses, and billing services must be prepared to comply with the transition to ICD-10.

ICD-10 will affect diagnosis and inpatient procedure coding for everyone covered by the Health Insurance Portability and Accountability Act (“HIPAA”). ICD-10 diagnosis codes must be used for all HIPAA entities in the United States, and ICD-10 procedure codes must be used for all hospital inpatient procedures. Claims with ICD-9 codes for services provided on or after the compliance deadline will not be paid by major insurance carriers.

Providers need to continue to work on their implementation strategy, including an assessment of the impact on their organization, a detailed timeline, and a budget.  It is important to check with their billing service, clearinghouse and practice management software vendor to ensure that they are currently testing submissions in both ICD-10 and ICD-9 formats.   Since claims may be submitted or appealed well after the date of service, both types of submissions will need to be available to providers for an extended period of time.

Most personnel will need some type of ICD-10 training.  Coders and billers need detailed code set training.  Office staff responsible for authorizations will need to understand the new code set in order to properly obtain preapproval for procedures.  Clinical personnel will need to be versed in the coding requirements in order to appropriately document services. 

Include staff members involved in medical records, coding, clinical functions, information technology and finance when coordinating transition efforts and training sessions.  Lack of preparation for ICD-10 implementation may result in lack of reimbursement for services rendered on or after October 1, 2015.  For more information on ICD-10 implementation, see the CMS website.

Nancy Clark is a Manager in the Health Care Services Group. Her expertise focuses on coding and documentation audits, which includes chart review and report compilation.

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