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Q: Will ConnectiCare be ready to accept ICD-10 codes on October 1, 2015?
A: ConnectiCare has been working to take the steps needed to meet the ICD-10 standards and timeline for implementation (e.g., remediation of our systems and vendor tools, business processes and policies). We plan to be ready to accept and process ICD-10 codes as of October 1, 2015.
Q: What is ConnectiCare’s testing timeline?
A: ConnectiCare has begun testing with all our claims clearinghouses. We expect this testing to continue through August 2015. We recommend providers contact their clearinghouse partners to initiate test planning.
Q: What is ConnectiCare’s position on submission of ICD-10 codes?
A: According to the Centers for Medicare & Medicaid Services (CMS), the ICD-10 codes allow for more accurate information to accompany a claim, and thus for more accurate claims payment and coverage decisions. ConnectiCare will require that only ICD-10 codes be submitted on claims for dates of service on or after October 1, 2015, and on claims involving inpatient discharges on or after October 1, 2015. We will work closely with providers and clearinghouses as they prepare to switch over to ICD-10.
Q: What is ConnectiCare doing to get ready for the ICD-10 conversion?
A: ConnectiCare has completed business assessments for all affected areas. We have been working to execute a multi-year plan incorporating system design and development, development of business processes and policies, and communication and training.
Q: What is ConnectiCare’s approach to mapping ICD-9 codes to ICD-10 codes?
A: CMS has provided General Equivalency Mappings (GEMs) as guidance for reasonable alternatives for mappings between ICD-9 and ICD-10 codes. While the GEMs provide guidance and a starting point for crosswalk development, there is currently no industry standard for mapping. ConnectiCare is using the CMS GEMs as a clinical equivalence tool to remediate business rules with ICD-9 codes.
Q: What should physician practices and facilities do to prepare for the switch to ICD-10?
A: ConnectiCare recommends that physician practices and health care facilities plan and prepare for the ICD-10 conversion well in advance of October 1, 2015. The conversion affects nearly all provider systems. The largest impacts will likely be on clinical and financial documentation, billing and coding.
Your office should contact your practice management software vendor to ask about its ICD-10 conversion plan and testing strategy. You should also contact the claims clearinghouse where you submit claims electronically to ask what you need to do before October 1, 2015.
Q: Will the ICD-10 conversion have an effect on provider reimbursement and contracting?
A: We are now evaluating the impact of ICD-10 on our contracting and clinical operations. The ICD-10 conversion is not intended to transform payment or reimbursement. However, CMS believes that ICD-10 may result in reimbursement methodologies that more accurately reflect patient status and care.
Q: Will ConnectiCare use a crosswalk for claims processing?
A: No. Starting on October 1, 2015, standard transactions must be submitted with ICD-10 codes. After October 1, 2015, we will process claims submitted with ICD-9 codes only for dates of service (outpatient) or dates of discharge (inpatient) prior to October 1, 2015.
Q: Will ConnectiCare support dual intake of codes?
A: ConnectiCare is prepared to accept both ICD-9 and ICD-10 codes for a period of time after October 1, 2015. We will process claims submitted with ICD-9 codes only for dates of service (outpatient) or dates of discharge (inpatient) prior to October 1, 2015. Claims with dates of service (outpatient) or dates of discharge (inpatient) after October 1, 2015, must be submitted with ICD-10 codes in order to be accepted for processing. We will continue to closely follow the communications from CMS, and will adapt our approach as necessary.
Q: Will ConnectiCare accept ICD-10 codes prior to October 1, 2015?
A: No. We will accept ICD-9 diagnosis codes for all claims with dates of service prior to October 1, 2015. We will accept ICD-10 codes for claims with dates of service (outpatient) or dates of discharge (inpatient) after October 1, 2015.