On October 1, 2016, the joint initiative between the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association(AMA), also known as the “grace period” will come to an end. The one year “grace period” allowed unspecified ICD-10-CM codes to be submitted on Medicare Part-B physician claims. The grace period was created to help ease the transition from ICD-9 to ICD-10 coding systems for physicians. While Medicare required the correct level of ICD-10-CM codes for National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), and other claims edits, pre-payment reviews, and prior authorization requests, physicians were given an overlook period from post-payment reviews due to unspecified codes. The end of this transitional period could be disastrous if Medicare providers did not use this time to prepare for it.

 Medicare physician providers that still submit unspecified ICD-10-CM codes after October 1, 2016, put their practices at risk for an increase in post-payment audits, quality reporting issues, an increase demand on their staff for Medicare audit requests for medical records, and close scrutiny of their clinical documentation.

 Many in the healthcare industry predicted doom during the ICD-9 to ICD-10 coding transition but with lots of bumps in the road, and having at least another year to prepare more efficiently for Medicare Part-B Physician billing, ICD-10 has been survivable if not fraught with issues. Issues such as; relying too much on the ICD-10 General Equivalence Mappings (GEMs) between ICD-9 and ICD-10 codes which led to many unspecified code mappings and the ever changing LCD ICD-10 code requirements that were being refined by CMS.

 But now not only do physicians have to contend with this grace period coming to an end on October 1, 2016, but also with over 3,000 new ICD-10 codes that will be effective at the same time.

 Is your practice ready? Context⁴ Healthcare, Inc. can help you by offering the ICDTransformer™. Our ICDTransformer™ is a state-of-the-art technology that uses a proprietary knowledgebase created by our highly experienced clinical coding team. Our unique methodology reviews the ICD-9 codes you’re accustomed to and identifies key pieces of the service to pick the proper ICD-10 code. Providers using the CMS General Equivalence Mappings (GEMs) are finding that the GEMs are not sufficient and cause issues in their ICD-10 transition. The coding equivalents are not accurate and rely too much on unspecific ICD-10 codes which can now do harm to accurate coding. Accurate coding of ICD-10 is essential for meaningful EHR listings, full revenue generation, lessen the likelihood of audits, and correct reimbursement.

To decrease the likelihood of audits and constant medical necessity policy checks for ICD-10 code updates, our A/B Medicare Administrative Contractors (MACs) Local Coverage Determinations data is available by state, Medicare Contractor, Part A or Part B, and is updated in real-time.