The Center for Medicare and Medicaid Services (CMS) has teamed up with the American Medical Association (AMA) to provide additional measures designed to ease the ICD-10 transition when the Oct. 1 deadline approaches.
These joint efforts are highlighted by the flexibility CMS is offering in regard to ICD-10 claim denials following the deadline.
“While diagnosis coding to the correct level of specificity is the goal for all claims,” CMS explained in a guidance proposal, “for 12 months after ICD-10 implementation, Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule …”
ICD-10 Codes Still Required
This doesn’t mean, however, that ICD-9 codes will still be accepted past Oct. 1. According to CMS, a “valid ICD-10 code will be required on all claims starting on Oct. 1, 2015.”
There’s another important caveat, too. Claims won’t be denied as long as the diagnosis codes are from the appropriate family of ICD-10 codes.
“This means that Medicare will not deny payment for these unintentional errors as practices become accustomed to ICD-10 coding,” AMA President Steven J. Stack, MD, said in a post to AMA Viewpoints.
This surprising concession from CMS will be a sigh of relief for medical practices as they continue to prepare for a major transition to ICD-10, which features 155,000 diagnosis and procedural codes. With so many new codes, not only would it be a large investment of time to learn new codes, but an influx of rejected claims would significantly impact practices’ revenue streams.
AMA Urges Practices to Continue to Prepare for ICD-10
Although this 12-month grace period after the ICD-10 deadline will inevitably take some of that pressure off for practitioners, there’s still no reason to delay ICD-10 preparation in your respective practice.
And the AMA agrees.
“ICD-10 implementation is set to begin on Oct. 1, and it is imperative that physician practices take steps beforehand to be ready,” Stack said. “The actions CMS is initiating today can help to mitigate potential problems. We will continue to work with the administration in the weeks and months ahead to make sure the transition is as smooth as possible.”
Other Changes to Note
In addition to the claim denial flexibility period, there are three other changes that will be a result from this joint agreement:
- Quality-reporting penalties – Similar to the claim denials, CMS will not penalize physicians for PQRS based on the specificity of diagnosis codes as long as the code is from the correct ICD-10 family of codes
- Payment disruptions – CMS will allow for advanced payment to physicians if Medicare contractors can’t process claims due to issues with ICD-10
- Communication center – CMS announced it will have an “ICD-10 ombudsman” to monitor ICD-10 implementation and quickly resolve any ICD-10 issues that may arise
Even with all of these changes, physicians and practices across the country still need to be diligent in their ICD-10 preparation with the deadline just three months away.
“Although physicians now have a yearlong transition period,” Stack said, “now is still the time to buckle down and make sure your practice is as prepared as possible ahead of Oct. 1.”