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How to Address ICD-10 Issues

ICD-10-logoWith the Oct. 1 ICD-10 implementation date behind us, the AMA has revised its online ICD-10 information and resources. If physicians experience any problems with the processing of claims or other administrative transactions, they should take the following steps.

  • Medicare: The AMA has created an ICD-10 complaint form, available on the AMA ICD-10 Web page, to report problems with Medicare claims. Note that submissions will be forwarded to the Centers for Medicare & Medicaid Services (CMS). The AMA will not provide individual responses to each complaint.
    Physicians also can contact their Medicare Administrative Contractor (MAC) or monitor their MAC’s website for information on problems with ICD-10.
    Physicians also may contact CMS directly by emailing the ICD-10 ombudsman William Rogers, MD.
  • Medicaid: Check the state Medicaid website for information about ICD-10 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 send an email to ICD10questions@uhc.com.
    • For Humana, physicians can send an email to ICD10Inquiries@humana.com.
    • For Anthem, physicians should contact the Provider Service Call Center for the locality and line of business involved (telephone numbers can be found on Anthem.com).
  • Vendors: Any issues with practice management systems, electronic health records, billing vendors or clearinghouses should be directed to the company.

Medicare advance payment for ICD-10 problems

CMS has announced that MACs will issue advance payments in situations where claims cannot be processed within established time limits because of administrative problems, such as contractor system malfunction or ICD-10 implementation problems. An advance payment is a conditional partial payment and will require repayment.

To apply for an advance payment, the physician is 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.

CMS issues additional ICD-10 question and answers

On Sept. 22, CMS updated “Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities,” providing further clarification on issues such as prior authorization requirements, Medicare Advantage claims and coding guidelines.

Information from the AMA Advocacy Update, 10-9-15.

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