CMS, AMA Transition Initiatives to Lead Providers into ICD-10 Deadline

With less than three months remaining until the ICD-9 to ICD-10 coding switch, The Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA) have agreed upon and announced new initiatives to help physicians prepare for October 1 deadline.

In response to requests from the provider community, including several collaborative letters from AAAAI, CMS is making critical changes to the ICD-9/ICD-10 transition period. Changes will affect the following issues:

• Claim denials. For the first year ICD-10 is in place, Medicare claims will not be denied solely based on the specificity of the diagnosis codes as long as they are from the appropriate family of ICD-10 codes.
  
  This means that Medicare will not deny payment for these unintentional errors as practices become accustomed to ICD-10 coding. In addition, Medicare claims will not be audited based on the specificity of the diagnosis codes as long as they are from the appropriate family of codes. This transition period will give physicians and their practice teams time to get up to speed on the more complicated code set.
  
  Both Medicare Administrative Contractors and Recovery Audit Contractors will be required to follow this policy.

• Quality-reporting penalties. Similar to claim denials, CMS will not subject physicians to penalties for the Physician Quality Reporting System, the value-based payment modifier or meaningful use based on the specificity of diagnosis codes as long as they use a code from the correct ICD-10 family of codes.
  
  In addition, penalties will not be applied if CMS experiences difficulties calculating quality scores for these programs as a result of ICD-10 implementation.

• Payment disruptions. If Medicare contractors are unable to process claims as a result of problems with ICD-10, CMS will authorize advance payments to physicians.
   
• Navigating transition problems. CMS has said it will establish a communication center to monitor issues and resolve them as quickly as possible. This will include an “ICD-10 ombudsman” devoted to triaging physician issues.

Remember, 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. You can find additional coding resources, including information about the ICD-10 deadline, on the AAAAI website.

Click here to read the joint CMS and AMA announcement in full.