Below is a link to a Medscape article on the rollout of ICD-10, CMS’s new billing code quagmire. It became effective on October 1st, and many (most?) docs aren’t ready.
Problem is, it’s not just for Medicare billing; private payers are also adopting it. Critics think insurers will take advantage of it to deny or delay payments to docs. See the last four paragraphs of the story.
The Centers for Medicare and Medicaid Services (CMS) has rolled out its new billing code system. For services delivered starting October 1 (the start of the federal government’s 2016 fiscal year), providers are required to use the new ICD-10 coding system. If you thought ICD-9 was a morass of minutiae, ICD-10’s 70,000 codes is considerably larger and its coding scheme is very different.
It’s vitally important that you get on top of this if you want to keep your business healthy.
Granted, you may not have a big book of Medicare business. But there is a larger issue to worry about: insurance companies. Health insurers almost always follow CMS’s lead in billing and payment issues, and it’s almost certain private payers will be requiring bills to be coded using ICD-10. I know this is hard to believe, but critics think insurers will take advantage of provider problems in adapting to ICD-10 to delay or deny payments to docs.
This also affects you and me in the personal injury world. Auto insurers use a computer program called Colossus (or others programs like it) when analyzing how they value a claim. Colossus relies heavily on ICD-9 and CPT codes to judge injury severity and how much they’ll pay for those injuries. Insurers will almost certainly reprogram Colossus using ICD-10, if they haven’t already. Improper provider coding or delaying the switch to ICD-10 could give insurers an excuse to delay payments at best – or at worst, to deny claims we make in our demand letters.
Bottom line: Help us help you.
The sooner you complete the switch to ICD-10, the sooner we can incorporate it into our demands and keep a strong hand in settlement negotiations – and get you paid.
Below are a couple sources to check for more info.
If you’d like more information on this issue, give me a call at (303) 758-4777.