Your 7 Top ICD-10 Questions Answered!

Lea Chatham November 20th, 2013

1 Comment Latest by COMMENTOR NAME

Kareo ICD-10 tools

On Wednesday, November 13, Kareo hosted a great webinar, ICD-10: Don’t Freak Out!, presented by practice management expert Rochelle Glassman. Over 700 practice managers, billers, coders, and providers attended this event. Rochelle discussed how to prepare for the coding change AND how to prepare for possible reductions in revenue and productivity. The attendees had more than 50 questions about the content from that presentation. While we’d love to answer them all in this blog, there just isn’t room. So, Kareo’s team picked seven questions that apply to most practices, and here are the answers…

Q: Should we start processing claims with the ICD-10 codes now or do we need to wait until the actual transition date?
A: Overall, you won’t be able to process ICD-10 claims until October 1, 2014. However, please check with your insurance companies as some of the larger companies may offer the option to submit claims with ICD-10 prior to the current implementation date. In the meantime, continue to submit claims with ICD-9. Again, as mentioned in the presentation, please contact any clearinghouses and at least the top 8-10 payers for your organization as soon as possible. Ask for the next steps on how and when submitting ‘practice claims’ with ICD-10 coding can begin. Being proactive today will allow your organization to work out any issues that come up prior to the deadline. 

Q: What do we do about patients with dates of service (DOS) before and after October 1, 2014?
A: You will use ICD-9 for the DOS before October 1 and ICD-10 for the DOS after.

Q: What about Personal Injury and Workers Comp claims? I have seen information that these carriers will continue to use ICD-9 codes. Is that true?
A: These non-covered entities will not be required to change to ICD-10 however they are encouraged to do so. According to CMS, “Because ICD-9-CM will no longer be maintained after ICD-10-CM/PCS is implemented, it is in non-covered entities’ best interest to use the new coding system. The increased detail in ICD-10-CM/PCS is of significant value to non-covered entities. The Centers for Medicare & Medicaid Services (CMS) will work with non-covered entities to encourage their use of ICD-10-CM/PCS.” Please refer to this CMS document, which addresses many common myths and facts about this and other frequently asked questions. (this answer was updated on 11/25/13).

Q: Will I need the ICD-10 Coding Manual even if I have software that gives me the codes?
A: Yes, you should always have the most current coding manual in your practice. You can’t rely entirely on your EHR or billing software. Your coding will be dictated by your documentation and there will certainly be times when you have to look something up or double check to be sure your coding correctly. You’ll want that reference book handy!Keep in mind that ICD-10 has over 68,000 codes.

Q: Can you please go over what specific office documents need to be updated for ICD-10?
A: You’ll need to update your superbill (if paper), order new CMS HCFA 1500 forms, referral forms, x-ray forms, laboratory forms, authorization forms, and any other forms that use diagnosis codes.

Q. When do we start using the HCFA 1500 form?
A: Medicare will begin accepting the revised form on January 6, 2014 and on April 1, 2014, will only accept the revised form. Use up the old forms and purchase the new ones. Be aware that some states will be converting to electronic-only claim submission. This is already mandated in some states.

Q: Since some payers have a very short time frame to send the claims, what do I do if claims are denied due to ICD-10 issues?
A: Check with all of your payers now and review your contracts to understand timely filing issues with ICD-10. The more testing you do ahead of time the better. Your software vendor and clearinghouse should also provide code scrubbing to help reduce problems. It would be wise to use your billing software to closely monitor rejections on a daily basis during the transition so you can fix problems whether they are caught at the software level, clearinghouse level, or payer level as soon as they happen. Your software vendor may also offer a no response tool to track claims that have not had any response in a specific period of time so that you can look into those before the submission period ends. For example, if most of your payers generally remit in 14 days or less then set your no response for three weeks. That gives an extra cushion for the payer but alerts you that you haven’t been paid or received a denial for those claims. For actual rejections from the payer, you’ll need to follow the same process you use now to resubmit them.

If you missed this event, you can view the recorded presentation ICD-10: Don’t Freak Out! For more tools and resources, you can also visit this ICD-10 resource page, or read more helpful ICD-10 articles.

About the Speaker:

Rochelle Glassman discusses the cost of bad customer service for Kareo

Rochelle Glassman, a passionate advocate for physicians and medical practices who has devoted her career to helping doctors get paid. Rochelle is the President & CEO of United Physician Services, and is a nationally recognized healthcare consultant known for her candor, tenacity, and vision.

1 Comment »

    Brad Howard said:

    Thank you for stressing that practices need their books and can’t completely rely on their software!! I have been doing ICD-10 bootcamps for past year and also perform audits and the one thing I tell all practices is to have at least one copy to reference – the coding guidelines at the beginning of each chapter are something that are easy to overlook when relying on software and are SO important.

    Friday, October 23, 2015 - 1:15 pm

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