Successful
ICD-10 Testing Shows Industry Ready
to Take Next Step to Modernize Health
Care
By Marilyn Tavenner,
Administrator, lefts for Medicare
and Medicaid Services.
I am delighted to
announce that CMS has recently successfully
completed the first week of end-to-end
testing of
new ICD-10 coding.
The International
Classification of Diseases, or ICD,
is used to standardize codes for medical
conditions and procedures. While most
countries already use the 10th revision
of these codes (or ICD-10), the United
States has yet to adopt this convention.
Since ICD-10 codes are more specific
than ICD-9, doctors can capture much
more information, meaning they can
better understand important details
about the patient’s health than with
ICD-9-CM.
Approximately
660 providers and billing companies
submitted nearly 15,000 test claims.
This successful week of testing continues
to put us on course for successful
implementation of this important initiative
that better reflects modern practice
of medicine by Oct. 1, 2015.
Health care professionals
use codes from the International Classification
of Diseases—or ICD—to record their
patients’ health conditions and document
inpatient hospital procedures.
The U.S. is the last
major industrialized nation to make
the switch to ICD-10. The structure
of ICD-9, which is more than 35 years
old, limits the number of new codes
that can be created, and many ICD-9
categories are full. ICD-10 provides
room for code expansion, so providers
can use codes more specific to patient
diagnoses. Fact
sheet on ICD-10.
To promote the health
care community’s smooth transition
from ICD-9 to ICD-10, CMS is conducting
a comprehensive
program of testing. Because ICD codes
are required on medical bills, we
want health care providers to be confident
they can submit Medicare claims and
get paid as the nation switches to
ICD-10.
To that end,
Medicare recently tested ICD-10 claims
processing with a variety of stakeholders
including health care providers, billing
agencies, and equipment suppliers.
Overall, participants in the January
26 to February 3 testing were able
to successfully submit ICD-10 claims
and have them processed through our
billing systems. To the extent that
some claims were rejected, most didn’t
meet the mark because of errors unrelated
to ICD-9 or ICD-10.
Testing allows us
to identify areas of improvement,
and we will work with outside entities
and stakeholders to improve those
very small deficiencies identified.
And we will continue to do testing,
especially in those areas we identify
as needing improvement.
We’ve also identified
one point that’s caused some confusion
in the health care community and beyond.
So, we are communicating far and wide
that everyone must use:
That means ICD-10
can be used only for test purposes
before October 1. And, only ICD-10
can be used for doctor’s visits and
other services that happen on or after
October 1. ICD-9 cannot be used to
bill for services provided on or after
October 1. This rule applies no matter
when the claim is submitted, so claims
submitted after October 1, 2015, for
services provided before that date
must use ICD-9 codes.
These rules and
others around adopting ICD-10 apply
to all health care providers, not
just those who accept Medicare or
Medicaid. So, like CMS, health insurance
plans across the country are engaging
in robust testing programs with doctors,
hospitals, and other health care providers
and suppliers. No major issues have
emerged in the course of testing.
As the ICD-10 deadline
draws near, I especially encourage
medical practices and hospitals that
bill Medicare to take advantage of
testing
opportunities.
Beyond testing, CMS has undertaken
an unprecedented level of outreach,
training, and education to prepare
the health care community for ICD-10.
Our website cms.gov/ICD-10, offers many resources,
including the Road to 10 tool, designed
especially for small medical practices.
CMS is ready
for ICD-10. And, thanks to our many
partners—spanning providers, health
plans, coders, clearinghouses, professional
associations and vendor groups—the
health care community at large will
be ready for ICD-10 on October 1.
I appreciate
the tremendous efforts and achievements
of health professionals as we work
together to realize the benefits of
ICD-10 and other advances toward the
ultimate goal of improving the quality
and affordability of health care for
all Americans.
Keep
Up to Date on ICD-10
Visit
the CMS ICD-10
website
for the latest news and resources
to help you prepare. Sign up for CMS
ICD-10 Industry Email Updates and follow
us
on Twitter.
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