Under the crosswalk system, claims that are submitted using ICD-10 codes will be cross-referenced to identify the appropriate ICD-9 codes that will be used to process the claims.
This article originally appeared in California HealthFax.
California is one of four states that received a federal waiver to use a "crosswalk" coding translation system for Medi-Cal claims for the Oct. 1 transition to ICD-10 coding.
The state Department of Health Care Services (DHCS) said it was granted a waiver from the Centers for Medicare & Medicaid Services (CMS) to use the crosswalk for ICD-9 codes until it replaces an antiquated health information technology system. Other states that received similar waivers are Louisiana, Maryland, and Montana.
DHCS officials said the department requested the waiver as a temporary fix while it works with Xerox Health Systems to create a new health information system for Medi-Cal. "California is working on a computer system replacement that, when implemented, will process claims using ICD-10," said Adam Weintraub, assistant deputy director for DHCS. "Medi-Cal requested and received approval from CMS to implement ICD-10 on our legacy system using a crosswalk. This is designed to reduce the cost and avoid changes to an aging system that is already being replaced."
Under the crosswalk system, claims that are submitted using the new ICD- 10 codes will be cross-referenced to identify the appropriate ICD-9 codes that will be used to process the claim. DHCS said the crosswalk will be used until the project to replace the state's existing computer system is completed in 2017. DHCS said its new system "has mapped all ICD-10 codes to corresponding ICD-9 codes starting with General Equivalency Mapping and Reimbursement Mappings provided by CMS."
And though DHCS is using the crosswalk for Medi-Cal, Weintraub said that "DHCS is fully prepared to implement ICD-10" and will "accept provider claims with ICD-10 codes, correctly adjudicate those claims, and return ICD-10 codes to providers."
Weintraub said the state "has thoroughly tested the crosswalk system in order to minimize gaps or variances in payments and to reduce any potential of disruption or impact to quality of care as a result of the ICD-10 implementation." He added that the crosswalk "is solely used internally within the California Medicaid Management Information System" and that "CMS staff has joined our state staff to train providers on their own readiness for ICD-10."
The California Hospital Association (CHA) said it has some concerns about the crosswalk system being implemented during an ICD-10 transition period that already carries the potential for billing issues and other problems.
"As is the case with any new system, the introduction of ICD-10 will create a greater margin for error in billing and payments," said Amber Ott, vice president of finance for the CHA. "Our concern with the crosswalk program is that it will add to that margin for error." Ott also said that hospitals in California lose billions of dollars each year with Medi-Cal because of low reimbursement rates and that "any additional problems with ICD-10 will just add to those losses."
The California Medical Association (CMA) did not offer an opinion on the crosswalk program but CMA associate vice president of public affairs Molly Weedn said the organization will "watch the situation closely and make sure our members are aware of what's going on." Weedn said the CMA has been assisting members with the ICD-10 transition through online toolkits, webinars, and other educational programs and materials.
HealthLeaders Media Webcast: How Health Systems Prep for ICD-10—Physician Alignment, Support and Technology, will be broadcast on Tuesday, October 20, 2015, from 1:00 to 2:00 p.m. ET. Hear from the University of Mississippi Medical Center's chief health information officer as he describes how to overcome the obstacles of implementing ICD-10.