ICD10 diagnosis code set update graphicAre you ready? For what’s to come…

Ten, nine, eight, seven, six, five, four, three, two, one
Count down to the date when the calls will start to arrive regarding ICD.9 coded claim denials.

As all of us who work within the healthcare space are aware that the World Health Organization (WHO) moved the diagnosis code set from ICD.9 to ICD.10, with the United States finally implementing October 1, 2015.  (Trivia question, who was President when this change was rolled out by WHO?)

The change was necessary for three critical reasons:

  1. ICD 9 code set was at a critical mass, meaning, there were a limited number of combinations still available.
  2. ICD 9 did not adequately identify causation thereby limiting knowledge of WHO and the US based counterpart, Centers for Disease Control (CDC), for rolling out medical care when needed on a large scale basis, e.g., epidemic or pandemic. Anyone remember the recent Ebola scare?
  3. ICD 9 did not adequately identify causation thereby limiting knowledge of Homeland Security for rolling out military forces in league with the CDC when needed on a large scale basis, e.g., biological warfare

For services performed on October 1, 2015 and after, ICD.9 codes are no longer valid and will no longer be accepted by payers, CMS being the largest of the US based insurance organizations.  For the providers who listened closely and made changes to their practice management systems, it will be a non-issue as they will bill appropriately.

BUT, have you been listening to the new reports; the debates on the hill over the move to ICD.10; and the agencies that support large provider groups who allegedly found that the change was not needed or too expensive.  It’s reasonable to suspect many providers have not made the appropriate changes and will bill payers incorrectly resulting in delayed payments and members getting billed.

What happens when members and providers receive a denial?  Are you ready to the increased call volume as the final transition occurs over the next few months?

It has just begun
It has just begun
It has just begun
Ameridial can help!

Trivia question answer:  President George W Bush

 

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