Circular No. 2 of 2024

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On 07 November 2024

Background

Circular 1 of September 2024 made mention that NAMAF was conducting a readiness assessment. Further assessment included the analysis of ICD-10 codes from claims data obtained from all four administrators. In addition, a practice management software (PMS) vendor survey was conducted through the practices to establish if software systems were compliant to the phase 2 implementation requirements.

Implementation Update

The findings from the second assessment revealed an overall compliance rate of 55% and the findings were similar to those of assessment 1. Findings from the PMS vendor survey suggest that not all vendors are compliant to the phase 2 ICD-10 requirements. The assessment findings and the PMS survey has revealed that the private healthcare industry is not ready for the next phase of ICD-10 implementation on 01 January 2025. To this end, NAMAF convened a special Management Committee (MC) where the findings of the assessments and the survey were presented to the MC together with a proposal for a phase approach to the ICD-10 implementation. The MC accepted the proposal and the phased approached to the implementation is outlined below:

Phase 1: will be the phase that is currently in effect and this phase will remain in effect until 31 March 2025. NAMAF encourages all healthcare providers to submit ICD-10 codes on all claims.

Phase 2: will come into effect on 01 April 2024 until 30 June 2026. This phase will entail a mandatory submission of at least one ICD-10 code on a claim by all healthcare providers. Multiple ICD-10 coding is encouraged during this phase. A “no ICD-10 code – no pay” principle will apply during this phase. All ICD-10 codes assigned to claims must be selected from the ICD-10 Master Industry Table (MIT) MIT. Administrators are requested to conduct claims validation against the ICD-10 MIT for correctness of the ICD-10 codes. Submission of either the referral diagnosis from the diagnosing provider, a sign or symptom code or a code from chapter XXI (Z codes) for non-diagnosing providers is encouraged.

In preparation for phase 2, NAMAF has commended with ICD-10 webinars and training. Healthcare stakeholders are encouraged to attend the webinars and training to understand the ICD-10 requirements for phase 2. Discipline specific ICD-10 workshops will be conducted as and when necessary. NAMAF also embarked on healthcare stakeholder engagement, the first engagement was with PMS vendors, most of whom indicated that their systems and switching companies are ready for phase 2.
NAMAF will also be establishing an ICD-10 Implementation Task Team that will be responsible for oversight and management of the implementation. The task team will comprise of 3 sub- committees that will address different aspects of the implementation. All healthcare stakeholders are encouraged to participate in the task team meetings. A follow up circular will provide further details regarding the constitution and structure of the task team.

Details pertaining to further phases of the ICD-10 implementation will be communicated in due course.

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