What’s new with ICD-10?

The Centers for Medicare & Medicaid Services (CMS) surprised many when it announced it would work with the American Medical Association (AMA) to ease the transition to ICD-10.

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After a great deal of pressure from the AMA, CMS has announced that it will make the transition to ICD-10 easier in four ways.

Change 1: Claims. The first change is that for one year after implementation of ICD-10, physician claims will not be denied under the Part B physician fee schedule based solely on the specificity of the ICD-10 diagnosis code. This is only the case if the physician used a valid code from the correct family of codes.

Change 2: Penalties. The second change is that quality reporting for 2015 Medicare clinical quality data review contractors will not subject physicians to the Physician Quality Reporting System, Value Based Modifier or Meaningful Use 2 penalty during primary source verification or auditing so long as the code is from the correct family. Also, eligible professionals will not be penalized if CMS has difficulty calculating quality scores due to the transition to ICD-10 codes.

Change 3: Payments. The third change is that advance payments will be authorized if Medicare contractors are unable to process claims because of ICD-10.

Change 4: Communication. The fourth change is that CMS will create better avenues of communication, including appointing an ICD-10 Ombudsman to resolve issues.

The AMA was critical in the changes to ICD-10.

Come October 2015, providers will need to use ICD-10, but now there are measures in place to ease the transition. We help our clients understand new regulations and transition their practices.

In our next blog post, we will keep you informed of related issues.  To get this important information delivered directly to your mail box, click here to Subscribe.

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