New CMS Guidance Helps Ease ICD-10 Transition for Physician Offices

October 13th, 2016

CHICAGO – The process of implementing ICD-10 coding in your practice by Oct. 1 has become a little less daunting.

For that, you can thank the American Medical Association. At the association’s request, CMS issued a guidance document with some important provisions. Chief among them is the assurance that, for the first year, physician offices will have some leeway on coding without facing reimbursement denials.

“While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation,” according to the CMS guidance. “Medicare review contractors will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review 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.”

Both Medicare administrative contractors and recovery audit contractors will be required to follow this policy, according to the AMA.

CMS also agreed not to subject physicians to penalties for the Physician Quality Reporting System based on the specificity of diagnosis codes as long as a code from the correct ICD-10 family of codes is used. In addition, no penalties will be applied if the agency has difficulty calculating quality scores for the programs as a result of ICD-10 implementation.

Furthermore, if problems with ICD-10 implementation cause problems that prevent Medicare contractors from processing claims, CMS said it will authorize advance payments to physicians.

Finally, CMS consented to establish a communication center to monitor issues and resolve them as quickly as possible, including appointing what it calls an “ICD-10 ombudsman” devoted to triaging physician issues.

Getting those and other concessions was a hard fought battle.

In a blog post, AMA President Steven J. Stack, MD, noted, “These provisions are a culmination of vigorous efforts to convince the agency of the need for a transition period to avoid financial disruptions during this time of tremendous change. These provisions are a testament to the power of organized medicine and what we can achieve when we band together for the good of our patients and our profession.”