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Fall is here and ICD-10 is near " are you ready?

Today is the first day of fall.  In the northern hemisphere autumn (fall) is the season between the September equinox and the December solstice.  For many of us, fall is a time for change and a time for preparation.  This year, one of the biggest changes in the health care sector happens this fall.  In just a few days, the transition from ICD-9 to ICD-10 will occur. Testing demonstrates CMS is ready to accept ICD"10 claims The Centers for Medicare and Medicaid Services (CMS) released a report stating 87 percent of more than 29,000 test claims were successfully received during an ICD-10 end-to-end testing week in late July.  According to the CMS report:

  • 1.8% of test claims were rejected due to invalid submission of ICD-10 diagnosis or procedure code
  • 2.6% of test claims were rejected due to invalid submission of ICD-9 diagnosis or procedure code

Most of the rejections were from non-ICD-10 related errors:

  • Incorrect NPI, Health Insurance Claim Number, or Submitter ID
  • Dates of service outside the range for valid testing
  • Invalid HCPCS codes
  • Invalid place of service

Understanding the grace period In July, CMS announced a one-year grace period to mitigate potential impacts of the transition to ICD-10.  Since this announcement, there has been some confusion regarding the ICD-10 grace period.  This grace period does not mean you will be able to submit ICD-9 codes for dates of service after September 30, 2015, nor may you submit both ICD-9 and ICD-10 codes.  Rather, entities covered by HIPAA must be able to successfully conduct health care transactions using ICD-10 diagnosis and procedure codes.  In other words, beginning October 1, 2015 all claims will require a valid ICD"10 code. Starting October 1, 2015, for 12 months, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family. Further, to avoid potential problems with mid-year coding changes in CMS quality programs (PQRS, VBM and MU) for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if CMS experiences difficulties in accurately calculating quality scores. Finally, CMS will authorize advanced payments if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation. Fall is here and ICD"10 is near " are you ready? We would again recommend that any employee who is involved with patient encounters should take advantage of our FREE ICD-10 Primer module.  Alternatively, if a greater level of ICD-10 CM understanding is needed, employees should consider taking our ICD-10 CM module. In case you missed it, we published an article featuring questions answered by Healthcare Management Consultant David Zetter, the founder and lead consultant with Zetter HealthCare.  Click ICD-10 Questions and Answers to access the article. While these resources most likely won™t help you transition from summer to fall, they will help you make the change from ICD-9 to ICD-10. If you have any questions or would like more information about our ICD"10 course offerings, please feel free to send us an email [email protected].com or reach us by phone toll"free 855"427"0427.

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