Experience. Integrity. Advocacy.
Experience. Integrity. Advocacy.

CMS Is Ready for ICD-10

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“CMS is ready for ICD-10.”

That was the assessment by Marilyn Tavenner, outgoing administrator for the Centers for Medicare and Medicaid Services (CMS), after recently completing their first week of end-to-end testing.

According to CMS, more than 660 volunteers submitted approximately 15,000 test claims, and 81 percent were accepted. Among the reasons claims were rejected, 13 percent were for issues unrelated to ICD-10. Of the total claims submitted, 56 percent were for professional services, 38 percent, institutional, and 6 percent, supplier.

Tavenner said some stakeholders expressed confusion about the timing of the code set transition from ICD-9 to ICD-10. CMS hopes to clarify that.

“So, we are communicating far and wide that everyone must use ICD-9 for services provided before the October 1 deadline and ICD-10 for services provided on or after October 1,” she said. “That means ICD-10 can be used only for test purposes before October 1. And, only ICD-10 can be used for doctor’s visits and other services that happen on or after October 1. ICD-9 cannot be used to bill for services provided on or after October 1. This rule applies no matter when the claim is submitted, so claims submitted after October 1, 2015, for services provided before that date must use ICD-9 codes.”

In addition, the industry as a whole is gearing up for the transition, even though some concerns still remain.

In its third ICD-10 readiness survey, Navicure and Porter Research found that most practices are “generally optimistic” about about the new code set, with 81 percent expressing confidence they will be ready for the transition. Sixty-seven percent of respondents believe the ICD-10 transition will take place as scheduled on the Oct. 1, 2015, transition date. At the same time, the majority (59 percent) of survey participants expressed concern about ICD-10’s potential impact on revenue and cash flow.

CMS will continue its comprehensive testing program, and Tavenner hopes many providers will participate and make the most of the extra time that last year’s Congressional delay provided.

“As the ICD-10 deadline draws near, I especially encourage medical practices and hospitals that bill Medicare to take advantage of testing opportunities,” she said. “Beyond testing, CMS has undertaken an unprecedented level of outreach, training, and education to prepare the health care community for ICD-10. Our website cms.gov/ICD-10, offers many resources, including the Road to 10 tool, designed especially for small medical practices.”

In fact, CMS recently released two new ICD-10 videos to help providers prepare for ICD-10 implementation.

Less than 4 minutes each, the videos are available at cms.gov/ICD-10:

  • Introduction to ICD-10 Coding” gives an overview of ICD-10’s features and explains the benefits of the new code set to patients and to the health care community.
  • ICD-10 Coding and Diabetes” uses diabetes as an example to show how the code set captures important clinical details.

Tavenner hopes that these CMS efforts among others will reach beyond Medicare readiness and into the entire industry.

“CMS is ready for ICD-10. And, thanks to our many partners—spanning providers, health plans, coders, clearinghouses, professional associations and vendor groups—the health care community at large will be ready for ICD-10 on October 1,” she said.

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Charity Singleton Craig

Charity Singleton Craig is a freelance writer and editor who provides communications and marketing services for CIPROMS. She is responsible for creating, editing, and managing all content, design, and interaction on the company website and social media channels in order to promote CIPROMS as a thought leader in healthcare billing and management.

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