The Centers for Medicare and Medicaid Services’ planned move to a larger set of medical billing codes next month could ease the compliance of Medicare secondary payers for employee compensation claims we have used before, ”said Rafael Gonzalez, vice president of strategic solutions based in Tampa, Florida , at Helios Settlement Solutions, a unit of the Helios pharmacy service manager.
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The International Classification of Diseases is a set of standardized codes that, according to the CMS, identify conditions and procedures in medical billing.
Starting October 1, healthcare providers will be transitioning from ICD-9, with approximately 17,000 diagnostic and procedural codes, to ICD-10, with more than 155,000 diagnostic and procedural codes. Many ICD-10 codes also specify the types, locations, and severity of conditions and injuries.
Mr Gonzalez said the increased number of codes will “provide a lot more flexibility (and) a lot more specificity, not just about the disease, but is this the first or second or third time (a condition has occurred)?” Is that right or left? Is this the result of trauma or degenerative changes? If it is trauma, what kind of trauma was it? “
Providers and insurers subject to the Health Insurance Portability Accountability Act must begin using ICD-10 codes in accordance with the Department of Health and Human Services final regulation published last year.
While HIPAA law states that employee computing programs are exempt from medical privacy compliance, HHS’s rule acknowledged that new codes are likely to affect Comp.
Rita Wilson, CEO of Medicare compliance firm Tower MSA Partners LLC, headquartered in Delray Beach, Fla., Said she believes workers who pay payers will adopt ICD-10 codes despite the exception because they do so can take advantage of the improved coding system specificity compared to ICD-9.
“I think wage earners will take this step,” she said. “They’ll make it over a slower period of time, but I absolutely think it’s the right direction.”
Experts say the new codes will have the biggest impact on workers dealing with Medicare second payers compliance.
The Medicare Secondary Payer Act requires insurers and self-insured employers to notify CMS of any compensation or liability arrangement that a Medicare-eligible person is involved in. CMS may issue liens that require compensation payments to be used to reimburse the agency for medical care it paid for on an applicant’s behalf or for payers to set aside money to pay for future medical care related to an indemnifiable injury .
Medicare secondary payer experts say employee insurers and self-insured employers are often asked to reimburse Medicare for injuries or illnesses unrelated to an employee compensation claim, as those conditions on the medical records are lumped together with the applicant’s work accident become.
Ms. Wilson said ICD-10 will be especially helpful in enabling employee insurers and self-insured employers to indicate which injuries they should be responsible for and which Medicare should pay for.
“Better accuracy and more granularity and detail in identifying and describing the breach will benefit us, the vendor community, and payers,” said Ms. Wilson.
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