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CMS Agrees to No ICD-10 Audits or Penalties for the First Year!

Written by: Kimberly Commito on Monday, July 13, 2015 Posted in: HME/DME, Home Infusion, Specialty Pharmacy

breaking-news_09f9f7ad69c48f11f3d847f150f58915On Monday, July 6, 2015, the Centers for Medicare & Medicaid Services (CMS) announced that they will take steps to help health care providers navigate the first year of ICD-10 coding. Conceding to pressure from the American Medical Association (AMA), CMS has agreed to “making several critical changes to the transition period so that physicians can continue to provide high-quality patient care without risking their livelihoods,” wrote AMA President Steven J. Stack, M.D. in a July 6 “AMA Viewpoints” post.

The specific changes to which CMS has agreed involve claim denials, quality reporting penalties, payment disruptions and navigating transition problems. CMS has published an FAQ document outlining the details, which are summarized below:

  • No ICD-10 Claim Denials for Unintentional Errors: For the 12 months following ICD-10 implementation, Medicare contractors “will not deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the practitioner used a valid code from the right family.”
  • No Penalties for Unintentional Errors in Quality Reporting: As long as the codes are from the correct ICD-10 family of codes, Medicare clinical quality data review contractors will not assess penalties based on the specificity of diagnosis codes for quality reporting completed for program year 2015. And if CMS has trouble calculating quality scores as a result of the transition to ICD-10, eligible providers will not be subject to penalties.
  • Advanced Payments May Be Available in the Event of Payment Disruptions: If contractors are unable to process payments within specified time frames due to administrative problems related to ICD-10, suppliers may apply for advance payments through their Medicare Administrative Contractors (MAC).
  • Quick Resolution of ICD-10 Problems: CMS has committed to establishing a “communication and collaboration center … to quickly identify and initiate resolution” of ICD-10-related issues. The center will also include an ICD-10 ombudsman who will prioritize issues that arise.

According to the AMA, these concessions resulted from its “vigorous efforts to convince [CMS] of the need for a transition period to avoid financial disruptions during this time of tremendous change.” In addition, wrote Dr. Stack, CMS’s concessions are a “testament to the power of organized medicine and what we can achieve when we band together for the good of our patients and our profession.”

For more in-depth information about getting ready for ICD-10 implementation, go to Mediware’s ICD-10 Resource Center:

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