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ICD-10 Compliance: What It Is and Who It Affects

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The transition from ICD-9 to ICD-10 is on its way. As the October 1 deadline approaches, one of your main responsibilities needs to be making sure your practice is ICD-10 compliant. But what does ICD-10 compliance mean?

It’s important that you fully understand what ICD-10 compliance entails exactly, so here are a few guidelines to help get you started:

Who does ICD-10 compliance affect?

The first step in complying with the ICD-10 switch is knowing whether or not your organization is affected. According to the Centers for Medicare and Medicaid Services (CMS), “ICD-10 compliance is mandatory for all HIPAA-covered entities, including those who do not handle Medicare claims. There are no exceptions to any HIPAA-covered entities.”

What about organizations that are not governed by HIPAA? CMS notes that these organizations “should be aware that their coding may become obsolete in the transition to ICD-10.”  If you’re not sure whether or not your organization qualifies as a HIPAA-covered entity, you can find more information at this website.

What does ICD-10 compliance mean?

Put as simply as possible, ICD-10 compliance means that HIPAA-covered entities must be able to successfully conduct health care transactions using ICD-10 diagnosis and procedure codes for services rendered on or after the compliance date (October 1, 2015). So after the deadline, CMS and other payers will only accept, recognize and process ICD-10 codes. Making a successful transition to the new system is especially important because claims billed with ICD-9 codes after October 1 will be rejected.

If you need more information about how to make sure your organization is ICD-10 compliant, feel free to contact us today.


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