Electronic Health Records

Policy & Regulation News

Lack of ICD-10 Readiness Leads Multiple States to Crosswalks

By Kyle Murphy, PhD

The Centers for Medicare & Medicaid Services (CMS) made clear in its most recent national provider call that Medicare is set to receive ICD-10 codes on October 1, with all its systems up and running and a new figure appointed to the position of ICD-10 ombudsman.

However, a handful of states have received permission to use a ICD-9 to ICD-10 crosswalk in order to manage the ICD-10 transition post-October 1, Modern Healthcare is reporting.

California, Louisiana, Maryland, and Montana will be translating ICD-10 codes into ICD-9 codes for their Medicaid fee-for-service programs because their current claims processing systems cannot properly calculate ICD-10 payments.

"We have worked closely with each state to understand how they will mitigate any issues that may arise and minimize impact on the accuracy and timeliness of provider payments," CMS spokesperson Jibril Boykin told the publication.

Of the four states, only California's Medicaid Program, Medi-Cal, provides details about the crosswalk approach:

Medi-Cal will be using a crosswalk solution in the legacy California Medicaid Management Information System (CA-MMIS). Medi-Cal has mapped all ICD-10 codes to corresponding ICD-9 codes starting with the General Equivalence Mappings (GEMs) provided by the Centers for Medicare & Medicaid Services (CMS) and modifying the mappings to align with existing Medi-Cal policy. Claims will be run against the crosswalk to determine the ICD-9 value to process through the system. The crosswalk will only be used temporarily for ICD-10 claim adjudication while the implementation of our new MMIS system is being completed. Once the new system is online, Medi-Cal will adjudicate all claims natively using ICD-10 and the crosswalk will no longer be used.

Currently, there is no timeline for the states to move away from this ICD-10 crosswalk solution. That being said, California appears to be in the process of still testing an ICD-10 enhancement to Medicaid management information system. Neither Alabama, Louisiana, nor Montana have shared their ICD-10 crosswalk mitigation plans. Additionally, the CMS Stated Medicaid ICD-10 Readiness resource contains little information about these alternative ICD-10 claims management practices.

Meanwhile, the Workgroup for Electronic Data Interchange (WEDI) is in the process of compiling a list of ICD-10 State Readiness, which the advisory group plans to update moving close to the ICD-10 compliance deadline.

For states that are ready for the ICD-10 deadline, they have the responsibility of ensuring that healthcare organizations and providers in their states are themselves ready. The Arkansas House of Representatives directly addressed ICD-10 readiness in a recent feature in a local news outlet.

"All major hospitals in our state are fully prepared for the transition," the group states. "However, we want Arkansans to be informed about this process so they can ensure that their local doctor or day treatment provider is prepared. If the new codes are not used in the billing process, Medicaid and private plans will not able to pay the balance due."




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