CMS clarifies actions regarding ICD-10 claims problems

Overall, there have been few complaints in the wake of the transition to ICD-10 but a few isolated incidents have led the Centers for Medicare & Medicaid Services (CMS) to issue clarifications on how it's resolving the issues.

A few short-term solutions have been put into place with regard to National Coverage Determinations (NCDs) errors, including coding refinements and claims processing instruction updates. These updates should be in place by January 4.

CMS will reprocess claims that produced errors at no cost or effort to the provider. CMS will automatically process these claims and update them in the system.

Additionally, some errors resulted from Local Coverage Determinations (LCDs) following the ICD-10 implementation because the Medicare Administrative Contractors (MACs) still needed to update certain LCD criteria. CMS postponed processing of these claims until the proper LCD criteria updates were made. Claims that encounter these errors in the future will be handled in the same manner.

CMS said it has addressed the errors encountered following the October implementation quickly and efficiently, taking into account the cumbersome process providers endured in transitioning to the new code set.

“Our contractors understand the challenges that updating CMS systems may bring to our providers and strive to provide quick resolution when issues are noted. For the handful of issues that were noted after October 1, 2015, CMS contractors have moved quickly to take action, such as temporarily suspending edits and/or claims, making fixes as quickly as possible, and reprocessing claims to minimize impact on providers,” CMS said in a statement.

CMS has said that it will take several pay cycles to realize how well--or poorly--the ICD-10 transition went. It takes approximately 30 days for Medicaid to issue claim submittal, and 30 days for Medicare to process claims, so CMS was not going to have its first batch of results following implementation until the end of the code set’s first month. CMS also needs a few cycles to have enough data to track trends.