CMS grants extension to state Medicaid programs unprepared for ICD-10
APCs Insider, September 11, 2015
Want to receive articles like this one in your inbox? Subscribe to APCs Insider!
By Steven Andrews
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 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.
Want to receive articles like this one in your inbox? Subscribe to APCs Insider!
Related Products
-
Briefings on APCs
Worried about the complexities of the new rules under OPPS and APCs? Briefings on APCs helps you understand the new rules...
-
HIM Briefings
Guiding Health Information Management professionals through the continuously changing field of medical records and toward a...
-
Briefings on Coding Compliance Strategies
Submitting improper Medicare documentation can lead to denial of fees, payback, fines, and increased diligence from payers...
-
Briefings on HIPAA
How can you minimize the impact of HIPAA? Subscribe to Briefings on HIPAA, your health information management resource for...
-
APCs Insider
This HTML-based e-mail newsletter provides weekly tips and advice on the new ambulatory payment classifications regulations...
Most Popular
- Articles
-
- Don't forget the three checks in medication administration
- Note similarities and differences between HCPCS, CPT® codes
- Practice the six rights of medication administration
- OB services: Coding inside and outside of the package
- Q&A: Primary, principal, and secondary diagnoses
- What to include on the incident report
- What does case-mix index mean to you?
- Pneumonia with a negative chest x-ray: Clinical diagnoses, physician documentation, and coding guidelines
- Diagnostic v. screening mammogram based on referring physician’s order
- Understanding and coding for critical care services
- E-mailed
-
- CDC: First Case of Wuhan Coronavirus Confirmed in U.S.
- What to include on the incident report
- Ask yourself: Could your CDI program work at home?
- Joint Commission addresses nurse burnout
- ICD-10-CM contracts the flu
- How to assign the correct ED E/M code
- Five keys to creating a CHF disease management program
- Documentation challenges for skin and dermatology coding
- Do not use pathology measurements to report a lesion's size
- Diagnostic v. screening mammogram based on referring physician’s order
- Searched
