Electronic Health Records

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Five Facts to Know Before the ICD-10 Transition Deadline

By Vera Gruessner

There are a variety of issues healthcare professionals, providers, and payers are concerned about regarding the ICD-10 transition deadline. Last week, we discussed and dispelled some common myths that stakeholders have about the ICD-10 transition deadline. This week we will go over an additional five facts that address some typical questions and concerns about ICD-10 implementation.

  1. Medicare offers options for those who can’t submit electronically

Some providers may not be able to submit claims electronically with the ICD-10 diagnosis codes due to system issues. While the Centers for Medicare & Medicaid Services (CMS) encourages providers and other stakeholders to submit their ICD-10 claims electronically by October 1, 2015, there are other options entities can proceed with. For example, free billing software can be downloaded at any point from one’s Medicare Administrative Contractor (MAC).

Additionally, approximately 50 percent of MACs offer Part B claims submission functionality through an Internet portal. If one’s Administrative Simplification Compliance Act waiver is passed through, it is also possible to submit paper claims. Whether one chooses free billing software or the Internet portal, be sure that staff is trained sufficiently on either platform before the ICD-10 transition deadline.

  1. Only claims using the new coding system will be accepted after the ICD-10 transition deadline

If your medical practice has not prepared for submitting ICD-10 claims, you will be unable to submit any claims for services performed on or after October 1, 2015. Once the ICD-10 transition deadline takes hold, CMS will only be accepting claims using the new diagnostic codes.

  1. ICD-10 codes do not decide reimbursement for physician office and outpatient procedures

CPT and HCPCS procedure codes are used for paying doctors for their outpatient and physician office procedures. These codes are not changing and new ICD-10 diagnostic codes will not affect this type of reimbursement.

When it comes to inpatient hospital procedures, ICD-10-PCS codes will be affecting the payment structure in much the same way that ICD-9 codes are used today. Additionally, at times, ICD-10 codes are used to decide on medical necessity regardless of the healthcare setting.

  1. The costs of upgrading to the new coding system by the ICD-10 transition deadline are much lower than expected

Studies that were recently published by the Professional Association of Health Care Office Management and others in the Journal of AHIMA show that a large amount of EHR vendors are including the upgrade to the new ICD-10 codes in their systems at little or no cost to their consumers. This means that the costs of software and systems upgrades in preparation for the ICD-10 transition deadline will be minimal.

  1. The time has come to move to the ICD-10 coding set

The ICD-10 coding set plays a pivotal role in modernizing the medical space and enhancing the quality of care provided across the healthcare spectrum. More specific and standardized data can help improve patient care coordination, public health research and surveillance, fraud detection strategies, emergency response, and payment models. It’s vital to move forward to this coding set and leave the outdated ICD-9 codes behind.





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