Four State Medicaid Programs Will Not Transition to ICD-10 by Oct. 1

Thu Sep 17 18:44:37 PDT 2015

September 8, 2015

<http://www.ihealthbeat.org/articles/2015/9/8/four-state-medicaid-programs-w
ill-not-transition-to-icd-10-by-oct-1> iHealthBeat

Four state Medicaid programs have received CMS approval to delay fully
transitioning to ICD-10 code sets by the Oct. 1 deadline to do so, Modern
Healthcare reports.

U.S. health care organizations are working to transition from ICD-9 to
ICD-10 code sets by Oct. 1 to accommodate codes for new diseases and
procedures.

According to Modern Healthcare, all HIPAA-covered entities are required to
complete the transition.

However, CMS will allow four states -- California, Louisiana, Maryland and
Montana -- to use a "crosswalk" technique to continue using the older code
sets for their Medicaid fee-for-service programs because their claims
processing systems in these four states are unable to use the new ICD-10
codes.

Details of Technique

Under the crosswalk technique, the Medicaid programs will convert claims
using the ICD-10 system into ICD-9 codes to calculate payments.

CMS spokesperson Jibril Boykin said, "We have worked closely with each state
to understand how they will mitigate any issues that may arise and minimize
impact on the accuracy and timeliness of provider payments." However, he
noted that the crosswalk technique is not "a long-term approach."

California Department of Health Care Services spokesperson Adam Weintraub
said CMS allowed the state's use of the crosswalk technique when it approved
funding for Xerox Health Systems' upgrade of California's Medi-Cal
management information system. Xerox's proposal included using a coding
crosswalk. The system was implemented in September 2014 and is still
undergoing external testing.

Weintraub said, "California is working on a (claims processing) system
replacement effort which, upon implementation, will process natively using
ICD-10," adding, "As an interim solution, Medi-Cal implemented ICD-10 on our
legacy system utilizing a crosswalk in order to reduce the cost and system
changes to an aging system that is being replaced."

A spokesperson for Maryland's Medicaid program said the state was approved
to use the crosswalk technique because its "system architecture does not
allow for ICD-10 native compliance." The spokesperson added that the state
will use the technique until it has transitioned to a new system.

According to Modern Healthcare, representatives for Louisiana's and
Montana's Medicaid programs were unavailable for comment.

Reaction

Some provider groups and health IT experts say the use of such a technique
could result in payment delays and other issues.

California Hospital Association spokesperson Jan Emerson-Shea said, "We do
continue to have some concerns about the use of the crosswalk approach and
we'll be raising these concerns during a stakeholder meeting."

Andrew Boyd, assistant professor in biomedical and health information
sciences at the University of Illinois-Chicago, said, "My biggest concern is
delay of payment for hospitals and physician groups, because cross-mapping
could result in a cash flow crunch on already narrow margin groups."

Meanwhile, Robert Tennant -- director of Health IT Policy at the Medical
Group Management Association, which has sought to delay the transition to
ICD-10 -- raised concerns about such readiness issues surfacing this close
to the compliance date (Conn, Modern Healthcare, 9/4).

Jeff Wells
Deputy Editor, CAL/AAEM News Service

Brian Potts MD, MBA
Managing Editor, CAL/AAEM News Service

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