Turn To Practice Insight® For
ICD-10 Guidance.

Overview

The Department of Health and Human Services (HHS) published a Final Rule for Modifications to HIPAA on January 16, 2009 that established a compliance date of October 1, 2013 for ICD-10 coding. On August 10, 2012, HHS published a Final Rule extending the ICD-10 compliance date one year to October 1, 2014. The introduction of an entire new set of diagnosis codes has never been done by the health care industry in the United States, and it affects every aspect of health care including health records, medical research, clinical protocols and medical billing.

In 2012, the migration to ANSI Version 5010 electronic claims prepared the way for ICD-10 compliance in medical billing. ICD-10 will allow for more detailed and accurate coding, but beware: it will feature one or two extra digits. ICD-9 codes are 3-5 digits while ICD-10 codes are 3-7 digits. Providers should check with your practice management software vendor or billing vendor and find out when and how they will upgrade your office system.

Now, Another Delay.

On April 1, 2014, President Obama signed legislation that includes another delay in the ICD-10 deadline, officially restarting the countdown toward compliance with the federally mandated conversion to the ICD-10 diagnostic and procedural codes. It is anticipated the new ICD-10 start date is Oct. 1, 2015, based on a brief statement from the CMS.

HHS “expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning Oct. 1, 2015,” the CMS statement said. “The rule will also require HIPAA-covered entities to continue to use ICD-9-CM through Sept. 30, 2015.”

Practice Insight Tested ICD-10 Successfully with CMS in 2014.

Earlier this year, Practice Insight assisted providers with testing during our special CMS Testing Week. During this week-long process, which took place March 3-7, 2014, Practice Insight participated in End-to-End Testing with all CMS contractors. Testing was conducted throughout this 5-day period.

What is End-To-End Testing?

Many payers have different definitions of “End-To-End” testing. During our CMS Testing Week, this included:

  • Sending TEST ICD-10 claims from Practice Insight to CMS
  • Receiving 999 and 277 responses from CMS and routing them through Practice Insight

End-To-End Testing was NOT:

  • Testing live claims – All claims must be “TEST”
  • Testing adjudication – CMS did NOT provide a remittance for tested ICD-10 claims

During our testing process, providers could either upload TEST ICD-10 claims to Practice Insight OR use the Practice Insight Duplicate Claim Feature to copy existing claims and convert them to TEST ICD-10 claims. All claims were required to have a Date of Service between 10/01/2013 and 03/03/2014 in order to qualify for testing.

Once uploaded or converted, the providers simply set the TEST ICD-10 claims to READY. During the week of CMS testing, Practice Insight batched these TEST ICD-10 claims and sent them to CMS.

Practice Insight Readiness.

Simply put, Practice Insight is ready to meet ICD-10 coding requirements. Our applications and processes currently support the ICD-10 procedure and diagnosis codes. Because the ICD-10 code set is implemented by Date of Service, our EDI systems will validate with either ICD-9 or ICD-10 codes, dependent on the Date of Service in each EDI transaction.

Practice Insight currently compares submitted claims to several external code sets to check for accuracy of data. Two of these external code sets are Diagnosis codes and Procedure codes, which include the beginning and ending effective date for each code. With the April 1, 2014 delay officially in effect, it is expected all current ICD-9 codes will all use an ending date of September 30, 2015, and ICD-10 codes will use a beginning effective date of October 1, 2015, per the mandated schedule.

Practice Insight is committed to ICD-10 readiness within our own systems and internal processes, and we recognize the need to assist our providers with implementation in EDI transactions.

We will:

  • Provide a testing environment for Providers and Authorized Resellers
  • Provide a view to the CMS-developed General Equivalence Mappings (GEMS)
  • Publish instructions for Providers uploading claims in legacy formats that do not support ICD-10 codes: NSF format and ANSI Version 4010
  • Accept and process claims with ICD-9 codes and also claims with ICD-10 codes and maintain existing levels of testing and validation
  • Communicate regularly with customers during the transition

We will not:

  • Automatically translate ICD-9 codes to ICD-10 codes
  • Predict Payer reimbursement or impact to revenue

Important dates

July 1, 2012 Compliance deadline for 5010.
August 2012 CMS announced the finalized rule to delay the original deadline by one year for the implementation of ICD-10 medical coding.
Q1-Q3 2013 A&D Phase: EDIinsight® user features and Dedicated user testing platform.
Q4 2013 Begin Testing Phase: begin testing with a Payers and Channel Partners according to readiness. Support provider-initiated testing. Ongoing customer communications.
Q3 2014 Awareness of known Payer Issues. Ongoing customer communications.
October 1, 2015 Go Live: The ICD-10-CM code set will be used to validate coding for Dates of Service October 1, 2015, and after. Claims with Dates of Service prior to this date will be validated with the ICD-9 code set. Ongoing awareness of Payer Issues.

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Qustions?

Please feel free to contact our Support team at (713) 333-6000 or support@practiceinsight.net.