On April 1, 2014, it was announced that the Protecting Access to Medicare Act of 2014 (PAMA) (Pub. L. No. 113-93) was enacted, which included language that the DHHS Secretary may not adopt ICD-10 prior to October 1, 2015. Accordingly, the U.S. Department of Health and Human Services 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 October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015.
Until the interim final rule is released, the South Carolina Department of Health and Human Services (SCDHHS) will continue forward with the ICD-10 development in order to meet the current compliance date of October 01, 2014.
Benefits of ICD-10
The revised ICD classification system offers many benefits for Payers, Clearinghouses, Billing Services, Software Vendors, and Providers.
- Updates terminology and disease classifications consistent with current clinical practices, medical, and technological advances
- Expands flexibility for future updates to the codes as necessary
- Enhances coding accuracy and specificity to classify anatomic site, etiology, and severity
- Provides detailed clinical information in a single ICD-10 procedure code
- Improves operational processes across healthcare industry
- ICD-10-CM may improve the ability of policy makers to compare and contrast the morbidity of various countries’ populations and the performance of their health systems
Preparing for ICD-10
It is important to start preparing now for the ICD-10 transition. Key tasks that will help your organization get ready for October 1, 2014:
- Develop an implementation strategy that includes an assessment of the impact on your organization, a detailed timeline, training, and a budget.
- Check with your billing service, clearinghouse, or practice management software vendor about their compliance plans:
- What are their plans to move to ICD-10?
- Will you need to update or replace your current systems?
- Are upgrades covered by existing contracts? Will there be additional costs?
- When will they be ready for testing?
- What customer service support and training will be provided to your staff?
- Providers who handle billing and software development internally should plan for medical records/coding, clinical IT, and finance staff to coordinate on ICD-10 transition efforts.
- Be proactive! Do not wait for your vendor to reach out to you.
Don't forget that you are able to test your ICD-10 claims submissions before the October impementation date.
View the ICD-10 Testing documentation in the internal links section for detailed information.
Software Vendors, Clearinghouses, and Billing Services
- Have products and services in development that will allow SCDHHS providers to fully test and implement ICD-10 code sets prior to October 1, 2014.
- Talk to your customers now about preparing for the transition. Your products and services will be obsolete if you do not take steps now to get ready.
Beginning October 1, 2014, the following applies:
- Medical coding in the U.S. health care settings will change from ICD-9 code sets to ICD-10 code sets.
- ICD-10 diagnosis and procedure codes are required on claims that contain Dates of Service or Dates of Discharge of 10/1/2014 or after.
- ICD-9 diagnosis and procedure codes will be required on claims that contain Dates of Service or Dates of Discharge of 9/30/14 and before.
- Claims submitted with ICD-9 codes that contain a Date of Service or Date of Discharge of 10/1/2014 or after will be rejected.
- Claims submitted with ICD-10 codes that contain a Date of Service or Date of Discharge of 9/30/14 or before will be rejected.
- Claims submitted with both ICD-9 and ICD-10 codes will be rejected. You must submit two different claims based on Dates of Service or Date of Discharge.
- The web portal will contain an indicator that the provider will need to check indicating if he/she is submitting a claim with ICD-9 or ICD-10 codes. An error message will appear if the provider selects an indicator that does not match with the codes entered. For example, if the provider selects the ICD-10 Indicator, but enters ICD-9 codes, then the error message will appear.
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