"Our goal is to have a smooth transition to ICD-10 both from a payment perspective and from the service around that payment," says CMS's ICD-10 ombudsman.
Even the threat of a government shutdown will not stop the Oct. 1 switch to ICD-10, the Centers for Medicare & Medicaid Services says.
"In the event of a shutdown we will continue – and I want to be clear on this -- to pay claims," CMS Principal Deputy Administrator Patrick H. Conway, MD, told media during a telephone conference call on Thursday.
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Patrick H. Conway, MD |
"We will continue to implement the ICD-10 transition. We do planning at any time when there's the potential of a government shutdown [and] we will continue to pay claims. We will continue to be operational and we will make the transition to ICD-10."
William Rogers, MD, CMS's ICD-10 ombudsman, added that "the MACs will still be operating. They'll still be accepting claims and claims will still be paid, and we are sure of that."
If government is kept operational by a continuing resolution, Conway says nothing would change.
"We would continue to process claims, the MACs would continue to pay claims and we would execute the ICD-10 transition," he says. "In terms of staffing we have the flexibility to ensure that core operations are operational and in effect and we say our payment systems are a core piece of the Medicare system that will continue to be fully operational."
This is not CMS's first experience with a government shutdown, so Rogers says they aren't starting from scratch.
"We do think service around core customer service and provider service functions are critical, so we would prioritize those, whether it be ICD-10 or other areas," he says. "Our goal is to have a smooth transition to ICD-10 both from a payment perspective and from the service around that payment."
Rogers says it's not clear if his office of the ombudsman would be considered a vital service during a government shutdown.
"We just don't know," he says. "It really is the different legal issues that have to be considered about what emergency operations and what aren't. So, honestly we don't know at this point. People who aren't in this room are deciding what we can do and can't do in case of a shutdown in terms of staffing here at CMS."
On other issues related to ICD-10, Conway says it will take "a couple weeks before we have a full picture" of the transition.
ICD-10: A Checklist for Implementation Readiness
"First off, very few providers file a claim on the day of the office visit, lab, or surgery. Most provider batch their claims and submit them every few days," he says. "Generally speaking Medicare claims take a couple of days to process and can take approximately two weeks. The Medicaid claims can take up to 30 days to be submitted and processed. For this reason we expect to have more detailed information after a full billing cycle is complete."
"We recognize that this is a significant transition and we have set up processes and operations to monitor the transition in real time assess our systems and investigate and address issues as they come in through the ICD-10 coordination centers."
Conway says that providers having problems with claims submissions should first contact their billing vendor or clearinghouse. If problems persist, they can contact their Medicare administrative contractor, or the ICD-10 ombudsman at CMS.
Although physicians' associations have expressed dread at the looming transition, Rogers says he believes the switch to ICD-10 will be relatively smooth.
"Most smaller practices just use a Superbill," he says. "It requires an expansion of the number of diagnoses on the Superbill but they can easily crosswalk their ICD-9-based Superbill to an ICD-10 Superbill. Once they've done that it's business as usual in the office. I expect that small practices should have little or no expense involved."
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.
John Commins is the news editor for HealthLeaders.