Feds Answer Questions on ICD-10 Flexibilities

The Centers for Medicare & Medicaid Services (CMS) released a "Clarifying Questions and Answers" document to help explain its July 6 announcement of a year's worth of slightly relaxed standards on the new ICD-10 coding system. As questions still appear to outnumber answers, Texas physicians should turn to the Texas Medical Association's extensive set of tools and resources to help prepare for the transition.

The basic message from CMS remains the same: For 12 months after the shift to ICD-10, Medicare will not deny claims solely on the specificity of the ICD-10 diagnosis codes provided, as long as the physician submits an ICD-10 code from an appropriate family of codes. And, during that year, 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.

CMS also announced that the promised ICD-10 ombudsman will be in place by the Oct. 1 deadline, but not necessarily any sooner.

Meanwhile, commercial health plans are telling TMA that the CMS announcement last month will have little to no impact on how they process claims after the Oct. 1 switch to ICD-10. All of the plans TMA has contacted say they are making no changes to their ICD-10 implementation plans, and they have received no directive from CMS to make any changes. The plans will not make advance payments available, nor will they honor the 12-month denial period.

Texas Medicaid officials tell TMA they do not expect the CMS announcement to have any impact on how Medicaid adjudicates claims, as it usually does not match the diagnosis code (ICD) and CPT code at the front end of claim processing. Instead, the 12-month grace period will make a difference if a Medicaid claim is audited. If the physician uses an incomplete ICD-10 code but provides one from the correct family of codes, Medicaid would honor the claim.

Remember: The sooner you learn to code claims and document services to the full level of specificity, the sooner you can get paid most accurately for your services.

Here's how TMA is helping:  

  • Registration is open for TMA's live seminars: ICD-10 Essentials — two seminars in one day: one for physicians and one for office staff. In Essentials in ICD-10 Coding, staff can perfect their coding and auditing skills with hands-on exercises using ICD-10. In Essentials in ICD-10 Documentation, physicians can find out how to improve their documentation to support increased code specificity and to set up their staff for success. These seminars run Aug. 4 through Sept. 16 in cities around the state. 
  • Specialty-specific, physician-developed three-hour online courses. Choose from 21 medical specialties to learn physician documentation tailored to your specialty. Each self-paced course shows you critical documentation elements you'll need to maintain payment under ICD-10 and features the top clinical conditions for each specialty with emphasis on their associated documentation and coding requirements. Complete this online documentation training now. Use coupon code 10DOCTMA to save $100 on the registration. 
  • Register for on-demand recordings of ICD-10 planning and implementation courses. View the on-demand webinar list
  • Visit TMA's ICD-10 Resource Center for tools, information, and links to on-demand webinars, including specialty-specific webinars.
  • Call (800) 523-8776 to learn more.  

Physicians also should plan to attend CMS' Countdown to ICD-10 National Provider Call, from 1:30 pm to 4 pm (CT) on Aug. 27. TMA staff will participate in the call. Details are available on the CMS website.

Action, Aug. 3, 2015

Last Updated On

December 12, 2016

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