Ready or not, tomorrow is the day. While the Medical Association has been and remains an opponent of the forced switch to ICD-10, we fought it and in 2014 got a one-year delay. We continued fighting the mandated changeover in 2015, but when it became evident it would be implemented, we worked diligently to soften the landing as much as possible.
ICD-10 will be implemented on Oct. 1, so the AMA revised its online ICD-10 information and resources. If physicians experience any problems with the processing of their claims or other administrative transactions, they should take the following steps:
Medicare
An ICD-10 complaint form will be available on the AMA ICD-10 web page on Oct. 1 to report problems with Medicare claims.
Please note: Forms will be forwarded to the Centers for Medicare & Medicaid Services (CMS). The American Medical Association will not provide individual responses to each complaint.
Physicians can also contact their Medicare Administrative Contractor (MAC) or monitor their MAC’s website for information on problems with ICD-10.
You may also contact CMS directly by emailing ICD-10 ombudsman Dr. William Rodgers.
Medicaid
Check Alabama Medicaid’s ICD-10 website for updated information about implementation and a method of contact for issues.
Commercial Payers
Check the payer’s website for information about ICD-10 implementation and a method of contact for issues.
- For UnitedHealth Group, physicians can use the following email address ICD10questions@uhc.com
- For Humana, physicians can use the following email address ICD10Inquiries@humana.com
- For Anthem, physicians should contact the Provider Service Call Center for the locality and line of business involved at Anthem.com.
Vendors
Any issues with practice management systems, electronic health records (EHR), billing vendors, or clearinghouses, should be directed to the company.
Physicians should also contact their state or specialty medical society for advice on handling problems and to find out if other practices are experiencing similar issues.
Note: CMS announced on Sept. 25 that the ICD-10 Coordination Center and claims processing will continue to operate even if there is a government shutdown due to the budget.
Medicare Advanced Payment
CMS announced that MACs will issue advanced payments in situations where the MAC is unable to process claims within established time limits because of administrative problems, such as contractor system malfunction or implementation problems. An advanced payment is a conditional partial payment and will require repayment.
To apply for an advance payment, the physician will be required to submit the request to their appropriate MAC. Should there be Medicare systems issues that interfere with claims processing, CMS and the MACs will post information on how to access advance payments. CMS does not have the authority to make advance payments in the case where a physician is unable to submit a valid claim for services rendered.
Updated Clarifying Questions and Answers for CMS ICD-10 Flexibilities
On Sept. 22, CMS released updated “Clarifying Questions and Answers Related to the July 6, 2015, CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities.” Information added includes the naming of the CMS ICD-10 Ombudsman, Dr. William Rodgers, and additional information about prior authorizations, Medicare Advantage plans, application to other provider types, Medicare advanced payments, cross-over claims, and audits.