ICD-10 Deadline of October 1 2015 Reaffirmed by CMS and AMA "... Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of services after September 30, 2015, nor will they be able to accept claims for both ICD-9 and ICD-10 codes."
Marilyn Tavenner, Administrator of the Centers for Medicare and Medicaid Services spoke at HIMSS 2014 in Orlando Florida spoke about interoperability, and "reduced spending in healthcare." Continue to reward programs that provide value and quality. "Linking quality data, reporting, and cost of care to outcomes, patient quality for all care settings and tie that to payments." She also spoke about ICD-10, Meaningful Use Stage 2, Healthcare.gov, interoperability and details about several quality and privacy initiatives.
Starting April 1, 2014, Medicare will accept only the revised version of the form. The revised form will give HIPAA Covered Entities who are health care providers the ability to indicate whether they are using ICD-9 or ICD-10 diagnosis codes, which is important as the October 1, 2014, transition approaches. Effectively this means that any healthcare IT system that was scheduled to be compliant as of October 1, 2014 with ICD-10 must actually comply with a component of the ICD-10 requirements early as of April 1, 2014.
Update August 2, 2013 - CMS published a list of 2,225 hospitals in 49 states that will lose up to 2% of their Medicare reimbursement that had too many patient readmission within 30 days of discharge because of three medical conditions: heart attack, heart failure and pneumonia. Under the PPACA, the maximum penalty will increase to 3% by 2015 and expand to include re-admissions for other medical conditions. ICD-10, a standard the describes the condition of the patient, will modify these quality measures when it goes into effect. We have published an interactive, searchable version of the penalties, by city, state, county and hospital for the healthcare industry and consumers to use to easily find the data relevant to their geography or organization.
Out of Network Claims Explained One of the most significant inefficiencies in health care is the pricing strategy of health plans regarding their policy on reimbursement for members who receive…
Since most of the cost containment and settlement solutions vendors do charge the plan, this actually works against the health plan's ability to manage their expenses and comply with regulations. Health plans should look to solutions that support the MLR calculation and regulations, and maximize the speed and the amount of reimbursement to the provider.