Request a Demo Practice Insight

Contact Us

Help

Learn More

HIPAA
Providers
Resellers
Payers
Service_and_Support
News and Events
Partners
About Practice Insight

Vendor Portal

(Login Required)

New Vendors Register Here

What about ICD-10-CM?

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 an extra digit. 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.

CMS Testing Week (March 3-7)

Practice Insight is prepared to assist providers with testing for the upcoming CMS Testing Week (March 3-7, 2014).

For CMS testing week, Practice Insight will be participating in End-to-End Testing with all CMS contractors. This testing week will begin Monday, March 3, 2014 and will end at the completion of the business day on Friday March 7, 2014.

What is End-To-End Testing?

Many payers have different definitions of "End-To-End" testing. For the purposes of the CMS testing week, this includes:

  • 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 is NOT:

  • Testing live claims - All claims must be TEST
  • Testing adjudication - CMS will NOT be providing a remittance for tested ICD-10 claims

How can providers participate in CMS Testing Week?

Providers can 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.

NOTE: All claims must 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 can simply set the TEST ICD-10 claims to READY. During the week of CMS Testing, Practice Insight will batch these TEST ICD-10 claims and send to CMS.

If you have any questions regarding CMS Testing Week and Practice Insight's involvement, please contact PI Support by email at support@practiceinsight.net or by phone at (713)333-6000.

Practice Insight Readiness

Practice Insight is prepared 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. Current ICD-9 codes will all use an ending date of: September 30, 2014. The new ICD-10 codes will use a beginning effective date of: October 1, 2014, 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, 2012Compliance deadline for 5010.
August 2012CMS 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 2013Begin Testing Phase: begin testing with a Payers and Channel Partners according to readiness. Support provider-initiated testing. Ongoing customer communications.
Q3 2014Awareness of known Payer Issues. Ongoing customer communications.
October 1, 2014Go Live: The ICD-10-CM code set will be used to validate coding for Dates of Service October 1, 2014, 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.

Industry Information Links

Questions?

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