Why You Still Need to be Prepared for ICD-10 on Oct. 1

Why You Still Need to be Prepared for ICD-10 on Oct. 1

For those breathing a sigh of relief in hopes of not having to be prepared based on the recent release from CMS and AMA need to take a deeper breath. Let’s take a closer look at two of the provisions to understand why:
CMS will not deny a claim based on the specificity of the ICD-10-CM code for up to 12 months as long as it is in the right “family” of codes. This sounds great, but what exactly are they referring to as “family”? Is it the category or subcategory? By definition, it could actually be more restrictive than just saying you can go ahead and use unspecified codes. Now think back, pull your admin reports, how often have you actually been denied for the use of unspecified diagnosis code from CMS? Rarely, unless there is a medical policy; the majority of all claims denied or rejected have little to do with the specificity of a diagnosis code. The worry for us on unspecified codes do not come from CMS, rather, all those commercial carriers we contract with and all the varying information they have put out there. Those questions still exist, will they or won’t they accept our claims? You still need to be prepared and do your research; chances are that CMS is not your largest payer.
CMS will employ advanced payments. This is something desperately needed in the industry, financial stability to our medical practices. But, it’s only if CMS is not ready. If you have vendor issues, or you have not prepared and cannot submit a compliant claim, you are on your own. Honestly, it makes sense, as we can’t expect the government to pay if we haven’t done anything to prepare, but it gives us a false sense of security. Also, keep in mind that this again only applies to CMS – find out what other payers may be willing to do for you.
I always try to encourage you to read what is printed and then ask yourself how this will really affect your practice. The bottom line is that the only one that can protect your practice is you. You must prepare and be ready by October 1st; there is no grace period for not being able to submit compliant claims. I applaud both the AMA and CMS for doing what they can to help the provider offices but we need to continue to push to make sure commercial carriers follow suit and that we do our due diligence in getting prepared.


Rhonda Buckholtz

About Has 38 Posts

Rhonda Buckholtz, CPC, CPMA, CRC, CDEO, CMPE, CHC, COPC, AAPC Approved Instructor, is owner of Coding and Reimbursement Experts. She spends her time helping physician practices achieve operational excellence, compliance, education, and Lean Six Sigma through her consulting. Buckholtz has more than 30 years of experience in healthcare management, compliance, and reimbursement/coding sectors. She was responsible for all ICD-10 training and curriculum at AAPC during the transition from ICD-9. Buckholtz has authored numerous articles for healthcare publications and she has spoken at numerous national conferences for AAPC and others. She is past co-chair for the WEDI ICD-10 Implementation Workgroup, Advanced Payment Models Workgroup, and she provided testimony for ICD-10 and standardization of data for National Committee on Vital and Health Statistics. Buckholtz is on AAPC’s National Advisory Board.

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