Why is ICD-10 Compliance Important to You?

If your claim does not comply with the NCAS ICD-10 Claim Submission Guidelines, it will be rejected/denied, and it will not be paid until a complaint claim is re-submitted. 

Our Claim Submission Guidelines apply to all claims regardless of submission channel, and provide information on submitting claims before, on and after Oct. 1, 2015.

The U.S. Department of Health and Human Services (HHS) has released a HIPAA administration simplification mandate requiring all HIPAA entities to adopt the 10th revision of the International Classification of Diseases (ICD-10) code set.

HHS published a final rule on August 4, 2014 finalizing October 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10. The rule also requires the continued use of the ICD-9 code set through September 30, 2015.

What is ICD-10?

The World Health Organization publishes ICD coding to deliver a standardized approach for categorizing diseases, patient conditions, surgical, diagnostic and therapeutic procedures. ICD codes are separated into two categories:

  • ICD-CM: Clinical Modification codes used to assign a diagnosis

  • ICD-PCS: Procedure Coding System used for inpatient hospital procedure coding

The United States is transitioning from the 30-year-old ICD-9 code set to ICD-10 codes because ICD-9 uses outdated terms, is inconsistent with current medical practices and limits the number of new codes that can be created.

While ICD-10 codes differ in length and structure from ICD-9 codes, they will provide more thorough detail about conditions, injuries, or illnesses. ICD-10 codes will also include specific detail about how an injury occurred, what parts of the body were affected, and the severity of a condition. This level of specificity means a significant increase in the number of codes.

 


NCAS Objectives

NCAS is focusing on:

  • Receiving properly coded clean claims electronically

    • We are communicating ICD-10 claims submission guidelines in advance of the transition, and will participate in end-to-end testing with our clearinghouses and select providers to validate successful acceptance and payment of claims using ICD-10 codes.
  • Processing and adjudicating ICD-10 claims successfully

    • We are working with the business units and system vendors to remediate and test the claim submission and adjudication platforms for handling ICD-10 codes successfully.
  • Addressing ICD-10 questions and claim disputes

    • We are preparing our staff so they can answer Provider questions about the NCAS ICD-10 policies and help resolve ICD-10 claims issues.

 

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