DecisionHealth, DecisionHealth - 2015 Issue 9 (September)
ICD-10 delays presented by four Medicaid programs raise fears of payment issues
ICD-10 vendors say they’ve prepared providers for the Oct. 1 start of the new ICD-10 coding system, but questions remain about the readiness of state Medicaid programs and private insurers.
CMS has granted California, Louisiana, Maryland and Montana permission to “crosswalk” claims coded the new way to payments based on the current ICD-9 codes. It found the four states currently are unable to process ICD-10 codes, a CMS spokesman says.
CMS didn’t announce the special status of the four states but disclosed it in response to questions about the ICD-10 readiness of state Medicaid programs posed by the publication Modern Healthcare. Although Medicaid programs in the remaining 46 states haven’t asked for similar crosswalk relief, it remains a mystery how many Medicare Advantage and other private payers might continue to base payments on ICD-9 codes.
And then there are the more than 1,000 private health plans, any of which are free to use crosswalks if they desire, notes Robert Tennant, a senior vice president with the Medical Group Management Association (MGMA), which is monitoring the effect ICD-10 coding could have on the physician practices MGMA represents.
The basic problem with the crosswalk approach is that it means forcing about 69,000 ICD-10 codes into approximately 13,000 ICD-9 codes for payment purposes, Tennant says. CMS won’t use crosswalks for Medicare payments.
In any event, “it’s going to be a rolling start” after CMS flips to ICD-10 on Oct. 1, and it will be “about three weeks before we start to see some trends,” Tennant predicts.
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