Expect challenges from ICD-10 transition

Friday, September 11, 2015

YARMOUTH, Maine – The transition to ICD-10 kicks off Oct. 1, but many HME providers are behind the eight ball, say consultants.

“I think some of the more sophisticated companies are in tune with the transition,” said Sarah Hanna, president of ECS Billing & Consulting North. “I think those who have been led to believe that it’s an easy one-to-one translation are missing out.”

ICD-10 features expanded alphanumeric code sets, as well as an expanded number of codes—68,000 vs. 13,000 under ICD-9—aimed at capturing more information to ensure better patient care.

The scope of the changes, by themselves, could be daunting for providers, say consultants.

“They have to tackle all of the rentals, and getting the diagnoses linked to future CMNs and setting up those connections on all of the orders,” said Andrea Stark, a reimbursement consultant with MiraVista. “Then there’s the research involved with the one-to-many diagnoses or ‘mappings.’ It is going to be a challenge.”

The challenges are likely to disrupt cash flow, even for proactive providers, say consultants. That’s because the switch impacts everyone from providers to physicians to insurers.

“It’s not all in their control,” said Kelly Wolfe, CEO of Regency Billing and Consulting. “There are physicians offices we know of that are going to drag their feet on this.”

Fortunately, there’s a one-year grace period—until Oct. 1, 2016—in which physicians and other practitioners under Medicare Part B won’t be denied for not having the exact diagnosis code.

“That will bleed over onto us,” said Hanna. “As long as they use a valid code from the right code family, they can’t be denied solely on the specific ICD-10 code.”



I looked up this grace period and spoke with out MAC, the offical rule says for claims under the part B physician fee schedule. It says nothing about claims under the DMEPOS. CGS stated they have nothing on file for them to allow this grace period. Can some please provide confirmation from CMS that the grace period will apply to the DME/HME contractors?

You are correct. The grace period applies to physicians, etc. What Sarah Hanna said to me: "We don't believe at this time, if the physician puts one code, and the DME provider puts another, they are not going to outright deny it, based solely on the specificity of the ICD-10 code, as long as they used a valid code from the same family."