The Centers for Medicare & Medicaid Services (CMS) has answered TMA's call to help doctors dodge disaster by providing some flexibility as physicians shift to the new ICD-10 medical billing and coding system. Recently, physician leaders from California, Florida, and New York joined TMA in sending a letter to Andy Slavitt, acting administrator for CMS, which will roll out the mandatory shift to ICD-10 on Oct. 1. While CMS didn't adopt the two-year, penalty-free grace period TMA and the other medical associations requested, the agency did take steps to alleviate some of the potential burdens physicians may face in 86 days.
The announcement from CMS and the American Medical Association says the organizations are "working to make sure physicians and other providers are ready ahead of the transition to ICD-10 that will happen on October 1. Reaching out to health care providers all across the country, CMS and AMA will in parallel be educating providers through webinars, on-site training, educational articles and national provider calls to help physicians and other health care providers learn about the updated codes and prepare for the transition."
TMA President Tom Garcia, MD, said in a statement, "A giant burden was slightly eased for physicians today with news of an ICD-10 transition grace period. Having a year to convert our medical practices – and the entire American health care infrastructure – to this gargantuan new coding system without as many penalties for errors will allow us to spend more time practicing medicine and focusing on patients."
He added that he is "concerned that one year will not be sufficient for all of the doctors in communities large and small to overhaul coding practices that have been in place for a generation. I'm worried that the software vendors, government, and other links in this complex chain will not be ready, and if so, physicians and their patients will suffer the consequences. I hope CMS will extend the one-year penalty-free and audit-free grace period if we need more time."
A frequently-asked-questions guidance document from CMS states that:
- For a one-year period starting Oct. 1, Medicare claims will not be denied solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submitted an ICD-10 code from an appropriate family of codes. And 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 policy will be followed by Medicare administrative contractors and recovery audit contractors.
- To avoid potential problems with mid-year coding changes in CMS quality programs for the 2015 reporting year, physicians using the appropriate family of diagnosis codes will not be penalized if CMS experiences difficulties in accurately calculating quality scores. CMS will continue to monitor implementation and adjust the duration if needed.
- CMS will establish an ICD-10 ombudsman to help receive and triage physician and health professional problems that need to be resolved during the transition.
- CMS will authorize advance payments if Medicare contractors are unable to process claims within established time limits due to problems with ICD-10 implementation.
AMA says it will monitor and keep CMS apprised of any implementation problems that arise in 2016. AMA will also urge the agency to make any needed adjustments to the grace period policy and timeline based on new information that surfaces during the implementation process.
The Oct. 1 deadline for implementation of the ICD-10 code set is fast approaching, and time is running out for physician practices to complete their preparation. TMA has a number of resources to help physicians prepare for the Oct. 1 deadline. Additionally, check your inbox for an upcoming ICD-10 survey from TMA.