Health Information Management

CMS grants extension to state Medicaid programs unprepared for ICD-10

HIM-HIPAA Insider, September 14, 2015

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by Steven Andrews, Editor

By now, providers are no doubt familiar with the group of entities required to switch to ICD-10—those covered by HIPAA—and those that can remain on ICD-9-CM, such as workers’ compensation and auto insurance companies.

State Medicaid offices are also required to switch to ICD-10, but not all of them are going to be ready and CMS has granted an extension to four states, reports Modern Healthcare. The claims processing systems in California, Louisiana, Maryland, and Montana apparently won’t be ready in time, affecting claims for millions of patients and many providers.

CMS approved the states to use a crosswalk system that will accept ICD-10-CM codes and translate them into ICD-9-CM codes to calculate payments, according to Modern Healthcare. No timeline for when they’ll be fully compliant has been announced. This should raise plenty of concerns for providers, who have spent a lot of time and resources to prepare for implementation.

I’ve written previously about the danger of providers using crosswalks to create ICD-10 codes, and the same holds true for payers. One-to-one translations don’t exist for the majority of codes, otherwise transitioning to ICD-10 would have no benefit.

Even more concerning, Modern Healthcare reports that California’s Medicaid program is keeping its crosswalks proprietary, so providers might have to do a lot of work to determine whether they were paid correctly for a code. Denials will have to be carefully reviewed to ensure the crosswalk didn’t lead to an incorrect translation.

Additionally, other small commercial payers might not be prepared for the transition and therefore may use crosswalks, Modern Healthcare reports. Providers should use the next couple weeks to check with payers and vendors to make sure their systems are ready for the conversion. If not, any denials may require additional scrutiny to determine if inadvertent mappings are to blame.

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