Planning for ICD-10: Working with Clearinghouses

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As we move towards the ICD-10 transition, CMS reminds practices that clearinghouses can be a valuable resource for testing ICD-10 preparedness. For instance, clearinghouses can help providers look at the reasons for rejection and analyze their claim problems during the transition. However, providers should not expect clearinghouses to offer the same level of assistance for ICD-10 transition as they did when HIPAA Version 5010 was implemented, since ICD-10 is based on provider data and clinical documentation.

The Role of Clearinghouses in the ICD-10 Transition 
Practices preparing for the October 1, 2014, ICD-10 deadline are looking for resources and organizations that can help them make a smooth transition. It is important to know that while clearinghouses can help, they cannot provide the same level of support for the ICD-10 transition as they did for the Version 5010 upgrade. ICD-10 describes a medical diagnosis or hospital inpatient procedure and must be selected by the provider or a resource designated by the provider as their coder, and is based on clinical documentation.

During the change from Version 4010 to Version 5010, clearinghouses provided support to many providers by converting claims from Version 4010 to Version 5010 format. For ICD-10, clearinghouses can help by:

  • Identifying problems that lead to claims being rejected
  • Providing guidance about how to fix a rejected claim (e.g., the provider needs to include more or different data)

Clearinghouses cannot, however, help you identify which ICD-10 codes to use unless they offer coding services. Because ICD-10 codes are more specific, and one ICD-9 code may have several corresponding ICD-10 codes, selecting the appropriate ICD-10 code requires medical knowledge and familiarity with the specific clinical event.

Read more at: mckessonpracticesolutions.com

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