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• Resources to help you prepare for the U.S. health care industry’s change from ICD-9 to ICD-10 for medical diagnosis and inpatient procedure coding
• Links to CMS Version 5010 information

These two transitions will require system and business changes throughout the health care industry. ICD-10 will affect coding for everyone covered by the Health Insurance Portability and Accountability Act (HIPAA), not just those who submit Medicare claims.

Start preparing now to ensure a smooth transition.

About the ICD-10 Transition on October 1, 2013

ICD-10 codes must be used on all HIPAA transactions, including outpatient claims with dates of service, and inpatient claims with dates of discharge on and after October 1, 2013. Otherwise, your claims and other transactions may be rejected, and you will need to resubmit them with the ICD-10 codes. This could result in delays and may impact your reimbursements, so it is important to start now to prepare for the changeover to ICD-10 codes.

This change does not affect CPT coding for outpatient procedures.

About the Version 5010 Transition on January 1, 2012

On January 1, 2012, standards for electronic health care transactions change from Version 4010/4010A1 to Version 5010. These electronic health care transactions include functions like claims, eligibility inquiries, and remittance advices.  Unlike the current Version 4010/4010A1, Version 5010 accommodates the ICD-10 codes, and must be in place first before the changeover to ICD-10. The Version 5010 change occurs well before the ICD-10 implementation date to allow adequate Version 5010 testing and implementation time.

If providers do not conduct electronic health transactions using Version 5010 as of January 1, 2012, delays in claim reimbursement may result. If health plans cannot accept Version 5010 transactions from providers, they may experience a large increase in provider customer service inquiries affecting their operations.

Preparing for ICD-10 and Version 5010 – including potential updated software installation, staff training, changes to business operations and workflows, internal and external testing, reprinting of manuals and other materials, and more – will take time.

Click here for more CMS resources on this and related issues…

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