A Little ICD-10 Relief
by Leigh-Ann Renz, 7.9.15
ICD-10 Annoucements & Resources that Affect Mental / Behavioral Health and Substance Usage Providers
“Medicare review contractors [MACs and RACs] 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.”
This week's CMS announcement offers a small sigh of relief from the Medicare sector - and helps to abate some of the financial disaster anxiety that ICD-10 has created. CMS also offered a confirmation that ICD-10 codes must be used for dates of service 10.1.15 and beyond - and that dual coding would not be required:
“In accordance with the coming transition, the Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of services after September 30, 2015, nor will they be able to accept claims for both ICD-9 and ICD-10 codes.”
Additionally, the announcement provided the promise of extra support and assistance for the massive transition to ICD-10: "CMS and AMA will in parallel be educating providers through webinars, on-site training, educational articles and national provider calls to help physicians and other health care providers learn about the updated codes and prepare for the transition."
“With easy to use tools, a new ICD-10 Ombudsman, and added flexibility in our claims audit and quality reporting process, CMS is committed to working with the physician community to work through this transition.” ~ Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services
In addition, at the request of the AMA, CMS will establish a CMS ICD-10 Ombudsman to "triage and answer questions about the submission of claims. CMS understands that moving to ICD-10 is bringing significant changes to the provider community. CMS will set up a communication and collaboration center for monitoring the implementation of ICD-10. This center will quickly identify and initiate resolution of issues that arise as a result of the transition to ICD-10.
As part of the center, CMS will have an ICD-10 Ombudsman to help receive and triage physician and provider issues. The Ombudsman will work closely with representatives in CMS’s regional offices to address physicians’ concerns. As we get closer to the October 1, 2015, compliance date, CMS will issue guidance about how to submit issues to the Ombudsman."
See the FAQs for details on the upcoming ICD-10 transition.
Upoming milestones include:
- Setting up an ICD-10 communications and coordination center, learning from best practices of other large technology implementations that will be in place to identify and resolve issues arising from the ICD-10 transition.
- Sending a letter in July to all Medicare fee-for-service providers encouraging ICD-10 readiness and notifying them of these flexibilities.
- Completing the final window of Medicare end-to-end testing for providers this July.
- Offering ongoing Medicare acknowledgement testing for providers through September 30th.
- Providing additional in-person training through the Road to 10 for small physician practices.
- Hosting an MLN Connects National Provider Call on August 27th.
For more resources about ICD-10 and how it affects mental & behavioral health care providers, see our ICD-10 Resource Center. To see how PIMSY can help you be ready for ICD-10, check out "How does PIMSY help you stay compliant?"