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CMS advice: Discuss ICD-10 preparation with your billing service
e-Reports, Jan. 22, 2013
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While implementation of the ICD-10 code set isn’t until Oct. 1, 2014, now is the time to initiate important conversations with your clearinghouses and billing services about their readiness.

Even if you are employed, you are responsible for claims and information submitted to payers, according to the Centers for Medicare & Medicaid Services (CMS).

“The provider must ensure that medical record documentation supports the level of service reported to a payer. The volume of documentation should not be used to determine which specific level of service is billed,” stated CMS.

Gloria Kirkham, ISMA practice advisor, suggested working closely with your coder and reviewing accounts receivable each month.

“If a claim is not submitted accurately, the payer can take the money back,” said Kirkham. “Ninety days to submit a claim is not a lot of time. So when a claim is resubmitted, you miss the filing deadline and that costs money. That’s why it is so important to know that claims are submitted accurately the first time.”

Kirkham advised that you research and enlist in a reliable clearinghouse or billing service. Also, ask your colleagues for recommendations.

Questions to ask
CMS provides questions for you to consider when discussing ICD-10 preparedness with your clearinghouse or billing service:

  • Are you prepared to meet the ICD-10 deadline of Oct. 1, 2014? Where is your organization in the transition process?
  • Who will be my primary contact at your organization for the ICD-10 transition?
  • Can we set up regular check-in meetings to keep progress on track?
  • What are your plans for testing claims containing ICD-10 codes? How will you involve your clients, such as my practice, in that process?
  • Can my practice send test claims with ICD-10 codes to see if they are accepted? If so, when will you begin accepting test claims?
  • Can you provide guidance or training on how my clinical documentation will have to change to support ICD-10 coding?
  • Do you anticipate any pricing changes for your services due to the switch to ICD-10?

Find additional information about ICD-10 on the CMS website.

Additional information about coding and billing guidelines can be found here.

Know your A&P for ICD-10
Since ICD-10 requires a high level of specificity, it is necessary that coders have a good understanding of anatomy and physiology (A&P) in order to code properly.

Watch ISMA Reports and the ISMA website for information about future workshops to help physician practices.

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