With less than three months remaining until the nation switches from ICD-9 to ICD-10, The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) are announcing efforts to continue to help physicians get ready ahead of the October 1 deadline.
In response to requests from the provider community, CMS is releasing additional guidance that will allow for flexibility in the claims auditing and quality reporting process as the medical community gains experience using the new ICD- 10 code set.
In guidance that is being transmitted today, CMS announced that:
For a one year period starting October 1, Medicare claims will not be denied solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes. In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes. This policy will be followed by Medicare Administrative Contractors and Recovery Audit Contractors.
To avoid potential problems with mid-year coding changes in CMS quality programs (PQRS, VBM and MU) for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if CMS experiences difficulties in accurately calculating quality scores (i.e., for PQRS, VBM, or Meaningful Use). CMS will continue to monitor implementation and adjust the duration if needed.
CMS will establish an ICD-10 Ombudsman to help receive and triage physician and provider problems that need to be resolved during the transition.
CMS will authorize advanced payments if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation.
Today’s announcement demonstrates that CMS is responsive to physician concerns. The AMA will monitor and keep CMS apprised of any implementation issues that persist in 2016, and will urge the agency to make any needed adjustments to the grace period policy and time line based on new information that surfaces during the implementation process. We encourage the Federation to report to us any problems their members experience during the transition, to better inform our advocacy efforts on their behalf.
The October 1 deadline for implementation of the ICD-10 code set is fast approaching, and time is running out for physician practices to complete their preparation. The FAFP has a variety of educational resources on our web site to assist physicians prepare for the October 1 deadline. To learn more and stay apprised on developments, visit the FAFP Practice Enhancement website by clicking here.
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