Insurance News:

Get Ready Now: Be Sure Your Systems Are Ready

by Centers for Medicare and Medicaid Services | 9/2/2015 3:51:03 PM

yb2xsZXJAbnlzY2EuY29tJmZsPSZleHRyYT1NdWx0aXZhcmlhdGVJZD0mJiY=&&&100&&&

With ICD-10 less than 30 days away, now is the time to get ready. You can make sure your practice is prepared by following the ABCs of ICD-10:

Today, we’ll explore “B” – “Be sure your systems are ready.”

You’ll want to verify that you can:

  • Generate and submit claims
  • Schedule outpatient procedures
  • Perform eligibility and benefits verifications
  • Prepare to submit quality data
  • Schedule office visits
  • Update patient histories and encounters
  • Code a patient encounter

CMS_ICD-10 Infographic

Testing
The best way to ensure your systems are ready is to test. Focus on your highest-risk scenarios like claims processing and the diagnoses you see the most often as you test any system that stores, processes, sends, receives, or reports diagnosis code information.

You can test:

  • Inside your practice
  • With clearinghouses, billing services, and health plans

And you can test even if your system is not ready. If you don’t have an ICD-10-ready system installed yet, you can still conduct meaningful testing. One good way to start is to look at ICD-10 codes for the top 10 conditions you see:

  1. Consider the volume of conditions and those that account for most of your revenue.
  2. Look at recent medical records for patients with these conditions and try coding them in ICD-10 for practice. Do the records include the documentation needed to supply select the correct ICD-10 code(s)?
  3. Use any cases of insufficient documentation to create a checklist for clinicians to consult.

All Medicare fee-for-service (FFS) providers who submit electronic claims can conduct acknowledgement testing with their Medicare Administrative Contractor (MAC) at any time untilSeptember 30:

  • You do not need to register to participate
  • You may submit an unlimited number of claims
  • You can acknowledgement test claims directly or through a clearinghouse or billing agency

To submit claims for testing, you must use:

  • Current dates of service
  • The test indicator “T” in the Interchange Control Structure (ISA) 15 field

For more information about testing your systems, check out the ICD-10 Testing Infographic.

Alternate Claims Submission Methods

  • Explore alternate ways to submit claims to health plans if you think your systems will not be ready for ICD-10 by October 1. For Medicare providers, options include:
  • Ask other health plans you work with about the options they offer

Keep Up to Date on ICD-10
Visit the CMS ICD-10 website and Roadto10.org for the latest news and resources to help you prepare. Sign up for CMS ICD-10 Email Updates and follow us on Twitter.

Save the Date
2018 Spring Convention
March 9-11, 2018

Mohegan Sun
Mohegan
Sun
Casino & Resort
Learn More!

Subscribe to our mailing list

* indicates required