American College of Physicians: Internal Medicine — Doctors for Adults ®

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How Y2K is affecting Medicare claims, ICD-9 codes

From the November 1999 ACP-ASIM Observer, copyright 1999 by the American College of Physicians-American Society of Internal Medicine.

By Brett Baker

Q: Is there still time to work with Medicare carriers to check computer systems for possible Y2K problems?

A: Yes, Medicare is still encouraging physicians to test their claims data exchange systems as soon as possible. Because testing your system will minimize the likelihood that you will experience major claim disruptions in the new millennium, it is well worth your time and effort.

Medicare recently reported that 10% to 20% of claims are being submitted with incorrect or invalid dates. Medicare attributes these failures to problems with vendor billing software, as well as problems with the hardware and software used to submit claims. Medicare noted, however, that most submitters have been able to correct the problems exposed by the testing.

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If you discover that you are unable to transmit claims to Medicare electronically, you can submit paper claims using the HCFA 1500 form. Medicare is concerned, however, that its carriers may not be able to handle a sudden increase in the volume of paper claims if a large number of physicians begin submitting them after Jan. 1.

Under normal conditions, physicians who submit paper claims wait to be paid a minimum of 28 days from the date that the Medicare carrier receives the bill. Physicians who submit claims electronically wait a minimum of only 14 days. Because of expected increases in the volume of paper claims, physicians who submit claims via paper after Jan. 1 can expect even longer delays.

Q: What changes were made to the International Classification of Diseases (ICD-9), Ninth Revision, codes for the year 2000?

A: No changes were made to the ICD-9 codes for the year 2000, and the codes remain identical to those in the 1999 edition of ICD-9.

The National Center for Health Statistics (NCHS), the organization that updates ICD-9, decided to leave the codes unchanged to avoid further complicating billing processes that may be susceptible to disruptions because of Y2K computer problems. Because no codes have been added, deleted or revised, you can safely refrain from purchasing an ICD-9 code book for the year 2000.

Annual update changes made by NCHS normally take effect Oct. 1. Payers typically give physicians and other providers a three-month grace period and begin requiring that physicians use updated codes Jan. 1. NCHS is expected to announce changes to ICD-9 codes to take effect on Oct. 1, 2000, sometime in the summer of 2000.

Brett Baker is a third-party payment specialist in the College's Washington Office. If you have questions on third-party payment or coding issues, call him at 202-261-4533, send a fax to 202-835-0441 or send an e-mail to bbaker@acponline.org

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