Questions About New Code Set?

CMS Directs Physicians to ICD-10 Resources

October 23, 2015 10:31 am News Staff

The nation's transition to the ICD-10 code set became official on Oct.1, and there's no doubt that many thousands of family physicians around the country have questions that deserve immediate attention.

[Red panic button with the text NEED HELP on the left]

After all, the system upgrade swells the number of diagnostic codes from some 13,000 to more than 68,000.

In the Oct. 22 issue of MLN Connects Provider eNews(www.cms.gov) from the Medicare Learning Network, CMS offers suggestions for how physicians can get the help they need.

Claim Status

Need to check on the status of a claim that's missing in action? According to CMS, physicians have a few options, all of which require a visit to the Medicare administrative contractor (MAC) online resource.(www.cms.gov)

After the physician has located his or her contractor using the Web page's interactive map, all of the applicable resources are just a few clicks away. The system allows physicians to

  • utilize an interactive voice response feature that gives physicians access to Medicare claims information via a toll-free phone number,
  • get in touch with a customer service representative through the provider contact center and
  • explore their MAC website for portal features that provide information access.

In addition, physicians who bill institutional claims have the option of submitting claims electronically using direct data entry.

The MAC websites also provide instructions about how to use a system dubbed "ASC X 12 Health Care Claim Status Request and Response," which allows physicians to electronically request claim status information and receive an electronic response.

Need Contact Info?

According to CMS, "help is available" if physicians run into any obstacles using ICD-10. To locate ICD-10 information and contacts quickly, CMS advises physicians to

  • visit CMS' ICD-10 Web page(www.cms.gov) and the Road to 10 website,(www.roadto10.org)
  • contact their MAC with Medicare claim questions (understanding that MACs cannot respond to questions about Medicaid or commercial health plans),
  • contact private and commercial health plans directly, or
  • email ICD-10 ombudsman William Rogers, M.D., director of CMS' Physicians Regulatory Issues Team, who is charged with serving as an impartial advocate and is supported by a team of experts; expect an email response within three business days.

In addition, CMS notes that the ICD-10 resource guide and contact list(www.cms.gov) organizes MAC and Medicaid contact information by state for easy reference.

Related AAFP News Coverage
AAFP Survey Shows More Physicians Ready for ICD-10
(10/1/2015)

In the Trenches Blog: Ready or Not, ICD-10 Is Here
(9/29/2015)

AAFP Fights to Shield FPs from ICD-10 Fallout
(6/22/2015)

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