ICD-10: All Systems Ready?

Even if you and your staff have mastered the ICD-10 codes you’ll use in your practice and the documentation elements to support them, your systems need to be ready to go when ICD-10 begins, too. If you can’t send claims, you can’t receive payment for them.

You’ll want to verify before the Oct. 1 ICD-10 start date that you can generate and submit claims. In addition, make sure you can:

  • Schedule outpatient procedures,
  • Perform eligibility and benefits verifications,
  • Prepare to submit quality data,
  • Schedule office visits, and
  • Update patient histories and encounters.

The best way to ensure your systems are ready is to test.

The Centers for Medicare & Medicaid Services  (CMS) recommends you focus on your highest-risk scenarios like claims processing, the diagnoses you see the most often, and those that account for most of your revenue as you test any system that stores, processes, sends, receives, or reports diagnosis code information.

You can test:

  • Inside your practice, and
  • With clearinghouses, billing services, and health plans.

You can conduct acknowledgement testing with Novitas Solutions on an unlimited number of electronic Medicare claims, any time until Sept. 30. Acknowledgement testing confirms you can submit claims. You do not need to register with Novitas for testing, and you can submit acknowledgement test claims directly or through a clearinghouse or billing agency.

To submit claims for testing, you must use:

  • Current dates of service, and
  • The test indicator “T” in the Interchange Control Structure (ISA) 15 field.

For more information about testing your systems, check out the infographic from CMS. Check with commercial payers about their testing opportunities as well.

Inside your practice, AAPC suggests playing “what if” throughout the practice to pinpoint situations that might trip up smooth operations. “How will the back office handle unexpected increases in claims denials? How will the coding department deal with slowdowns, as coders adjust to coding in ICD-10 throughout their daily workload? Answers to questions like these can provide insight into the true state of readiness,” AAPC says.

Explore alternate ways to submit claims to health plans.

Have a plan if you think your systems will not be ready for ICD-10 by Oct. 1. For Medicare physicians, options include (each requires you to code in ICD-10): 

  • Free billing software available from Novitas,
  • Part B claims submission via Novitasphere, and
  • Paper claims for providers who meet Administrative Simplification Compliance Act waiver requirements.

Ask other health plans you work with about the options they offer.

And, if you haven’t mastered those new codes yet, use e-MDs ICD-10 Code Search Tool MembersOnlyRed. This intuitive tool is free for TMA members, a $1,250 value. Read about this and more in TMA’s ICD-10 Resource Center.

Published Sept. 9, 2015

TMA Practice E-Tips main page

Last Updated On

September 29, 2015

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