CMS to cut providers a break when it comes to ICD-10 deadline

With the implementation of ICD-10 just around the corner (Oct. 1) comes word from the Centers for Medicare & Medicaid Services that it will not deny claims made under the Part B physician fee schedule if there are coding errors.

The guidance notice, which was issued with the blessing of the American Medical Association, is a sign that the AMA is taking a conciliatory attitude and is now willing to work with, not against, CMS on the pending changes.

It wasn’t long ago that the AMA was backing legislation proposed by Rep. Ted Poe of Texas that would prohibit the Secretary of Health and Human Services from replacing ICD-9 with ICD-10.

In its latest guidance, CMS said that it “understands that moving to ICD-10 is bringing significant changes to the provider community.†As a result, it will not deny physician or other practitioner claims based solely on the specificity of the ICD-10 diagnosis code, so long as a valid code from the right family is used.

“The (year-long) transition period will give physicians and their practice teams time to get up to speed on the more complicated code set,†according to a statement by AMA President Dr. Steven J. Stack.

CMS states that: “For all quality reporting completed for program year 2015 Medicare clinical quality data review contractors will not subject physicians or other Eligible Professionals (EP) to the Physician Quality Reporting System (PQRS), Value Based Modifier (VBM), or Meaningful Use 2 (MU) penalty during primary source verification or auditing related to the additional specificity of the ICD-10 diagnosis code, as long as the physician/EP used a code from the correct family of codes,” CMS explained. “Furthermore, an EP will not be subjected to a penalty if CMS experiences difficulty calculating the quality scores for PQRS, VBM, or MU due to the transition to ICD-10 codes.”

CMS goes on to note that a claim could be chosen for review for reasons other than the specificity of the ICD-10 code and the claim would continue to be reviewed for these reasons.

In an effort to avoid payment disruptions, CMS said that if Medicare contractors cannot process claims as a result of ICD-10 problems, CMS will authorize advance payments to physicians.

It’s no surprise that there’s been resistance to the change given that the codes, which are used for diagnosis and billing, have not been significantly updated in more than three decades. However, it is a necessity, given that many of the codes are no longer relevant.

In an effort to make the transition as smooth as possible CMS will have an ICD-10 Ombudsman who will work with representatives in CMS’ regional offices to address physicians’ concerns and, as the Oct. 1 deadline draws nearer, CMS has promised to issue guidance on how to submit issues to the Ombudsman.

The AMA’s Stack points out that although there is a yearlong transition period, “now is the time to buckle down†and make sure your practice is as prepared as possible before the Oct. 1 deadline.

The Health Law Offices of Anthony C. Vitale can assist clients with ICD-10 training to make sure their practice is prepared. Contact us for additional information.