New Medicare Policies Aid Physician ICD-10 Compliance

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Under pressure from the American Medical Association, the Centers for Medicare and Medicaid Services has made several important policy changes to ease physicians’ transitions to the ICD-10 code set, including advanced payments under certain conditions.

The ICD-10 compliance date remains October 1, but for the first year of the code set Medicare will not deny claims solely based on the specificity of diagnosis codes as long as they are in the appropriate diagnostic family of codes. This means physicians won’t be financially penalized because of a coding error.

Medicare claims also will not in the first year be audited based on the specificity of diagnosis codes if they are in the appropriate family of codes, and Medicare Administrative Contractors as well as Recovery Audit Contractors will be required to follow the policy, AMA President Steven Stack, M.D., says in a blog posting. “This transition period will give physicians and their practice teams time to get up to speed on the more complicated code set.”

Also See: 7 Tips from CMS as Final ICD-10 Testing Week Approaches

Further, if Medicare contractors cannot process physician claims because of any issues with ICD-10, CMS will authorize advance payments. Other policy changes include:

CMS will establish an ICD-10 Ombudsman office to help physicians resolve problems that arise during the transition.

As with the new flexibility on claims denials, Medicare will not financially penalize physicians via a smaller reimbursement for errors in selecting and calculating quality codes for the EHR meaningful use, PQRS and Value-based Modifier reporting programs as long as they use codes within the appropriate family of codes. Penalties also will not be applied if CMS has difficulty calculating quality scores during the ICD-10 transition.

CMS in July will send letters to all Medicare fee-for-service providers notifying them of these policy changes. ICD-10 education continues on the CMS Road to 10 website. The agency also will host a National Provider Call on August 27.

For its part, the AMA offers a range of guidance on its ICD-10 website.

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