In Claim Management Best Practices, Disability Claims

On July 6th, 2015 the Centre for Medicare and Medicaid Services (CMS) announced a 1-year grace period for claims bearing the ICD-10 codes, which go into effect on October 1st this year. Still holding out on postponing the go-live date for the third time, the CMS has decided to address fears being voiced in the industry by allowing an extended grace period.

It was originally announced that services coded using incorrect codes would be deemed non-compliant and rejected for payment. Other than the costs of actually implementing the ICD code transition, there was fear that Medicare would reject claims based on innocent coding mistakes, leading to delayed payments and additional costs.

To take this into account, the CMS has decided that until October 1st, 2016, any claims submitted with an unspecific ICD-10 code will not be rejected for payment, although the code does need to come from the correct ICD-10 family. This will ensure that physicians will begin to identify ICD-10 codes, ensuring that within one year they will be able to use the specific codes without a problem.

The ICD-10 codes are more specific than previous ICD-9 codes. Rather than simply identifying the illness or injury, the new codes will indicate the cause, body location, and other more specific information. To ensure you are compliant in October, you should talk to your vendors now to check:

  • If system upgrades or replacements will be provided to accommodate ICD-10
  • If upgrades will be covered by existing contracts, or will additional costs apply
  • When upgrades or new systems will be available for testing and implementation
  • How the product will accommodate both ICD-9 and ICD-10 as you work with claims for service provided both before and after the transition deadline for code sets.

To assist practitioners with the transition to ICD-10, ClaimVantage has upgraded the MDGuidelines package to allow an easy transition on October 1st. ICD mapping has been implemented to provide accurate ICD-9 to ICD-10 equivalents. If you have any additional questions, feel free to contact us today.

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