Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

4 State Medicaid Agencies Secure ICD-10 Deadline Extension

By Jacqueline DiChiara

- ICD-10 implementation kicks off in less than 3 weeks with the Centers for Medicare & Medicaid Services insistent that the healthcare industry remains primed up for the upcoming switch with a firm deadline of October 1. According to CMS’s  recent national provider call, CMS will not accept ICD-9 codes for dates of service after September 30 and will not accept claims with both ICD-9 and ICD-10 codes once implementation begins. But, such a mandate is beginning to bend as CMS has granted ICD-10 deadline extensions to four states.

ICD-9 to ICD-10 implementation deadline crosswalk

According to a report from Modern Healthcare, four state Medicaid agencies – California, Louisiana, Maryland, and Montana – are now exempt from the ICD-9 to ICD-10 mandate via official CMS approval. These states will be allowed to calculate healthcare providers’ payments by converting incoming ICD-10 claims codes to ICD-9 codes.

“The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD-10 code sets as the standard for code sets under section 1173(c) of the Social Security Act (42 U.S.C. 1320d–2(c)) and section 162.1002 of title 45, Code of Federal Regulations,” confirms Medi-Cal’s ICD-10 FAQ page.

Federal mandate definitions extend to various parties. “All HIPAA-covered entities, including hospitals, office-based physicians, claims clearinghouses and health plans must comply with the federal mandate for full ICD-10 conversion on Oct. 1,” reports Modern Healthcare, additionally confirming the aforementioned four states cannot perform payment calculations with new ICD-10 codes.

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  • Will such a tactic merely increase the threat of payment delays? Healthcare providers and healthcare information technology experts confirm such a “patchwork approach” may merely tear the revenue cycle apart and boost delays in payment, says Modern Healthcare.

    Lack of ICD-10 preparation may be the underlying cause of this ICD-10 delay. The four states “basically haven’t converted to ICD-10,” says Robert Tennant, Director of Health Information Technology Policy at the Medical Group Management Association (MGMA), to TechTarget. Even more states will soon utilize this exact ICD-10 delay approach, maintains Tennant.

    How long will such an extension continue before the ICD-9 cord is cut? As reported by EHRIntelligence.com, there is no present timeline for states to disconnect themselves from this crosswalk solution. Alabama, Louisiana, and Montana have yet to disclose their ICD-10 mitigation plans.

    California, however, has merely confirmed the crosswalk is a fleeting endeavor that will not last forever. According to the Department of Health Care Services Medi-Cal, “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.” Medi-Cal additionally confirms the crosswalk will not be published since a process for appeal of claim adjudication involving payment disparity is already underway.

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