Last Minute ICD10 Testing Opportunities

CMS has finished the third and final round of end-to-end testing for claims containing ICD10 codes.  The tests results included an 87% acceptance rate of the claims submitted.  Only 1.8% of the claims were rejected because of the new codes, 2.6% were rejected because of invalid ICD9 codes.  These rejection rates are about normal for the current production claims processing environment.

The minor problems discovered by CMS in their system after round two of tests in April appear to be corrected.  On the surface it would appear that the industry, or at least CMS, is ready to process these claims, however, these statistics are deceiving.


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The Impact of CMS Flexibility on ICD10 Implementation

CMS announced a joint statement with the AMA in early July regarding a compromise on how claims with 10 codes would be processed after 10/1/15.  They published FAQs and responses for this announcement on 7/27.

This announcement was advertised to be a settlement between these organizations regarding the efforts of the AMA to delay the implementation of ICD10 and the insistence of CMS that this deadline was final.

Initially, I was concerned about how this announcement might affect the adjudication of all Medicare claims and the potential modifications to Medicare contractor systems we had already tested with our applications over the last several months.  As it turns out, these changes to CMS policy are largely cosmetic and will have no impact on the processing of most claims.  Additionally, although this policy is promoted as a relaxation of the implementation, it provides little relief to healthcare providers and their staff that are unprepared for the transition.


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Opposition to ICD10 – A Perspective of Self Interest

Last week I read several articles about the current efforts to delay the implementation of ICD10 by the AMA and some of our congressmen, possibly influenced by this organization.  Their extremely weak arguments against implementation focus on their own lack of preparedness for the implementation.  Anyone with any knowledge of what has already been done to prepare for this new code set would realize that the negative impact of another delay would far outweigh any benefits of allowing these procrastinators additional time to prepare.

ICD10 Coding
Opposition to ICD10

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ICD10 and Medi-Cal Processing – Preparing for Chaos

As the ICD10 deadline approaches, providers and health plans (and their vendors) prepare for the transition with varying levels of effort, efficiency and success.  Although it is true that the organizations that plan, train and test for this event will be more prepared for the transition from ICD9 to ICD10 than their competitors, no organization will avoid the consequences of an industry that seems to struggle with change.

What will happen when Medicare requires the ICD10 codes and other health plans are unable to accept them?  From the provider perspective, the bottom line is receiving reimbursement for your services.  Regardless of the “rules”, providers have always had to comply with reality to get their money.

prepare for chaos
ICD10 Chaos on the horizon.

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CMS End-To-End ICD10 Testing – April Results

CMS conducted the second round of end-to-end testing of claims with ICD10 data during the third week of April. MEDTranDirect, and one of our customers, Kimble Hospital of Junction, TX, were selected by Novitas for this round of testing.

As part of the testing process, 30 claims were sent for processing through our 837Direct product in a single batch. Most contained ICD10 codes and future dates, some contained ICD9 and current dates. All the submitted claims processed properly and the corresponding 999s and 277CA records were received.

In addition, CMS provided test 835 electronic remittance files that contained payment and adjustment data for the test claims reflecting how they will be paid in October.

ICD10 Testing
ICD10 Testing

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ICD10 Implementation – Possible Delays Pending

With just a few months to go until ICD10 implementation, there is still some chance that implementation might be delayed yet again.

On 4/30/15, Representative Ted Poe of Texas introduced a bill to ban the use of ICD10.

The bill is called the “Cutting Costly Codes Act of 2015”. It prohibits the federal government from requiring the use of ICD10 instead of ICD9. Poe claims that the implementation of the new code set will put unnecessary strain on the medical community.

Possible Delays Pending

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Moving from ICD9 to ICD10 – Dealing with the Transition and Learning from the Past

As the healthcare industry prepares for the October transition from ICD9 to ICD10, many organizations are dealing with the obvious issues.  Computer systems are being upgraded to handle the new codes, health plans are developing new business rules for reimbursement, coders and physicians are being retrained.  These are all necessary steps in the adoption of these codes, but some of the most difficult issues will not be in dealing with the new codes, but transitioning to them as these systems are implemented.

One of the strategies in dealing with these types of transitions is to look toward similar situations in the past.  How did this impact you last time?  What issues came up that you did not anticipate?  These transitions are never smooth, but they have to be dealt with.  Experience is the best teacher.

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The Impact of ICD-10 on the ANSI 837


Not since the introduction of HIPAA transactions over 15 years ago has there been a project that impacts healthcare data processing like the implementation of ICD-10.  This code set conversion impacts almost every business process for every partner in the exchange of healthcare data.

The fact that this change impacts so many systems and partners in the collection and exchange of healthcare data means that the risk of financial setbacks due to the implementation of these codes is very high. Continue reading

ICD10 to be delayed by one year

Yesterday, March 31, 2014, the senate passed a bill to delay ICD-10 implementation until 10/1/2015.  By a vote of 64 to 35, the Senate voted to delay ICD-10 by at least one year.  The bill is being sent to President Obama where his signature is expected.

This bill includes a suspension of Medicare’s Sustainable Growth Rate (SGR) formula, delaying a 24% cut in physician reimbursement, and delays the Medicare “two midnight” payment policy for hospitals until March of next year.  This was the original content of the bill, it is not clear how or when the ICD-10 delay later became part of this bill.

While the delay in implementing the new ICD-10 code sets helps organizations that were struggling to meet the 10/1/14 deadline, many organizations feel that this legislation is a big step backwards.  The bill actually states that the Department of Health and Human Services cannot adopt the ICD-10 code set until at least 10/1/15, allowing for possible further delays. Continue reading