5 Need-To-Know Facts about ICD-10 Transition

With the October 1st deadline rapidly approaching, Center for Medicare Services (CMS) is dispelling rumors and misconceptions about ICD-10 transition.  Here are 5 facts you need to know to prepare for claim submission:

1.      Medicare has options for those who cannot submit ICD-10 claims electronically.

While CMS encourages you to prepare to submit your claims electronically as of October 1, 2015, there are alternatives to electronic submission for providers:

·         Medicare Administrative Contractor (MAC) has free billing software available for download.

·         Part B claim submission functionality on the provider internet portal for half of the MAC jurisdictions

·         Paper claim submission if the Administrative Simplification Compliance Act waiver provisions are met.

Please note that all of these alternatives require the provider’s ability to code in ICD-10.  If you plan to utilize one of these alternative methods, CMS encourages you to prepare by attending the free training on billing software and internet portals.

2.      Practices that do not transition to ICD-10 will not be able to submit claims on or after October 1, 2015.

CMS will only accept claims coded with ICD-10 for services on or after October 1, 2015.  Whether you submit electronically or through an alternative method, the claims will not be accepted unless they are appropriately coded under ICD-10.

3.      Reimbursement for outpatient and physician office procedures are not determined by ICD-10 codes.

Outpatient and physician office claims are paid on CPT and HCPCS procedure codes, which are not changing.  ICD-10-PCS will replace the current ICD-9 procedure codes that are currently used for hospital inpatient procedures.  However, ICD diagnosis codes may be used to determine medical necessity regardless of care setting, and will therefore be affected by the transition to ICD-10.

4.      Costs for transitioning to ICD-10 are lower than original projections.

Software and system costs for ICD-10 could be minimal for providers as more EHR vendors are including ICD-10 in software and updates.  CMS shared reports from 3M and Professional Association of Health Care Office Management that show little to no cost for providers to access ICD-10 capable software updates.

5.      Now is the time to transition to ICD-10.

CMS strongly encourages providers to begin preparation now for transition on October 1, 2015.  ICD-10 will provide greater specificity and standardization that can

  • Improve coordination of a patient’s care across providers over time
  • Advance public health research, public health surveillance, and emergency response through detection of disease outbreaks and adverse drug events
  • Support innovative payment models that drive quality of care

o    Enhance fraud detection efforts

Learn More about ICD-10 by visiting CMS ICD-10 website.