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ICD-10 Update: Millions of claims submitted successfully since October 1

Written by: Rebecca Bowden on Monday, November 2, 2015 Posted in: HME/DME, Home Infusion, Specialty Pharmacy

magnifyDocumentOn October 1, 2015, every entity covered by the Health Insurance Portability Accountability Act (HIPAA) was required to switch from ICD-9 electronic healthcare transaction coding to ICD-10 coding. This was a major transition for providers, who had to begin billing according to ICD-10’s 68,000 codes instead of the 14,000 ICD-9 codes, which they’d been using for more than 30 years.

While there was great concern among providers and patients, as well as lawmakers, that the more complex and specific ICD-10 system would be prone to errors, which would lead to massive claim denials and, of course, significantly delayed reimbursements, insurers are reporting that millions of claims have been processed with few mishaps and only a slight increase in denials.

This means that physicians, who are on the front lines of the ICD-10 conversion, must be, for the most part, taking the time to get the coding right. If that’s the case, when patients come to you for infusions, specialty medications, or home and durable medical equipment, the codes their providers give to you are likely to be correct. Nevertheless, you still need to be vigilant to protect your business from denials.

1. Be Sure Codes are Specific: Although ICD-10 does include “unspecified” options, be sure your providers are supplying the detailed coding required for reimbursement.

2. Track Errors and Ongoing Challenges: Assign someone to keep tabs on ICD-10 issues, so you can begin to identify patterns and common problems and then take action to avoid them in the future.

3. Educate and Stay Informed: Keep staff training up to date, so you always have someone available who can evaluate provider coding and at least raise a red flag if the coding doesn’t seem to fit the prescriptions or other directives provided. And stay on top of the latest ICD-10 news and issues via the CMS ICD-10 web page.

Visit the Mediware ICD-10 resource center for further clarifications on these coding changes, click here.

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