Looking for LCDs Converted to ICD-10?

Now you can see a list of Local Coverage Determinations (LCDs) converted to ICD-10CM codes.

Here's the link:

CMS LCDs with ICD-10CM Codes

Use the scroll box on the index to select your Medicare Administrative Contractor (MAC) and select the “Submit” button to view a list of states that the specified MAC services. You can then select your MAC name from the table to view the future translated LCDs.

Just another way to start getting ready.

Ever want to know how the ICD-10 Testing Week went with CMS?

This past March, CMS conducted a successful ICD-10 testing week. Testers submitted more than 127,000 claims with ICD-10 codes to the Medicare Fee-For-Service (FFS) claims systems and received electronic acknowledgements confirming that their claims were accepted. 

Approximately 2,600 participating providers, suppliers, billing companies and clearinghouses participated in the testing week, representing about five percent of all submitters. Clearinghouses, which submit claims on behalf of providers, were the largest group of testers, submitting 50 percent of all test claims. Other testers included large and small physician practices, small and large hospitals, labs, ambulatory surgical centers, dialysis facilities, home health providers, and ambulance providers. 

Nationally, CMS accepted 89 percent of the test claims, with some regions reporting acceptance rates as high as 99 percent. The normal FFS Medicare claims acceptance rates average 95-98 percent. Testing did not identify any issues with the Medicare FFS claims systems. 

This testing week allowed an opportunity for testers and CMS alike to learn valuable lessons about ICD-10 claims processing. In many cases, testers intentionally included such errors in their claims to make sure that the claim would be rejected, a process often referred to as negative testing. To be processed correctly, all claims must have a valid diagnosis code that matches the date of service and a valid national provider identifier. Additionally, the claims using ICD-10 had to have an ICD-10 companion qualifier code and the claims using ICD-9 had to use the ICD-9 qualifier code. Claims that did not meet these requirements were rejected.   

HHS expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning October 1, 2015. The rule will also require HIPAA covered entities to continue to use ICD-9-CM through September 30, 2015. Providers, suppliers, billing companies, and clearinghouses are welcome to submit acknowledgement test claims anytime up to the anticipated October 1, 2015 implementation date. Submitters should contact their local Medicare Administrative Contractor (MAC) for more information about acknowledgment testing. However, those who submit claims may want to delay acknowledgement testing until after October 6, 2014, when Medicare updates its systems. 

CMS will be conducting end-to-end testing in 2015. Details about this testing will be released soon.

When can I use a modifier 59?

Here's a great article from CMS that outlines the proper use of Modifier 59.

I get calls and emails all the time about this issue - CMS is starting to request and review encounters and services billed with modifier 59.  This article from CMS will help explain the proper use of this confusing modifier.

It's worth keeping on your desktop: When Can I Use a Modifier 59

What do I really need in my note for DME services

This article contains information on what documentation should be included in the patient’s medical records for durable medical equipment (DME) services you may order as a provider.

Sometimes it helps to know what you should document in your note so when you get those letters from the DME companies you'll know exactly what you should sent to support the services ordered.

Get a complete list at the following link:

Documentation Requirements for DME

Senate Votes to Delay ICD-10 for One-Year

The Senate voted today to approve a bill that will delay the implementation of ICD-10-CM/PCS by at least one year. The bill now moves to President Obama, who is expected to sign it into law.

Rest of article in the link below from AHIMA:

Click Here For Rest of Story

Senate will vote on ICD-10 delay, SGR fix on Monday

From EHR Intelligence:

According to official Democratic Congressional floor news, the Senate has reached an agreement to vote on HR 4302 on the evening of Monday, March 31.  The bill provides for a temporary patch to the Medicare sustainable growth rate (SGR), repealing the planned 24% reduction in reimbursements slated to take place on April 1, 2014, and also includes language delaying the implementation of ICD-10 for at least one year and extending the controversial “two-midnight” rule.  The bill was voted through the House of Representatives on March 27.

Here's the entire article:

Link to the article

Medicare Holding Claims for 10 Business Days in April

The 2014 Medicare Physician Fee Schedule (MPFS) final rule stipulated a negative update to the MPFS that was to be effective January 1, 2014. That reduction was averted for three months with the passage of the Pathway for SGR Reform Act of 2013, which provided for a 0.5 percent update for services paid under the MPFS through March 31, 2014.

CMS is hopeful that there will be congressional action to prevent the negative update from taking effect on April 1, 2014. CMS has instructed the Medicare Administrative Contractors to hold claims containing services paid under the MPFS for the first 10 business days of April (i.e., through April 14, 2014). This hold would only affect MPFS claims with dates of service of April 1, 2014, and later. The hold should have minimal impact on provider cash flow, because under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 days for paper claims) after the date of receipt. All claims for services delivered on or before March 31, 2014, will be processed and paid under normal procedures, regardless of any Congressional actions.