July 06, 2015
Area(s) of Interest: Payor Issues and Reimbursement Practice Management Public Payors
The Centers for Medicare & Medicaid Services (CMS) announced that it will provide a one-year grace period during which it will allow for flexibility in the claims payment, auditing and quality reporting processes as the medical community gains experience using the new ICD-10 code set. The ICD-10 implementation date of October 1, 2015, has not changed.
The changes announced include:
Claim denials: Medicare review contractors will not deny claims based solely on the specificity of the ICD-10 diagnosis code as long as a valid code from the right family of codes is used. Moreover, physicians will not be subject to audits as a result of ICD-10 coding mistakes during the grace period.
Quality reporting: Physicians also will not be penalized under the quality reporting programs for errors related to the additional specificity of the ICD-10 diagnosis code, again as long as a code from the correct family of codes is used.
Advance payments: If Medicare contractors are unable to process claims within established time limits because of administrative problems, such as contractor system malfunction or implementation problems, advance payment may be available to keep resources flowing to physician practices.
ICD-10 communication center: CMS will set up a communication center to monitor the implementation of ICD-10 in an effort to quickly identify and resolve issues related to the transition. As part of the center, CMS will have an ICD-10 ombudsman to help receive and triage physician and provider issues.
These provisions are a culmination of organized medicine's efforts to convince CMS of the need for a transition period to avoid financial disruptions during this time of tremendous change. The California Medical Association (CMA) has been working closely with the American Medical Association (AMA) and other medical associations, urging CMS to help mitigate the impact of the transition. Most recently, CMA, AMA and other large state medical associations (New York, Texas and Florida), met with CMS and Congressional leadership, urging them to support a two-year grace period during which physicians would not have claims delayed, denied or subject to audits because of simple ICD-10 errors.
ICD-10 education and training available
Recognizing that health care providers need help with the transition, CMS, AMA and CMA are also working to make sure physicians and other providers are ready for the October 1 transition to the new ICD-10 code sets. CMS and AMA will be offering webinars, on-site training, educational articles and national provider calls to help physicians and other health care providers prepare for the transition. For more information, see CMS's ICD-10 provider page and AMA's ICD-10 web page.
CMA, in partnership with its local county medical societies and the California Medical Group Management Association, is offering two-day ICD-10 code set seminars around the state. The two-day boot camps include 16 hours of intensive general ICD-10 code set training, along with hands-on coding exercises.
Physicians should be aware the Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of services after September 30, 2015, nor will they be able to accept claims for both ICD-9 and ICD-10 codes.