ICD-10 Updates
Most Private Insurers Won’t Honor CMS’s ICD-10 Grace Period
Most private payers will not match the CMS’s year-long grace period when ICD-10 goes into effect October 1. Due to the fact that all private payers have not offered insight into their policy, the best advice is to assume none of them will observe a grace period. Here are some of the major private payers that have gone on record about their policies:
Aetna: No grace period, saying “For dates of service of Oct. 1, 2015 and after, providers should use ICD-10 codes in all transactions where ICD coding is required.”
Anthem: There has been no indication they will offer a grace period.
Blue Cross/Blue Shield: Most likely no grace period.
Humana: Will offer a grace period similar to CMS.
UnitedHealth: Will NOT offer a grace period.
Smaller Groups are Nervous as the Switch Flips on Oct. 1
Experts believe that most large hospitals, health systems, and physician groups will successfully convert to ICD-10 system. But fears abound that smaller doctor groups could be run out of business. A recent study by the Medical Group Management Association indicated that 9.2% of physician groups surveyed were still using an electronic data transmission format that could not handle ICD-10 codes. In addition, cash-flow issues could delay payments to small physician practices, causing them to retire early or close their doors.
CMS Updates ICD-10 FAQs
The CMS has revised and added several answers in their FAQ's regarding ICD-10. The new sections address Medicare Advantage, expansion to other provider types, advanced and accelerated payments, crossover claims, and the audit look-back period.
CMS Clarifies Coding Around October 1
The CMS is referring providers to a Medicare Learning Network article for questions about which code set to use when submitting claims close to the October 1 transition. The CMS notes that claims cannot contain both types of codes and will not be paid by Medicare. The article provides more information, but in general:
For dates of service prior to October 1, 2015, providers should submit claims using ICD-9 codes.
For dates of service on or after October 1, 2015, providers should claims using ICD-10 codes.
CMS Points Providers Toward ICD-10 Resources
ÂThe ICD-10 transition has been a relatively smooth one, but the CMS wants healthcare providers to be aware of resources in case they have any challenges.
The ICD-10 Ombudsman is Dr. Bill Rogers. He is meant to function as a one-stop shop for questions and concerns and to be an impartial advocate.
The ICD-10 Coordination Center is a group of CMS’s Medicare, Medicaid, and IT experts and serves as the hub for ICD-10 communications and operations.
 ÂPrivate Insurers' ICD-10 Policies
ÂNow that the ICD-10 deadline has officially come and gone, many private insurance companies are formally announcing their policies toward processing ICD-10 claims.
United Healthcare: No grace period, but will take it easy on providers
Humana: A limited 12-month grace period, similar to the CMS
Wellmark: Existing policy is to not deny based solely on specificity, but will deny for other reasons.
Blue Cross Blue Shield Texas: No grace period
Anthem: Will follow the CMS's lead for an ICD-10 grace period
Aetna: No grace period
