ICD-10 Update: How CMS is Easing the Big Transition

September 22, 2015 by Antonio Arias, MBA, CHBME

Topics: Medical Billing, Revenue Cycle Management, Practice Management, Medical Billing Company

On July 6, the stuff of comic book legend happened: Two antagonists joined forces for the benefit of their shared community. But we’re not talking about Batman, Catwoman, and Gotham here – this time, it was the Centers for Medicare & Medicaid Services (CMS) and the American Medical Association (AMA).

What beef has been putting these two rivals at odds? ICD-10. The AMA has long been hell-bent on putting a stop to the mandated shift from ICD-9 to the new, vastly expanded code set – voting way back in 2011 to “work vigorously to stop implementation” of ICD-10, with their president saying it would “create significant burdens on the practice of medicine with no direct benefit to individual patients' care.”

CMS has held its ground that ICD-10 needs to happen, arguing that the increased specificity of the codes will be better for medical documentation, billing, and outcomes. But the organization didn’t stay rigid about the timing – giving the U.S. healthcare system three delays over the years from its original implementation date. With their latest deadline of October 1, 2015 mere days away, many procrastinating providers were hoping they’d push it back yet again.

But this time, it’s different. In a July 6 news release, issued jointly by the two former adversaries, the CMS held firm to its required October 1 transition date. But it did make concessions to the other side – concessions that will make it easier for unprepared medical practices to adapt to the ICD-10 transition in the short term.

Creating Infrastructure: CMS is easing the big transition by setting up an ICD-10 communications and coordination center, saying they’ll be “learning from best practices of other large technology implementations… to identify and resolve issues arising from the ICD-10 transition.” Within the coordination center, there will be a new “ICD-10 Ombudsman” tasked with triaging and answering questions about the submission of claims.

Leniency in Specificity: With ICD-10 vastly expanding the number of codes available, there was widespread concern that providers would see a spike in denials due to lack of specificity. But CMS is assuaging fears by allowing for a one-year reprieve from denials for granular coding errors. For now, claims will not be denied based solely on the specificity of the ICD-10 code IF it is a valid ICD-10 code from the correct family of codes for the diagnosis. ICD-10 Conversion Tool

Flexibility with Quality Reporting: Specificity issues also won’t ding providers when it comes to Meaningful Use, PQRS, and other quality reporting measures. Providers won’t be subject to penalties during primary source verification or auditing related to code specificity (again, provided that the ICD-10 code family is correct).

Advanced Payment Availability: To keep potential administrative ICD-10 issues with Part B Medicare contractors from stalling payments, the CMS will allow providers to apply for advanced, conditional partial payments in some circumstances. (For more details on that, practice management, and other CMS guidance, click here.)

Working with an outsourced medical billing service can help you make sense of ICD-10. For more information, click here.

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