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The October 1, 2015, ICD-10 compliance date is only two months away.
Now is the time to make sure your office is ICD-10 ready. The transition will
go much more smoothly for organizations that plan ahead. A successful
transition to ICD-10 will be vital to transforming our nation's health care
system and ensuring uninterrupted operations.
As previously communicated, for referrals, authorizations, or claims with a
date of service on or after October 1, 2015, AmeriHealth will only accept
ICD-10 codes. We will not accept ICD-9 codes on claims with a date of service
on or after October 1, 2015.
Understanding claims that span the compliance date
Depending on the type of claim, there are different rules for how to code a
claim with dates of service that span the ICD-10 compliance date. Please refer
to MLN
Matters® Number: SE1408, a news flash published by the
Centers for Medicare & Medicaid Services (CMS) with detailed information based
on facility type/service.
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Facility/Institutional
inpatient claims
Facility/Institutional inpatient claims with a date of
discharge on or before September 30, 2015, must be billed with ICD-9
codes. Facility/Institutional inpatient claims with a date of
discharge on or after October 1, 2015, must be billed with ICD-10
codes. Do not split inpatient claims by date of service, and do not include
both ICD-9 and ICD-10 codes on a single claim.
Professional and outpatient
claims
Professional and outpatient claims with a date of service on
or before September 30, 2015, must be billed using ICD-9 codes. Professional
and outpatient claims with a date of service on or after October
1, 2015, must be billed using ICD-10 codes. We will not accept claims
containing both ICD-9 and ICD-10 codes – as is consistent with CMS
billing guidelines.
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Billing tip
When claims span the compliance date:
- Use the date of discharge for facility/institutional inpatient claims.
- Use the date of service for professional and oupatient claims.
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AmeriHealth is ready for ICD-10
AmeriHealth has conducted thorough testing of our system both internally and
externally. Our testing efforts focused on minimizing potential business
disruptions for our providers, aligning medical policies to ensure no changes
in current policy-based outcomes, and verifying that services covered under
ICD-9 will be covered under ICD-10.
AmeriHealth is confident with the outcome of our testing results so far,
which show that both internal and external validation has been successful. We
continue to encourage our providers to take time to train coders and
concentrate on clean coding practices to make the transition to ICD-10 as
successful as possible.
ICD-10 resources
For the most up-to-date information on ICD-10 rules and guidelines,
including updated frequently asked questions,
visit the AmeriHealth Pennsylvania ICD-10 website and the AmeriHealth New Jersey ICD-10 website.
The CMS
ICD-10 web page offers numerous resources, including the following:
- Latest News
- Road to 10 (an online resource built for small practices)
- CMS ICD-10 Quick Start Guide
We encourage you to use these resources as you prepare for the upcoming
compliance date.]