Four State Medicaid Programs Will Not Transition to ICD-10 by Oct. 1

Four state Medicaid programs have received CMS approval to delay fully transitioning to ICD-10 code sets by the Oct. 1 deadline to do so, Modern Healthcare  reports.

U.S. health care organizations are working to transition from ICD-9 to ICD-10 code sets by Oct. 1 to accommodate codes for new diseases and procedures.

According to Modern Healthcare, all HIPAA-covered entities are required to complete the transition.

However, CMS will allow four states — California, Louisiana, Maryland and Montana — to use a “crosswalk” technique to continue using the older code sets for their Medicaid fee-for-service programs because their claims processing systems in these four states are unable to use the new ICD-10 codes.

Details of Technique

Under the crosswalk technique, the Medicaid programs will convert claims using the ICD-10 system into ICD-9 codes to calculate payments.

CMS spokesperson Jibril Boykin said, “We have worked closely with each state to understand how they will mitigate any issues that may arise and minimize impact on the accuracy and timeliness of provider payments.” However, he noted that the crosswalk technique is not “a long-term approach.”

California Department of Health Care Services spokesperson Adam Weintraub said CMS allowed the state’s use of the crosswalk technique when it approved funding for Xerox Health Systems’ upgrade of California’s Medi-Cal management information system. Xerox’s proposal included using a coding crosswalk. The system was implemented in September 2014 and is still undergoing external testing.

Weintraub said, “California is working on a (claims processing) system replacement effort which, upon implementation, will process natively using ICD-10,” adding, “As an interim solution, Medi-Cal implemented ICD-10 on our legacy system utilizing a crosswalk in order to reduce the cost and system changes to an aging system that is being replaced.”

A spokesperson for Maryland’s Medicaid program said the state was approved to use the crosswalk technique because its “system architecture does not allow for ICD-10 native compliance.” The spokesperson added that the state will use the technique until it has transitioned to a new system.

According to Modern Healthcare, representatives for Louisiana’s and Montana’s Medicaid programs were unavailable for comment.

Reaction

Some provider groups and health IT experts say the use of such a technique could result in payment delays and other issues.

California Hospital Association spokesperson Jan Emerson-Shea said, “We do continue to have some concerns about the use of the crosswalk approach and we’ll be raising these concerns during a stakeholder meeting.”

Andrew Boyd, assistant professor in biomedical and health information sciences at the University of Illinois-Chicago, said, “My biggest concern is delay of payment for hospitals and physician groups, because cross-mapping could result in a cash flow crunch on already narrow margin groups.”

Meanwhile, Robert Tennant — director of Health IT Policy at the Medical Group Management Association, which has sought to delay the transition to ICD-10 — raised concerns about such readiness issues surfacing this close to the compliance date (Conn, Modern Healthcare, 9/4).