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Steps to take for non-payment of claims after Oct. 1, 2015
e-Reports, Aug. 10, 2015
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The Centers for Medicare & Medicaid Services (CMS) has announced an ICD-10-CM “grace-period” for the first year. Officials stated: “For 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a code from the right family. However, a valid ICD-10 code will be required on all claims starting on October 1, 2015.”

The ISMA sent an inquiry to other plans, but at this time, there is no indication other plans will adhere to the CMS guidance. To follow up on denied claims after Oct. 1, the process remains the same as you currently use for denied claims – until further notification is received.

Most providers will have issues confirming the correct diagnosis code was used. Since coders will not likely have ICD-10 codes memorized, researching denied claims will require more time. Therefore, you are encouraged to start researching policies for procedures you currently perform; determine whether the payer offers guidance on how to code or bill the claim after Oct. 1.

Remember you must code for the condition you treat, not code for payment. If you notice trends with denials, please contact Practice Advisor Gloria Kay at (317) 454-7730 or via email.

The ISMA staff is available to answer your ICD-10-CM questions.

For more information, see the ICD-10 area on the ISMA website. Visit the ICD-10 resources page often for specialty education and all the ICD-10 news.

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