The New ICD-10 is Here!

The transition to ICD-10 began in October 2015. ASCO would like to hear about your successes and struggles with the implementation. If you have questions or comments, please send them to ASCO's Billing and Coding team.

Updates and Reminders from the American Medical Association

The AMA has revised its online ICD-10 resources page. This page includes:

  • information on how to report issues with Medicare claims
  • Implementation tools
  • ICD-10 FAQs

How to Report Problems about Processing Claims

Physicians may experience problems with the processing of their Medicare, Medicaid, commercial payer, vendor claims, or other administrative transactions. Find out how to report complaints by visiting the following sites:

  • Physicians can contact their Medicare Administrative Contractor (MAC) or monitor their MAC’s website for information on problems with ICD-10.
  • You may also contact CMS directly by emailing the ICD-10 ombudsman.
  • Check your state Medicaid website for information about ICD-10 implementation and to learn whom to contact about reporting issues.
Commercial Payers
  • Check the payer’s website for information about ICD-10 implementation and to learn whom to contact about payment issues.
    • UnitedHealth Group: Email
    • For Humana: Email
    • For Anthem, contact the Provider Service Call Center to get contact information for specific localities and businesses (telephone numbers can also be found on Anthem.com)
  • Contact companies directly to report all issues regarding practice management systems, electronic health records (EHRs), billing vendors, or clearinghouses. Physicians should also contact their state or specialty medical society for advice on handling problems and to find out if other practices are experiencing similar issues. If you have questions, please e-mail ASCO.

Medicare Advanced Payments

CMS has announced that Medicare Administrative Contractors (MACs) will issue advanced payments in certain situations. This applies to situations where the MAC is unable to process claims within established time limits because of administrative problems. Examples of administrative problems include contractor system malfunction or implementation problems. An advanced payment is a conditional partial payment and will require repayment.

To apply for an advance payment, the physician will be required to submit the request to his or her appropriate MAC. If the Medicare systems experience issues that interfere with processing claims, CMS and the MACs will post information on how to access advance payments. CMS does not have the authority to make advance payments when a physician is unable to submit a valid claim for services rendered.

An Updated “Clarifying Questions and Answers” from CMS regarding ICD-10 Flexibilities

In September 2015, CMS released an updated “Clarifying Questions and Answers Related to the July 6, 2015 CMS/AMA Joint Announcement and Guidance Regarding ICD-10 Flexibilities.”

This updated document includes:

  • The name and email of the CMS ICD-10 Ombudsman
  • Additional information about prior authorizations, Medicare Advantage plans, and application to other provider types
  • Additional information on Medicare advanced payments, cross-over claims, and audits

General Equivalence Mapping (GEM)

GEMs provide a temporary mechanism to link ICD-9 to ICD-10 and vice versa.

Disclaimer: ASCO’s ICD-10 Resources provide general information about ICD-10 issues. ASCO staff are not coding and billing consultants.

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