CMS Commits To Flexible ICD-10 Implementation, But What Does That Mean?

CMS Commits To Flexible ICD-10 Implementation, But What Does That Mean?

Tpatient billinghe Centers for Medicare and Medicaid Services reports that over the next five years, $46 billion will be spent annually on national healthcare programs. And in a few months, all healthcare providers will have to master an entirely new patient billing and medical coding system, the dreaded ICD-10.

For thousands in the medical community, the looming implementation of the ICD-10 has been a constant source of background anxiety in 2015. And as the implementation date of October 1, 2015 approaches, many in the healthcare industry have lobbied for a delay.

To say that the U.S. medical billing and coding system is complex can only be described as a massive understatement. By some estimates, as many as 250 people can be involved in generating a single patient billing. And since the new ICD-10 will include thousands of new medical codes, it’s clear why the U.S. Bureau of Labor Statistics predicts that by 2018 employment among medical transcriptionists will rise 11%, while medical coding and health information technician employment will surge by 20%.

So when the Centers for Medicare and Medicaid Services(CMS) announced this July that they would commit to a “flexible” phasing in of the ICD-10, there were accounts of medical professionals jumping for joy. Unfortunately, it’s become clear that “flexible” does not mean delayed. So what does flexible ICD-10 implementation really mean for patient billing?

In addition to calling for a delay, many providers requested a period of “dual coding” in patient billing, meaning a period of time in which either ICD-10 or ICD-9 patient billing codes could be used interchangeably, at least until the industry caught up to speed. Those hopes have been dashed as well. Starting October 1, any claims without a valid ICD-10 code will be rejected out of hand.

So how exactly will the implementation provide flexible patient billing for providers? If a provider makes an ICD-10 related mistake, then CMS will notify them of the error. Providers will then have the opportunity to resubmit any rejected claims.

But remember, private payers have made no such guarantees for flexibility come October, and providers would be wise not to count on a grace period. Any provider or health care facility that lacks confidence in their ability to master the thousands of new (and longer) medical coding regulations should consider contacting a medical billing company, investing in medical billing resources, or praying before October 1.