On October 1, 2014, home health agencies are required to bill Medicare and other health insurers using ICD-10 codes to report medical diagnoses instead of ICD-9 codes. From Medicare’s perspective, the new codes will enhance the ability of the Centers for Medicare & Medicaid Services (CMS) to monitor quality, safety, and efficacy of care, monitor resource use, and prevent and detect fraud, waste, and abuse. We hope that it will also reduce Medicare and other payer’s need to request additional documentation to explain an individual’s condition.
When Medicare changes from ICD-9 to ICD-10 at 12:01 AM on October 1, 2014, Medicare will require home health agencies to use the most specific diagnosis code possible based on the information available at the time.
Since there are about five times as many ICD-10 codes as ICD-9 codes, the information will be far more specific than under the current system. If home health agencies use ICD-9 codes after October 1, 2014, or include both ICD-9 and ICD-10 codes on a single claim, Medicare will return the claims to the home health agency as unprocessable.
CMS says it is confident that it will be ready to proceed with implementation and does not anticipate further delays. Whether private insurers will also be ready is a bit murkier.
According to DecisionHealth, surveys show most home health agencies are behind in planning for the ICD-10 transition. To help remedy this, on June 7, 2013, the Home Care Technology Association of America and DecisionHealth hosted a panel presentation at the Palmer House in Chicago highlighting health information technology vendors working to help home health agencies get up to speed on their transition to ICD-10.
“Straight Talk: Home Health IT Vendors Detail Their ICD-10 Transition Status” provided attendees with insight into available software solutions, the implications of the ICD-10 transition, and offered tips on how to plan effectively and how to prepare financially.
At the presentation, Karen Utterback, Vice President of Product Management and Marketing at McKesson, explained that unprepared home health agencies risked increased claim rejections and denials, increased delays in processing authorizations and reimbursement claims, improper claims payment, cash flow issues, coding backlogs, compliance issues and decisions based on inaccurate data. However, Ms. Utterback emphasized that even though most home health agencies are behind in the planning process, there is still time to prepare if they start now.
Tom Maxwell, the Chief Strategy Officer with Homecare Homebase, explained that the ICD-10 transition was manageable. Mr. Maxwell stressed the importance of working with a software vendor that deliver updates on time and with a plan that walks them through every step of the process well before the mandated implementation date.
Russ Krengel, with Kinnser Software, offered his perspective as a former homecare agency owner. He explained that the ICD-10 transition would likely result in significant productivity loss for home health agencies. However, the key to minimizing that productivity loss is planning for the ICD-10 transition and making sure to train staff well in advance of the October 1, 2014, deadline.
All the speakers agreed that prepared home health agencies will be able to the transition to ICD-10, even those who being the process today, and health IT will play a central role in that transition. However, home health agencies need to start preparing now or risk significant productivity losses.
ICD-10: What Are YOU Waiting For?
Learn more about how to efficiently train and transition your coding from ICD-9 to ICD-10 at the upcoming 24th Annual Conference & Trade Show in Orlando! Both pre-conference and conference sessions address ICD-10, and there’s no better time than now to get ahead of the curve. Click here to learn more.