Ready or Not: ICD-10 Arrives for Home Health Agencies

ICD-10 is here for home health agencies in most states, whether they are ready or not.

Approximately 69,000 new medical codes officially go into effect Oct. 1, replacing the roughly 14,000 codes currently available with ICD-9. The implementation of the new code set is meant as a way for providers to keep up with the health care system’s increasing data demands and new advancements in medicine.

Unprepared agencies will face “decreased productivity and rejected reimbursement claims” as immediate challenges following implementation, according to Jennifer Gibson, RN, an Axxess coding expert who has been conducting related trainings. Axxess is a home health software vendor based in Dallas.

Gibson said a lack of practice in actually coding in ICD-10-CM may slow the agencies down, resulting in a backlog in OASIS C1 processing.

“If agencies can’t code OASIS, they can’t bill,” Gibson said. “This cash flow interruption will be one of the biggest issues agencies face for the next six months or so.”

Though Gibson says she is unaware of any outstanding issues with ICD-10 that could hamper home health agencies’ ability to make the transition, some think otherwise.

The Visiting Nurse Associations of America has reached out to the Centers for Medicare & Medicaid Services (CMS) with concerns, Molly Smith, vice president of policy and innovation at VNAA, told Home Health Care News.

“We are very concerned about the potential problems that may be caused by providing physicians with a one year grace period but not other providers,” Smith said. “Home health agencies rely on physician coding and documentation to complete their own – you can see the potential for problems when a primary source of information is not being held to the same standard.”

Smith also mentioned the possibility of a technical error that may result in initial encounters not being appropriately case-mix adjusted.

Meanwhile, Gibson has offered some last-minute tips to HHCN readers and home health agencies on how to make a smooth transition to ICD-10:

  • Agencies should contact all insurance companies they bill and inquire about their readiness. Specifically, they should ask if there billing will change in any respect due to the transition.
  • Agencies should also ensure that they have a final 2016 copy of the ICD-10-CM coding manual to use for coding.
  • Finally, agencies should contact their software vendors to ensure they are ready for the transition, and that test claims were processed well ahead of transition time.

Implementation of ICD-10 has been delayed three times. Providers have pushed against it due to its cost and complexity.

Written by Mary Kate Nelson