Nebraska Medicaid Program
ICD-10 Implementation Project
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CMS HAS NO PLANS TO EXTEND THE IMPLEMENTATION DATE OF 10-1-2014
TESTING ICD-10 ELECTRONIC CLAIMS – TO BEGIN APRIL 1, 2014
- Contact your clearinghouse/trading partner to assess their testing readiness.
- To be approved for testing, please contact the Nebraska Medicaid EDI Help Desk at 866-498-4357 or 402-471-9467 (Lincoln) or DHHS.MedicaidEDI@nebraska.gov.
- In the Nebraska test plan:
- 10/1/2013 will be used as the test ICD-10 implementation date. This one year backdate will allow for testing of claims with pre- and post- implementation dates of service.
- One test file for each 837 claim type (I, P, D) will be accepted per day, i.e., one file for 837P (professional) claims and one file of 837I (institutional) claims may be submitted the same day.
- Test Files will be limited to a maximum of 50 claims.
- Both ICD-9 and ICD-10 codes should be submitted during testing following these testing rules:
- ICD-9 will be accepted only with dates of service prior to 10-1-2013.
- ICD-10 will be accepted only with “to” or “discharge” dates of service on or after 10-1-2013.
- ICD-9 and ICD-10 will not be accepted on the same claim.
- Practitioner claims with dates of service that span the implementation date should be split into two claims, so that ICD-9 codes and dates of service prior 10-1-2013 are on one claim, and ICD-10 codes with dates of service 10-1-2013 or later on the other.
- ICD-10 codes should be submitted without the decimal, just as ICD-9 is submitted today.
- Be sure claims are correct and complete. This will allow testing to be of ICD-10 diagnosis codes and procedures and not of normal claim submission requirements.
- For claim outcome comparison, real claim data that was previously paid in production should be re-submitted in test files with ICD-9 diagnosis and surgical procedure codes modified, as needed.
- Outcome results will be provided.
- Testing is not required, but is highly recommended.
- ICD-10 end-to-end testing of PAPER claims is also scheduled to begin in April 2014. Details will be communicated in future provider bulletins.
Preparation for Testing:
- Providers should begin creating/coding test claims. Examples of ways to begin might be to dual code a few claims in both ICD-9 and ICD-10 every day or to devote ½ hour every day to coding ICD-10.
- This will help build a diverse grouping of claims to be used for comparison in testing.
- This will help evaluate the completeness of clinical documentation to ensure that a specific ICD-10 code can be identified and supported by the documentation.
- Coders will gain practice and insight into ICD-10 coding and discover any training needs.
- Coders/billers will gain knowledge of the most commonly used ICD-10 codes for the services provided.
- Production claims that have successfully been processed by Nebraska Medicaid would be good claims to re-code with ICD-10 for testing as resulting errors are more likely to relate to ICD code testing. This will also allow for comparison of payment information.
- Please work with your billing staff, office management software vendor, IT staff and clearinghouse, as appropriate, to ensure readiness for testing.
REVISED CMS 1500 PAPER CLAIM FORM IMPLEMENTATION
- Nebraska Medicaid is following the same timeline adopted by the Centers for Medicare & Medicaid (CMS) for the transition of the CMS 1500 health insurance paper claim form. The transition timeline for moving from the current 08/05 version to the 02/12 version is as follows:
- Effective January 6, 2014, Nebraska Medicaid will begin receiving and processing paper claims submitted on the revised CMS 1500 claim form (version 02/12).
- Effective January 6 through March 31, 2014, Nebraska Medicaid will have a dual use and processing period during which we will continue to receive and process paper claims submitted on the old CMS 1500 claim form (version 08/05).
- Effective April 1, 2014, Nebraska Medicaid will receive and process paper claims submitted only on the revised CMS 1500 claim form (version 02/12).
- Note that on or after April 1, 2014, any claims received utilizing the older versions of the CMS 1500 claim form will be returned to the provider. See the Provider Bulletin #13-75: http://dhhs.ne.gov/medicaid/Documents/pb1375.pdf for additional information.
- Do not use ICD-10 diagnosis codes prior to the October 1, 2014.
- ICD-10 diagnosis codes can be used effective October 1, 2014, but only for dates of service on or after October 1, 2014.
- If ICD-10 codes are submitted before October 1, 2014, the claims will be denied.
Information about the International Classification of Diseases, 10th Revision
The United States Department of Health and Human Services requires that all HIPAA covered entities use ICD-10 codes beginning October 1, 2014. This date is an extension from the original deadline of October 1, 2013. The ICD-10 coding system will fully replace the current ICD-9 coding system and will have a substantial impact on the entire health care industry.
The ICD-10 final rule concurrently adopts the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for diagnosis coding, and the International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS) for inpatient hospital procedure coding. These code sets will replace the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) Volumes 1 and 2, and the International Classification of Diseases, Ninth Revision, Clinical Modification (CM) Volume 3 for diagnosis and procedure codes, respectively.
As a HIPAA covered entity, Nebraska Medicaid will be transitioning to ICD-10 for both electronic transactions and paper claims. Other affected forms and processes will be announced as decisions are made. We are currently in the process of remediating the Medicaid Management Information System (MMIS) to accept and process with ICD-10 codes beginning October 1, 2014, for dates of service on or after October 1, 2014.
Highlights of how claims will be impacted when ICD-10 is implemented on October 1, 2014
Reimbursements will be impacted if ICD-10 is not implemented timely and accurately by providers.
Providers must use either ICD-9 or ICD-10 depending on the date(s) of service:
Claims for dates of service prior to October 1, 2014, must be submitted with ICD-9 codes, regardless of the date submitted
When the dates of service span the implementation date, for example, the discharge date and/or through date is on or after October 1, 2014, the claim should contain only ICD-10 codes.
Electronic and paper claims combining both ICD-9 and ICD-10 codes will be rejected, regardless of the date of service
Nebraska Medicaid will not accept ICD-10 codes prior to the compliance date of October 1, 2014
Dental Claims (paper and electronic 837D) will not require ICD-10 diagnosis codes. Claims will not be rejected if a valid diagnosis code(s) is submitted.
Electronic and paper claims will be processed using the same rules for diagnosis coding.
On or after 10-1-2014, Providers must use either ICD-9 or ICD-10 based on the date(s) of services claimed, regardless of the billing date.
Providers must submit claims within180 days (6 months) after the date of service.
To assist in delivery of information, a dedicated email address has been created for questions and answers specific to the ICD-10 transition. This email address is: DHHS.ICD-10Implementation@Nebraska.gov
The Centers for Medicare & Medicaid (CMS) provides extensive information, facts sheets, tools, and resources for providers, vendors and payers for implementing ICD-10. We are providing select links to assist you with your ICD-10 efforts. For more information, visit the CMS website at www.cms.gov/icd10.
CMS ICD-10 Code Sets: The ICD-10-CM, ICD-10-PCS code sets and the ICD-10-CM official guidelines are available free of charge.
45 CFR Part 162, Final Rule : Governing legislation for implementing the ICD-10 code sets.
CMS Provider Resources: Resources to assist providers in the transition to ICD-10
CMS Vendor Resources: Resources to assist vendors in the transition to ICD-10
CMS 2013 ICD-10-CM and GEMs and CMS 2013 ICD-10 PCS and GEMs: GEMs are General Equivalence Mappings between ICD-10-CM and PCS and ICD-9-CM codes. They are designed to assist converting applications and systems from ICD-9 and ICD-10 codes and are updated annually.
The CMS ICD-10 Planning Check List on the CMS website outlines the critical steps for providers to follow to accomplish implementation of ICD-10 codes.
Check out the Nebraska Health Information Management Association website at: http://www.nhima.org for some training opportunities in Nebraska.
Nebraska ICD-Collaborative is the website of Nebraska individuals and organizations working together to facilitate communication, collaboration and information sharing. It includes resources and events.