CMS tackles isolated issues following ICD-10 implementation

CMS tackles isolated issues following ICD-10 implementation

Since the implementation of the ICD-10 codes, the Centers for Medicare and Medicaid Services and industry stakeholders have been watching to see how practices handle the transition. While overall, there have not been any major issues so far, the CMS has encountered a few minor obstacles, some of which include isolated problems with National Coverage Determinations and Local Coverage Determinations.

CMS works to resolve isolated issues
The CMS issued a statement in late November announcing that a few short-term solutions, such as claims processing instruction modifications and coding refinements, have been put into place to overcome NCD error. The agency hopes to have these updates in place by Jan. 4, 2016. Providers who submitted a claim that produced errors will have their claims reprocessed by the CMS and updated in the system at no cost. 

The Medicare Administrative Contractors are still in the process of updating LCD criteria, which has resulted in errors from LCDs following the ICD-10 implementation. In response, the CMS postponed processing these claims until the needed updates to the LCD criteria are made. As the CMS expects future LCD errors, it explained that it plans to use the same process down the road. The agency's goal is to implement these solutions quickly, as officials know providers have put a lot of time and effort into the ICD-10 transition, a cumbersome process at times.

"Our contractors understand the challenges that updating CMS systems may bring to our providers and strive to provide quick resolution when issues are noted," explained CMS officials in the statement. "For the handful of issues that were noted after October 1, 2015, CMS contractors have moved quickly to take action, such as temporarily suspending edits and/or claims, making fixes as quickly as possible, and reprocessing claims to minimize impact on providers."

Obstacles contradict readiness claims
While the CMS has made it a priority to resolve these problems, many providers who were affected by the errors were upset at how these issues contradicted the preparedness the agency had reported just before the ICD-10 deadline. 

The CMS had been confident in its ability to process claims without running into any bumps in the road, reporting successful test results prior to ICD-10 implementation. Some of its last results show an 87 percent claims acceptance rate after processing over 29,000 claims. The federal agency also confirmed its readiness in a conference call one week before the Oct. 1 deadline. The CMS Principal Deputy Administrator Patrick H. Conway, M.D., reported having all of the resources needed to ensure a smooth transition, including sufficient staffing and fully operational payment systems. 

After a little less than one month following ICD-10 implementation, the CMS released a metrics report for Medicare fee-for-service payments showing that claims denial rates were low at just 10 percent. However, despite the success that the first couple of reports showed, the CMS urged providers and organizations to remember that it will be near impossible to determine the true results of the transition until more than several pay cycles have taken place. Ample data is needed to identify trends, which will take many months to collect. 

"The Medicaid claims can take up to 30 days to be submitted and processed," Conway said in the September conference call, according to EHR Intelligence. "This end can take approximately two weeks. For this reason, we expect to have more detailed information after a full billing cycle is complete."

The CMS and industry organizations will continue releasing regular reports on implementation success rates with each new pay cycle.