Home Health & Hospice

CMS clears up common misconceptions about the transition to ICD-10

Homecare Insider, May 4, 2015

CMS recently spoke with the provider community to help dispel some of the myths surrounding ICD-10. Through these conversations, the agency identified some prevalent misperceptions about the looming transition to the new coding system and published these clarifying facts in response:
  • CMS offers several alternative submission methods for providers that cannot transmit ICD-10 claims electronically. Although CMS encourages providers to prepare for the transition to ICD-10 by ensuring they will be able to electronically submit claims coded using the updated methodology for all services provided on or after October 1, 2015, the agency will offer several alternative options for those who will be unable to submit claims in this way due to problems with their electronic reporting system:
    • Through free billing software that can be downloaded from any Medicare Administrative Contractor (MAC)
    • Using Part B claims submission functionality on their designated MAC’s provider internet portal, available in about half of these contractors’ jurisdictions
    • Submitting paper claims, if the Administrative Simplification Compliance Act waiver provisions are met

A couple caveats: Each of these options requires the provider to be able to code in ICD-10. In addition, CMS advises facilities opting for non-electronic claim submission to be sure to set aside enough time for staff to prepare and complete training on free billing software or portals before the compliance date.

  • Providers that do not prepare for ICD-10 will not be able to submit claims for services performed on or after October 1, 2015. An organization’s claims WILL NOT be accepted for services provided on or after October 1 unless they are coded in ICD-10 and submitted either electronically or using one of the alternative methods outlined above.
  • Reimbursement for outpatient and physician office procedures will not be determined by ICD-10 codes. Outpatient and physician office claims are not paid based on ICD-10 diagnosis codes but on CPT and HCPCS procedure codes, which are not changing. However, ICD-10-PCS codes will be used for hospital inpatient procedures, just as ICD-9 codes are used for such procedures today. Also, ICD diagnosis codes are sometimes used to determine medical necessity, regardless of care setting.
  • Costs could be substantially lower than initially projected. Recent studies by 3M and the Professional Association of Health Care Office Management have found many EHR vendors are including ICD-10 in their systems or upgrades at little or no cost to their customers. As a result, CMS concludes that software and systems costs for ICD-10 could be minimal for many providers.
  • It’s time to transition to ICD-10. CMS considers ICD-10 foundational to modernizing health care and improving quality. The agency states that the coding system serves as a building block that allows for greater specificity and standardized data, both of which can:
    • Improve coordination of a patient’s care across providers over time
    • Advance public health research, public health surveillance, and emergency response through detection of disease outbreaks and adverse drug events
    • Support innovative payment models that drive quality of care
    • Enhance fraud detection efforts
For the latest ICD-10 news and resources to prepare for the October 1 implementation, click here to visit CMS’s dedicated website section.