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Providers angle for coding relief before ICD-10 deadline

Though it has been delayed twice already, some providers and physician organizations fear the industry isn't prepared for the coming ICD-10 deadline.

The Oct. 1 deadline for healthcare providers to start using ICD-10 codes is creeping closer. Though the ICD-10...

deadline has twice been delayed, providers and physician groups are still concerned that they're short on time and will suffer possible claims acceptance and other coding issues. A recent announcement by CMS presented providers with new opportunities for coding flexibility that could help them face the new code set head on without experiencing a high rate of rejected claims.

A common request made by many of the physician associations and healthcare groups ahead of the ICD-10 transition is for the deadline to be moved or adjusted. Many organizations have addressed public letters to Congress to request a delay of the deadline to give physicians, healthcare systems, and software vendors additional time to complete any testing, mapping or other planning that would ensure a seamless transition from ICD-9.

Other concerns of providers are the detrimental effects rejected ICD-10 claims could have on revenues and on the day-to-day operations of the organization. The worries about time consumption are primarily caused by the new coding standards which require physicians to use a new data set when documenting a patient encounter. Physicians in the United States, for example, will be making the jump from using approximately 13,000 ICD-9-CM diagnostic codes to 68,000 ICD-10-CM codes.

One pixel What is ICD-10? SearchHealthIT's definition
helps explain.

In past years, the majority of ICD-10 concerns have involved billing, as well as EHRs not being ready for the new diagnosis codes. However, these problems have dissipated as many software vendors have used the two previous year-long extensions to upgrade their systems to support ICD-10.

CMS issued a response to some of the concerns it has heard in the form of a frequently asked questions document. The questions and answers provide some clarity in four areas for those making the ICD-10 transition.

Resolution center: CMS is setting up a communication center designed to help providers resolve any issues that may arise after the ICD-10 deadline.

Claim processing flexibility: CMS will accept improper claims for 12 months after the ICD-10 deadline, as long as physicians use valid diagnosis codes that are from the right code family. This will help providers encounter fewer denied claims as they continue to learn the new codes.

Protection from quality reporting penalties: For physicians submitting their quality measures to CMS, they will not be subjected to penalties, "If CMS experiences difficulty calculating the quality scores for PQRS [Physician Quality Reporting System], VBM [Value Based Modifier], or MU [meaningful use] due to the transition to ICD-10 codes."

Funds for claims processing delays: In the event that claims are not processed in a timely manner by the Part B Medicare contractors, physicians are able to request advance payments for their claims while the issue is resolved.

These services offer flexibility and a degree of relief to providers and healthcare practitioners, some of whom view the move to ICD-10 codes as a threat to their organizations' financial well-being. While these changes are helpful, healthcare policy makers are pushing for more changes to help providers that may still be struggling to ready their systems for ICD-10. A bill introduced into the House of Representatives would allow providers to use ICD-9 codes for six months after the ICD-10 deadline.

About the author:
Reda Chouffani is vice president of development at Biz Technology Solutions Inc., which provides software design, development and deployment services for the healthcare industry. Let us know what you think about the story; email editor@searchhealthit.com or contact @SearchHealthIT on Twitter.

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This was last published in August 2015

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