Last Minute ICD10 Testing Opportunities

CMS has finished the third and final round of end-to-end testing for claims containing ICD10 codes.  The tests results included an 87% acceptance rate of the claims submitted.  Only 1.8% of the claims were rejected because of the new codes, 2.6% were rejected because of invalid ICD9 codes.  These rejection rates are about normal for the current production claims processing environment.

The minor problems discovered by CMS in their system after round two of tests in April appear to be corrected.  On the surface it would appear that the industry, or at least CMS, is ready to process these claims, however, these statistics are deceiving.

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Embracing Disruption for Growth

As we approach the October deadline for ICD10, you can sense the tension in the industry as the unknown consequences of using this code set move closer to the present as each day passes, or as Snoopy would begin the story, it was a dark and stormy night.

Even the most prepared organizations can only guess what the impact of switching to ICD10 will have on their transaction processing, cash flow, and procedures.  Every organization is linked to others and the disruption caused by this will be felt by everyone.  It can’t be avoided, only mitigated through planning, preparation, and then making adjustments quickly.

Charles M. Schulz, Snoopy
Charles M. Schulz, Snoopy

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The Impact of CMS Flexibility on ICD10 Implementation

CMS announced a joint statement with the AMA in early July regarding a compromise on how claims with 10 codes would be processed after 10/1/15.  They published FAQs and responses for this announcement on 7/27.

This announcement was advertised to be a settlement between these organizations regarding the efforts of the AMA to delay the implementation of ICD10 and the insistence of CMS that this deadline was final.

Initially, I was concerned about how this announcement might affect the adjudication of all Medicare claims and the potential modifications to Medicare contractor systems we had already tested with our applications over the last several months.  As it turns out, these changes to CMS policy are largely cosmetic and will have no impact on the processing of most claims.  Additionally, although this policy is promoted as a relaxation of the implementation, it provides little relief to healthcare providers and their staff that are unprepared for the transition.

Flexibility
Flexibility

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