CMS Answers 5 ICD-10 Coding, Reimbursement, Test Questions
By - ICD-10 implementation formally kicks off in less than 50 days. To aid the healthcare industry with the upcoming transition and promote the dissemination of accurate, intelligent information, the Centers for Medicare & Medicaid (CMS) has released 5 concrete pieces of information about ICD-10 coding, reimbursement, and testing. Says CMS, ICD-10 is more than an update; it is a leap in how care is defined.
When do I stop using ICD-9?
According to CMS, you must use ICD-10 on claims for those services provided on or after October 1, 2015. Before October 1, using ICD-9 on claims is acceptable.
Time is of the essence, as others in the industry have confirmed. “ICD-10-CM and ICD-10-PCS must be adopted as soon as possible to reverse the trend of deteriorating health data,” states the American Health Information Management Association (AHIMA). “Never in US history have we used the same version of ICD for 35 years,” the organization adds.
Also, the familiar notion that time is money rings especially true when it comes to matters of ICD-10. CMS estimated a one-year ICD-10 delay could cost the healthcare industry up to 6.6 billion dollars, excluding incurred costs from previous delay expenses.
How will I be reimbursed for professional claims?
Payment for professional claims is not associated or connected to ICD-10 codes, says CMS. Payment will continue to be based on CPT codes, CMS confirms.
What free resources are available?
A variety of medical and trade associations offer resources at little or no cost, says CMS. Additionally, the Road to 10 tool from CMS shows common codes, provides documentation tips, and contains clinical scenarios based on specialty. A customizable action plan can be constructed to help make October 2 and beyond smoother revenue cycle wise. Additionally, CMS notes an ICD-10 payer directory reference to help bridge gaps payers have regarding general lack of ICD-10 testing knowledge.
A list of ICD-10 codes may also prove invaluable – whether a patient has accidentally fallen off a cliff (MELAS syndrome) or a chair (MERRF syndrome) – focusing on the most common codes may boost up readiness efforts.
What about Medicare testing opportunities?
CMS confirms all Medicare fee-for-service providers have the ability to test their systems with CMS. Acknowledgement testing – open to all Medicare fee-for-service electronic submitters – can be conducted anytime with your MAC.
Is now really the best time to make the ICD-10 switch?
CMS confirms the answer to this question is a strict yes. Other organizations have weighed in with similar sentiments. The benefits of making sure ICD-10 preparation is in full swing is multifaceted and highly beneficial, confirms AHIMA.
“ICD-10 will improve national healthcare initiatives such as Meaningful Use, value-based purchasing, payment reform and quality reporting,” says AHIMA. “Without ICD-10 data, there will be serious gaps in the ability to extract important patient health information needed to support research and public health reporting, and move to a payment system based on quality and outcomes.”
