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

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CMS Details How to Resolve ICD-10 Implementation Issues

To resolve challenges with ICD-10 implementation, healthcare providers need to create a feedback system to address clinical and coding, system, and payer issues.

By Jacqueline Belliveau

- In the second update about ICD-10 implementation, CMS has released infographic and statement guidance on how to address issues and questions about IDC-10. The recent statement encourages providers to create a feedback system to review clinical documentation and code selection processes, system problems, and issues with payers.

CMS advises on ICD-10 implementation

The infographic asks healthcare providers to assess, address, and maintain their progress with the ICD-10 transition, which went into effect on October 1, 2015.

In earlier guidance, CMS showed providers how to assess ICD-10 progress by establishing baselines for key performance indicators (KPIs), such as days to final bill, to use for comparing specific factors before and after the transition.

In the next installment, CMS advises healthcare providers on how to address their findings by creating a feedback system to address concerns and issues the organization may have about ICD-10 implementation. Organizations should establish a process for gathering feedback from healthcare staff. Then, providers can develop a method for sharing observations and progress with the ICD-10 transition.

CMS advises organizations to create a comprehensive list for all staff to document challenges. The system would track specific issues by sharing the status and steps taken to resolve them.

A feedback system helps healthcare providers to target problem areas and resolve issues, especially with clinical documentation and code selection. CMS recommends that healthcare providers review clinical documentation from before and after the transition. All services provided on or after October 1, 2015 use ICD-10 codes and all services provided before will use ICD-9 codes.

Comparing pre- and post- documentation will assist providers with understanding how staff choose diagnosis codes and apply guidelines. A majority of coding problems can be solved with additional training on ICD-10 coding concepts and use. A variety of educational resources are available from the government, CMS, smartphone apps, and vendor training.

CMS also suggests selecting a physician, or group of physicians, to be a resource in the organization for ICD-10 implementation and best practices.

The feedback system can also identify system and technical issues. All systems should be upgraded to use ICD-10 coding for services provided on and after the implementation date, CMS reports.

CMS emphasizes that clearinghouses are good resources for system issues. They can help providers pinpoint why claims are being rejected and provide support on how to fix rejected claims.  

For any technical issues, healthcare providers should contact their vendors for assistance.

Additionally, the feedback system can help organizations to resolve issues with payers.

CMS has released the Medicare/Medicaid Provider Contact List to help providers who are having difficulty with KPIs that are specific to Medicaid or Medicare Fee-for-Service. CMS created an ICD-10 Ombudsman and Coordination Center to assist organizations with the transition.

CMS encourages providers to contact their Medicare Administrator Contractor (MAC) and CMS regional office with any questions or concerns about claims.

When an issue is related to a KPI not specific to Medicare or Medicaid, CMS directs providers to contact their payer, clearinghouse, or billing service.

CMS hopes that their informational reminders will help healthcare providers transition to ICD-10 with the resources they need to implement the new system.

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