On October 1, the U.S. health care system moved to the International Classification of Diseases, 10th Revision (ICD-10). Recognizing that health care providers may need help with the transition, CMS has established an ICD-10 Ombudsman and ICD-10 Coordination Center to help track, triage, and resolve issues. Generally speaking, Medicare claims take several days to be processed and must also – by law – wait 2 weeks before payment is issued. The truth is that very few health care providers file claims on the same day a medical service is given. Most providers batch their claims and submit them every few days. If you want to check on the status of your claim before that time you can access your Medicare Administrator Contractor’s interactive voice response or portal (Noridian Endeavor) as you do today to check on the status of your claim. Commercial payers have 30 days by law to process your claims. Medicaid claims can take up to 30 days by law. However, in most cases, claims are processed before that time. If you have issues with your claims related to ICD-10, help is available. To learn more about ICD-10 and to locate important contacts quickly, check the steps below:
- General ICD-10 Info: For general ICD-10 information, check the resources on the CMS ICD-10 website and the Road to 10 web pages.
- Connect with Payers: Connect with your payers regarding any ICD-10 issues as follows:
- Medicare: Contact Noridian at 855-609-9960 for any Medicare claims questions. Noridian is the MAC provider in California. Contact Noridian first for any Medicare claims help. You can also contact Noridian regarding any Local Coverage Determination (LCD) at email@example.com
- Commercial Plans: Check the web sites of the payers that you work with. Most common payers are listed below:
- Medi-Cal: Check Medi-Cal’s website for information and method of contact at http://files.medi-cal.ca.gov/pubsdoco/hipaa/hipaa_icd10_home.asp
- The ICD-10 Ombudsman: You can also contact the ICD-10 Ombudsman for any ICD-10 questions. This is only for your Medicare claims. The ICD-10 Ombudsman is an impartial advocate with a dedicated team of experts to answer your questions. Providers should send their Ombudsman inquiries to ICD10_Ombudsman@cms.hhs.gov. Responses typically will be sent within 3 business days of receipt. You could also submit your ICD-10 issues online. To submit an issue, go to http://www.wedionline.org/icd-10/default.aspx. Then, click the button labeled: “Submit your ICD-10 Issue Online“. Fill out all required fields, enter your security code, and click submit. The issue will be submitted for review by WEDI staff and will be made available online after it has been approved. Note: The ICD-10 Issue Reporting System is not intended to be used for ICD-10 coding questions or training.
William Rogers, MD, is the ICD-10 ombudsman. Dr. Rogers will “triage” and help address concerns from healthcare professionals regarding ICD-10. Dr. Rogers can be reached at ICD10_ombudsman@CMS.HHS.gov. Dr. Rogers has served as Battalion Surgeon in the USMC Reserves. He has served as Director of the Physicians Regulatory Issues team at CMS since 2003, and is Clinical Assistant Professor of Emergency Medicine at Georgetown University. Dr. Rogers is a regular on CMS provider calls. In addition to the above, you can take additional steps to avoid or handle ICD-10 related denials. Contact your practice management system or electronic health record (EHR) vendor, if your claims are being denied. Similarly, if you are having issues with your billing vendor or clearinghouse, contact them directly. For advice on handling problems and to find out if other practices are experiencing similar issues, you can also contact your state or specialty medical society. Finally, you could contact us at PractiCons or call us at (800) 372-6602 to help you with any of these issues. Note: All links are current as of this writing but may change by the source.