ICD-10 Works, but Concerns Remain Over Audits, Productivity
Let The Firm services assist you. By James Swann Feb. 24 — The switch to ICD-10 five months ago was uneventful, but concerns about provider productivity using the new codes and the threat of increased government audits remain among industry stakeholders. Specifically, providers need to make sure their claims contain enough detail to support the selected ICD-10 code, George B. Breen, an attorney with Epstein Becker & Green, in Washington, said. While Breen said it's too early to expect federal enforcement action involving ICD-10 coding, providers should expect the government to be focusing on appropriate clinical documentation to support claims coding. Providers need to look at ICD-10 through the prism of the increasing government focus on value-based payments, Breen said. “Health-care entities also need to anticipate and be prepared to respond to aggressive payer audits, both private and public,” Breen said. Providers are currently operating under a one-year grace period from the Centers for Medicare & Medicaid Services during which Medicare contractors won't deny claims as long as a valid ICD-10 code from the right coding family is used. The grace period means that a claim won't be denied if it isn't as specific as required under ICD-10. Breen said providers should take advantage of the time to create effective audit protocols that can address ICD-10 issues. “An open question that providers must determine an answer to is whether the grace period also permits that same flexibility in an overpayment analysis,” Breen said. While the grace period will prevent outright claims denials, Breen said, it's uncertain whether the CMS will offer a similar dispensation for any nonspecific ICD-10 claims that result in overpayments. The International Classification of Diseases, 10th Revision (ICD-10), which took [...]