The United States spends more than $150 billion annually on health care administration; for the average physician, two-thirds of a full- time employee is needed to carry out billing and insurance- related tasks.
To ease these financial and administrative burdens, the Health Insurance Portability and Accountability Act (HIPAA) and the Patient Protection and Affordable Care Act (Affordable Care Act) established administrative simplification requirements aimed at lowering costs, creating uniform electronic standards, and streamlining exchanges between health care providers and payers.
The result: a new revision to the International Classification of Diseases.
The Centers for Medicare & Medicaid Services (CMS) was charged with carrying out and enforcing the administrative simplification requirements for HIPAA-covered entities, which include health care providers that conduct certain transactions in electronic form, health care clearinghouses, and health plans.
On October 1, the nation’s health care system moved to the International Classification of Diseases, 10th Revision: ICD-10. After thorough testing, the Centers for Medicare and Medicaid Services announced their readiness to accept properly coded ICD-10 claims.
With this change, nursing homes and other providers can capture more details about the health status of patients. By setting the stage for improved care and public health surveillance, ICD-10 promises to help move the nation’s health care system to better, smarter care.
CMS has cautioned that it will take a few weeks before the full picture of ICD-10 implementation can be seen, because few health care providers file claims on the same day a medical service is given. Most providers batch their claims and submit them every few days.
Medicare claims take several days after submission to be processed, and by law must wait two weeks before issuing payment. Medicaid claims can take up to 30 days to be submitted and processed by states. Therefore, it will likely be after completion of a full billing cycle before the transition to ICD-10 can be analyzed. During the first weeks, CMS is busy monitoring the transition in real time and addressing any issues that come to attention through the ICD-10 Coordination Center.
In the Coordination Center, a group of Medicare, Medicaid, billing, coding, and information technology systems experts are set to offer help if you have problems. For general ICD-10 information, there are many resources on CMS’s Road to 10 webpage. The first line for help for claims questions is the Medicare Administrative Contractor. You can also contact the ICD-10 Coordination Center or ICD-10 Ombudsman Dr. Bill Rogers, who will act as an impartial advocate.
If you have a Medicaid claim question contact your State Medicaid Agency. Responses typically will be sent within 3 business days of receipt.
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Resource: The Centers for Medicare and Medicaid