Five More Facts about ICD-10 from CMS

are you allergic to anything cartoon - AZCOMP TechnologiesThe other week, the Centers for Medicare & Medicaid Services (CMS) shared five facts dispelling misperceptions about the transition to ICD-10.  We posted about that and added some comments.  In case you missed it, you can read that one here.

Here are five more facts addressing common questions and concerns CMS has heard about ICD-10:

Five More Facts about ICD-10 & comments about them

1. If you cannot submit ICD-10 claims electronically, Medicare offers several options.

CMS encourages you to prepare for the transition and be ready to submit ICD-10 claims electronically for all services provided on or after October 1, 2015. But if you are not ready, Medicare has several options for providers who are unable to submit claims with ICD-10 diagnosis codes due to problems with the provider’s system. Each of these requires that the provider be able to code in ICD-10:

  • Free billing software that can be downloaded at any time from every Medicare Administrative Contractor (MAC)
  • In about ½ of the MAC jurisdictions, Part B claims submission functionality on the MAC’s provider internet portal
  • Submitting paper claims, if the Administrative Simplification Compliance Act waiver provisions are met

If you take this route, be sure to allot time for you or your staff to prepare and complete training on free billing software or portals before the compliance date.

2. Practices that do not prepare for ICD-10 will not be able to submit claims for services performed on or after October 1, 2015.

Unless your practice is able to submit ICD-10 claims, whether using the alternate methods described above or electronically, your claims will not be accepted. Only claims coded with ICD-10 can be accepted for services provided on or after October 1, 2015.

3. Reimbursement for outpatient and physician office procedures will not be determined by ICD-10 codes.

Outpatient and physician office claims are not paid based on ICD-10 diagnosis codes but on CPT and HCPCS procedure codes, which are not changing. However, ICD-10-PCS codes will be used for hospital inpatient procedures, just as ICD-9 codes are used for such procedures today. Also, ICD diagnosis codes are sometimes used to determine medical necessity, regardless of care setting.

4. Costs could be substantially lower than projected earlier.

Recent studies by 3M and the Professional Association of Health Care Office Management have found many EHR vendors are including ICD-10 in their systems or upgrades—at little or no cost to their customers. As a result, software and systems costs for ICD-10 could be minimal for many providers.

5. It’s time to transition to ICD-10.

ICD-10 is foundational to modernizing health care and improving quality. ICD-10 serves as a building block that allows for greater specificity and standardized data that can:

  • Improve coordination of a patient’s care across providers over time
  • Advance public health research, public health surveillance, and emergency response through detection of disease outbreaks and adverse drug events
  • Support innovative payment models that drive quality of care
  • Enhance fraud detection efforts

What this means for smaller independent practices (from our perspective)

First – Don’t put yourself in a position where you are scrambling to try and figure out a work-around at the 11th hour.

It is very nice that Medicare offers some options for you in the event that you haven’t gotten your act together in time.  The problem with this is that you will still be scrambling to figure things out, to learn a new system, to learn what crazy hoops you have to jump through just to get by.  This will still cripple your operation.

Don’t rely on some duct tape patch job free software program provided by MAC.  The software may be free but your time is not.  Remember this is free software for sending a claim – period.  It is not a Practice Management software and it will not integrate with Medisoft or Lytec.

In the free program, you won’t be able to post payments, send statements, run reports, track aging, etc.  This means you will still need to log all of the information into your Practice Management software (Medisoft or Lytec), and then rekey it into the “free software” so that you can submit the claim.

If you are already using Medisoft or using Lytec for your billing, your best bet is to continue managing all aspects of your billing from one place in a program that you are already familiar with.

We also recommend getting the ICD-10 ready version early.  Get it early so you can practice and be prepared.  Get it early so you don’t get caught in a tidal wave of other practices who are waiting till the last minute.


Second – if you are using the Medisoft or Lytec EMR systems, the ICD-10 billing components are included.

When you use McKesson Practice Choice EMR that is integrated with either Lytec or Medisoft, your ICD-10 ready version of Lytec or Medisoft is included with the EMR subscription.  Same with Lytec MD or Medisoft Clinical EMR systems.  If you have already been using these systems then the ICD-10 features you need are already available to you.

If you are one of the hold-outs for implementing EMR, and if you have not upgraded your PM software, then maybe now is the time to consider implementing an EMR.  Aside from all the regular advantages of implementing EHR (which are many), and also aside from the fact that when you implement a Medisoft or Lytec EHR you will get the ICD-10 features for free, there are many aspects of our EHR systems that will make your life easier with the transition to ICD-10.

Do you want to learn how to make the transition to ICD-10 easier on you?

Click here to opt-in to our ICD-10 webinar recordings.


Start Practicing Using Your ICD-10 Codes As Soon As…Now!

Even if you have all of the tools that you need, if you wait until October 1 to start using everything, then it will be a rough transition.  If you haven’t worked out your own kinks, then you could see significant delays in getting your claims paid and you will be frustrated with the process.  Don’t do that to yourself.  You can start practicing today!

Here are a couple tips to help you start practicing.

Our second webinar recording shows you how to put your software (either Lytec or Medisoft) into “testing mode” so that you can submit test claims.  In our third webinar, we outline how you can test your ICD-10 claims with your clearinghouse.  We provide specific information from Relay Health because that is our preferred clearinghouse, but we give you the info you need so you can enquire with your own.

There is also a feature in your ICD-10 version of the program that allows you to just start coding everything in ICD-10 right now, but your claims will still be submitted in ICD-9 right up until September 30th!  In the program, you can set a date for when to start submitting your ICD-10 claims.  Set that date right now so you don’t need to worry about making any changes on the morning of October 1.  Learn how to do this by watching the webinars.

Doing all this will allow you to practice coding in ICD-10 now and so that you and your staff can get comfortable with the changes, but without the added stress of potentially delayed payments.

Good luck!  Please comment below if you have any questions, need any help, or have any success / failure stories to share with the community.


Disclaimer: AZCOMP Technologies, Inc, (AZCOMP) is providing this material as an informational reference for practices who currently submit claims using ICD-9 codes. Although every reasonable effort has been made to assure the accuracy of the information within these pages at the time of posting, the Health Care industry is constantly changing, and it is the responsibility of each provider to keep themselves up to date of industry requirements.

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