Provider Resources

On October 1, 2013, medical coding in U.S. health care settings will change from ICD-9 to ICD-10. The transition will require business and systems changes throughout the health care industry. Everyone who is covered by the Health Insurance Portability and Accountability Act (HIPAA) must make the transition, not just those who submit Medicare or Medicaid claims.

The first ICD-10-related compliance date is less than 2 years away. On January 1, 2012, standards for electronic health transactions change from Version 4010/4010A1 to Version 5010. Unlike Version 4010, Version 5010 accommodates the ICD-10 code structure. This change occurs before the ICD-10 implementation date to allow adequate testing and implementation time.

The compliance dates are firm and not subject to change. If you are not ready, your claims will not be paid. Preparing now can help you avoid potential reimbursement issues.

Basic Steps to Prepare for Version 5010/ICD-10

Begin preparing now for the ICD-10 transition to make sure you are ready by the October 13, 2013, compliance deadline. The following quick checklist will assist you with preliminary planning steps.

• Identify your current systems and work processes that use ICD-9 codes. This could include clinical documentation, encounter forms/superbills, practice management system, electronic health record system, contracts, and public health and quality reporting protocols. It is likely that wherever ICD-9 codes now appear, ICD-10 codes will take their place.

• Talk with your practice management system vendor about accommodations for both Version 5010 and ICD-10 codes. Contact your vendor and ask what updates they are planning to your practice management system for both Version 5010 and ICD-10, and when they expect to have it ready to install. Check your contract to see if upgrades are included as part of your agreement. If you are in the process of making a practice management or related system purchase, ask if it is Version 5010 and ICD-10 ready.

• Discuss implementation plans with all your clearinghouses, billing services, and payers to ensure a smooth transition. Be proactive, don't wait. Contact your payers, clearinghouse, billing service with whom you conduct business, ask about their plans for the Version 5010 and ICD-10 compliance, and when they will be ready to test their systems for both transitions.

• Talk with your payers about how ICD-10 implementation might affect your contracts. Because ICD-10 codes are much more specific than ICD-9 codes, payers may modify terms of contracts, payment schedules, or reimbursement.

• Identify potential changes to work flow and business processes. Consider changes to existing processes including clinical documentation, encounter forms, and quality and public health reporting.

• Assess staff training needs. Identify the staff in your office who code, or have a need to know the new codes. There are a wide variety of training opportunities and materials available through professional associations, online courses, webinars, and onsite training. If you have a small practice, think about teaming up with other local providers. You might be able, for example, to provide training for a staff person from one practice, who can in turn train staff members in other practices. Coding professionals recommend that training take place approximately 6 months prior to the October 1, 2013 compliance date.

• Budget for time and costs related to ICD-10 implementation, including expenses for system changes, resource materials, and training. Assess the costs of any necessary software updates, reprinting of superbills, training and related expenses.

• Conduct test transactions using Version 5010/ICD-10 codes with your payers and clearinghouses. Testing is critical. Allow yourself enough time to first test that your Version 5010 transactions, and subsequently, claims containing ICD-10 codes are being successfully transmitted and received by your payers, clearinghouses, etc. Check to see when they will begin testing, and the test days they have scheduled. See the "Compliance Timelines" link below for important interim deadline information.

How to Find Resources on This Web Site

On this Web page you will find educational resources especially for health care providers to prepare you for the transitions to:

• ICD-10 medical coding: compliance deadline October 1, 2013
• Version 5010 standards for electronic health claims: compliance deadline January 1, 2012

Select links at left to access more ICD-10 and Version 5010 transition resources from CMS.

Check the "Compliance Timelines" link for important interim implementation and testing dates for both ICD-10 and Version 5010.

Be sure to scroll down to the:

• Downloads section of this page for fact sheets and other materials
• Related Links Inside CMS section of this page for basic information about Version 5010
• Related Links Outside CMS section of this page for resources available from provider associations

Downloads
The ICD-10 Transition: An Introduction [PDF, 851 KB] ICD-10 Basics for Medical Practices [PDF, 940 KB] Talking to Your Vendors About ICD-10 and Version 5010: Tips for Medical Practices [PDF, 939 KB] ICD-10 Overview [PDF, 1713 KB] ICD-10 Myths and Facts [PDF, 243 KB] ICD-10 Overview Power Point [PDF, 225 KB] GEMs/Crosswalks Basic FAQ [PDF, 1,627 KB] GEMs/Crosswalks Technical FAQ [PDF, 957 KB] GEMs Fact Sheet [PDF, 966 KB]
Related Links Inside CMS
Compliance Timelines Medicare Learning Network Version 5010 Version 5010 basics [PDF, 955KB]
Related Links Outside CMS
American Academy of Family Physicians American Academy of Professional Coders American Health Information Management Association American Hospital Association American Medical Billing Association Healthcare Information and Management Systems Society Workgroup for Electronic Data Interchange

Page Last Modified: 06/22/2010 3:03:21 PM
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