New CMS Claim Form 02 12The AAPC reports that Medicare receives 500 million paper claims each year, but just about everything being written about ICD-10 focuses on the Oct. 1, 2014 deadline when all electronic claims must be submitted with the new codes. But there’s an earlier deadline that many practices need to focus on first—like right now.

The typical medical practice submits 5% to 10% of its claims on paper, and as of April 1, 2014, paper claims submitted on the old CMS-1500 form will be rejected by CMS. The new claim form on January 6th includes:

  • Indicators for differentiating between ICD-9-CM and ICD-10-CM diagnosis codes.
  • Expansion of the number of possible diagnosis codes to 12.
  • Qualifiers to identify the following provider roles (on item 17):
ordering, referring, and supervising.
  • 30 changes in all, with the addition of 4 qualifiers, and 11 fields renamed.

Steady indications from CMS confirm that the April 1 deadline will not be extended, giving practices just months to make the transition to ICD-10 codes for all paper claims.
The AMA estimates overall costs of creating and processing paper claims as high as $6.63 versus $2.90 for an electronic claim. Since paper claims are more expensive than electronic claims, some practices would be better off simply moving to a new software platform than to struggle to meet the April deadline.

But many of the paper claims submitted each day, can only be submitted on paper, so practices that switch ahead of time to a platform that allows dual coding  of the new printed form will avoid a multitude of problems in one fell swoop:

  1. By eliminating paper claims, they’ll save money and avoid the rush to train billers before April 1.
  2. By using dual coding, their billers will learn ICD-10 codes while submitting claims in ICD-9. As the biller enters the ICD-9 code, the software looks up the corresponding ICD-10 code using general equivalence mappings (GEMs) created by CMS and CDC. Some codes have an exact GEM match; others require the biller to choose from a list of more specific diagnoses.
  3. Because billers are on the job, entering codes for actual patients (as opposed to a classroom), they’ll be learning the codes most used in their practice.
  4. Practices that begin dual coding now will experience a much smoother transition to ICD-10 next fall, including: A slower ramp-up for staffers, no abrupt learning curve of brand new software, and minimal disruption to billing processes and cash flow.
  5. A new software platform today will eliminate the need for multiple updates to legacy software (as we saw during the NPI transition with MediSoft and Lytec).

The AAPC estimates that more than 64% of back office staff still need additional training to avoid ICD-10 coding errors, and it reports that a surprising number of practices still use an version of billing software that’s not 5010 compliant, so depending on how slowly a practice acts, a negative fiscal impact from rejected paper claims alone can range from $12,000 to $24,000.
As even the most prepared practices are being told to expect delays with payers and vendors and cashflow during the transition, scratching off one radical element from your preparedness list makes some sense. Moving to dual mode software ahead of time may let you enjoy a small sense of satisfaction when October rolls in, and while other practices are experiencing a bumpy transition to ICD-10 implementation, you have it all behind you.

New Year, Less Rejections

Effective January 1, 2021, CMS is implementing 6 new diagnosis codes after re-evaluating its response to the COVID-19 outbreak. The codes revolve around discharge codes and those used for patient encounters. Both the discharge and encounter codes are valid from October 2020 to September 2021. As the world continues to wrestle with the ramifications of COVID-19, it would be advantageous that practices are able to decrease the number of claim rejections during this time.

Medical Billing Software to fit your needs

Free Trial Signup!

Last Updated on January 6, 2021