The ICD-10 compliance date may be October 1, but it will take a little while for industry stakeholders to learn how rocky or smooth the transition will be.
Medicare generally pays clean claims within two weeks, as do many commercial insurers, although payment periods vary among commercials. Medicaid has 30 days to pay a clean claim, but any provider knows payment often is much slower. So, if there is to be a tsunami of rejected claims in October, it likely will take time to manifest.
Consequently, now is the time for provider organizations to make sure they know who to contact at all of their major insurers to get questions answered if claims are being denied. In general, that number will be the usual provider support line, although insurers may route code-related calls to a dedicated ICD-10 support desk.
That’s what Michigan Medicaid will do as it anticipates an increase in rejected claims and has geared up an ICD-10 call center after having done road shows and web seminars for the past three years to raise awareness of the need to be ready for the new code set. Michigan Medicaid has been ready for ICD-10 for some time, says Michelle Miles, project lead for ICD-10 awareness and training.
Providers calling Michigan Medicaid to inquire about rejected claims will get help understanding why a claim was rejected, and directed to a web site to get the right codes. The top anticipated reasons for claims rejections include not having a valid ICD-10 code, having two sets of codes on one claim, and mistakenly by force of habit using ICD-9 codes, Miles says.
Requests sent to four national health insurers—Aetna, Cigna, Humana and UnitedHealthcare—for information on services being offered to providers following the ICD-10 compliance date were not responded to.
CMS in recent months has consistently released new ICD-10 guidance documents to providers, particularly those in Medicare Part B.
To help physicians and staff members code optimally, CMS recently issued a comprehensive 31-page ICD-10 family practice “cheat sheet” giving codes for services across a dozen types of common treatments in family practice and giving the specific codes for specific services within each treatment type. For instance, it gives the appropriate code for 12 specific types of abdominal pain.
CMS also offers new guidance on successful billing of services using ICD-10, with an infographic loaded with links to information on checking with payers for alternative claims submission options, checking if staff is ready to code in ICD-10, and if clinicians are familiar with ICD-10 coding and documentation concepts.
CMS declined to make an official available to discuss how to deal with Medicare contractors when ICD-10 becomes live, saying pertinent new guidance is soon coming out.
Medicare Part B, however, relaxed its claims adjudication policy this summer for Part B claims. Medicare contractors in the first year of ICD-10 will not deny a claim because the submitted ICD-10 code is not the most appropriate, as long as the given code is in the right family of codes.
Other Medicare programs, Medicaid agencies and commercial insurers at least publicly do not have similar formal contingency programs to ease cash flow concerns. But they likely have similar policies, whether or not they announce them in coming days, according to Patrick Kennedy, president of PJ Consulting Inc., which covers electronic data interchange and insurers.
Not wishing to ease pressure on providers and vendors to be ready for ICD-10, commercial insurers, particularly larger ones, are not broadcasting but often are offering some type of concessions, Kennedy says. It simply is not in their interests to have providers suffering cash flow problems, he notes. Providers showing a concerted effort to be ready for ICD-10 will get help, but laggards shouldn’t count on it.
Note: An earlier version of this story indicated Michigan Medicaid would adopt a flexible policy in processing claims that do not have the appropriate ICD-10 code, similar to Medicare Part B’s policy. Subsequent guidance from a second Michigan Medicaid official indicated that it will not offer such flexibility.
Register or login for access to this item and much more
All Health Data Management content is archived after seven days.
Community members receive:
- All recent and archived articles
- Conference offers and updates
- A full menu of enewsletter options
- Web seminars, white papers, ebooks
Already have an account? Log In
Don't have an account? Register for Free Unlimited Access