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Tuesday Oct 27, 2015

A month in, how is ICD-10 doing?

Implementation of ICD-10 will be a month old at the end of this week. On average, that represents about one billing cycle for the typical family medicine practice, so this is a good time to assess the initial impact.

Despite some dire predictions, implementation has not led to mass chaos or brought claims processing to a halt. In fact, preliminary reports suggest implementation is proceeding relatively smoothly. For instance, insurers such as Humana and UnitedHealth Group have reported smooth transitions, according to a report by Forbes(www.forbes.com). Communications from the Centers for Medicare & Medicaid Services (CMS) suggest things are running equally smoothly on Medicare’s end. Physician complaints about the actual implementation have been sparse to non-existent.

That does not mean that implementation has been universally positive. For instance, there are reports(journal.ahima.org) that coder productivity has dropped between 20 percent and 40 percent. Also, there are anecdotal stories that some payers, including at least one state Medicaid agency, are not paying for “not otherwise specified” codes under ICD-10.

What should you do if you are among those experiencing challenges in implementing ICD-10? CMS suggests that you take the following steps to locate ICD-10 information and contacts quickly:

•    Step 1 Find resources on the CMS ICD-10 website(www.cms.gov) and Road to 10(www.roadto10.org) online tool.
•    Step 2 Contact your Medicare administrative contractor (MAC)(www.cms.gov) for Medicare claims questions. Your MAC is your first line for Medicare claims help. MACs cannot respond to questions about Medicaid or commercial health plans.
o    If you have a Medicaid claim question, contact your state Medicaid agency(www.medicaid.gov).
      o    If you have a commercial or private health plan claim question, please contact your health plan directly.
      o    The new ICD-10 Resource Guide and Contact List(www.cms.gov) gives MAC and Medicaid contact info organized by state.
•    Step 3 Contact the ICD-10 Ombudsman for questions. The ICD-10 Ombudsman is an impartial advocate with a dedicated team of experts to answer your questions. Responses will typically be sent within three business days of receipt.

– Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians

Posted at 11:56AM Oct 27, 2015 by David Twiddy

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The views expressed here do not necessarily reflect the opinions of FPM or the AAFP. Some payers may not agree with the advice given. This is not a substitute for current CPT and ICD-9 manuals and payer policies. All comments are moderated and will be removed if they violate our Terms of Use.

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