CMS Names ICD-10 Ombudsman As October Transition Nears

It’s crunch time for the nation’s healthcare professionals and their staffs as the Oct. 1 transition to a new ICD-10 code set is just a month away.

International Classification of Diseases and Related Health Problems, Clinical Modification (ICD) codes are used to identify medical diagnoses and procedures. ICD codes are used by healthcare providers and payors.

The United States’ healthcare system has been using the current ICD-9 set of codes since 1979. That’s expected to change next month – a transition that will especially test the preparedness and resources of smaller healthcare businesses, including physicians’ offices.

Mindful of that, the Centers for Medicare & Medicaid Services (CMS) named William Rogers, M.D., its ICD-10 ombudsman last week. The agency also announced the creation of an ICD-10 Coordination Center, to be based in Baltimore, to help handle issues related to ICD-10. The Coordination Center is scheduled to open in late September.

Last week, CMS also said it saw successful results from the last of the now-concluded ICD-10 end-to-end testing that had been going on in previous months.

“From July 20 through 24, 2015, Medicare Fee-for-Service healthcare providers, clearinghouses and billing agencies participated in a third successful ICD-10 end-to-end testing week with all Medicare Administrative Contractors and the Durable Medical Equipment (DME) MAC Common Electronic Data Interchange contractor,” CMS said in an Aug. 27 bulletin. “CMS was able to accommodate most volunteers, representing a broad cross-section of provider, claim and submitter types.”

CMS said the final test involved about 1,200 providers and billing companies, who submitted more than 29,000 claims.

“Overall, participants in the July end-to-end testing week were able to successfully submit ICD-10 test claims and have them processed through Medicare billing systems,” CMS said. “The acceptance rate for July was similar to the rates in January and April, but with an increase in the number of testers and test claims submitted. Most of the claim rejections that occurred were due to errors unrelated to ICD-9 or ICD-10.”

Results of the latest test, CMS said, “demonstrated that CMS systems are ready to accept and process ICD-10 claims.”

Regardless of the agency’s confidence, other reports from healthcare industry watchers suggest at least some nervousness over the upcoming transition.

In early August, TechTarget said a poll conducted by SERMO, a social network for physicians, suggested that most doctors weren’t ready to change over to ICD-10. On Twitter, the #ICD10 hashtag page was filled with last-minute advice for healthcare professionals and businesses still working to be compliant by Oct. 1.

Despite the massive amount of work required by the transition, ICD-10 advocates say the much more detailed new codes – numbering about 68,000 total – will help ultimately benefit healthcare professionals and their patients and clients by enabling greater precision in coding, as well as providing a much-needed update given advances in medicine and technology.

On its ICD-10 Web site, CMS points out that “most industrialized countries moved to ICD-10 several years ago…. It’s time our Medical Dictionary reflected modern medicine.”

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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