May 11, 2012 | Compliance, Legal, and Malpractice, Laboratory Hiring & Human Resources, Laboratory Pathology
AMA opposition to ICD-10 deadline moves HHS to reconsider, while leaving some transition-ready providers rankled
When it comes to implementation of ICD-10 in the United States, the “do it later” crowd seems to have convinced the Department of Health and Human Services (HHS) of the need to once again move back the compliance date for ICD-10. On April 9, HHS announced a proposed rule to defer implementation by one year, with a new effective date of October 1, 2014.
Clinical laboratories and anatomic pathology groups have a big stake in a successful transition from ICD-9 to ICD-10. Among other reasons, Medicare Part B claims for medical laboratory tests must be submitted with an appropriate ICD code [provided by the physician who ordered the lab tests] for the clinical lab or pathology group to be paid by the Medicare program.
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Jan 12, 2012 | Coding, Billing, and Collections, Compliance, Legal, and Malpractice, Laboratory Management and Operations, Laboratory News, Laboratory Pathology, Managed Care Contracts & Payer Reimbursement
Payors also are straining to handle new payment requirements under Form 5010, say intermediaries
Across the nation, providers, including clinical laboratories and pathology groups, are holding their collective breath as they wait to see whether implementation of the electronic claim Form 5010 goes smoothly, becomes a disaster, or ends up somewhere between.
Just two weeks into this national transition, experts are predicting that most providers—including medical labs and pathology groups—are likely to see a drop in revenue collections. Worse yet, it is not until the first claim denial forms are received from payors that clinical labs and pathology groups can learn the reasons why different payors rejected these claims.
UNEXPECTED PROBLEMS
“We expected, with a transition of this magnitude, that the industry would encounter challenges,” said Jackie Griffin, Director, Client Services, Gateway EDI, a bill-paying clearinghouse in St. Louis, Missouri. “But in addition to the problems we expected, we’ve seen a lot of unexpected problems too.”
Gateway EDI serves both small and large practices, but has seen that its clients that are small labs and physician practices of 1 to 5 doctors are experiencing more problems than larger provider organizations because the smaller entities lacked the resources to prepare for 5010, Griffin explained. Providers are likely to see less reimbursement in the coming weeks because many claims are being rejected and going unpaid, she said. (more…)
