Frequently Asked Questions
- What should providers be doing to prepare for the transition to ICD-10?
Providers should begin to prepare by taking the following steps NOW:
- Talk with your billing service, clearinghouse, or practice management software vendor NOW.
- Identify ICD-9 (and presumably ICD-10) touch points in your systems and business processes.
- Identify needs and resources, such as training, printing, etc.
An ICD-10 transition plan should take into account specific practice or organization needs, vendor readiness, and staff knowledge and training.
Providers should check with their billing service, clearinghouse, or practice management software vendor about their readiness plans.
Providers who handle billing and software development internally, should plan for medical records/coding, clinical, IT, and finance staff to coordinate ICD-10 transition efforts.
Work together to make sure you will have what you need to be ready. A successful transition to ICD-10 will be vital to maintaining business operations.
CMS has resources to help providers prepare for a smooth transition to ICD-10. Visit www.cms.gov/ICD10 to find out more. CMS will continue to add new tools and information to the site through the course of the transition.
- Why should I start preparing now for the ICD-10 transition when it doesn't happen until Oct. 1, 2015?
The transition to ICD-10 is a major undertaking for providers, payers, and vendors. Providers need to devote staff time and financial resources to transition activities. The transition will go smoothly for organizations that plan ahead and prepare now. A successful transition to ICD-10 will be vital to ensuring uninterrupted operations.
- What type of training will providers and staff need for ICD-10 transition?
Training needs will vary for different organizations. For example, physician practice coders will need to learn ICD-10 diagnosis coding only, while hospital coders will need to learn both ICD-10 diagnosis and ICD-10 inpatient procedure coding.
ICD-10 resources and training materials will be available through CMS, professional associations and societies, and software/system vendors. Visit www.cms.gov/ICD10 regularly throughout the course of the transition to access the latest information on training opportunities.
- What should software vendors, clearinghouses, and third party billing services be doing to prepare for the transition to ICD-10?
- Talk to their customers NOW to get them ready so their claims will continue to be paid.
- Take a proactive role in assisting in the transition.
- Ask customers about their needs and establish a comprehensive approach that will deliver compatible products well ahead of the key transition deadlines.
- Develop testing guidelines and schedules.
- Products and services will be obsolete if steps are not taken now to get ready.
- Is BCBSKS prepared to meet the ICD-10 deadline of Oct, 1, 2015?
Yes BCBSKS is prepared to meet the Oct. 1, 2015 deadline for transiting to ICD-10.
- Where is BCBSKS in the transition process for ICD-10?
BCBSKS has completed a review of our medical policies and our system changes. We are currently working on upgrading systems identified in the review phases. We continue to work on converting the ICD-9 codes imbedded in our claim's system to ICD-10.
- What happens if I do not switch to ICD-10?
Claims for all services and hospital inpatient procedures provided on or after Oct. 1, 2015 must use ICD-10 diagnosis and inpatient procedure codes. (This does not apply to CPT coding for outpatient procedures.) Claims that do not use ICD-10 diagnosis and inpatient procedure codes cannot be processed. It is important to note, however, that claims for services and inpatient procedures provided before Oct. 1, 2015 must use ICD-9 codes even if they are submitted after the compliance date.
- If I transition early to ICD-10, will BCBSKS be able to process my claims?
No. BCBSKS will not be able to process claims using ICD-10 until the Oct. 1, 2015 compliance date. BCBSKS is planning now.
- Who is affected by the transition to ICD-10? If I don't deal with Medicare claims, will I have to transition?
Everyone covered by the Health Insurance Portability and Accountability Act (HIPAA) must transition to ICD-10 Oct. 1, 2015, including providers and payers who do not deal with Medicare claims.
Special provisions exist for dental providers. For more information, see newsletter D-1-14 (Availity log-in required).
- Who will be our primary contact at BCBSKS for the ICD-10 transition?
BCBSKS has two primary contacts. They are:
- Gina-DOT-Sherretts-AT-bcbsks-DOT-com Gina Sherretts, Program Manager, 785-291-7304
- Deanna-DOT-Karle-AT-bcbsks-DOT-com Deanna Karle, KHDS, Manager, 785-291-8702
- Is BCBSKS anticipating the initial change from ICD-9 to ICD-10 to be revenue neutral?
At this time, BCBSKS has not completed our analysis to know the complete impact of our provider reimbursement.
- Will there be changes to the pre-authorization process?
No, the process for Precertification will not be changing.
- When will you accept ICD-10 pre-authorization request for services provided on and after Oct. 1, 2015?
Precertification will be able to accept requests for Oct. 1, 2015 or after beginning on July 1, 2015.
- Will pre-authorizations submitted before 10/1/15 that use ICD-9 codes work for ICD-10 claims?
- When will BCBSKS be ready to accept test transaction from our system?
For information regarding testing, go to www.ask-edi.com/icd-10/
- What will we need to test with BCBSKS?
If you would like to learn more about testing, please go to the www.ask-edi.com/icd-10/
- Is ICD-10 testing required?
While not required, providers are encouraged to test with BCBSKS.
To learn more about testing options, please go to www.ask-edi.com/icd-10/
- Please explain how you will accommodate both ICD-9 and ICD-10 as we work with claims for services provided before and after the deadline and non-covered entities.
We will accommodate both ICD-9 and ICD-10 as we will have native coding for both in our claims systems starting Oct. 1, 2015.
- What MS-DRG Grouper will BCBSKS be using?
BCBSKS will use the current MS-DRG grouper in place when ICD-10 is implemented. Currently we are using version 30.
- Will BCBSKS allow both ICD-9 and ICD-10 codes on the same claim?
No. Use ICD-9 codes for date of service and date of discharge before Oct. 1, 2015, and use ICD-10 codes for date of service and date of discharge after Oct. 1, 2015. If using the current 1500 claim form (02-12 version) to file, be sure to include the appropriate ICD indicator.
- Will BCBSKS allow ICD-9 and ICD-10 codes in the same BATCH claim file?
Yes. However, once we accept the batch, claims are reviewed at the claim level, and we will stop claims that have a mix of ICD-9 and ICD-10 codes.
- After Oct. 1, 2015, how long will you continue to process claims submitted in ICD-9 with a date of service before the code change?
BCBSKS will continue to accept ICD-9 after Oct. 1, 2015 as long as the date of discharge or date of service is before Oct. 1, 2015. Timely filing requirements are not impacted by ICD-10.
- For claims with dates of service Oct. 1, 2015 and after, what ICD code set (ICD-9 or ICD-10) will you be accepting?
BCBSKS will only accept ICD-10-CM/PCS on or after date of discharge or date of service of Oct. 1, 2015.