Hurricanes have been the backdrop of countless stories ranging from Shakespeare’s The Tempest to the Humphrey Bogart movie, Key Largo. Similarly, just over a year ago, the healthcare industry was ramping up to face its own hurricane: ICD-10. Instead, the Oct. 1, 2015 transition probably felt more like a moderate mid-afternoon shower—certainly not a category-grade hurricane—thanks to a lot of hard work and preparation.
It’s important to remember, however, that October 2015 wasn’t the end of the ICD-10—it was only the middle. While most organizations prepared and began using the full ICD-10 code-set on Oct. 1, 2015, some took advantage of the Centers for Medicare and Medicaid Services’ (CMS) grace period, which granted several flexibilities. This one-year grace period for ICD-10-coded medical claims ends on Oct. 1, 2016 and will not be extended, meaning many healthcare organizations could still face whirlwinds. Here’s a few facts to help keep a potential storm at bay:
- CMS will not be phasing in its requirement to code to the highest level of specificity. As of Oct. 1, 2106, providers will be required to code to accurately reflect the clinical documentation in as much specificity as possible.
- Beginning Oct. 1, 2016, all CMS review contractors can use coding specificity as the reason for a denial of a reviewed claim to the same extent that they did prior to Oct. 1, 2015.
Even if you’d classify ICD-10 as a Category 1 hurricane rather than 4, it’s important to ensure your organization is ready for the end of CMS’ grace period. Arm yourself with helpful resources such as CMS’ webpage providing the 2016 ICD-10-CM valid codes and code titles listed in tabular order to reflect the codebook. Also, check out the Medical Economics article, ICD-10 Changes Could Impact Practice Cash Flow, for tips and insights from industry experts.