Ohio Medicaid is accepting ICD-10 test claims from trading partners indefinitely, but encourages your organization to test as soon as possible
The U.S. Department of Health & Human Services released a final rule that includes the new ICD-10 compliance date of 10/1/15. This final rule implements Section 212 of the Protecting Access to Medicare Act of 2014 by changing the compliance date for the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) and Procedure Coding System (ICD-10-PCS) from 10/1/14 to 10/1/15. It also requires the continued use of the International Classification of Diseases, 9th Revision, Clinical Modification, Volumes 1 and 2 (diagnoses), and 3 (procedures) (ICD-9-CM) through September 30, 2015. The final rule was published in the Federal Register on August 4, 2014.
On February 11, 2015, a Congressional Hearing concerning ICD-10 implementation was held. Witnesses explained how implementation will improve and modernize the U.S. health care system. Read all witness testimony and watch a complete recording of the hearing.
On July 6, 2015, CMS and the AMA made a joint announcement on their efforts to help providers get ready for ICD-10, which included sending a letter and guidance to each Medicare fee-for-service provider about ICD-10 readiness. CMS then issued clarifying questions and answers related to the July 6, 2015 CMS/AMA joint announcement and regarding ICD-10 flexibilities. The flexibility provided by CMS concerns the level of ICD-10 specificity required starting October 1, 2015. The CMS/AMA announcement does not mean there is a delay in the implementation of the ICD-10 code set requirement. Medicaid claims with a date of service on or after October 1, 2015, will be rejected/denied if they do not contain a valid ICD-10 code.
All Ohio Medicaid providers using ICD-9 on a claim today will be required to use ICD-10 on a claim starting 10/1/15. There is no transition period; 10/1/15 is a hard date for compliance. The compliance date is based on: date of service for outpatient and professional services and date of discharge for inpatient hospital services. ICD-9 codes will continue to be used on claims with dates of service/discharge prior to 10/1/15. Providers cannot bill ICD-9 and ICD-10 codes on the same claim; only one code set per claim will be accepted into MITS. If your organization typically bills span dates and your span crosses the 10/1/15 compliance date, break the claim into two claims: one claim through September 30, 2015, and another claim from October 1, 2015 to last date of span. Paid claims that need adjusted will follow the same compliance date guidelines. If the claim is originally filed with the date of service/discharge prior to 10/1/15, ICD-9 will be required. If the claim is originally filed with the date of service/discharge on or after 10/1/15, ICD-10 will be required. Prior authorization requests that will span the 10/1/2015 compliance date will accept ICD-10 codes prior to 10/1/2015. If your organization submits claims directly to Ohio Medicaid’s MITS web portal, please be sure to select the appropriate ICD version indicator (ICD-9 or 10). Claims that do not use the ICD-10 codes for dates of service/discharge on or after 10/1/2015 will deny.
Please prepare your organization for the transition to ICD-10 now. If your organization is interested in testing with Ohio Medicaid, please contact our ICD-10 testing team at: DAS-EDI-SUPPORT@das.ohio.gov. Testing information for trading partners is available here.
Continue to visit this webpage for updates related to ICD-10 implementation in Ohio.
International Classification of Disease (ICD) codes are used in virtually every healthcare setting, including inpatient and outpatient hospital settings and physician offices as well as in professional, medical services. As the 10th edition, ICD-10 will replace the current ICD-9 code set. All HIPAA covered entities are required to comply with the new code set regulations.
Claims for all health care services on or after October 1, 2015 and inpatient hospital with date of discharge on or after October 1, 2015 must use ICD-10 diagnosis & inpatient procedure codes.
ICD-10 offers a number of benefits to Ohio Medicaid, some of which include:
Ohio Medicaid is on schedule to meet the ICD-10 implementation compliance date of October 1, 2015. Systems remediation is complete and the project has moved into the testing phase. End-to-end testing in Ohio Medicaid’s CERT region is available now; testing in this environment is being used to verify that inbound and outbound transactions have been processed correctly.
Ohio Medicaid continues to be actively engaged with many provider associations, sister state agencies, Medicaid managed care plans, trading partners, and CMS to ensure all Ohio Medicaid Partners will be ready for the transition to ICD-10 on October 1, 2015.
For additional information to help you prepare for the transition from ICD-9 to ICD-10, CMS has developed several implementation handbooks. Each guide provides detailed information for planning and executing the transition. To view the guides, please visit: http://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html.
Visit Ohio Medicaid's ICD-10 Resources web page for additional information.