A new Centers for Medicare & Medicaid Services (CMS) website is up and operational. It is the ICD-10 website http://www.cms.gov/ICD10/01_Overview.asp. This website is designed to assist health care providers change over from the current International Classification of Diseases [ICD] -9 to the ICD-10 medical diagnosis and inpatient procedure coding system. While the final date by which all claims and transactions must use the ICD-10 system is not until October 1, 2013, there are steps in the transition that must be met earlier than this final compliance date. These steps must be followed and implemented and the transition completed in order that processes are accurate and in place for all outpatient claims with dates of service and inpatient claims with dates of discharge on and after October 1, 2013. Failure to do so will most likely result in delays in reimbursement and billing turn-around time, thus decreasing the organization’s cash flow. It is important to note that at this time, these requirements do not impact outpatient procedure codes and transactions. However, these coding changes do affect all entities and individuals and everyone covered by the Health Insurance Portability and Accountability Act (HIPAA).
It is recommended that health care providers conduct internal testing of the Version 5010 electronic transmission standards. The current versions in use, Version 4010/4010A1, are used for claims, eligibility inquiries and remittance advices. The Version 5010 accommodates ICD-10 codes and thus must be in place and working prior to the complete transition to the ICD-10 system. Version 5010 standards are the revised HIPAA transaction standards that replace the Version 4010/4010A HIPAA transaction standards.
It is imperative that providers test their ability to correctly submit electronic health care transactions, using Version 5010, in order to conduct electronic health transactions with this version by January 1, 2012. Compliance will assist the provider to avoid experiencing extended claim processing times and reimbursement delays. The successful transition to Version 5010 is one of the first steps in the transition from the ICD-9 to the ICD-10 coding system.
Affected Groups - Many segments of the industry are affected by this change-over, including not only health care providers and payers, but also software vendors and clearinghouses/third-party billers. It will be important that the healthcare provider assure that these groups with which they interact are ready by the compliance deadlines. There are several Version 5010 levels of compliance, with Level I to be met by December 31, 2010 and Level II to be met by December 31, 2011. Should health plans find that they have not prepared to accept Version 5010 transactions from providers, they will most likely have a significant increase in provider customer service inquiries, which could further negatively impact their operations.
Preparation/Resources - Providers are cautioned to prepare now by determining and completing needed updates to software, staff training, process revisions, conducting internal and external testing and obtaining and providing the needed resources and materials relative to using Version 5010 and the ICD-10 system. CMS offers resources at the ICD-10 designated website that includes a link to the CMS Version 5010, provided according to care setting. Since CMS will begin accepting Version 5010 claims as early as January 2011, it is important that providers understand and remain current with compliance deadlines and revisions and updates to expectations.
Resources:
Overview. Retrieved on June 16, 2010 from http://www.cms.gov/ICD10/01_Overview.asp
ICD-10 and Version 5010 Compliance Timelines. Retrieved on June 16, 2010 from
http://www.cms.gov/ICD10/03_ICD-10andVersion5010ComplianceTimelines.asp#TopOfPage |
