Frequently Asked Questions (FAQs)

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BACKGROUND
IEHP will be transitioning to ICD-10 diagnosis and procedure coding on October 1, 2015 as mandated by the Centers for Medicare and Medicaid Services (CMS).  Payers, Providers, Clearinghouses and other vendors that provide services to IEHP will need to update systems, databases, interfaces, reports and any other internal infrastructure or policy and procedure to be ready for the transition date.

The information below will address Frequently Asked Questions (FAQs) in regards to ICD-10.  If you have any additional questions, please e-mail us at icd-10@iehp.org.

COMPLIANCE PLAN

  1. Will IEHP offer training to Providers to be ready for ICD-10?
  2. What resources are available to Providers?
  3. Should I update any business processes with ICD-10?
  4. Will IEHP provide a special help line for ICD-10 support, post implementation?

CLAIMS

  1. Can I submit a claim with ICD-10 before October 1, 2015?
  2. If a patient is admitted on September 25, 2015 and is discharged October 5, 2015, how do I submit a claim that spans the transition date?
  3. Will a claim be allowed to have both ICD-9 and ICD-10 codes on it?
  4. If any of IEHP's partners are not compliant by the ICD-10 transition date of October 1, 2015, will IEHP convert their claims to ICD-10 codes for processing?
  5. Will IEHP have a "grace period" for accepting ICD-9 codes with a date of service on or after October 1, 2015?
  6. Will ICD-10 replace Current  Procedural Terminology (CPT) coding?
  7. If I do not deal with Medicare claims, do I have to transition?
  8. Will State Medicaid (Medi-Cal) programs need to transition to ICD-10?
  9. What transition or mapping tools will IEHP use to convert existing and future databases to ICD-10?

TESTING PLAN

  1. What are the testing dates for IEHP?
  2. Does IEHP plan to test with external trading partners?
  3. Does IEHP have testing requirements available yet for external trading partners?

 

COMPLIANCE PLAN

  1. Will IEHP offer training to Providers to be ready for ICD-10?
    While a “basic training” class will be offered to Providers by IEHP explaining what ICD-10 looks like and generally how it functions for the top diagnosis codes used, the Provider will need to review and attend other external training sources that are available in order to be compliant with the CMS mandated October 1, 2015 transition date.


  2. What resources are available to Providers
    A Provider’s technical and claims resources should be the first group to reach out to in order to determine readiness.  Additional resources available include organizations that can train staff to code with ICD-10, cheat sheets, transition assistance and consulting services, etc.  Please review the Useful Links section to get you started.  Here are other preparation tasks to consider:

    • Establish a transition team or ICD-10 project coordinator.
    • Develop a plan for making the transition to ICD-10 by October 1, 2015.
    • Determine how ICD-10 affects your organization and make the necessary changes to authorizations/pre-certifications, physician orders, medical records, superbills/encounter forms, practice management, and billing systems and coding manuals.
    • Review how ICD-10 will affect clinical documentation requirements and Electronic Health Record (EHR) templates and submission.
    • Communicate the plan, timeline, and system changes (if any) and processes to your organization.
    • Secure a budget.
    • Talk with your payers, billing staff, IT staff, practice management system, and EHR vendors about their readiness.
    • Coordinate your ICD-10 transition plans with these groups.
    • Talk to your partners about creating and implementing a test plan.

  3. Should I update any business process with ICD-10?
    Yes.  Internal policies, procedures, and training should be reviewed and updated accordingly in order for office staff to be ready for the change.

  4. Will IEHP provide a special help line for ICD-10 support post implementation?
    This request is under review and details for testing and post-implementation support will be provided to our external trading partners between the 2nd and 3rd quarter of 2015.  An overall transition plan will be provided at an appropriate time closer to the October 1, 2015 transition date.

 

CLAIMS
  1. Can I submit a claim with ICD-10 before October 1, 2015?
    No.  IEHP will not be able to accept ICD-10 claims with a Date of Service date before October 1, 2015.  Any claims with ICD-10 before the transition date will be rejected.  Claims must have ICD-9 if the Date of Service is on or before September 30, 2015 or the claim will be rejected.

  2. If a patient is admitted on September 25, 2015 and is discharged October 5, 2015, how do I submit a claim that spans the transition date?
    For Professional, the claim will be split into two with ICD-9 codes used before October 1, 2015 and ICD-10 used after October 1, 2015.  For Institutional, claims will use ICD-10 for the entire span.  This process and the different bill types affected are discussed in CMS CR7492:

    Professional
    • 09/25/15 – 09/30/15 (Claim 1 – ICD-9)
    • 10/01/15 – 10/05/15 (Claim 2 – ICD-10)

    Institutional
    • 09/25/15 – 10/05/15 (Claim 1 – ICD-10)
  3. Will a claim be allowed to have both ICD-9 and ICD-10 codes on it?
    No.  Claims must be either only ICD-9, or only ICD-10.  Claims that have a mix of both ICD-9 and ICD-10 codes will be rejected.  The Date of Service will be the determining factor of when to use either code type.

  4. If any of IEHP’s partners are not compliant by the ICD-10 transition date of October 1, 2015, will IEHP convert their claims to ICD-10 codes for processing?
    No.  IEHP is not able to change a submitted ICD-9 code to a mapped ICD-10 code and will reject the claim.  IEHP cannot change the coding as it could be an issue of fraud between the submitting partner and the health plan.  The submitting partner will need to change the code and re-submit a clean claim.

  5. Will IEHP have a “grace period” for accepting ICD-9 codes with a Date of Service on or after October 1, 2015?
    No.  IEHP will follow the CMS mandated rules and transition date for when ICD-9 and ICD-10 codes can be accepted.  There will be no “grace period.”

  6. Will ICD-10 replace Current Procedural Terminology (CPT) coding?
    No.  The transition to ICD-10 does not affect CPT coding for outpatient procedures and physician services.  Like ICD-9-PCS, ICD-10-PCS codes are for hospital inpatient procedures only.

  7. If I don’t deal with Medicare claims, do I have to transition?
    Yes.  Everyone who is covered by HIPAA must use ICD-10 starting October 1, 2015.  This includes providers and payers who do not deal with Medicare claims.

  8. Will state Medicaid (Medi-Cal) programs need to transition to ICD-10?
    Yes.  Like everyone else covered by HIPAA, state Medicaid (Medi-Cal) programs must use ICD-10 for services provided on or after October 1, 2015 as mandated by CMS.

  9. What transition or mapping tool(s) will IEHP use to convert existing and future databases to ICD-10?
    IEHP is employing a hybrid approach to remediation.  Internally, we will leverage Blues Cross General Equivalence Mappings (Blue GEMs) in our effort to provide crosswalk solutions for our team members to translate codes in their everyday activities.  Our systems have been remediated through code changes that were based on the Blue GEMs.

     

TESTING PLAN

  1. What are the testing dates for IEHP?
    IEHP is currently in the process of completing remediation of systems, databases, interfaces, forms, and reports in order to complete internal testing of systems by the end of the 3rd Quarter of 2014.  External testing with vendors is expected to run from the 2nd Quarter of 2015 to the 3rd Quarter of 2015.  The Go-Live date for ICD-10 is October 1, 2015.

  2. Does IEHP plan to test with all external trading partners?

    Yes.  Given the number of external partners IEHP has and the scope of testing, IEHP’s intention is to test with select external trading partners only.  We are currently in the process of identifying these partners based on (1) transaction volume, and (2) relationship specifics.  This approach follows the recommendation established by the Workgroup for Electronic Data Interchange (WEDI).

  3. Does IEHP have testing requirements available yet to external trading partners?

    No.  IEHP is in the process of developing the requirements and instructions for testing and will notify those selected for testing in 2nd Quarter of 2015.

 

If you have any questions about ICD-10, please e-mail icd-10@iehp.org