[{"innerBlocks":[],"name":"core\/freeform","postId":4094,"blockType":{"name":"core\/freeform","keywords":[],"attributes":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"providesContext":[],"usesContext":[],"selectors":[],"supports":{"className":false,"customClassName":false,"reusable":false},"styles":[],"variations":[],"apiVersion":3,"title":"Classic","description":"Use the classic WordPress editor.","category":"text"},"originalContent":"With Saturday marking the one-year anniversary of the implementation of ICD-10 codes, healthcare organizations must now focus on some new requirements that went into effect on October 1.

While the transition from ICD-9 version codes universally is considered to be an unqualified success, the ICD-10 grace period has ended, and the Centers for Medicare and Medicaid Services no longer will be accepting unspecified codes on Medicare fee-for-service claims. The year of coding flexibilities that CMS agreed to last year in cooperation with the American Medical Association has expired and will not be extended.

However, as the agency pointed out in guidance<\/a> issued in August, the end of the ICD-10 grace period should not be a big deal for providers, as many commercial health insurers did not offer providers any coding flexibility, requiring them to use specific ICD-10 codes. Besides, CMS stated, healthcare organizations \u201cshould already be coding to the highest level of specificity\u201d and \u201cshould code claims to the degree of specificity supported by the encounter and the medical documentation.\u201d

Further, Sue Bowman, senior director of coding policy and compliance at the American Health Information Management Association (AHIMA), contends that the grace period only applied to Medicare fee-for-service claims from physician or other practitioner claims billed under the Medicare Fee-for-Service Part B physician fee schedule.

The grace period \u201cdid not apply to hospitals, so it doesn\u2019t affect anything hospitals are doing going forward on October 1, and even from the physician standpoint it was limited in its impact because it only applied to post-payment reviews,\u201d says Bowman, who adds that \u201cmost people have been having to do the highest degree of code specificity over the past year anyhow, regardless of the flexibility.\u201d

Starting October 1, CMS review contractors will \u201cuse coding specificity as the reason for an audit for a denial of a reviewed claim\u201d and they will \u201cnotify providers of coding issues they identify during review and of steps needed to correct those issues,\u201d the agency says.

Similarly, Debi Primeau, president of revenue cycle consultancy Primeau Consulting Group, believes that the end of the ICD-10 grace period is \u201cnot a big deal for acute-care hospitals, which have done retrospective and\/or concurrent audits,\u201d but it \u201cmay be a bid deal for smaller physician groups and individual practices.\u201d

Primeau contends that physician groups and practices \u201chave not really been aggressively auditing to identify whether their physicians are using unspecified codes.\u201d She also highlights the fact that many practices do not have coding professionals but are instead utilizing drop-down boxes in their electronic health record systems to choose codes.

\u201cIf they are hurried and don\u2019t really understand codes, these practices may be choosing unspecified codes, and because many of these organizations have not yet performed coding audits, they really don\u2019t know if there is a problem or not,\u201d adds Primeau, who highly recommends coding and documentation audits. \u201cWhat we\u2019re talking about is identifying opportunities where you can focus on denial prevention versus denial management.\u201d

Overall, Bowman says she doesn\u2019t expect adverse consequences as a result of the end of the ICD-10 grace period. Nonetheless, Mary Beth Haugen, CEO of Haugen Consulting Group, is not as optimistic.

\u201cWe\u2019re assuming with that change we\u2019ll see an increase in denials,\u201d says Haugen. \u201cI think everybody is vulnerable.\u201d She recommends \u201creally aggressive audits\u201d and that providers review their frequently used codes to determine if they are still using unspecified codes. \u201cWe could see a significant hit.\u201d

Primeau\u2019s concern going forward is health insurers\u2014not just Medicare but commercial payers, who may begin to adjust medical policies based on the new specificity offered by ICD-10. \u201cThey have been collecting data for a year, and now is their opportunity to go back and identify where some of these unspecified codes have been used and to start denying claims,\u201d she adds. \u201cThere are a lot of commercial payers out there, and they\u2019ve been data mining. They\u2019ve seen bills that have been submitted for the last year, know what\u2019s going on, and who is and is not submitting unspecified codes.\u201d

For its part, AHIMA is encouraging healthcare organizations to continue to monitor their documentation and work to improve it when necessary, Bowman says.

In addition, she notes that CMS has lifted the partial code freeze, and as a result, thousands of new ICD-10 diagnosis and procedure codes have been added for fiscal year 2017, which began on October 1.

Also See<\/b>: Thousands of new ICD-10 codes slated for October release<\/a>

\u201cBe aggressive in knowing what the code changes are,\u201d advises Bowman. \u201cFor hospitals, they really have to know all of them\u2014that\u2019s what coders have to do. On the physician and individual healthcare provider side, they only have to worry about the diagnosis codes. They don\u2019t have to worry about the procedure codes. Only hospitals have to worry about the new procedure codes. And for physician practices, they usually have a subset of new codes that they would need to be concerned with, depending on their specialty and patient population.\u201d

This backlog of ICD-10-CM and ICD-10 PCS codes is a one-time occurrence, asserts Bowman, who adds that while there is \u201csomewhat of a bigger educational challenge because there are so many new codes,\u201d going forward the industry will return to the \u201cnormal amount of code changes\u201d on an annual basis.

Likewise, CMS states in its guidance that the annual update to codes is not a new process, as \u201ccodes were regularly updated on an annual basis until a freeze was established to assist providers and health plans to prepare for ICD-10.\u201d

Haugen concludes that it\u2019s critical that coders are educated on all of the code updates for fiscal year 2017. At the same time, Bowman says reassuringly that \u201ccoders, by and large, are used to having to learn about new codes,\u201d even with the larger-than-normal volume of coding changes they\u2019re assimilating this year.","saveContent":"With Saturday marking the one-year anniversary of the implementation of ICD-10 codes, healthcare organizations must now focus on some new requirements that went into effect on October 1.

While the transition from ICD-9 version codes universally is considered to be an unqualified success, the ICD-10 grace period has ended, and the Centers for Medicare and Medicaid Services no longer will be accepting unspecified codes on Medicare fee-for-service claims. The year of coding flexibilities that CMS agreed to last year in cooperation with the American Medical Association has expired and will not be extended.

However, as the agency pointed out in guidance<\/a> issued in August, the end of the ICD-10 grace period should not be a big deal for providers, as many commercial health insurers did not offer providers any coding flexibility, requiring them to use specific ICD-10 codes. Besides, CMS stated, healthcare organizations \u201cshould already be coding to the highest level of specificity\u201d and \u201cshould code claims to the degree of specificity supported by the encounter and the medical documentation.\u201d

Further, Sue Bowman, senior director of coding policy and compliance at the American Health Information Management Association (AHIMA), contends that the grace period only applied to Medicare fee-for-service claims from physician or other practitioner claims billed under the Medicare Fee-for-Service Part B physician fee schedule.

The grace period \u201cdid not apply to hospitals, so it doesn\u2019t affect anything hospitals are doing going forward on October 1, and even from the physician standpoint it was limited in its impact because it only applied to post-payment reviews,\u201d says Bowman, who adds that \u201cmost people have been having to do the highest degree of code specificity over the past year anyhow, regardless of the flexibility.\u201d

Starting October 1, CMS review contractors will \u201cuse coding specificity as the reason for an audit for a denial of a reviewed claim\u201d and they will \u201cnotify providers of coding issues they identify during review and of steps needed to correct those issues,\u201d the agency says.

Similarly, Debi Primeau, president of revenue cycle consultancy Primeau Consulting Group, believes that the end of the ICD-10 grace period is \u201cnot a big deal for acute-care hospitals, which have done retrospective and\/or concurrent audits,\u201d but it \u201cmay be a bid deal for smaller physician groups and individual practices.\u201d

Primeau contends that physician groups and practices \u201chave not really been aggressively auditing to identify whether their physicians are using unspecified codes.\u201d She also highlights the fact that many practices do not have coding professionals but are instead utilizing drop-down boxes in their electronic health record systems to choose codes.

\u201cIf they are hurried and don\u2019t really understand codes, these practices may be choosing unspecified codes, and because many of these organizations have not yet performed coding audits, they really don\u2019t know if there is a problem or not,\u201d adds Primeau, who highly recommends coding and documentation audits. \u201cWhat we\u2019re talking about is identifying opportunities where you can focus on denial prevention versus denial management.\u201d

Overall, Bowman says she doesn\u2019t expect adverse consequences as a result of the end of the ICD-10 grace period. Nonetheless, Mary Beth Haugen, CEO of Haugen Consulting Group, is not as optimistic.

\u201cWe\u2019re assuming with that change we\u2019ll see an increase in denials,\u201d says Haugen. \u201cI think everybody is vulnerable.\u201d She recommends \u201creally aggressive audits\u201d and that providers review their frequently used codes to determine if they are still using unspecified codes. \u201cWe could see a significant hit.\u201d

Primeau\u2019s concern going forward is health insurers\u2014not just Medicare but commercial payers, who may begin to adjust medical policies based on the new specificity offered by ICD-10. \u201cThey have been collecting data for a year, and now is their opportunity to go back and identify where some of these unspecified codes have been used and to start denying claims,\u201d she adds. \u201cThere are a lot of commercial payers out there, and they\u2019ve been data mining. They\u2019ve seen bills that have been submitted for the last year, know what\u2019s going on, and who is and is not submitting unspecified codes.\u201d

For its part, AHIMA is encouraging healthcare organizations to continue to monitor their documentation and work to improve it when necessary, Bowman says.

In addition, she notes that CMS has lifted the partial code freeze, and as a result, thousands of new ICD-10 diagnosis and procedure codes have been added for fiscal year 2017, which began on October 1.

Also See<\/b>: Thousands of new ICD-10 codes slated for October release<\/a>

\u201cBe aggressive in knowing what the code changes are,\u201d advises Bowman. \u201cFor hospitals, they really have to know all of them\u2014that\u2019s what coders have to do. On the physician and individual healthcare provider side, they only have to worry about the diagnosis codes. They don\u2019t have to worry about the procedure codes. Only hospitals have to worry about the new procedure codes. And for physician practices, they usually have a subset of new codes that they would need to be concerned with, depending on their specialty and patient population.\u201d

This backlog of ICD-10-CM and ICD-10 PCS codes is a one-time occurrence, asserts Bowman, who adds that while there is \u201csomewhat of a bigger educational challenge because there are so many new codes,\u201d going forward the industry will return to the \u201cnormal amount of code changes\u201d on an annual basis.

Likewise, CMS states in its guidance that the annual update to codes is not a new process, as \u201ccodes were regularly updated on an annual basis until a freeze was established to assist providers and health plans to prepare for ICD-10.\u201d

Haugen concludes that it\u2019s critical that coders are educated on all of the code updates for fiscal year 2017. At the same time, Bowman says reassuringly that \u201ccoders, by and large, are used to having to learn about new codes,\u201d even with the larger-than-normal volume of coding changes they\u2019re assimilating this year.","order":0,"get_parent":{},"attributes":[],"attributesType":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"dynamicContent":""}]

Small providers may struggle as ICD-10 ‘grace period’ ends

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