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You’re probably elbows-deep in your ICD-10 transition prep as we speak, but take a moment to review a few points about the transition that experts say may be eluding even the most conscientious practice managers: 
Don’t count on the advance payment option. CMS brought up in its recent FAQs the possibility of advance payment on claims held up by ICD-10-related snafus. “If the Part B Medicare administrative contractors (MACs) are unable to process claims within established time limits because of administrative problems, such as contractor system malfunction or implementation problems, an advance payment may be available,” CMS said in FAQ No. 18.  “Physicians would be allowed to submit a single advance payment request for multiple claims for an eligible period of time.”
But advance payments will be available only if Medicare’s systems fail, points out Michelle Cavanaugh, an AHIMA-approved ICD-10 trainer and RCM manager for electronic health record (EHR) vendor Kareo in Irvin, Calif. “The prepayment request will not be available for the provider who is not prepared or whose software vendors are not ready to send ICD-10 claims. This is not a safety net.”
Don’t get caught up in wishful thinking. Advance payment remains what it has always been – a remedy for CMS’ screw-ups, not yours (PBN 6/16/08).
Click here to read the full story.
ICD-10 vendors say they’ve prepared providers for the Oct. 1 start of the new ICD-10 coding system, but questions remain about the readiness of state Medicaid programs and private insurers.
CMS has granted California, Louisiana, Maryland and Montana permission to “crosswalk” claims coded the new way to payments based on the current ICD-9 codes. It found the four states currently are unable to process ICD-10 codes, a CMS spokesman says.
CMS didn’t announce the special status of the four states but disclosed it in response to questions about the ICD-10 readiness of state Medicaid programs posed by the publication Modern Healthcare. Although Medicaid programs in the remaining 46 states haven’t asked for similar crosswalk relief, it remains a mystery how many Medicare Advantage and other private payers might continue to base payments on ICD-9 codes.
And then there are the more than 1,000 private health plans, any of which are free to use crosswalks if they desire, notes Robert Tennant, a senior vice president with the Medical Group Management Association (MGMA), which is monitoring the effect ICD-10 coding could have on the physician practices MGMA represents.
The basic problem with the crosswalk approach is that it means forcing about 69,000 ICD-10 codes into approximately 13,000 ICD-9 codes for payment purposes, Tennant says. CMS won’t use crosswalks for Medicare payments.
In any event, “it’s going to be a rolling start” after CMS flips to ICD-10 on Oct. 1, and it will be “about three weeks before we start to see some trends,” Tennant predicts. 
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Question: One of our providers has not yet been credentialed by one of our plans. Can we have a credentialed physician co-sign the notes, then bill under the credentialed physician, as we would with a midlevel provider?
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Here's the provider credentialing checklist used by Zetter Healthcare Management Consultants in Mechanicsburg, Pa. 


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