CMS Unveils Steps to Ease ICD-10 Transition
Written by Editor   
Friday, July 10, 2015 08:53 PM

The 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 addition, the agency will appoint an ICD-10 ombudsman "to triage and answer questions about the submission of claims."

The ombudsman will be located in a new ICD-10 communications and coordination center that CMS is setting up. The center will be "learning from best practices of other large technology implementations that will be in place to identify and resolve issues arising from the ICD-10 transition," the announcement said.

The guidance document noted that "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 ... based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a valid code from the right family." This 1-year grace period also will apply to codes submitted in connection with the Meaningful Use program as well as quality reporting programs like the Physician Quality Reporting System.

The guidance also said that if there are problems submitting ICD-10 codes, CMS may in some cases authorize advance payments to physicians.

A joint AMA/CMS press release did note that "the Medicare claims processing systems will not have the capability to accept ICD-9 codes for dates of services after Sept. 30, 2015, nor will they be able to accept claims for both ICD-9 and ICD-10 codes."

The AMA House of Delegates adopted a policy at its annual meeting in June in which members agreed to implement ICD-10 if they could get a 2-year transition period from CMS allowing them not to be penalized for mistakes in ICD-10 coding; an AMA representative noted "however, we appreciate the 1-year period that CMS agreed to ... I am hopeful that the private payers [and state Medicaid agencies] will agree to the same grace period and follow the lead of CMS.”

A senior fellow for health policy studies was not so complimentary. "I don't think [this announcement] solves the problem," he said. "My understanding is that there are a significant number of practices that are not ready to go -- not ready meaning they haven't purchased the [ICD-10] software yet. I don't know if being a little more lenient about errors in coding is really going to help those practices."

He also said he wondered how it was possible that CMS wouldn't accept ICD-9 claims after Sept. 30. "Let's say you take care of somebody on Sept. 30. When you submit that bill, you do it according to ICD-9 codes -- and you get a year to submit your claim, so [CMS] has got to work with ICD-9 and ICD-10 for a period of time."