Health Information Management

CMS offers alternatives for providers having difficulty submitting ICD-10 claims

APCs Insider, September 18, 2015

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By Steven Andrews
Despite years of lead time and numerous delays, it’s almost certain that some providers, vendors, and payers will not be 100% prepared for ICD-10 implementation in two weeks.
Acknowledging that, this week CMS published a list of claims submissions alternatives for providers who have difficulties submitting ICD-10 claims due to being unable to complete systems changes or issues with billing software, vendors, or clearinghouses.
The first option is free billing software for providers who submit claims to MACs. CMS stresses that the software is only meant to provide an ICD-10-compliant claims submission format; it will not provide coding assistance. Also, while the software itself is free, fees may be associated with submitting claims through a Network Service Vendor or dial-up.
Providers may also be able to submit professional claims through MAC provider internet portals, but this option is not available for institutional or supplier claims.
Institutional claims may be submitted via direct data entry (DDE) screens, but providers will need to register and look for DDE service vendors through their MAC.
Finally, CMS offers the option to submit paper claims in a limited number of circumstances. Providers may apply for a waiver if their software or software vendor is not ready for ICD-10 and it will cause a financial hardship to switch. Plus, the provider’s MAC must not offer a provider internet portal supporting electronic claims submissions and it would cause financial hardship to procure the services of a billing agent or clearinghouse.
If you’re facing difficulty with your software or vendors and may need to use these options, check your local MAC’s website for more information.

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