ICD-10 Matters, Issue 11, September 2015

Will Payers follow CMS's "Advance Payment" Policy with ICD-10 Claims?
CMS's ICD-10 FAQs addressed accessing advance payments by stating the following: "When the Part B Medicare Contractors are unable to process claims within established time limits because of administrative problems, such as contractor system malfunction or implementation problems, an advance payment may be available. An advance payment is a conditional partial payment, which requires repayment, and may be issued when the conditions described in CMS regulations at 42 CFR Section 421.214." One of the conditions listed is, "the carrier is unable to process the claim timely."
Some providers have assumed that payers will follow CMS's lead on this issue and as a result feel there is no need to worry about delayed payments during ICD-10 transition. Unfortunately, it does not appear that payers have in place an "advance payment" option.  For example, Aetna stated, "While Medicare may be making advanced payments available if Part B Medicare contractors aren't able to process claims within established time limits due to administrative issues, we don't plan on taking such action. Based on results from our extensive provider testing, we're confident that this won't be necessary."
With this information in mind, we encourage you to contact payers directly and inquire about their "back up plan" should their systems fail to process ICD-10 claims correctly. In the meantime, as suggested by ACA's ICD-10 Implementation Checklist, you may want to access reserved funds in preparation of the "go live" date.
Is Your Clinic Signed Up?
The article ICD10 Likely to Bring Payment Challenges  states, "Call it payment policies, coverage determinations or reimbursement guidelines, third-party payers create custom, proprietary algorithms to govern the claims adjudication process. The protocols incorporate many factors - place of service, national provider identifier (NPI) and so forth - but the decision to pay - or pre-authorize to perform - often hinges on the diagnosis code."
Being familiar with each payer's clinical reimbursement guidelines or coverage determinations is of utmost importance. The attitude "we always got paid for that in the past" or "I have been billing this way for twenty years" will only lead to lost revenue and unnecessary write-offs.  Take time to find your topmost payers' reimbursement policies for each and every procedure code rendered in your practice. Know for certain that your treatment plan, documentation and diagnoses meet the necessary payer requirements.  It may help to create a folder and bookmark the online payer policies in your web browser or print this information and keep it in a binder for easy access. 
You will want to check back often as policy updates including use of modifiers are updated quarterly by most payers. Be sure that your ICD-10 project manager has access to the online portals for your top ten payers in order to receive the most current information regarding ICD-10 claims submission. A great resource for recent updates can be found in each issue of ICD-10 Matters under the subheading, "Payer News."
Where is Your Clinic on the Implementation Timeline?
ACA has fielded numerous calls within in the past few weeks with regards to ICD-10. Although the majority of providers we spoke with are in the final stages of implementation, sadly some have not started. As a result we have received requests for a list of codes or a list of what steps they should take.  Unfortunately, there is not a "quick start" method toward implementation of ICD-10. If you find your clinic in an unprepared state, ACA suggests that your clinic take the following steps immediately:

  1. Download ACA's ICD-10 Toolkit (can be purchased HERE)
    • Click on the Implementation Checklist  link and find your place on the Implementation Timeline.
    • Complete an ICD-9 Assessment of your clinic and create a list of ICD-9 codes most often used in your clinic (worksheets available in the Toolkit). Convert those codes using the Mapping Tool (link available on the Tools tab in the Toolkit; directions can be found HERE).
    • Print the Vendor Worksheet (available in the Toolkit) and contact your vendors such as your billing software and clearinghouse to be sure they are ready for ICD-10. Make any needed changes in your software, electronic record templates, and billing procedures.
  2. Purchase ChiroCode's ICD-10 Manual - Transitioning and coding without a manual is simply not feasible.
  3. Access ACA's ICD-10 Coding for the Chiropractic Clinic webinar; a member discount available HERE. This four hour comprehensive coding course with companion workbook will assist you in learning the steps needed for coding with ICD-10. The ChiroCode manual or other ICD-10 Code book is required.
  4. Review or print the following free resources available on ACA's ICD-10 webpage:

ICD-10 Made Simple

Coding Instruction Made Simple! 
In an effort to make ACA's ICD-10 Workshop that has been hosted by state associations across the country available to everyone, we created an on-demand webinar titled ICD-10 Coding for the Chiropractic Clinic based on the workshop.This comprehensive four-hour coding course (that includes companion workbook for attendees) is designed to provide your clinic with instruction on everything from the basics to billing with ICD-10, including how to code patient cases with ICD-10. You and your staff will be equipped for successful transition to ICD-10 after this webinar course. You may purchase the webinar at the introductory rate until September 22nd by clicking here

Quick Links

Outside Resources

Payer News


  • How to Find CMS' LCDs - Step-by-step directions are available here. Please note, on step #4 we suggest that you choose LCDs by state (rather than contractor). Once you check LCDs by state and submit, two or three listings for your MAC may appear; click each one and scroll down the alphabetic list until you find "chiropractic services." 
  • CMS announces ICD-10 Coordination Center and  ICD-10 Ombudsman


Countdown to ICD-10 

There are 12 days left until implementation.  
Where should you be on the timeline?

  • Code several patient files each day in both ICD-9 and ICD-10.
  • Ready your clinic's follow up procedures for possible future denied claims. 
  • Make adjustments in workflow processes to free more time for billing staff in October.

Code It!

If your clinic does not have a professional coder on staff then ICD-10 implementation will require providers to step out of their 'comfort zone' and get familiar with an entirely new coding process. We encourage you and your staff to take advantage of these short coding exercises in order to increase your coding 'look up' skills. Check out the new coding exercise at www.acatoday.org/codeit.