ICD-10 Coding Delay Approved by CMS for Four States

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TL;DR
ICD-10 implementation delay approved in some states, allowing some healthcare providers to use a “crosswalk” technique that converts ICD-10 codes back to ICD-9 for processing. Some well known figures in the healthcare industry are unhappy with the leeway given to these select groups.


ICD-10 Delay for Four States

ICD-10 Delay Calendar

The Centers for Medicare and Medicaid Services (CMS) has required all HIPAA-covered entities using ICD-9 codes to transition to ICD-10 by October 1st. However, four states Medicaid programs – California, Louisiana, Maryland, and Montana – have received authorization from CMS to delay their transition to the new coding system. Modern Healthcare reported on Tuesday that these states’ claim processing systems are “unable to perform payment calculations using the new ICD-10 codes”.

They will instead be using something called a “crosswalk” technique, which will allow them to convert claims with ICD-10 codes back to ICD-9 for processing.

While this allows the four states more time to adjust their systems, this could be a risky approach, as some ICD-10 codes may not match up with ICD-9. It is possible that the crosswalk technique could result in claims delays or rejections.

California’s Medicaid program, Medi-Cal, is in the process of implementing their Medicare information management system (MMIS). Medi-Cal’s ICD-10 FAQ page includes information about the approach, “The crosswalk will only be used temporarily for ICD-10 claim adjudication while the implementation of our new MMIS system is being completed. Once the new system is online, Medi-Cal will adjudicate all claims natively using ICD-10 and the crosswalk will no longer be used.”

They have used General Equivalence Mappings provided by CMS to produce their own crosswalk and modified it “to align with existing Medi-Cal policy.” Unwilling to publish their crosswalk technique, they claim that providers already have the opportunity to appeal the claim denials. If Medi-Cal makes a mistake, providers can simply appeal the decision; however, that process is a lengthy one, and will likely still result in payment delays.

The other states have not been as detailed with their plans for mitigating the situation. A spokesperson for Maryland’s Medicaid program has said that they will be using the crosswalk until it has migrated to a new system.

CMS has been very clear that this is only a short-term solution, but the Modern Healthcare article indicates that many are unhappy with it.

The California Hospital Association is wary of the situation. Spokesperson Jan Emerson-Shea says, “We do continue to have some concerns about the use of the crosswalk approach and we’ll be raising these concerns during a stakeholder meeting.”

Senior Policy Advisor at the Medical Group Management Association (MGMA), Robert Tennant, said what everyone is thinking, “If they’re going to convert it to ICD-9, why did we do this?” Providers are going to be sending in their claims with ICD-10 codes, only to have them switched back to ICD-9. State Medicaid programs have had years to ready their systems for the transition, and the lack of preparedness these four states have shown is unacceptable.

Stanley Nachimson, a renowned figure in the Health IT landscape, feels that the group is getting off easy. “They should have gotten their machines ready. They could have talked with some other states and seen how they’ve done it.”

According to EHRIntelligence, the Workgroup for Electronic Data Exchange (WEDI) is developing a list of ICD-10 state readiness and will be updating it as the deadline nears. The group has reached out to the governor of each state, asking for their level of readiness for the upcoming transition and expressing the impact it will have on stakeholders if the state is not prepared for ICD-10.

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Author: Apoorva Anupindi

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