Revenue Cycle Management Blog | GroupOne Health Source

CMS Releases Notice To Address ICD-10 Claims Processing Issues

Written by Kaitlyn Houseman | December 7, 2015

CMS recently issued an update on the steps it has taken to address isolated problems with processing ICD-10 codes, AHA News reports (AHA News, 11/20). The U.S. health care system transitioned from using ICD-9 codes to the ICD-10 code set on Oct. 1. The switch required health care providers and insurers to change out about 14,000 codes for about 68,000 codes (iHealthBeat, 10/30).

Update Details

According to CMS, there have been a few issues stemming from local and national coverage determinations.

CMS said it will reprocess claims that produced errors at no cost to providers. Such claims will be automatically processed and updated in CMS' system.

According to EHR Intelligence, CMS has implemented some short-term remedies to the national coverage determination errors, such as:

  • Refining coding; and
  • Updating claims processing instructions.

The agency said updates should be in place by Jan. 4, 2016.

Meanwhile, CMS said that some errors resulting from local coverage determinations occurred because some Medicare Administrative Contractors needed to update certain criteria. The agency said it delayed processing those claims until the contractors' updates were in place.

CMS said, "Our contractors understand the challenges that updating CMS systems may bring to our providers and strive to provide quick resolution when issues are noted. For the handful of issues that were noted after Oct. 1, 2015, CMS contractors have moved quickly to take action, such as temporarily suspending edits and/or claims, making fixes as quickly as possible and reprocessing claims to minimize impact on providers" (Heath, EHR Intelligence, 11/23).