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CMS Addresses the Isolated Issues in ICD-10 Implementation

Since October ICD-10 implementation, CMS has seen a few isolated errors, and now explains its resolution process.

By Sara Heath

After encountering a few isolated bumps in the ICD-10 road, the Centers for Medicare & Medicaid Services (CMS) has issued clarifications for the measures it’s taking to resolve those issues.

According to the CMS statement, there have been a few isolated issues with National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs).

A few short-term solutions have been put into place with regard to NCD error, including coding refinements and claims processing instruction updates. These updates should be in place by January 4.

CMS states that claims that produced errors will be reprocessed by the agency at no cost or effort to the provider. CMS will automatically process these claims and update them in the system.

Additionally, some errors resulted from LCDs following the ICD-10 implementation because the Medicare Administrative Contractors (MACs) still needed to update certain LCD criteria. CMS postponed processing of these claims until the proper LCD criteria updates were made. Claims that encounter these errors in the future will be handled in the same manner.

CMS explained that it has addressed the errors encountered following October ICD-10 deadline implementation quickly and efficiently, taking into account the cumbersome process providers endured in transitioning to the new code set.

“Our contractors understand the challenges that updating CMS systems may bring to our providers and strive to provide quick resolution when issues are noted. For the handful of issues that were noted after October 1, 2015, CMS contractors have moved quickly to take action, such as temporarily suspending edits and/or claims, making fixes as quickly as possible, and reprocessing claims to minimize impact on providers,” CMS said.

These kinds of issues are somewhat contradictory to the preparedness CMS reported prior to implementation, as well as to the initial metrics reports produced by the agency.

Prior to ICD-10, CMS was optimistic in its ability to process claims, citing multiple tests with favorable results. At the end of July, for example, the agency stated that its last test run resulted in an 87 percent claims acceptance rate of the 29,286 tests the agency received. The rejection rate for ICD-10 errors was 1.8 percent and the rejection rate for ICD-9 errors was 2.6 percent.

Furthermore, CMS confirmed its ICD-10 readiness in a conference call just one week prior to implementation. During that conference call, CMS Principal Deputy Administrator Patrick H. Conway, MD, MSc, stated that the agency had ample resources to effectively assist during the transition.

“In terms of staffing, we do have the flexibility to ensure core operations are operational and in effect,” Conway stated. “And obviously, our payment systems are a core piece of the Medicare program that will continue to be fully operational.”

Just under a month following ICD-10 implementation, CMS released its first metrics reports for Medicare fee-for-service payments. This report showed few issues, with a claims denial rate as low as 10 percent.

That all said, CMS has long maintained that it will take several pay cycles to get a handle of how the ICD-10 transition went. Because it takes approximately 30 days for Medicaid to issue claim submittal, and 30 days for Medicare to process claims, CMS was not going to have its first batch of results following implementation until the end of the code set’s first month. Furthermore, it would not have ample data to notice trends until several months into the new code set.

“The Medicaid claims can take up to 30 days to be submitted and processed,” Conway said in the September conference call. “This end can take approximately two weeks. The Medicaid claims can take up to 30 days to be submitted and processed. For this reason, we expect to have more detailed information after a full billing cycle is complete.”




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