10 Key Points to Remember About the ICD-10 Transition
Here are ten facts to consider in advance of October 1, 2015, when ICD-10 is set to become the required diagnosis code structure for medical claims.
- Practice Insight software and our clearinghouse are ready for implementation.
- Providers are NOT REQUIRED to test their ICD-10 readiness.
- ICD-10 compliance is mandatory for all HIPAA covered entities.
- ICD-10 codes apply to dates of service beginning October 1, 2015. Health services and claims for dates of service through September 30, 2015 remain coded with ICD-9.
- ICD-9 codes cannot be reported with ICD-10 codes on the same claim.
- Denial rates may increase with ICD-10 resulting from miscoding or an incorrect level of specificity.
- Practice Insight offers providers two ICD-10 testing options: either submit test claims from your PM or build them in EDIinsightSM, including self-batching.
- Practice Insight offers a customer-specific ICD-10 Code Analysis Report that analyzes historical claims for diagnosis code usage and offers probable matches to ICD-10.
- The CMS GEM (General Equivalency Mapping) crosswalk is built-in to EDIinsightSM
as a searchable resource.
- EDIinsightSM Clinical Claim Scrubbing and EDIinsightSM ERA Denial Manager are two ICD-10-ready products Practice Insight offers that can help ease the transition.
How Prepared for ICD-10 Are You?
- Have your employees gone through training on ICD-10?
- Do you have any of the ICD-10 coding books or ICD-10 software?
- Are your PM and EHR ICD-10-ready?
Have you analyzed your current ICD-9 code usage and translated it to ICD-10 codes?
If you answered No to any of these questions, don’t panic. You can get a jump-start by taking advantage of our ICD-10 Code Analysis Report.
ICD-10 Code Analysis Report
Our ICD-10 Code Analysis Report enables you to view and analyze exactly what ICD-9 codes you are using right now. Through GEMs integration, you may also gain insight into exactly how many claims are using those ICD-9 codes and what the potential ICD-10 matches might be. It can give you a clearer picture of your readiness.
Contact us at 713-333-6000 or by email at email@example.com to arrange for an ICD-10 Code Analysis Report.
- CMS GEMs loaded directly into the DX Search
- All possible scenarios listed underneath the selected code
- GEMs search from within claim edit
- Reverse searching from ICD-10 to ICD-9
- Analytics including a working DX list to show all codes billed and their potential mappings
ICD-10 Compliance with a Legacy Practice Management System
Practice Insight has aligned with many members of the Association of Independent Medical Software Value Added Resellers (AIMSVAR) to support providers with legacy practice management systems seeking to make the transition to ICD-10. Rather than taking on wholesale PM system upgrades, Practice Insight and its AIMSVAR partners are utilizing P.I.’s EDI capabilities to deliver ICD-9 to ICD-10 solutions that ease this financially critical transition for providers.
AIMSVAR members represent well over 5,000 healthcare providers, the preponderance of which utilize Practice Insight’s suite of EDI products. Members cite P.I.’s holistic, PM/EMR-vendor agnostic EDI solution as a key advantage in helping providers meet ICD-10 mandates.
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.
- 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
Industry Information Links
Please feel free to contact our Support team at (713) 333-6000 or firstname.lastname@example.org.