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From Health Law Daily, September 30, 2015

With ICD-10 hours away, these resources can keep you on pace

By Bryant Storm, JD

The CMS ICD-10 countdown clock shows only hours remaining, which means the compliance date for implementation of the International Classification of Diseases, Tenth Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) is almost here. While the transition from ICD-9 to ICD-10 will continue to be complex from a compliance and regulatory perspective, Wolters Kluwer has prepared and compiled resources to make the transition an easier one.

ICD-10. After multiple delays, the compliance date for the transition to ICD-10 was set for October 1, 2015. The ICD-10CM/PCS code sets, which will be used to report diagnoses, represent a significant improvement over the existing set—ICD-9. With the addition of more digits and more complex diagnostic codes, ICD-10 will allow for more detailed condition classification. However, despite the promises of the new code set, industry readiness has remained a concern throughout the run up to the compliance date (see Weathering the storm of ICD-10’s ‘regulatory tsunami’, August 26, 2015).

Alternative claim submission. For providers that experience difficulties or disruptions with claim submission on or after October 1, 2015, there are several alternative claim submission methods available. Those alternatives include the use of free billing software, provider internet portals, direct Data Entry (DDE), and paper claims (see ICD-10 claims won’t go through? CMS has alternatives for you!, September 17, 2015).

CMS resources. CMS has made efforts to assist providers in their preparation for October 1, 2015. Resources like the ICD-10 Quick Start Guide were provided to outline the steps providers should take to ready themselves for the transition. Additionally, Medicare Learning Network (MLN) Matters SE1408 describes how physicians, providers, and suppliers submitting claims to Medicare administrative contractors (MAC) should handle claims that span October 1, 2015 (see Providers still have time to prepare for ICD-10, say experts, August 28, 2015). CMS also provides resources for small physician practices through its "Road to 10" website.

Grace period. To ease the impact of the transition on physicians, CMS also announced a grace period, during which it will not penalize physicians who submit improper codes for billing. Physicians will qualify for the lenient treatment provided they have selected the appropriate family of codes, along with other measures intended to educate physicians on ICD-10 billing and claims submissions. Specifically, CMS announced that Medicare review contractors will neither deny nor audit practitioner claims billed under the Medicare Part B Physician Fee Schedule "based solely on the specificity of the ICD-10 diagnosis code," provided the practitioner has used a valid code from the proper family. CMS also announced the appointment of an ICD-10 Ombudsman. The ombudsman, whose email address is icd10_ombudsman@cms.hhs.gov, is part of the CMS triage effort to answer questions about ICD-10 claim submission (see CMS won’t penalize docs transitioning to ICD-10, July 7, 2015).

State sites. In the in the Medicaid context, a new resource designed to help physicians, providers, and suppliers make a smooth transition to the new code set was recently made available by the Workgroup for Electronic Data Interchange (WEDI). That resource—a List of State Medicaid Sites with ICD-10 Information—provides links to state Medicaid sites that offer state-specific information on ICD-10 testing, readiness, and training. Additionally, WEDI made available an ICD-10 State Workers’ Compensation Readiness List that is designed to help members of the worker’s compensation industry navigate state-specific requirements for transactions and code sets as states make the transition to ICD-10 (see New ICD-10 resources provide state progress and information, September 15, 2015).

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