After the big hullabaloo about the transition to ICD-10 last year, it looks like things have settled down. For the most part, Data Soft Logic’s home health software users haven’t seen any issues with their claims due to ICD-10, but that doesn’t mean that we should get comfortable, yet.
When ICD-10 was implemented CMS announced that it would not audit claims for ICD-10 specificity in year one. This means that CMS has not been letting claims process even if unspecified codes were used. As long as you were using codes from the right family, your claim would be A-Ok. Now, this could change on October 1st 2016. (to be clear, CMS didn’t say it would start looking at code specificity in claims on October 1st, it just said it WOULDN’T do it till then). Now, even though CMS isn’t docking you for unspecified codes yet that doesn’t mean that private insurances aren’t looking at the specificity of ICD-10 codes in claims. You should check with your payors to see what their standards are and what they are looking for. The difference in standards could cause you some problems if you are unaware of them.
Okay, great. So what does all this mean? Well, it means you should probably do your best to use the right specific codes as soon as possible. If you are doing things the right way then it won’t matter when CMS or other payors start looking at ICD-10 specificity, you will be ahead of the game. Like the saying goes, its better to be proactive than reactive. As long as you keep paying attention to what you are doing, you should be fine.
sources: https://www.healthleadersmedia.com/technology/cms-no-icd-10-audit-claims-specificity-year-one
