California, Other States Will Not Fully Transition to ICD-10 in October

Medi-Cal is one of four state Medicaid programs that will not fully transition to ICD-10 code sets by the Oct. 1 deadline to do so, Modern Healthcare reports.

Medi-Cal instead will use a technique to translate the new codes into the ICD-9 format (Conn, Modern Healthcare, 9/4).

Background

A recent California Medical Association survey found that 21% of California physician practices reported they are not prepared for the Oct. 1 transition from ICD-9 to ICD-10 codes sets. In addition, the survey showed that more than half of California physician practices said they are minimally prepared for the new coding sets (California Healthline, 6/15).

Details of Technique

According to Modern Healthcare, all HIPAA-covered entities are required to fully transition to ICD-10 codes by Oct. 1.

However, CMS will allow California and three other states -- Louisiana, Maryland and Montana -- to use a "crosswalk" technique to continue using the older code sets for their Medicaid fee-for-service programs.

The claims processing systems in these four states are unable to use the new ICD-10 codes, Modern Healthcare reports. 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 Implications

According to Modern Healthcare, about 2.2 million Medi-Cal beneficiaries are covered by traditional fee-for-service programs. Payments for their services will be calculated using the code conversion technique.

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.

The Medi-Cal website states that the crosswalk "will only be used temporarily."

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."

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, other stakeholders have criticized Medi-Cal for refusing to publish its crosswalk methodology (Modern Healthcare, 9/4).