With less than 3 months until the October 1, 2015 deadline for switching to ICD-10 codes, the Centers for Medicare & Medicaid Services just granted providers some unexpected leniency. But what do the changes mean to your medical group?
First of all, what’s not changing: the October 1, 2015 deadline for ICD-10 implementation remains. And no, CMS will not accept ICD-9 or dual coding after the switch. So you still have to start using the more specific ICD-10 codes come October.
The American Medical Association— more than 225,000 physician members strong — is credited with influencing CMS to implement these changes:
Advanced Payments
CMS will grant advance payments to physicians who experience payment disruptions if their Medicare contractor experiences problems processing ICD-10 claims in a timely manner.
Denied Claims
For the first 12 months, CMS will not deny claims or reject payment based solely on incorrect specificity. ICD-10 codes are more complex, and the agency will still process payments as long as you choose the correct family of codes for a given procedure or service.
Quality Reporting
Again, as long as you choose the right family of ICD-10 codes, CMS will not penalize providers through the Physician Quality Reporting System (PQRS).
Help Wanted: ICD-10 Ombudsman
The AMA also asked, and convinced, CMS to name an ICD-10 Ombudsman to help providers correctly submit claims. At the same time, CMS is setting up an ICD-10 Coordination Center to monitor transition issues, respond to them, and facilitate questions for the ombudsman.
