Leadership

CMS to make ICD-10 transition less disruptive for physicians

Implementation of the ICD-10 code set is just around the corner, with a hard deadline of Oct. 1. Many physicians have been concerned about adopting this code set because of the heavy investment of time and resources and the potential for claims disruptions that could interfere with patient care.

Fortunately, the AMA has secured provisions that will ease this transition, particularly for physicians in practices with limited resources.

In response to our extensive communication of physicians’ concerns, the Centers for Medicare & Medicaid Services (CMS) announced today that it is making several critical changes to the transition period so that physicians can continue to provide high-quality patient care without risking their livelihood. 

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.

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.

What you need to prepare

Although physicians now have a yearlong transition period, now is still the time to buckle down and make sure your practice is as prepared as possible ahead of Oct. 1. Here are several important resources that can help you get ready over the next three months:

  • A special series on payment and coding at AMA Wire® examines what you need to do each month to prepare for the transition, whether you’re an ICD-10 expert or just getting started.
  • The AMA’s ICD-10 Web page offers important information and resources on implementation planning, from cross-walking between ICD-9 and ICD-10 to testing your readiness.
  • CMS also is offering free assistance, including its “Road to 10” website aimed specifically at smaller physician practices. This collection includes primers for clinical documentation, clinical scenarios and other specialty-specific resources to help with implementation. Read more about the agency’s resource offerings.

These significant improvements for the impending ICD-10 roll-out are just one way our collective voice is helping improve our practice environment for greater practice stability and ongoing quality care.