UPDATE: CMS has issued clarifying questions and answers related to the July 6, 2015 CMS/AMA joint announcement and guidance regarding ICD-10 flexibilities. Please review the FAQ here.
Responding to requests from the provider community and recognizing that health care providers need additional help with the transition, the Centers for Medicare & Medicaid Services (CMS) has announced will allow for greater flexibility in the claims auditing and quality reporting process by granting a one-year grace period.
Beginning October 1, 2015, the date of ICD-10 implementation, Medicare claims will not be denied nor audited based on which diagnosis code was selected as long as the physician submits an ICD-10 code from an appropriate family of codes.
Additionally, CMS will not penalize physicians participating in the Physician Quality Reporting System (PQRS), the value-based payment modifier or meaningful use during the 2015 reporting year for failure to select a specific code as long as they select from the appropriate ICD-10 family of codes.
If Medicare contractors experience trouble processing claims as a result of ICD-10 issues, CMS will authorize advance payments to physicians if the claim is otherwise valid. These payments will be partial payments, pending submission of a request by the provider to the appropriate Medicare Administrative Contractor (MAC).
Finally, CMS is setting up a communication and collaboration center to monitor issues and resolve them as quickly as possible. The center will include an ICD-10 Ombudsman who will work closely with representatives in CMS’s regional offices to address physicians’ concerns.
As we get closer to the October 1, 2015, compliance date, CMS will issue additional guidance, including how to submit issues to the Ombudsman and a National Provider Call scheduled for Aug. 27.
Even with the yearlong grace period, there are less than three months remaining until the ICD-10 transition. But there is still time to prepare and make sure your organization is ready for the October 1st deadline.