Federal Agency: [Delayed] ICD-10 Compliance. Make the transition or your claims won't be paid.


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Topic Federal Agency: [Delayed] ICD-10 Compliance. Make the transition or your claims won't be paid.
Background [Delayed] (The federal government has announced an indenfinate delay of ICD-10) On Oct. 1, 2013, medical practices, health insurers, and clearinghouses must use International Statistical Classification of Diseases and Related Health Problems (ICD-10) to record all diagnoses and inpatient procedures. Mandated by the U.S. Department of Health and Human Services, the upgrade from ICD-9 will enable doctors’ offices to collect and exchange more-detailed patient data. Don’t be fooled, there's more to ICD-10 than just learning a new code set and upgrading software. The transition affects every aspect of your practice. To start, gain a basic understanding of the differences between the code sets and complete an inventory of any business practice or process that makes use ICD-9 codes. This will help you identif how ICD-10 will impact your practice operations.
Regulating Body Centers for Medicare and Medicaid Services (CMS)
Compliance Date 10/1/2013
Consequences If you do not transition to ICD-10 by Oct. 1, 2013, Medicare, Medicaid, and commercial insurance carriers will not pay your claims.
Next Steps 1) Comply with HIPAA 5010 electronic claims standards by Jan. 1, 2012. 2) Evaluate current technology. Ask electronic health record and practice management software vendors if they'll maintain updates to both code sets during the transition and if they'll provide any "crosswalk" tools. 3) Ask your top payers for education. Many payments are tied to quality reporting, performance, and medical necessity, so ask about any changes to review or audit processes, coverage, and medical policies. 4) Update internal processes that support coding. This includes superbills, encounter forms, quality data and public health data collection forms. 5) Become familiar with documentation requirements. Review your most frequently used codes and look at your documentation habits — are the details sufficient to accurately assign an ICD-10 code with expanded options? 6) Conduct training for every staff member based on individual job descriptions.
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