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Home Health Coding and OASIS Expert

ICD-10 Transition:

ICD-10 Claims Processing Hits a Few Bumps in the Road

Adjustments are on the way.

Understanding and using ICD-10 codes correctly isn’t the only hurdle home health agencies face during the transition to the new code set. Medicare claims system glitches have added to the difficulty.

Latest problem: “Claims with dates of service that span into October 2015, with correct ICD-10 diagnosis codes are receiving reason code 31276; however, the Fiscal Intermediary Standard System (FISS) edits as if the claim is prior to October 1, 2015, and includes ICD-10 codes,” described HHH Medicare Administrative Contractor CGS in a message to providers.

For the rejections, “the reason code narrative states ‘Outpatient claim contains an ICD-10 indicator of 9 and an ICD-10 diagnosis is present,” HHH MAC Palmetto GBA says on its website.

The solution: After the problem was discovered, MACs began “suspending these claims, including those already rejected/returned to providers,” Palmetto says. “The system fix for this issue was implemented on October 23, 2015,” HHH Medicare Administrative Contractor Palmetto GBA says on its website. “All claims that were suspended for this issue prior to the system fix implementation have been released for processing.”

“Claims that were in the return to provider (RTP) file incorrectly have been moved to continue processing as well as claims suspended in status/location S MICD1 with reason code 31276,” CGS said in an Oct. 27 message to providers. “No provider action is required; however, claims receiving reason code 31276 as of October 28, 2015, are valid and will need to be corrected from your RTP file.”

CGS also announced a fix to a previous ICD-10-related claims system error in which providers’ NPIs “fall off” the crosswalk. “Because providers are unable to see the RAPS, NOEs and claims in their RTP file, CGS is working to move the affected claims out of the RTP file to allow them to continue processing,” the MAC said in the provider update.

The ICD-10 problem, combined with other slow-downs, are taking a serious toll on providers’ cash flow, reports billing expert M. Aaron Little with BKD in Springfield, Mo. So far October payments have been very delayed, says Little, who hopes “it’s just a temporary disruption.”