ICD-10 project releases implementation guidance for transition period specific billing scenarios

Jason Gottlieb

Billing, independent of ICD-10 is the conduit that converts delivered and documented patient care services into cash for the hospital. The bill generation and claim submission activity is largely an automated process that enables the translation of care into billable information capable of supporting accurate and timely payment. That billable information populates an electronic (or paper) claim form with numerous demographic, financial, and clinical data elements including ICD-9 diagnosis and procedure codes.

Beginning with dates of service/dates of discharge of October 1, 2015 billing will now include ICD-10 codes.  The implementation guidance for billing is intended to provide direction on enablement of payer and/or service specific billing scenarios that are likely to manifest themselves during the ICD-10 transition period.  Some of those scenarios may include but are not necessarily limited to:

  • Patients admitted to an inpatient setting prior to October 1, 2015, discharged after October 1, 2015, and covered under Medicare Part B benefits only.
  • Patients admitted to an inpatient rehabilitation setting prior to October 1, 2015, discharged after October 1, 2015 and covered under New York State Medicaid benefits
  • Patients seen and treated in outpatient settings prior to October 1, 2015, receive services ordered as a result of that outpatient encounter after October 1, 2015, and covered under Medicare part B benefits
  • Patients seen and treated in outpatient settings prior to October 1, 2015, receive services ordered as a result of that outpatient encounter after October 1, 2015, and covered by New York State Medicaid benefits or a Medicaid managed care plan providing such benefits.
  • Patients covered by one entity (i.e. – insurance carrier) required and/or capable of receiving ICD-10 diagnosis and procedure codes and an additional entity not required and/or capable of receiving ICD-10 codes

Please review this guidance as you prepare you departments and staff for ICD-10.  ICD-10 goes live October 1, 2015 – Are you ready?