Government Shutdown Won’t Affect ICD-10 Rollout, CMS Says

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Despite the possibility of a federal government shutdown in October, the Centers for Medicare and Medicaid Services says its new ICD-10 Coordination Center will continue to operate, as will claims processing systems.

Created to manage and triage issues arising from the October 1 code compliance deadline, the center will not be affected by the fact that the federal fiscal year ends on September 30 and agencies could run out of money. CMS officials made the announcement on Thursday during a conference call with members of the press.

“We recognize that this is a significant transition and we have set up processes and operations to monitor the transition in real time, assess our systems, and investigate and address issues as they come into the ICD-10 Coordination Center,said Patrick Conway, M.D., CMS principal deputy administrator and chief medical officer.

In the event of a government shutdown, CMS will continue to pay claims and continue to implement the ICD-10 transition, Conway said. “In terms of staffing, we do have the flexibility to ensure core operations are operational and in effect. And, obviously our payment systems are a core piece of the Medicare program that will continue to be fully operational,” he said.  

Also See: CMS Establishes ICD-10 Coordination Center, Ombudsman Role

When it comes to knowing how ICD-10 claims processing is going, Conway said it will take a couple weeks after the October 1 compliance deadline for CMS to “have a full picture” of the situation.

“Very few providers file a claim on the day of the office visit, lab or surgery,” he commented. “Most providers batch their claims and submit them every few days. Generally speaking, Medicare claims take several days to be processed and can take approximately two weeks. Medicaid claims can take up to 30 days to be submitted and processed. For this reason, we expect to have more detailed information after a full billing cycle is complete. ”

After the agency has better situational awareness of the code switchover, Conway added that CMS “will, of course, communicate transparently with our various stakeholders about how the transition is progressing.” 

Conway said that providers experiencing issues related to the submission of claims should first contact their billing vendor and/or clearinghouse, followed by their Medicare Administrative Contractor. If providers need additional assistance, he advised them to contact the CMS ICD-10 Ombudsman, William Rogers, M.D., at:   

“I see ICD-10 as a source of great anxiety to the clinicians,” said Rogers. But, he reassured providers that CMS has proven that its processing systems will be able to accept claims “without any problem and they’ll be paid.”

However, a Government Accountability Office report released last week concluded that while CMS has taken actions to update, test, and validate its systems, as well as plan for contingencies to help mitigate risks and minimize impacts of system errors, “the extent to which any such errors will affect the agency’s ability to properly process claims cannot be determined until CMS’s systems begin processing ICD-10 codes.”

Nonetheless, Conway said CMS’s goal is to “have a smooth transition to ICD-10 both from a payment perspective and from the service around that payment.”      

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