Why You Should Ignore the ICD-10 ‘Grace Period’

Correct coding is essential in order to get your insurance billing claims paid. For twelve months after the ICD-10 coding updates, beginning October 1st, Medicare review trackers will not deny any incorrect claim made by a physician or practitioner as long as they were codes within the same family. But what defines family? Why is this change so important? Without a full understanding in the language of medical coding, your practice could experience a significant loss of revenue.

Defining “Families”

Simply put, for the 12 month ICD-10 ‘grace period’, claims will not be denied for not being specific enough.

Under ICD-10, there are significantly more codes, built to make claims more exact in order to reduce billing fraud.  Under ICD-9, many codes are fairly generic. ICD-10 codes are designed to paint a more accurate picture of a patient’s diagnosis, using “families” of codes.

A family of codes would be any code in between the most generic, to the most specific ICD-10. This grace period allows physicians more time to learn and train their employees to eventually use the correct diagnosis code from the correct family.

Putting A Hold On Trouble

Practitioners everywhere have been worried about the harm incorrect ICD-10 codes may have on their practice. After all, the number of codes are nearly eight times as many as the number of ICD-9 codes.

(The orthopedic section of coding is expanding more than virtually any other section. Learn more about how these changes will impact  orthopedic practices.)

More than likely, some errors will be made. The major concerns are unpaid claims and, worse, audits. For the twelve months following the implementation of ICD-10 codes, Centers for Medicaid and Medicare Services (CMS) have stated that if a claim cannot be processed authorized advanced payments for claims will be given to physicians. CMS has also stated that they will then seek to work out the unprocessed claims in a temporary,  new ‘coordination center’.

The requirement of correct coding within code ‘families’ allows practitioners the flexibility to learn a new set of codes while still demonstrating a basic knowledge of the new system.

Ignore The ICD-10 ‘Grace Period’

While medical practices everywhere are breathing a sigh of relief after being granted a grace period for the learning curve of about 55,000 new codes, there is still a major reason to take caution. Twelve months may sound like an incredibly long time, but just how much additional training can you fit in within your already booked calendar year?

If practitioners find that a basic coding system is working for them, procrastination of more in-depth coding knowledge could easily follow.  At MEREM Healthcare Solutions, we recommend the most perfect practices of ICD-10 codes from the start. Ignoring the ICD-10 grace period will result in your staying ahead, and being fully prepared for the days without such leniencies.

At MEREM Healthcare Solutions, our professional medical coders are already trained to implement ICD-10 codes today. Outsourcing your medical coding has never been more beneficial. Contact us today.